Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach.
Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach.
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DOI：
10.1097/qai.0000000000000236
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发表时间：
2014-08-15
期刊：
影响因子：
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通讯作者：
Johnson BT
中科院分区：
文献类型：
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作者：
Kaufman MR;Cornish F;Zimmerman RS;Johnson BT
尽管最近越来越强调艾滋病毒相关行为的社会和结构决定因素，但实证研究和干预措施落后，部分原因是社会结构方法的复杂性。本文提供了一个全面的和实际的审查，对艾滋病毒相关的行为改变的多层次的方法的利益，促进正在进行的转变，更全面的理论，研究和实践的各种文献。它有以下具体目标：（1）提供与个体结构谱上所有点的行为变化相关的相关变量/因素的综合列表，（2）绘制并比较最近重要的多层次模型的特征，（3）反思使用这种复杂的理论工具的挑战，以及（4）确定下一步并提出可行的建议。采用多层次方法意味着纳入越来越多的变量和越来越多的针对具体情况的机制，总体上产生更大的复杂性。最后，我们就如何最好地应对这一复杂性提出了建议，其中包括：利用形成性研究和跨学科合作，在特定背景下选择最适当的水平和变量;在适当的水平上衡量社会和体制变量，以确保对多个层面进行有意义的评估;以及参考理论模型和机制，将干预和研究概念化，以促进可转移性、可持续性和可扩展性。
Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual–structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.