Multilevel Interventions and Racial/Ethnic Health Disparities
Multilevel Interventions and Racial/Ethnic Health Disparities
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DOI：
10.1093/jncimonographs/lgs015
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发表时间：
2012-01-01
期刊：
影响因子：
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通讯作者：
Das, Irene Prabhu
中科院分区：
文献类型：
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作者：
Gorin, Sherri Sheinfeld;Badr, Hoda;Das, Irene Prabhu
为了考察旨在减少健康差距的多层次干预措施(具有三个或更多级别的影响)的影响，我们对2000年1月至2011年7月发表的针对少数族裔/种族(非西班牙裔白人除外)的干预措施进行了系统的回顾和荟萃分析。主要目的是综合评估针对族裔和种族少数群体的多层次干预措施(三种或更多影响级别)的研究结果，以减少他们在卫生保健方面的差异，并获得对这些亚群中多级别干预措施对健康结果的影响的量化估计。利用医学主题词条和关键词检索电子数据库PubMed。在对摘要进行初步审查后，至少两名独立编码者对26项已发表的研究进行了系统审查。那些有足够数据的患者(n=12)通过荟萃分析进行评估，并使用经修改的九项物理治疗证据数据库编码方案进行质量检查。这项描述性审查的结果表明，多层次干预措施对几种健康行为结果有积极影响，包括癌症预防和筛查，以及改善卫生保健系统过程的质量。在个体参与者水平上报告的所有健康行为结果的加权平均效应大小(k=17)为优势比(OR)=1.27(95%可信区间[CI]=1.11至1.44)；对于提供者或组织报告的结果，加权平均效应大小(k=3)为OR=2.53(95%CI=0.82至7.81)。对于这一新兴领域，建议加强对多层次变化的理论应用，新颖的设计方法，以及在干预设计和实施中使用文化杠杆。
To examine the impact of multilevel interventions (with three or more levels of influence) designed to reduce health disparities, we conducted a systematic review and meta-analysis of interventions for ethnic/racial minorities (all except non-Hispanic whites) that were published between January 2000 and July 2011. The primary aims were to synthesize the findings of studies evaluating multilevel interventions (three or more levels of influence) targeted at ethnic and racial minorities to reduce disparities in their health care and obtain a quantitative estimate of the effect of multilevel interventions on health outcomes among these subgroups. The electronic database PubMed was searched using Medical Subject Heading terms and key words. After initial review of abstracts, 26 published studies were systematically reviewed by at least two independent coders. Those with sufficient data (n = 12) were assessed by meta-analysis and examined for quality using a modified nine-item Physiotherapy Evidence Database coding scheme. The findings from this descriptive review suggest that multilevel interventions have positive effects on several health behavior outcomes, including cancer prevention and screening, as well improving the quality of health-care system processes. The weighted average effect size across studies for all health behavior outcomes reported at the individual participant level (k = 17) was odds ratio (OR) = 1.27 (95% confidence interval [CI] = 1.11 to 1.44); for the outcomes reported by providers or organizations, the weighted average effect size (k = 3) was OR = 2.53 (95% CI = 0.82 to 7.81). Enhanced application of theories to multiple levels of change, novel design approaches, and use of cultural leveraging in intervention design and implementation are proposed for this nascent field.