NYU School of Medicine, Department of Population Health, New York, NY, USA.
Kalusugan Coalition, Woodside, NY, USA.
Transl Behav Med. 2020 Dec 31;10(6):1525-1537. doi: 10.1093/tbm/ibz106.
Hypertension affects a third of U.S. adults and is especially high among Asian American groups. The Racial and Ethnic Approaches to Community Health for Asian AmeRicans (REACH FAR) project delivers culturally adapted, evidence-based hypertension-related programs to Bangladeshi, Filipino, Korean, and Asian Indian communities in New York and New Jersey through 26 sites: ethnic grocery stores, restaurants, and Muslim, Christian, and Sikh faith-based organizations. Knowledge of the implementation mechanisms of culturally adapted programs is limited and is critical to inform the design and execution of such programs by and in community sites. We applied four categories of the Consolidated Framework for Implementation Research-intervention and individuals' characteristics, inner and outer setting-to analyze factors influencing implementation outcomes, that is, site leaders' perceptions about adopting, adapting, and sustaining REACH FAR. We conducted semistructured interviews with 15 leaders, coded them for implementation outcomes, and recoded them to identify contextual factors. Our findings show that REACH FAR resonated in sites where leaders perceived unhealthy diet and lifestyles in their communities (intervention characteristics), sites had historically engaged in health programs as a public-service mission (inner setting), and leaders identified with this mission (individuals' characteristics). Site leaders strived to adapt programs to respond to community preferences (outer setting) without compromising core objectives (inner setting). Leaders noted that program sustainability could be impeded by staff and volunteer turnover (inner setting) but enhanced by reinforcing programs through community networks (outer setting). The findings suggest that to facilitate implementation of culturally adapted health behavior programs through community sites, interventions should reinforce sites' organizational commitments and social ties.
高血压影响了三分之一的美国成年人，而亚裔美国人族群的高血压发病率尤其高。“美国亚裔种族和民族社区健康促进（REACH FAR）”项目通过 26 个地点（包括民族杂货店、餐馆以及穆斯林、基督教和锡克教信仰组织），向纽约和新泽西的孟加拉国、菲律宾、韩国和印度裔社区提供文化适应性强、基于证据的高血压相关项目。尽管人们对文化适应性项目实施机制的了解有限，但这些知识对于在社区站点设计和执行此类项目至关重要。我们应用实施研究综合框架的四个类别——干预和个人特征、内部和外部环境——来分析影响实施结果的因素，即，针对站点负责人对采用、调整和维持 REACH FAR 的看法。我们对 15 名负责人进行了半结构化访谈，对他们进行了实施结果编码，并重新进行了编码以确定背景因素。我们的研究结果表明，REACH FAR 在以下社区得到了共鸣：负责人认为他们的社区存在不健康的饮食和生活方式（干预特征）；社区历史上一直将健康项目作为公益使命（内部环境）；而负责人认同这一使命（个人特征）。负责人努力调整项目以响应社区的偏好（外部环境），同时不影响核心目标（内部环境）。负责人指出，工作人员和志愿者的更替（内部环境）可能会影响项目的可持续性，但通过社区网络加强项目（外部环境）可以增强项目的可持续性。研究结果表明，为了通过社区站点促进文化适应性健康行为项目的实施，干预措施应加强站点的组织承诺和社会联系。
