Eastwood John G, De Souza Denise E, Shaw Miranda, Garg Pankaj, Woolfenden Susan, Tyler Ingrid, Kemp Lynn A
School of Women's and Children's Health, The University of New South Wales, Sydney, NSW, AU.
Ingham Institute of Applied Medical Research, Liverpool, NSW, AU.
Int J Integr Care. 2019 Jul 25;19(3):9. doi: 10.5334/ijic.3963.
Intergenerational cycles of poverty, violence and crime, poor education and employment opportunities, psychopathology, and poor lifestyle and health behaviours require innovative models of health care delivery to break them. We describe a programme of research informed service development targeting vulnerable families in inner metropolitan Sydney, Australia that is designed to build and confirm a "Theory of Neighbourhood Context, Stress, Depression, and the Developmental Origins of Health and Disease (DOHaD)". We describe the development of an intervention design and business case that drew on earlier realist causal and programme theoretical work.
Realist causal and programme theory were used to inform the collaborative design of initiatives for vulnerable families. The collaborative design process included: identification of desirable and undesirable outcomes and contextual factors, consultation forums, interagency planning, and development of a service proposal.
The design elements included: perinatal coordination, sustained home visiting, integrated service model development, two place-based hubs, health promotion and strengthened research and analysis capability.
We demonstrate here the design of interventions for vulnerable families in Sydney utilising translational research from previous realist causal and program theory building to operational service design. We have identified the importance of our earlier analysis of underlying causal mechanisms and related programme mechanisms for identifying the elements for the full intervention design. The application of theory added rigour to the design of the integrated care initiatives. In applying the theory to the local situation the analysis took into account: the role of the local agencies; evidence of program effectiveness; determinants and outcomes for local children and their families; the current deployment of service resources; and insights from front-line staff and interagency partners.
贫困、暴力与犯罪的代际循环、糟糕的教育与就业机会、精神病理学问题以及不良的生活方式和健康行为，都需要创新的医疗服务模式来打破。我们描述了一项针对澳大利亚悉尼内城区弱势家庭的研究知情服务发展计划，该计划旨在构建并验证一种“邻里环境、压力、抑郁与健康和疾病的发育起源理论（DOHaD）”。我们阐述了干预设计和商业案例的发展过程，这一过程借鉴了早期的现实主义因果关系和项目理论研究成果。
运用现实主义因果关系和项目理论为弱势家庭的倡议合作设计提供信息。合作设计过程包括：确定期望和不期望的结果以及背景因素、咨询论坛、跨机构规划以及服务提案的制定。
设计要素包括：围产期协调、持续的家访、综合服务模式发展、两个基于地点的中心、健康促进以及强化的研究与分析能力。
我们在此展示了利用先前现实主义因果关系和项目理论构建的转化研究成果，从运营服务设计的角度为悉尼弱势家庭设计干预措施。我们已经明确了早期对潜在因果机制和相关项目机制的分析对于确定完整干预设计要素的重要性。理论的应用为综合护理倡议的设计增添了严谨性。在将理论应用于当地情况时，分析考虑了：当地机构的作用；项目有效性的证据；当地儿童及其家庭的决定因素和结果；服务资源的当前配置；以及一线工作人员和跨机构合作伙伴的见解。
