Schölmerich Vera L N, Kawachi Ichiro
Harvard School of Public Health, Boston, MA, USA University of Rotterdam, Rotterdam, Netherlands
Harvard School of Public Health, Boston, MA, USA.
Health Educ Behav. 2016 Jun;43(3):246-55. doi: 10.1177/1090198116629442. Epub 2016 Apr 22.
Scholars and practitioners frequently make recommendations to develop family planning interventions that are "multilevel." Such interventions take explicit account of the role of environments by incorporating multilevel or social-ecological frameworks into their design and implementation. However, research on how interventions have translated these concepts into practice in the field of family planning-and generally in public health-remains scarce. This article seeks to review the current definitions of multilevel interventions and their operationalization in the field of family planning. First, we highlight the divergent definitions of multilevel interventions and show the persistent ambiguity around this term. We argue that interventions involving activities at several levels but lacking targets (i.e., objectives) to create change on more than one level have not incorporated a social-ecological framework and should therefore not be considered as "multilevel." In a second step, we assess the extent to which family planning interventions have successfully incorporated a social-ecological framework. To this end, the 63 studies featured in Mwaikambo et al.'s systematic review on family planning interventions were reexamined. This assessment indicates that the multilevel or social-ecological perspective has seldom been translated into interventions. Specifically, the majority of interventions involved some form of activity at the community and/or organizational level, yet targeted and measured intrapersonal change as opposed to explicitly targeting/measuring environmental modification.
学者和从业者经常建议制定“多层次”的计划生育干预措施。此类干预措施通过将多层次或社会生态框架纳入其设计和实施过程，明确考虑了环境的作用。然而，关于干预措施如何在计划生育领域（以及一般在公共卫生领域）将这些概念转化为实践的研究仍然很少。本文旨在回顾多层次干预措施的当前定义及其在计划生育领域的实施情况。首先，我们强调了多层次干预措施的不同定义，并指出围绕这一术语的持续模糊性。我们认为，涉及多个层面活动但缺乏在多个层面创造变革的目标（即目的）的干预措施并未纳入社会生态框架，因此不应被视为“多层次”。第二步，我们评估计划生育干预措施成功纳入社会生态框架的程度。为此，我们重新审视了姆瓦坎博等人关于计划生育干预措施的系统评价中所涉及的63项研究。这一评估表明，多层次或社会生态视角很少被转化为干预措施。具体而言，大多数干预措施涉及社区和/或组织层面的某种形式的活动，但目标是个人层面的改变并对其进行衡量，而不是明确针对/衡量环境变化。
