{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T21:54:54Z","timestamp":1789682094219,"version":"4.0.1"},"reference-count":32,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Institute of Health","award":["1R21TW011718-01"],"award-info":[{"award-number":["1R21TW011718-01"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,3]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 at primary healthcare (PHC) facilities in Nepal after healthcare workers received training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>PHC facilities across various provinces in Nepal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 180 healthcare workers trained in PEN, recruited from a random selection of 105 basic healthcare facilities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>The adoption of PEN Protocol 1 components: blood pressure measurement, blood glucose screening, 10-year cardiovascular disease (CVD) risk assessment using WHO\/International Society of Hypertension risk charts and body mass index (BMI) assessment. Factors associated with protocol adoption were assessed using generalised estimating equations for ORs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among participants, 100% reported measuring blood pressure, while 56% measured blood sugar, 28% assessed CVD risk and 27% assessed BMI. The adoption of the CVD risk prediction chart was positively associated with the availability of amlodipine (adjusted OR (aOR) 3.00; 95%\u2009CI 1.09 to 8.27). The adoption of BMI assessment was positively associated with access to a stadiometer (aOR 3.23; 95%\u2009CI 1.26 to 8.30) and a glucometer (aOR 3.07; 95%\u2009CI 1.12 to 8.40), and negatively associated with lack of motivation\/inertia of previous practice (aOR 0.60; 95%\u2009CI 0.42 to 0.87) and environmental factors such as lack of time and resources (aOR 0.57; 95%\u2009CI 0.37 to 0.89). Blood glucose level measurements were positively associated with being at a PHC centre (aOR 7.34; 95%\u2009CI 2.79 to 19.3) and the availability of metformin (OR 2.40; 95%\u2009CI 1.08 to 5.29).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Adoption of PEN Protocol 1 varied by component and was influenced by resource availability, provider motivation and system barriers. Addressing these factors is key to optimising implementation in low-resource settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090923","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T06:00:14Z","timestamp":1757570414000},"page":"e090923","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2418-9894","authenticated-orcid":false,"given":"Dinesh","family":"Timalsena","sequence":"first","affiliation":[{"name":"Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal"},{"name":"Prayatnashil Community Development Society (PRAYAS-Nepal), Dhading, Bagmati, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandani Singh","family":"Nakarmi","sequence":"additional","affiliation":[{"name":"Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushmita","family":"Mali","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarati","family":"Dhakal","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Bharati","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupama","family":"Bishwokarma","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmita","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bikram","family":"Poudel","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binuka Kulung","family":"Rai","sequence":"additional","affiliation":[{"name":"Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phanindra Prasad","family":"Baral","sequence":"additional","affiliation":[{"name":"Department of Health Services (DoHS), Government of Nepal, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4246-9117","authenticated-orcid":false,"given":"Sanju","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"Institute for Implementation Science and Health, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lonim","family":"Dixit","sequence":"additional","affiliation":[{"name":"World Health Organization, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashashwi","family":"Pokharel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Emory, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7438-632X","authenticated-orcid":false,"given":"Dong Roman","family":"Xu","sequence":"additional","affiliation":[{"name":"SMU Institute for Global Health (SIGHT), Southern Medical University, Guangzhou, Guangdong, People's Republic of China"},{"name":"School of Health Management and Dermatological Hospital, Southern Medical University, Guangzhou, Guangzhou, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Spiegelman","sequence":"additional","affiliation":[{"name":"Yale University, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4741-090X","authenticated-orcid":false,"given":"Archana","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Dhulikhel Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"2025091023000672000_15.9.e090923.1","unstructured":"World Health Organization . 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