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如何设计复杂的行为改变干预措施:印度农村营养敏感型农业试验的经验。

How to design a complex behaviour change intervention: experiences from a nutrition-sensitive agriculture trial in rural India.

机构信息

Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA.

出版信息

BMJ Glob Health. 2020 Jun;5(6). doi: 10.1136/bmjgh-2020-002384.

Abstract

Many public health interventions aim to promote healthful behaviours, with varying degrees of success. With a lack of existing empirical evidence on the optimal number or combination of behaviours to promote to achieve a given health outcome, a key challenge in intervention design lies in deciding what behaviours to prioritise, and how best to promote them. We describe how key behaviours were selected and promoted within a multisectoral nutrition-sensitive agriculture intervention that aimed to address maternal and child undernutrition in rural India. First, we formulated a Theory of Change, which outlined our hypothesised impact pathways. To do this, we used the following inputs: existing conceptual frameworks, published empirical evidence, a feasibility study, formative research and the intervention team's local knowledge. Then, we selected specific behaviours to address within each impact pathway, based on our formative research, behaviour change models, local knowledge and community feedback. As the intervention progressed, we mapped each of the behaviours against our impact pathways and the transtheoretical model of behaviour change, to monitor the balance of behaviours across pathways and along stages of behaviour change. By collectively agreeing on definitions of complex concepts and hypothesised impact pathways, implementing partners were able to communicate clearly between each other and with intervention participants. Our intervention was iteratively informed by continuous review, by monitoring implementation against targets and by integrating community feedback. Impact and process evaluations will reveal whether these approaches are effective for improving maternal and child nutrition, and what the effects are on each hypothesised impact pathway.

摘要

许多公共卫生干预措施旨在促进健康行为,但取得的成功程度不一。由于缺乏关于促进实现特定健康结果的最佳行为数量或组合的现有经验证据,干预设计的一个关键挑战在于决定优先考虑哪些行为,以及如何最好地促进这些行为。我们描述了在一项多部门营养敏感型农业干预措施中如何选择和促进关键行为,该干预措施旨在解决印度农村地区的母婴营养不足问题。首先,我们制定了一个变革理论,概述了我们假设的影响途径。为此,我们使用了以下投入:现有的概念框架、已发表的经验证据、可行性研究、形成性研究以及干预团队的本地知识。然后,我们根据形成性研究、行为改变模型、本地知识和社区反馈,在每个影响途径中选择要解决的具体行为。随着干预的进展,我们将每个行为映射到我们的影响途径和行为变化的跨理论模型上,以监测途径和行为变化阶段的行为平衡。通过共同商定复杂概念和假设影响途径的定义,实施伙伴能够在彼此之间以及与干预参与者之间进行清晰的沟通。我们的干预措施通过持续审查、对照目标监测实施情况以及整合社区反馈得到了迭代式的信息更新。影响和过程评估将揭示这些方法是否有助于改善母婴营养,以及对每个假设的影响途径有什么影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8969/7282327/ce11ab8f004c/bmjgh-2020-002384f01.jpg

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