负责酒精的社区（CICA）：酒精健康大使计划的阶梯式随机对照试验方案。

Communities in charge of alcohol (CICA): a protocol for a stepped-wedge randomised control trial of an alcohol health champions programme.

机构信息

School of Health Sciences, University of Salford, Manchester, UK.

School of Health & Society, University of Salford, Manchester, UK.

出版信息

BMC Public Health. 2018 Apr 19;18(1):522. doi: 10.1186/s12889-018-5410-0.

DOI:10.1186/s12889-018-5410-0

PMID:29673337

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5909208/

Abstract

BACKGROUND

Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Through a cascade training model, supported by a designated local co-ordinator, local volunteers are trained to become accredited 'Alcohol Health Champions' to provide brief opportunistic advice at an individual level and mobilise action on alcohol availability at a community level. The CICA programme is the first time that a devolved UK region has attempted to coordinate an approach to building health champion capacity, presenting an opportunity to investigate its implementation and impact at scale. This paper describes the protocol for a stepped wedge randomised controlled trial of an Alcohol Health Champions programme in Greater Manchester which aims to strengthen the evidence base of ABCD approaches for health improvement and reducing alcohol-related harm.

METHODS

A natural experiment that will examine the effect of CICA on area level alcohol-related hospital admissions, Accident and Emergency attendances, ambulance call outs, street-level crime and anti-social behaviour data. Using a stepped wedged randomised design (whereby the intervention is rolled out sequentially in a randomly assigned order), potential changes in health and criminal justice primary outcomes are analysed using mixed-effects log-rate models, differences-in-differences models and Bayesian structured time series models. An economic evaluation identifies the set-up and running costs of CICA using HM Treasury approved standardised methods and resolves cost-consequences by sector. A process evaluation explores the context, implementation and response to the intervention. Qualitative analyses utilise the Framework method to identify underlying themes.

DISCUSSION

We will investigate: whether training lay people to offer brief advice and take action on licensing decisions has an impact on alcohol-related harm in local areas; the cost-consequences for health and criminal justice sectors, and; mechanisms that influence intervention outcomes. As well as providing evidence for the effectiveness of this intervention to reduce the harm from alcohol, this evaluation will contribute to broader understanding of asset based approaches to improve public health.

TRIAL REGISTRATION

ISRCTN 81942890 , date of registration 12/09/2017.

摘要

背景

社区负责酒精（CICA）采取资产为基础的社区发展（ABCD）方法，以减少酒精危害。通过级联培训模式，由指定的当地协调员提供支持，当地志愿者接受培训成为认可的“酒精健康大使”，以便在个人层面提供简短的机会性建议，并在社区层面调动有关酒精供应的行动。CICA 计划是英国首次尝试协调建立健康大使能力的方法，为调查其在规模上的实施和影响提供了机会。本文描述了在大曼彻斯特地区进行酒精健康大使计划的阶梯式随机对照试验方案，旨在加强 ABCD 方法在改善健康和减少与酒精相关的伤害方面的证据基础。

方法

这是一项自然实验，将研究 CICA 对地区层面的酒精相关住院、急诊就诊、救护车出动、街头犯罪和反社会行为数据的影响。使用阶梯式随机设计（即干预按随机指定的顺序顺序推出），使用混合效应对数比率模型、差异差异模型和贝叶斯结构时间序列模型分析健康和刑事司法主要结果的潜在变化。经济评估使用 HM 财政部批准的标准化方法确定 CICA 的设立和运营成本，并按部门解决成本后果。过程评估探讨了干预措施的背景、实施和应对情况。定性分析利用框架方法确定潜在主题。