Maar Marion, Yeates Karen, Barron Marcia, Hua Diane, Liu Peter, Moy Lum-Kwong Margaret, Perkins Nancy, Sleeth Jessica, Tobe Joshua, Wabano Mary Jo, Williamson Pamela, Tobe Sheldon W
Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.
Department of Medicine, Queens University, Kingston, ON, Canada.
Implement Sci. 2015 May 4;10:64. doi: 10.1186/s13012-015-0257-6.
Non-communicable chronic diseases are the leading causes of mortality globally, and nearly 80% of these deaths occur in low- and middle-income countries (LMICs). In high-income countries (HICs), inequitable distribution of resources affects poorer and otherwise disadvantaged groups including Aboriginal peoples. Cardiovascular mortality in high-income countries has recently begun to fall; however, these improvements are not realized among citizens in LMICs or those subgroups in high-income countries who are disadvantaged in the social determinants of health including Aboriginal people. It is critical to develop multi-faceted, affordable and realistic health interventions in collaboration with groups who experience health inequalities. Based on community-based participatory research (CBPR), we aimed to develop implementation tools to guide complex interventions to ensure that health gains can be realized in low-resource environments.
We developed the I-RREACH (Intervention and Research Readiness Engagement and Assessment of Community Health Care) tool to guide implementation of interventions in low-resource environments. We employed CBPR and a consensus methodology to (1) develop the theoretical basis of the tool and (2) to identify key implementation factor domains; then, we (3) collected participant evaluation data to validate the tool during implementation.
The I-RREACH tool was successfully developed using a community-based consensus method and is rooted in participatory principles, equalizing the importance of the knowledge and perspectives of researchers and community stakeholders while encouraging respectful dialogue. The I-RREACH tool consists of three phases: fact finding, stakeholder dialogue and community member/patient dialogue. The evaluation for our first implementation of I-RREACH by participants was overwhelmingly positive, with 95% or more of participants indicating comfort with and support for the process and the dialogue it creates.
The I-RREACH tool was designed to (1) pinpoint key domains required for dialogue between the community and the research team to facilitate implementation of complex health interventions and research projects and (2) to identify existing strengths and areas requiring further development for effective implementation. I-RREACH has been found to be easily adaptable to diverse geographical and cultural settings and can be further adapted to other complex interventions. Further research should include the potential use of the I-RREACH tool in the development of blue prints for scale-up of successful interventions, particularly in low-resource environments.
非传染性慢性病是全球主要死因，其中近80%的死亡发生在低收入和中等收入国家（LMICs）。在高收入国家（HICs），资源分配不均影响到包括原住民在内的较贫困及其他弱势群体。高收入国家的心血管疾病死亡率最近开始下降；然而，在低收入和中等收入国家的公民或高收入国家中在健康社会决定因素方面处于不利地位的亚群体（包括原住民）中，这些改善并未实现。与经历健康不平等的群体合作制定多方面、负担得起且切实可行的健康干预措施至关重要。基于社区参与式研究（CBPR），我们旨在开发实施工具，以指导复杂干预措施，确保在资源匮乏的环境中实现健康收益。
我们开发了I-RREACH（社区医疗保健干预与研究准备参与及评估）工具，以指导在资源匮乏环境中实施干预措施。我们采用CBPR和共识方法来（1）建立该工具的理论基础，以及（2）确定关键实施因素领域；然后，我们（3）收集参与者评估数据，以便在实施过程中验证该工具。
I-RREACH工具通过基于社区的共识方法成功开发，其植根于参与性原则，平衡了研究人员和社区利益相关者的知识和观点的重要性，同时鼓励进行尊重性对话。I-RREACH工具包括三个阶段：实情调查、利益相关者对话和社区成员/患者对话。参与者对我们首次实施I-RREACH的评价绝大多数是积极的，95%或更多的参与者表示对该过程及其所促成的对话感到满意并给予支持。
I-RREACH工具旨在（1）确定社区与研究团队之间对话所需的关键领域，以促进复杂健康干预措施和研究项目的实施，以及（2）识别现有优势和需要进一步发展以实现有效实施的领域。已发现I-RREACH易于适应不同的地理和文化环境，并且可以进一步适用于其他复杂干预措施。进一步的研究应包括I-RREACH工具在制定成功干预措施扩大规模蓝图方面的潜在用途，特别是在资源匮乏的环境中。
