Multilevel intervention research: lessons learned and pathways forward.
Multilevel intervention research: lessons learned and pathways forward.
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DOI：
10.1093/jncimonographs/lgs019
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发表时间：
2012-05-01
期刊：
影响因子：
--
通讯作者：
Kaluzny, Arnold D
中科院分区：
文献类型：
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作者：
Clauser, Steven B;Taplin, Stephen H;Kaluzny, Arnold D
本摘要反映了这本关于多层次干预（MLI）研究的专著，以1）评估其附加值; 2）讨论迄今为止在癌症护理提供方面所学到的挑战; 3）确定提高其科学合理性，可行性，政策相关性和研究议程的具体方法。提交的12个章节以及在2011年3月多级别会议上对这些章节的讨论，在作者之间进行了审查和讨论，以得出解决这一努力开始时提出的问题的关键结论和结果。MLI研究在癌症文献中作为一个明确的焦点是不够的，但如果他们评估对理解行为和/或系统水平干预很重要的背景，组织和环境因素，可能会改善癌症护理提供研究的实施。该领域缺乏一个统一的理论，尽管一些心理学或生物学理论是有用的，生态模型有助于概念化和沟通干预措施。MLI研究设计通常很复杂，涉及非线性和非层次关系，在随机设计中可能无法进行最佳研究。模拟建模和试点研究可能是必要的，以评估MLI干预措施。在癌症护理中，特别需要对团队和组织干预措施进行衡量和评价，同时也需要关注医疗保健改革、电子保健技术和基因组医学的背景。在多边工具研究的未来进展需要更多的注意开发和支持相关的水平的影响和相互作用的指标和评估多边工具干预。MLI研究为了解如何改善癌症护理提供提供了一个未实现的承诺。
This summary reflects on this monograph regarding multilevel intervention (MLI) research to 1) assess its added value; 2) discuss what has been learned to date about its challenges in cancer care delivery; and 3) identify specific ways to improve its scientific soundness, feasibility, policy relevance, and research agenda. The 12 submitted chapters, and discussion of them at the March 2011 multilevel meeting, were reviewed and discussed among the authors to elicit key findings and results addressing the questions raised at the outset of this effort. MLI research is underrepresented as an explicit focus in the cancer literature but may improve implementation of studies of cancer care delivery if they assess contextual, organizational, and environmental factors important to understanding behavioral and/or system-level interventions. The field lacks a single unifying theory, although several psychological or biological theories are useful, and an ecological model helps conceptualize and communicate interventions. MLI research designs are often complex, involving nonlinear and nonhierarchical relationships that may not be optimally studied in randomized designs. Simulation modeling and pilot studies may be necessary to evaluate MLI interventions. Measurement and evaluation of team and organizational interventions are especially needed in cancer care, as are attention to the context of health-care reform, eHealth technology, and genomics-based medicine. Future progress in MLI research requires greater attention to developing and supporting relevant metrics of level effects and interactions and evaluating MLI interventions. MLI research holds an unrealized promise for understanding how to improve cancer care delivery.