<h3>BACKGROUND CONTEXT</h3> Global health estimates suggest the burden of musculoskeletal (MSK) impairments, especially spinal pain, will rise globally, painting a stark warning to health systems and economies. Health system strengthening efforts are urgently needed to improve the prevention and management of MSK impairments and arrest the global disability burden. <h3>PURPOSE</h3> To engage and consult with the MSK health and broader health and policy communities to inform the co-design of a blueprint for a global strategy. The purpose was to identify requisite components to guide later strategy development, adaptable for global-level and/or national-level health systems. <h3>STUDY DESIGN/SETTING</h3> A mixed-methods, three-phased design was utilized. The three phases included a qualitative study with international key informants (KIs) (phase 1); a scoping review of national health policies (phase 2); and a global eDelphi (phase 3). <h3>PATIENT SAMPLE</h3> 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. <h3>METHODS</h3> In phase 1, virtual semi-structured interviews were conducted and recorded. Verbatim transcripts were analyzed using grounded theory approach. Phase 2 was a scoping review of national health policies to identify MSK policy trends and foci across the 30 most populated nations. Text data were extracted from the documents and evaluated using content analysis to identify themes and subthemes. Phase 3, informed by phases 1–2, was a global two-round eDelphi where panelists rated and iterated a framework of priorities and detailed components/actions, including identification of essential actions. In round 1, feedback on the logic model and components was sought using quantitative ratings (analysed using the RAND UCLA approach) and free text fields. A revised framework was presented in round 2 where participants rated the overall framework for value and credibility using a Likert scale (1-5) and to identify elements that were ‘essential, desirable, or unsure.' <h3>RESULTS</h3> Phase 1: Thirty-one KIs representing 25 organizations were sampled from 20 countries (40% low- and middle-income (LMIC)). Inductively derived themes were used to construct a logic model consisting of 5 guiding principles, 8 strategic priority areas and 7 accelerators for action. Phase 2: Of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model. Phase 3: 674 panelists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2. Fifty-nine 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 panelists 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. <h3>CONCLUSIONS</h3> 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 and prioritize health system strengthening initiatives. Further exploration of issues and priorities relevant to LMICs and implementation monitoring are warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.
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