Background/Purpose: The need to control the burden of musculoskeletal (MSK) conditions is not reflected in policies and practices across the globe. This study aims to identify requisite components to strengthen health systems in response to the rising burden of MSK conditions to guide strategy development, adaptable for global-level and/or national-level health systems.

Methods: The MSK and broader health and policy communities were engaged to inform the co-design of a blueprint for a global strategy. A 3 phase design was utilized. Participants were recruited through intentional sampling of representatives of international organizations involved in MSK health care, health systems strengthening, and patient advocates (phase 1). In phase 3 open recruitment was leveraged through professional networks and social media.

• Phase 1: qualitative study with virtual semi-structured interviews with international key informants (KIs) and verbatim transcripts analyzed using grounded theory approach.
• Phase 2: scoping review of national health policies to identify MSK policy trends and foci across the 30 most populated nations. Documents evaluated using content analysis to identify themes and subthemes.
• Phase 3: informed by phases 1–2, a global two-round eDelphi where panellists rated and iterated a framework of priorities and detailed components/actions, including identification of essential actions. Round 1-feedback on the logic model and components was sought using quantitative ratings (analysed using the RAND UCLA approach) and free text fields. Round 2-revised framework rated for value and credibility using a Likert scale (1-5) and to identify elements that were ‘essential, desirable, or unsure’.

Results: Phase 1: 31 KIs representing 25 organisations sampled from 20 countries (40% low- and middle-income (LMIC)). Inductively derived themes used to construct a logic model consisting of 5 guiding principles, 8 strategic priority areas and 7 accelerators for action.

Phase 2: Of 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. 8 overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.

Phase 3: 674 panellists from 72 countries (46% LMICs) participated in Round 1 and 439 (65%) in Round 2. 59 components were retained with 10 (17%) identified as essential for health systems globally and 15 (25%) identified specifically for LMICs. 97.6% and 94.8% of panellists agreed or strongly agreed the framework was valuable and credible for health systems strengthening.
Ultimately, a framework of 8 pillars and 59 components was proposed. The pillars for health systems strengthening were 1) Engaging, empowering and educating communities 2) Leadership, governance and shared accountability, 3) Financing approaches, 4) Service delivery, 5) Equitable access to medicines and technologies, 6) Workforce, 7) surveillance, 8) Research and innovation.

Conclusion: An empirically derived framework, co-designed and strongly supported by multi-sectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve musculoskeletal health.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-a-global-strategy-to-strengthen-health-systems-for-prevention-and-management-of-musculoskeletal-health/