Breslau Erica S, Weiss Elisa S, Williams Abigail, Burness Allison, Kepka Deanna
National Cancer Institute, Bethesda, MD, USA
The Leukemia & Lymphoma Society, White Plains, NY, USA.
Health Promot Pract. 2015 Jan;16(1):46-54. doi: 10.1177/1524839914528705. Epub 2014 Apr 3.
Southern rural and underserved counties have high proportions of individuals with increased mortality for cervical and breast cancers. To improve the integration of behavioral research into practice, the dissemination and implementation of efficacious interventions to encourage the use of screening have increased in recent years. This study addressed gaps in the dissemination and implementation of evidence-based interventions with a pilot called Team Up. Qualitative interviews with 24 key individuals in six state-level partnerships explored partnership characteristics that influenced selection and use of evidence-based interventions among low-income, rarely or never screened women. Guided by diffusion of innovations theory and the Lasker and Weiss partnership functioning model, interviews about the intervention centered on (a) knowledge surrounding evidence base; (b) identification, selection, and adoption; (c) planning and adaptation; (d) implementation; and (e) partnership reflections and impact. Using grounded theory and content analysis, data revealed that lack of communication and high partner turnover hindered adoption and adaptation, whereas failure of partnership leaders to engage local stakeholders and lack of sufficient funds hampered implementation. Delivery of evidence-based interventions was more effective when partnerships included local partners in early decision making and when coaches were introduced to facilitate strategic thinking about translating evidence-based interventions into practice. A challenge for public health partnerships was the translation of interventions into successful programs, such that underserved communities benefited from early detection intervention research.
美国南部农村地区以及医疗服务不足的县，宫颈癌和乳腺癌死亡率较高的人群比例很大。为了加强行为研究与实践的结合，近年来，鼓励进行筛查的有效干预措施的传播与实施有所增加。本研究通过一项名为“携手合作”的试点项目，填补了循证干预措施在传播与实施方面的空白。对六个州级合作项目中的24位关键人物进行了定性访谈，探讨了影响低收入、很少或从未接受过筛查的女性选择和使用循证干预措施的合作特征。以创新扩散理论以及拉斯克和韦斯的合作运作模式为指导，围绕干预措施展开的访谈集中在以下几个方面：（a）循证依据相关知识；（b）识别、选择和采用；（c）规划与调整；（d）实施；以及（e）合作反思与影响。通过扎根理论和内容分析，数据显示缺乏沟通以及合作伙伴更替频繁阻碍了采用和调整，而合作项目负责人未能让当地利益相关者参与进来以及资金不足则妨碍了实施。当合作项目在早期决策中纳入当地合作伙伴并且引入指导人员以促进将循证干预措施转化为实践的战略思考时，循证干预措施的实施会更有效。公共卫生合作项目面临的一个挑战是将干预措施转化为成功的项目，以便医疗服务不足的社区能够从早期检测干预研究中受益。
