Tim J. Horton (
John H. Illingworth is an Improvement Fellow at the Health Foundation and an honorary research associate at the Institute of Global Health Innovation, Imperial College London.
Health Aff (Millwood). 2018 Feb;37(2):191-197. doi: 10.1377/hlthaff.2017.1161.
The complex nature of many health care interventions poses challenges for successful replication. This article presents insights on tackling these challenges primarily drawn from recent research and programs in the UK. These insights include the need to codify complex interventions in ways that reflect their social, context-sensitive, and dynamic nature; to capture learning as the intervention is implemented in new contexts; and to design programs in ways that respect adopters' role in the spread process. We argue that program leaders should have familiarity with theoretical approaches for conceptualizing complex interventions, that a discrete testing-and-revision phase should be recognized as part of the spread process, and that programs should be designed in ways that build and sustain adopter commitment. These perspectives complement the traditional focus on the innovator in models of spread by highlighting the role adopters play in adapting interventions and generating learning, and they have implications for the design of programs to spread innovation.
许多医疗干预措施的复杂性给成功复制带来了挑战。本文主要从英国最近的研究和项目中提出了解决这些挑战的见解。这些见解包括需要以反映其社会、情境敏感和动态性质的方式对复杂干预措施进行编纂；在新的环境中实施干预措施时捕捉学习；并以尊重采用者在传播过程中的作用的方式设计方案。我们认为，项目负责人应该熟悉用于概念化复杂干预措施的理论方法，应该认识到测试和修订阶段是传播过程的一部分，并且应该以建立和维持采用者承诺的方式设计方案。这些观点补充了传播模型中传统上对创新者的关注，突出了采用者在适应干预措施和产生学习方面所扮演的角色，并且对传播创新的方案设计具有启示意义。
