Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies
Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies
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DOI：
10.1186/s43058-020-00034-4
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发表时间：
2020-04-30
影响因子：
--
通讯作者：
Perez, Giselle K.
中科院分区：
文献类型：
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作者：
Porteny, Thalia;Alegria, Margarita;Perez, Giselle K.
到2040年，预计美国三分之一的老年人属于少数种族/族裔群体。这一人群患精神和身体残疾的风险增加，在获得护理方面存在重大障碍。社区组织经常提供方案，为少数民族和移民老年人服务。有限的资源和其他障碍，如缺乏训练有素的工作人员，使得难以在社区组织中长期采用循证干预措施。然而，鲜为人知的是什么因素可以促进通过的EBI在CBO服务少数elders.Methods积极的思想，强大的机构（PM-SB），以证据为基础的干预提供了四种语言，旨在减少精神和身体残疾的少数民族和移民老人通过社区卫生工作者和运动教练的努力。干预包括认知行为疗法和运动训练课程，为期6个月。在最近的一项临床试验中，我们从CBO工作人员那里得到了反馈，以确定如何最好地促进PM-SB在其机构内的实施和长期可持续性。我们调查了30 CBO的工作人员，举行了四个焦点小组，并进行了20次深入访谈，以研究工作人员的观点，并揭示因素或需要的变化，以促进长期采用在未来的CBOs.Results参与者报告说，工作人员的动机和执行可以通过以下变化得到改善：增加患者对治疗的补偿，降低组织责任的水平，减少干预措施中对工作人员的要求。虽然大多数工作人员认为，PM-SB提高了他们的机构的能力，以解决老年人的健康和福祉，能力建设战略，如“培训员培训”的倡议被确定为优先事项，以解决工作人员更替的可持续性。调整干预措施，以获得财政recommendation.Conclusions增加财政奖励，简化程序，并简化工作人员的问责制，建议战略，促进过渡，从残疾预防临床试验在少数民族和移民老人的常规服务在CBOs.Trial注册ClinicalTrials.gov，NCT 02317432可扩展的实施。
Background By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders.Methods Positive-Minds-Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs.Results Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency's ability to address the health and well-being of elders, capacity-building strategies such as a "train-the-trainer" initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital.Conclusions Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs.Trial registration ClinicalTrials.gov, NCT02317432.