Orkin Aaron M, McArthur Allison, Venugopal Jeyasakthi, Kithulegoda Natasha, Martiniuk Alexandra, Buchman Daniel Z, Kouyoumdjian Fiona, Rachlis Beth, Strike Carol, Upshur Ross
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada.
SSM Popul Health. 2019 Jan 24;7:100366. doi: 10.1016/j.ssmph.2019.100366. eCollection 2019 Apr.
Task shifting interventions have been implemented to improve health and address health inequities. Little is known about how inequity and vulnerability are defined and measured in research on task shifting. We conducted a systematic review to identify how inequity and vulnerability are identified, defined and measured in task shifting research from high-income countries.
We implemented a novel search process to identify programs of research concerning task shifting interventions in high-income countries. We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and CENTRAL to identify articles published from 2004 to 2016. Each program of research incorporated a "parent" randomized trial and "child" publications or sub-studies arising from the same research group. Two investigators extracted (1) study details, (2) definitions and measures of health equity or population vulnerability, and (3) assessed the quality of the reporting and measurement of health equity and vulnerability using a five-point scale developed for this study. We summarized the findings using a narrative approach.
Fifteen programs of research met inclusion criteria, involving 15 parent randomized trials and 62 child publications. Included programs of research were all undertaken in the United States, among Hispanic- (5/15), African- (2/15), and Korean-Americans (1/15), and low socioeconomic status (2/15), rural (2/15) and older adult populations (2/15). Task shifting interventions included community health workers, peers, and a variety of other non-professional and lay workers to address a range of non-communicable diseases. Some research provided robust analyses of the affected populations' health inequities and demonstrated how a task shifting intervention redressed those concerns. Other studies provided no such definitions and measured only biomedical endpoints.
Included studies vary substantially in the definition and measurement of health inequity and vulnerability. A more precise theoretical and evaluative framework for task shifting is recommended to effectively achieve the goal of equitable health.
已实施任务转移干预措施以改善健康状况并解决健康不平等问题。在任务转移研究中，对于如何定义和衡量不平等与脆弱性知之甚少。我们进行了一项系统综述，以确定在高收入国家的任务转移研究中如何识别、定义和衡量不平等与脆弱性。
我们实施了一种新颖的检索流程，以识别有关高收入国家任务转移干预措施的研究项目。我们检索了MEDLINE、Embase、CINAHL、PsycINFO、科学引文索引和CENTRAL，以识别2004年至2016年发表的文章。每个研究项目都包含一项“母”随机试验以及来自同一研究团队的“子”出版物或子研究。两名研究人员提取了：（1）研究细节；（2）健康公平或人群脆弱性的定义和衡量指标；（3）使用为本研究开发的五点量表评估健康公平和脆弱性报告与衡量的质量。我们采用叙述性方法总结了研究结果。
15个研究项目符合纳入标准，涉及15项母随机试验和62篇子出版物。纳入的研究项目均在美国开展，涉及西班牙裔（5/15）、非裔（2/15）、韩裔美国人（1/15）以及社会经济地位较低（2/15）、农村地区（2/15）和老年人群体（2/15）。任务转移干预措施包括社区卫生工作者、同伴以及各种其他非专业和非专业人员，以应对一系列非传染性疾病。一些研究对受影响人群的健康不平等进行了有力分析，并展示了任务转移干预措施如何解决这些问题。其他研究则未给出此类定义，仅测量了生物医学终点。
纳入的研究在健康不平等和脆弱性的定义和衡量方面差异很大。建议为任务转移建立一个更精确的理论和评估框架，以有效实现公平健康的目标。
