Brook Judy, McGraw Caroline
Division of Health Services Research and Management, School of Health Sciences, City University of London, London, UK.
Health Soc Care Community. 2018 May;26(3):e386-e395. doi: 10.1111/hsc.12536. Epub 2018 Jan 7.
Long-term conditions are a leading cause of mortality and morbidity. Their management is founded on a combination of approaches involving government policy, better integration between health and care systems, and individual responsibility for self-care. Health coaching has emerged as an approach to encouraging individual responsibility and enhancing the self-management of long-term conditions. This paper focuses on the evaluation of a workforce initiative in a diverse and socially deprived community. The initiative sought both to improve integration between health and care services for people with long-term conditions, and equip practitioners with health coaching skills. The aim of the study was to contribute an empirical understanding of what practitioners perceive to be the contextual factors that impact on the adoption of health coaching in community settings. These factors were conceptualised using the Consolidated Framework for Implementation Research (CFIR). A stratified purposive sample of 22 health and care practitioners took part in semi-structured telephone interviews. Data were analysed using the CFIR as an analytical framework. The perceptions of trainees mapped onto the major domains of the CFIR: characteristics of the intervention, outer setting, inner setting, characteristics of individuals involved and process of implementation. Individual patient expectations, comorbidities and social context were central to the extent to which practitioners and patients engaged with health coaching. Structural constraints within provider services and the wider NHS were also reported as discouraging initiatives that focused on long-term rewards rather than short-term wins. The authors recommend further research is undertaken both to understand the role of health coaching in disadvantaged communities and ensure the service user voice is heard.
慢性病是导致死亡和发病的主要原因。其管理基于多种方法的结合，包括政府政策、卫生与护理系统之间更好的整合以及个人的自我护理责任。健康指导已成为一种鼓励个人承担责任并加强慢性病自我管理的方法。本文重点评估了一个多元化且社会贫困社区中的劳动力倡议。该倡议旨在改善慢性病患者的卫生与护理服务整合，并使从业者具备健康指导技能。该研究的目的是通过实证了解从业者认为哪些背景因素会影响社区环境中健康指导的采用。这些因素使用实施研究综合框架（CFIR）进行概念化。22名卫生与护理从业者的分层目的抽样参与了半结构化电话访谈。数据以CFIR作为分析框架进行分析。学员的看法映射到了CFIR的主要领域：干预措施的特征、外部环境、内部环境、相关个人的特征以及实施过程。从业者和患者参与健康指导的程度，个人患者期望、合并症和社会背景是关键因素。还报告称，提供者服务机构和更广泛的国民保健服务体系（NHS）内部的结构限制不利于那些侧重于长期回报而非短期成果的倡议。作者建议进一步开展研究，以了解健康指导在弱势社区中的作用，并确保听取服务使用者的意见。
