Ferdinand Angeline S, Paradies Yin, Kelaher Margaret
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Burwood, Australia.
Health Res Policy Syst. 2017 Jul 11;15(1):61. doi: 10.1186/s12961-017-0223-7.
The Localities Embracing and Accepting Diversity (LEAD) programme was established to improve the health of ethnic minority communities through the reduction of racial discrimination. Local governments in the state of Victoria, Australia, were at the forefront of LEAD implementation in collaboration with leading state and national organisations. Key aims included expanding the available evidence regarding effective anti-racism interventions and facilitating the uptake of this evidence in organisational policies and practices.
One rural and one metropolitan local government areas were selected to participate in LEAD. Key informant interviews and discussions were conducted with individuals who had participated in LEAD implementation and members of LEAD governance structures. Data were also collected on programme processes and implementation, partnership formation and organisational assessments.
The LEAD model demonstrated both strengths and weaknesses in terms of facilitating the use of evidence in a complex, community-based health promotion initiative. Representation of implementing, funding and advisory bodies at different levels of governance enabled the input of technical advice and guidance alongside design and implementation. The representation structure assisted in ensuring the development of a programme that was acceptable to all partners and informed by the best available evidence. Simultaneous evaluation also enhanced perceived validity of the intervention, allowed for strategy correction when necessary and supported the process of double-loop organisational learning. However, due to the model's demand for simultaneous and intensive effort by various organisations, when particular elements of the intervention were not functional, there was a considerable loss of time and resources across the partner organisations. The complexity of the model also presented a challenge in ensuring clarity regarding roles, functions and the direction of the programme.
The example of LEAD provides guidance on mechanisms to strengthen the entry of evidence into complex community-based health promotion programmes. The paper highlights some of the strengths and weaknesses of the LEAD model and implications for practical collaboration between policymakers, implementers and researchers.
“接纳与包容多样性地区”（LEAD）项目旨在通过减少种族歧视来改善少数民族社区的健康状况。澳大利亚维多利亚州的地方政府与州及全国的主要组织合作，在LEAD项目的实施中处于前沿位置。主要目标包括扩充有关有效反种族主义干预措施的现有证据，并促进在组织政策和实践中采用这些证据。
选择了一个农村和一个城市地方政府区域参与LEAD项目。对参与LEAD项目实施的人员以及LEAD治理结构的成员进行了关键 informant 访谈和讨论。还收集了有关项目流程与实施、伙伴关系形成以及组织评估的数据。
在促进将证据用于一项复杂的、基于社区的健康促进倡议方面，LEAD模式展现出了优势与不足。实施机构、资助机构和咨询机构在不同治理层面的代表性，使得在设计和实施过程中能够输入技术建议和指导。这种代表性结构有助于确保制定出一个所有伙伴都能接受且以现有最佳证据为依据的项目。同步评估还提高了干预措施的可信度，必要时可进行策略修正，并支持双环组织学习过程。然而，由于该模式要求各组织同时投入大量精力，当干预措施的某些特定要素不起作用时，各伙伴组织会在时间和资源上出现相当大的损失。该模式的复杂性在确保项目的角色、功能和方向清晰明确方面也构成了挑战。
LEAD项目的实例为加强将证据纳入复杂的基于社区的健康促进项目的机制提供了指导。本文强调了LEAD模式的一些优势与不足，以及对政策制定者、实施者和研究者之间实际合作的启示。
