Our Approach

The ACROSS research pathway

From Co-Design to Sustainable Implementation

ACROSS is developing and evaluating affordable, culturally appropriate home-based rehabilitation for people living with heart disease and related mental health difficulties in Bangladesh and Pakistan, supported by international collaboration with UK partners.

Our research is organised through four connected Work Packages, covering intervention adaptation, feasibility testing, effectiveness and implementation evaluation, and capacity strengthening.

Work Package 1

Cultural and Contextual Adaptation

Co-leads: Professor Karina Lovell and Professor Imran Chaudhry

WP1 is co-designing and adapting established home-based rehabilitation approaches, including the Heart Manual and REACH-HF, for people living with coronary heart disease or heart failure in Bangladesh and Pakistan.

• Work with patients, caregivers, healthcare professionals and communities;
• Adapt content to local languages, cultures and healthcare contexts;
• Integrate appropriate psychological support for depression and anxiety; and
• Develop facilitator and train-the-trainer programmes to support future delivery.

Work Package 2

External Pilot Trial

Co-leads: Professor Nusrat Husain and Dr Mithila Faruque

WP2 will assess whether the adapted ACROSS intervention and the proposed study procedures are feasible and acceptable before progressing to a larger evaluation.

• Assess the acceptability of the intervention to patients, caregivers and practitioners;
• Test recruitment, randomisation and participant-retention procedures;
• Review intervention delivery and data-collection processes; and
• Gather information needed to refine the full-scale trial.

Work Package 3

Effectiveness and Implementation Trials

Co-leads: Professor Rod Taylor and Dr Jeemon Panniyammakal

WP3 will evaluate the ACROSS rehabilitation programme across participating sites in Bangladesh and Pakistan, examining both health outcomes and the practical conditions needed for successful implementation.

• Evaluate clinical effectiveness for people living with heart disease and multimorbidity;
• Assess cost-effectiveness and potential value for health systems;
• Identify barriers and facilitators affecting implementation; and
• Generate evidence to inform sustainability and future scale-up.

Work Package 4

Capacity Strengthening

Co-leads: Dr Amy Blakemore and Dr Md. Jamal Uddin

WP4 strengthens research and rehabilitation capacity across ACROSS partner organisations and supports sustainable knowledge exchange between Bangladesh, Pakistan and the UK.

• Deliver research-methods and rehabilitation training;
• Support PhD students and early-career researchers;
• Develop facilitator and implementation capacity;
• Promote international knowledge exchange and mentorship; and
• Work with specialist partners, including ICCPR, the Heart Manual Office UK and The Global Health Network.

Principles Across All Work Packages