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This article describes how a structured lifestyle modification intervention for hypertension and diabetes was scaled within Kerala's health system, focusing on how implementation knowledge was generated and embedded in routine practice. Grounded in an implementation research approach, the work documents how evidence-informed strategies were continuously adapted through stakeholder engagement, peer-led delivery, and supportive institutional processes. Drawing on qualitative data from stakeholder consultations, document review, and field observations in Janakeeya Arogya Kendrams (basic unit of primary health care centres in Kerala), the article shows how local context, social learning, and power dynamics shaped iterative learning cycles. The findings outline key facilitators and barriers to knowledge use in practice. It offers practical insights for strengthening sustainable non-communicable disease prevention and control programmes in similar settings.