Rehfuess Eva A, Bartram Jamie
Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
Water Institute, Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7431, 135 Dauer Drive, Chapel Hill, NC 27599-7431, United States.
Int J Hyg Environ Health. 2014 Mar;217(2-3):155-9. doi: 10.1016/j.ijheh.2013.07.011. Epub 2013 Jul 30.
Systematic reviews are a cornerstone of evidence-based public health, and there is much discussion on how this method may need to be modified to do justice to complex interventions, such as environmental health interventions. This paper asserts that intervention effectiveness is influenced by variability in five distinct layers--direct (intrinsic) impact, user compliance, delivery, programming and policy measures--which are embedded in the broader geographical, socio-economic, political and cultural context. The multi-component, multi-sectoral nature of most environmental health interventions results in a complex relationship between these layers of influence, involving systemic interactions. As illustrated with examples, understanding environmental health interventions critically relies on considering all of these layers. These distinct layers of influence can serve as a framework towards the comprehensive analysis of environmental health interventions in systematic reviews, drawing on quantitative and qualitative methods and a variety of disciplines.
系统评价是循证公共卫生的基石，关于如何对该方法进行修改以公正地评估复杂干预措施（如环境卫生干预措施）存在诸多讨论。本文认为，干预效果受到五个不同层面的变异性影响，即直接（内在）影响、用户依从性、实施、规划和政策措施，这些层面嵌入在更广泛的地理、社会经济、政治和文化背景之中。大多数环境卫生干预措施的多成分、多部门性质导致这些影响层面之间存在复杂的关系，涉及系统相互作用。正如实例所示，对环境卫生干预措施的理解严重依赖于对所有这些层面的考量。这些不同的影响层面可作为一个框架，用于在系统评价中综合分析环境卫生干预措施，借鉴定量和定性方法以及多种学科知识。
