Lost in translation: overcoming the barriers to global implementation and exchange of behavioral medicine evidence.
Lost in translation: overcoming the barriers to global implementation and exchange of behavioral medicine evidence.
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DOI：
10.1007/s13142-011-0051-1
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发表时间：
2011-06
影响因子：
3.6
通讯作者：
Absetz P
中科院分区：
文献类型：
--
作者：
Oldenburg B;Absetz P
行为对几乎所有传染性和非传染性疾病的发病过程和管理至关重要。卫生条件差、不安全性行为、吸烟、过度饮酒、不健康饮食和营养、缺乏身体活动和久坐不动的生活方式等关键行为通常也与心理健康相关[1,2]。这些不健康的行为和相关疾病在处境不利和更脆弱的人群中几乎总是更常见。慢性健康状况，如心血管疾病、癌症、糖尿病和相关风险因素行为，在低收入和中等收入国家变得越来越重要和普遍，世界上大多数人口现在都生活在这些国家。此外，许多中低收入国家承受着双重疾病负担，即它们同时面临传染病和非传染性疾病的高流行率。目前，全球慢性病负担的80%以上发生在低收入和中等收入国家。这些国家中大多数用于预防和管理这类疾病的资源有限，这一事实进一步加剧了这一双重负担。社会、行为和社区干预可以有效地用于预防许多这些疾病和/或在早期发现它们，改善其管理，提高患者的生活质量，并协助指导有效分配有限的卫生保健资源[2,4,5]。尽管有这些令人信服的证据，但在采取这些干预措施方面仍存在重大的证据差距。这在高收入国家和中低收入国家都是一个严重的问题。正如Shonkoff在他的报告《缩小我们知道的和我们做的之间的差距》中所说，“我们知道的和不做的之间的差距，比我们知道的和不知道的差距要大得多”。在更多处于社会不利地位和脆弱的社区和社会中，证据执行差距甚至更大。尽管北美、欧洲和其他地区的高收入国家能够为提供卫生和医疗服务分配大量的国家资源，即使在行为医学和公共卫生项目没有得到应有的有效实施和支持的情况下，大多数中低收入国家也无法承受这种情况。为了“扩大”干预措施并促进和维持其更广泛地融入政策和实践，需要新的循证方法和方法。本期特刊在全球范围内就这些问题提供了一系列研究、案例和评论。事实上，在不同文化和国家之间有计划地转移和交流循证行为医学和公共卫生干预措施是重要的，也是行为医学领域需要解决的紧迫挑战。然而，到目前为止，这个问题很少受到关注。尽管现在在行为医学实践的许多领域都有实践和政策指导方针，但这些主要是基于发达国家进行的研究。因此，它们对不同文化和国家的相关性和适当性往往不够充分，在执行时也没有得到评价。当将干预措施引入不同于项目制定和最初评估的文化和环境时，需要解决一系列不同的问题。高收入环境中可获得的许多支持和基础设施(例如，拥有大量训练有素的卫生人力、良好的治理以及相对…
Behavior is centrally important to the disease processes and management of almost all communicable and non-communicable health conditions. Key behaviors such as poor hygiene, unsafe sex, tobacco use, excessive alcohol consumption, unhealthy diet and nutrition, physical inactivity, and sedentary lifestyles are also commonly interrelated with mental health [1, 2]. These unhealthy behaviors and related diseases are almost always more common in disadvantaged and more vulnerable populations. Chronic health conditions such as cardiovascular disease, cancers, diabetes, and related risk factor behaviors are becoming more important and prevalent in low-and middle-income countries (LMICs), where the majority of the world’s population now live. Furthermore, many LMICs suffer from a double burden of diseases, ie, they are simultaneously confronted by high prevalence of both communicable and non-communicable diseases. More than 80% of the global burden of chronic disease now occurs in low-and middleincome countries [3]. This double burden is further exacerbated by the fact that most of these countries have limited resources available for prevention and management of such conditions. Social, behavioral, and community interventions can be effectively used to prevent many of these conditions and/or detect them at an earlier stage, improve their management, increase patient quality of life, and assist with guiding the efficient allocation of limited health care resources [2, 4, 5]. This compelling evidence notwithstanding, there remains a significant evidence gap in relation to the uptake of these kinds of interventions. This is a serious problem in both high income countries and LMICs. As stated by Shonkoff in his report, Closing the gap between what we know and what we do,‘the gap between what we know and don’t do, is much larger than the gap between what we know and don’t know’[6]. The evidence–implementation gap is even greater for more socially disadvantaged and vulnerable communities and societies [7]. While high income countries in North America, Europe, and elsewhere are able to allocate significant national resources to the delivery of health and medical services, even where behavioral medicine and public health programs are not as effectively implemented and supported as they might be, most LMICs can ill afford to have this situation. In order to ‘scale up’interventions and to promote and sustain their wider integration into policy and practice, new evidence-based methods and approaches are needed. This special issue provides a series of studies, case examples, and commentaries on these issues within a global context. Indeed, the planned transfer and exchange of evidence-based behavioral medicine and public health interventions between cultures and countries are important and are urgent challenges for the field of behavioral medicine to address. To date, however, this issue has received little attention. Even though there are now practice and policy guidelines in many areas of behavioral medicine practice, these are largely based on research conducted in developed countries. Subsequently, their relevance and appropriateness to different cultures and countries are often poorly developed and evaluated upon implementation. A range of different issues needs addressing when interventions are introduced into cultures and settings which differ from where the program was developed and originally evaluated. This challenge is made greater by the fact that many of the supports and infrastructure available in highincome settings (eg, having a large well-trained health workforce, good governance, and a relatively …
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
对受艾滋病毒影响的家庭的干预措施。
影响因子：
3.6
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Rotheram-Borus, Mary Jane;Swendeman, Dallas;Lee, Sung-Jae;Li, Li;Amani, Bita;Nartey, Myralyn
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影响因子：
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通讯作者：
Bartholomew, L. Kay
影响因子：
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Kreuter, Matthew W.
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5.5
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Fisher, Edwin B.;Fitzgibbon, Marian L.;Ockene, Judith K.
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