Perrin Karen M, Burke Somer Goad, O'Connor Danielle, Walby Gary, Shippey Claire, Pitt Seraphine, McDermott Robert J, Forthofer Melinda S
College of Public Health, University of South Florida, Tampa, Florida, USA.
Implement Sci. 2006 Oct 26;1:26. doi: 10.1186/1748-5908-1-26.
Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design.
The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance.
This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation.
Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.
疾病自我管理项目一直是降低慢性病发病率和死亡率的常用方法。成功复制基于证据的疾病管理项目要求从业者确保与原始项目设计保持一致。
佛罗里达健康素养研究（FHLS）旨在调查辉瑞公司糖尿病和高血压疾病自我管理项目在佛罗里达州14个社区卫生中心基于健康素养原则的实施影响。讨论的干预组成部分包括健康教育工作者的招募与培训、患者招募、课程、项目材料的使用、项目手册的翻译、患者留存与随访以及技术援助。
本报告描述了在各诊所实施健康教育项目时，在实现文化相关性适应与一致性之间取得平衡所面临的挑战。这种平衡对于实现疾病自我管理项目的有效性是必要的。FHLS项目在很大程度上按照原始设计并使用原始项目材料进行实施。讨论了被认为有利于项目参与的调整措施，例如采用替代方法招募患者以及制定员工参与激励措施。
有效的项目实施取决于诊所工作人员的才能、技能和积极参与。能够节省工作人员时间和资源并认可其贡献的项目调整措施可以提高项目有效性，同时又不损害其一致性。
