Percival Nikki A, McCalman Janya, Armit Christine, O'Donoghue Lynette, Bainbridge Roxanne, Rowley Kevin, Doyle Joyce, Tsey Komla
Centre for Primary Health Care Systems, Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD 4000, Australia.
The Cairns Institute, James Cook University, Cairns, Australia.
Health Promot Int. 2018 Feb 1;33(1):92-106. doi: 10.1093/heapro/daw049.
In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services.
Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model.
An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing.
The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.
在澳大利亚,已投入大量资源来制定健康促进最佳实践指南、框架和工具(以下简称健康促进工具),作为改善原住民健康促进项目的一项战略。然而,关于健康促进工具是否得到实施以及如何实施,却很少有严谨的实施研究。本文对原住民综合初级卫生保健服务中健康促进工具实施的复杂过程进行了理论分析。
数据来源于已发表的文献和灰色文献,涉及四种原住民健康促进工具的开发与实施。从理论上对工具进行抽样,以涵盖文献中描述的关键实施类型。采用扎根理论的编码和持续比较方法对数据进行分析,构建一个理论实施模型。
开发了一个原住民健康促进工具实施模型。实施是一个社会过程,在此过程中,研究人员、从业者和社区成员为了促进赋权这一共同目标,共同互动以创建具有文化适应性的健康促进。健康促进工具的实施受到变革推动者的存在、互惠承诺以及组织治理和资源配置的影响。
原住民健康促进工具实施模型有助于解释健康促进工具是如何实施的以及影响这些行动的条件。我们的研究表明,与其仅仅开发更多的健康促进工具,不如持续投入资源来创造支持赋权实施过程的条件,以最大限度地提高健康促进工具的有益影响和效果。