应用规范化过程理论理解家庭暴力筛查与护理模式在母婴健康护理实践中的实施：一项随机对照试验的混合方法过程评估
Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial.
作者信息
Hooker Leesa, Small Rhonda, Humphreys Cathy, Hegarty Kelsey, Taft Angela
机构信息
Judith Lumley Centre, La Trobe University, Melbourne, Australia.
School of Social Work, University of Melbourne, Melbourne, Australia.
出版信息
Implement Sci. 2015 Mar 28;10:39. doi: 10.1186/s13012-015-0230-4.
BACKGROUND
In Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to families with children 0-6 years, focusing on health promotion, parenting support and early intervention. Family violence (FV) has been identified as a major public health concern, with increased prevalence in the child-bearing years. Victorian Government policy recommends routine FV screening of all women attending MCH services. Using Normalization Process Theory (NPT), we aimed to understand the barriers and facilitators of implementing an enhanced screening model into MCH nurse clinical practice.
METHODS
NPT informed the process evaluation of a pragmatic, cluster randomised controlled trial in eight MCH nurse teams in metropolitan Melbourne, Victoria, Australia. Using mixed methods (surveys and interviews), we explored the views of MCH nurses, MCH nurse team leaders, FV liaison workers and FV managers on implementation of the model. Quantitative data were analysed by comparing proportionate group differences and change within trial arm over time between interim and impact nurse surveys. Qualitative data were inductively coded, thematically analysed and mapped to NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) to enhance our understanding of the outcome evaluation.
RESULTS
MCH nurse participation rates for interim and impact surveys were 79% (127/160) and 71% (114/160), respectively. Twenty-three key stakeholder interviews were completed. FV screening work was meaningful and valued by participants; however, the implementation coincided with a significant (government directed) change in clinical practice which impacted on full engagement with the model (coherence and cognitive participation). The use of MCH nurse-designed FV screening/management tools in focussed women's health consultations and links with FV services enhanced the participants' work (collective action). Monitoring of FV work (reflexive monitoring) was limited.
CONCLUSIONS
The use of theory-based process evaluation helped identify both what inhibited and enhanced intervention effectiveness. Successful implementation of an enhanced FV screening model for MCH nurses occurred in the context of focussed women's health consultations, with the use of a maternal health and wellbeing checklist and greater collaboration with FV services. Improving links with these services and the ongoing appraisal of nurse work would overcome the barriers identified in this study.
背景
在澳大利亚维多利亚州，母婴健康（MCH）服务为有0至6岁儿童的家庭提供初级卫生保健，重点是健康促进、育儿支持和早期干预。家庭暴力（FV）已被确定为一个主要的公共卫生问题，在育龄期的患病率有所上升。维多利亚州政府政策建议对所有接受MCH服务的妇女进行常规家庭暴力筛查。运用正常化过程理论（NPT），我们旨在了解在母婴保健护士临床实践中实施强化筛查模式的障碍和促进因素。
方法
NPT为澳大利亚维多利亚州墨尔本大都市地区八个母婴保健护士团队开展的一项实用的整群随机对照试验的过程评估提供了信息。我们采用混合方法（调查和访谈），探讨了母婴保健护士、母婴保健护士团队负责人、家庭暴力联络工作人员和家庭暴力管理人员对该模式实施的看法。通过比较中期和影响期护士调查中各试验组随时间的比例差异和变化，对定量数据进行分析。对定性数据进行归纳编码、主题分析，并映射到NPT构建要素（连贯性、认知参与、集体行动和反思性监测），以加深我们对结果评估的理解。
结果
中期和影响期调查的母婴保健护士参与率分别为79%（127/160）和71%（114/160）。完成了23次关键利益相关者访谈。参与者认为家庭暴力筛查工作有意义且有价值；然而，该实施恰逢临床实践发生重大（政府主导）变化，这影响了对该模式的全面参与（连贯性和认知参与）。在专门的妇女健康咨询中使用母婴保健护士设计的家庭暴力筛查/管理工具以及与家庭暴力服务机构的联系增强了参与者的工作（集体行动）。对家庭暴力工作的监测（反思性监测）有限。
结论
基于理论的过程评估有助于确定哪些因素抑制和增强了干预效果。在专门的妇女健康咨询背景下，通过使用孕产妇健康和幸福检查表以及与家庭暴力服务机构加强合作，成功地为母婴保健护士实施了强化家庭暴力筛查模式。改善与这些服务机构的联系以及对护士工作的持续评估将克服本研究中确定的障碍。
Zotero 插件