After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World.
After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World.
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在随机试验之后：在现实世界中实施基于社区的延续性促进。
DOI：
10.1111/jgs.16771
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Brown HW
中科院分区：
文献类型：
--
作者：
Schmuhl NB;Brow KA;Wise ME;Myers S;Mahoney JE;Brown HW
≥65岁的大多数女性都患有大小便失禁，与高昂的医疗费用、制度化和负面的生活质量有关，但很少有人寻求治疗。“精神战胜物质：健康的肠道，健康的膀胱”(MOM)是一个小团体自我管理研讨会，由社区中训练有素的促进者领导，已被证明可以改善老年女性的大小便失禁。在一项随机对照试验(RCT)之后，我们使用混合方法收集了社区机构实际采用、维护和实施MOM的信息，该试验测试了对大小便失禁的干预效果。为威斯康星州六个社区的老年人提供服务的社区机构。社区机构管理人员和辅导员接受培训，为RCT提供MOM。研究人员跟踪了六个社区的领养率(在随机对照试验后的12个月内向母亲提供)和维持率(在接下来的18个月内向母亲提供1次)。个别访谈和焦点小组(N=17)产生了与采用和维护有关的障碍和促进者的定性数据。训练有素的观察员在42次MOM会议上评估了实施保真度(与计划协议一致)。67%(4/6)的社区收养了母亲，50%(3/6)的社区维持了母亲。没有发生实施保真度失误的情况。领养和维护的促进者包括MOM的组织良好的协议和精益时间承诺；伙伴组织之间分享执行工作；专门负责健康促进活动的工作人员；以及社区对促进大小便的高度兴趣。除了与大小便失禁相关的耻辱之外，障碍与其他以社区为基础的老年人项目相似：资金/人员有限，组织优先事项相互竞争，难以确定/培训促进者，以及难以吸引社区合作伙伴/参与者。利用传播设计和社区参与，结合临床随机对照试验评估实施结果是可行的。以合作伙伴为中心的实施方案可以解决采用和维护方面的障碍。
Most women aged ≥65 suffer from incontinence, associated with high healthcare costs, institutionalization, and negative quality of life, but few seek care. “Mind over Matter: Healthy Bowels, Healthy Bladder” (MOM) is a small-group self-management workshop, led by a trained facilitator in a community setting, proven to improve incontinence in older women. We used mixed methods to gather information on the real-world adoption, maintenance, and implementation of MOM by community agencies following a randomized controlled trial (RCT) that tested intervention effects on incontinence. Community agencies serving older adults in six Wisconsin communities. Community agency administrators and facilitators trained to offer MOM for the RCT. Investigators tracked rates of adoption (offering MOM in the 12 months following the RCT) and maintenance (offering MOM > 1 time in the next 18 months) in six communities. Individual interviews and focus groups (N=17) generated qualitative data about barriers and facilitators related to adoption and maintenance. Trained observers assessed implementation fidelity (alignment with program protocol) at 42 MOM sessions. 67% of communities (4/6) adopted MOM and 50% (3/6) maintained MOM. No implementation fidelity lapses occurred. Facilitators of adoption and maintenance included MOM’s well organized protocol and lean time commitment; sharing of implementation efforts between partner organizations; staff specifically assigned to health promotion activities; and high community interest in continence promotion. Other than stigma associated with incontinence, barriers were similar to those seen with other community-based programs for older adults: limited funding/staffing, competing organizational priorities, challenges identifying/training facilitators, and difficulty engaging community partners/participants. Using design for dissemination and community engagement, assessment of implementation outcomes is feasible in conjunction with a clinical RCT. Partner-centered implementation packages can address barriers to adoption and maintenance.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
29.4
作者：
Miner, PB
通讯作者：
Miner, PB
影响因子：
4.5
作者：
Litman, Heather J.;McKinlay, John B.
通讯作者：
McKinlay, John B.