Merzel Cheryl, D'Afflitti Joanna
Center for Applied Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Am J Public Health. 2003 Apr;93(4):557-74. doi: 10.2105/ajph.93.4.557.
Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.
当代公共卫生强调以社区为基础的健康促进和疾病预防方法。然而，过去20年的证据表明，许多以社区为基础的项目只产生了适度的影响，一些艾滋病毒预防项目是明显的例外。为了更好地理解这些结果的原因，我们对32个以社区为基础的预防项目进行了系统的文献综述。表现不佳的原因包括研究设计和评估的方法挑战、同时存在的长期趋势、小于预期的效应量、干预措施的局限性以及所用理论的局限性。艾滋病毒项目的有效性似乎部分与广泛的形成性研究以及对改变社会规范的强调有关。
