Group interventions to improve health outcomes: a framework for their design and delivery
Group interventions to improve health outcomes: a framework for their design and delivery
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DOI：
10.1186/1471-2458-10-800
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发表时间：
2010-12-31
影响因子：
4.5
通讯作者：
Britten, Jane
中科院分区：
文献类型：
--
作者：
Hoddinott, Pat;Allan, Karen;Britten, Jane
背景资料：为一组患者提供干预措施以改善健康结果在公共卫生和初级保健中越来越受欢迎，但"组"是一个总括术语，包含一系列复杂的目标，理论，实施过程和评估方法。我们提出了一个框架的设计和过程中发生的一组设置，这将有助于从业人员，研究人员和决策者的健康改善干预措施的评估：我们回顾了更广泛的文献提供给患者群体的健康改善干预措施，并确定了文献中的差距设计，评估和报告这些干预措施。我们利用我们的经验进行系统的审查，干预，混合方法和人种学研究的群体母乳喂养和体重管理。健康改善组的设计和交付的框架，通过一个迭代的过程中的主要研究，参考文献和研究团队discussion. Results：虽然有大量的文献组的过程中的教育，工作，政治和心理治疗，少得多的是已知的群体的目的是改善健康。经过验证可供个人使用的行为改变理论通常被认为可推广到群体环境，而无需经过严格的测试。在小组环境中提供的健康改善或行为改变干预措施是复杂的适应性社会过程，小组领导人，参与者以及更广泛的社区和环境之间存在互动。生态模型的健康改善，其中包括行为，系统和环境之间的复杂关系可能是更相关的比个人的方法behaviorchanges.Conclusion：证据的有效性和成本效益的组相比，一对一的干预措施，许多领域的健康改善公共卫生和初级保健是薄弱或未知的。我们提出的框架是朝着倡导一种更系统的方法来设计，评估和报告群体环境中的干预措施迈出的第一步，这对于改善目前薄弱的证据基础是必要的。这一框架将使决策者和从业人员能够更好地了解在群体环境中改善健康时哪些措施有效、如何有效以及在何种情况下有效。
Background: Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet "group" is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers.Methods: We reviewed the wider literature on health improvement interventions delivered to patient groups and identified a gap in the literature for designing, evaluating and reporting these interventions. We drew on our experiences conducting systematic reviews, intervention, mixed method and ethnographic studies of groups for breastfeeding and weight management. A framework for health improvement group design and delivery evolved through an iterative process of primary research, reference to the literature and research team discussion.Results: Although there is an extensive literature on group processes in education, work, politics and psychological therapies, far less is known about groups where the aim is health improvement. Theories of behaviour change which are validated for individual use are often assumed to be generalisable to group settings, without being rigorously tested. Health improvement or behaviour change interventions delivered in a group setting are complex adaptive social processes with interactions between the group leader, participants, and the wider community and environment. Ecological models of health improvement, which embrace the complex relationship between behaviour, systems and the environment may be more relevant than an individual approach to behaviour change.Conclusion: The evidence for effectiveness and cost-effectiveness of group compared with one-to-one interventions for many areas of health improvement in public health and primary care is weak or unknown. Our proposed framework is the first step towards advocating a more systematic approach to designing, evaluating and reporting interventions in group settings, which is necessary to improve this currently weak evidence base. This framework will enable policy makers and practitioners to be better informed about what works, how it works and in which contexts when aiming to improve health in a group setting.