评估公共卫生干预措施评估在不同环境中的适用性：评估工具和框架可用性及有用性的方法学研究。
Assessing the applicability of public health intervention evaluations from one setting to another: a methodological study of the usability and usefulness of assessment tools and frameworks.
机构信息
Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, United Kingdom.
Evidence for Policy and Practice Information and Coordinating Centre, UCL Institute of Education, University College London, London, United Kingdom.
出版信息
Health Res Policy Syst. 2018 Sep 4;16(1):88. doi: 10.1186/s12961-018-0364-3.
BACKGROUND
Public health interventions can be complicated, complex and context dependent, making the assessment of applicability challenging. Nevertheless, for them to be of use beyond the original study setting, they need to be generalisable to other settings and, crucially, research users need to be able to identify to which contexts it may be applicable. There are many tools with set criteria for assessing generalisability/applicability, yet few seem to be widely used and there is no consensus on which should be used, or when. This methodological study aimed to test these tools to assess how easy they were to use and how useful they appeared to be.
METHODS
We identified tools from an existing review and an update of its search. References were screened on pre-specified criteria. Included tools were tested by using them to assess the applicability of a Swedish weight management intervention to the English context. Researcher assessments and reflections on the usability and utility of the tools were gathered using a standard pro-forma.
RESULTS
Eleven tools were included. Their length, content, style and time required to complete varied. No tool was considered ideal for assessing applicability. Their limitations included unrealistic criteria (requiring unavailable information), a focus on implementation to the neglect of transferability (i.e. little focus on potential effectiveness in the new setting), overly broad criteria (associated with low reliability), and a lack of an explicit focus on how interventions worked (i.e. their mechanisms of action).
CONCLUSION
Tools presenting criteria ready to be used may not be the best method for applicability assessments. They are likely to be either too long or incomplete, too focused on differences and fail to address elements that matter for the specific topic of interest. It is time to progress from developing lists of set criteria that are not widely used in the literature, to creating a new approach to applicability assessment. Focusing on mechanisms of action, rather than solely on characteristics, could be a useful approach, and one that remains underutilised in current tools. New approaches to assessing generalisability that evolve away from checklist style assessments need to be developed, tested, reported and discussed.
背景
公共卫生干预措施可能复杂、复杂且依赖于背景，这使得适用性评估具有挑战性。然而，为了使其在原始研究环境之外得到应用，它们需要能够推广到其他环境，并且至关重要的是，研究人员需要能够确定它可能适用于哪些情况。有许多工具具有评估可推广性/适用性的既定标准，但似乎很少被广泛使用，也没有共识应该使用哪些工具，或者何时使用。这项方法学研究旨在测试这些工具，以评估它们的易用性和有用性。
方法
我们从现有的综述和对其搜索的更新中确定了工具。参考文献根据预先规定的标准进行筛选。通过使用这些工具来评估瑞典体重管理干预措施在英语环境中的适用性来测试纳入的工具。使用标准表格收集了研究人员对工具可用性和实用性的评估和反思。
结果
纳入了 11 种工具。它们的长度、内容、风格和完成所需的时间各不相同。没有一种工具被认为是评估适用性的理想工具。它们的局限性包括不切实际的标准（需要无法获得的信息）、关注实施而忽略可转移性（即很少关注新环境中的潜在效果）、过于宽泛的标准（与低可靠性相关），以及缺乏对干预措施如何运作的明确关注（即其作用机制）。
结论
呈现可使用标准的工具可能不是适用性评估的最佳方法。它们可能要么太长或不完整，要么过于关注差异，而未能解决特定感兴趣主题的重要元素。现在是时候从开发未广泛用于文献中的设定标准清单，发展到创建新的适用性评估方法。关注作用机制，而不仅仅是特征，可能是一种有用的方法，而这在当前工具中仍未得到充分利用。需要开发、测试、报告和讨论新的评估可推广性的方法，这些方法逐渐远离清单式评估。
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