Kåks Per, Målqvist Mats
Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, SE-75185, Sweden.
BMC Health Serv Res. 2020 Jul 23;20(1):682. doi: 10.1186/s12913-020-05540-8.
Disparities in health persist even in high-income countries, and healthcare systems do not reach disadvantaged families as needed. A number of home-visiting interventions in high-income countries offering peer support for parents have been implemented to bridge the gaps in health in a cost-effective way. The lack of standard for intervention design has however resulted in a large variety of the strategies used. The objective for this article is to conduct a review of peer support home visiting interventions for parents and children in high-income countries, aiming to assess the strategies used, their outcomes and the challenges faced by peer supporters.
Relevant articles published in English between January 2004 and August 2019 were identified using PubMed, and reference lists were reviewed to identify additional articles. Studies were included if they reported on individual peer support health interventions, delivered at home to socioeconomically disadvantaged parents in high-income countries. Nineteen studies were found that met the inclusion criteria, and data were extracted on study characteristics, intervention design and outcomes. Data on intervention design was characterized iteratively to generate overarching categories of strategies used in the programs.
Most studies used healthcare facilities for recruitment, even when the interventions were not delivered by the formal healthcare system. The strategies used to engage supported parents included (1) connection in the form of emotional support, relationship building and matching for background, (2) flexibility in regards to content, intensity, location and mode of contact, and (3) linking through referrals and facilitation of other contacts. A number of significant quantifiable improvements could be demonstrated. Due to large heterogeneity of outcomes, meta-analyses were not viable. Peer supporters experienced challenges with involving other family members than the supported parent as well as with finding their role in relation to other support structures.
Peer support delivered as home visiting interventions have been used for hard-to-reach parents in a variety of high-income contexts and for a multitude of health concerns. Overall, despite variation in intervention design, the strategies employed followed common themes and were generally well received.
即使在高收入国家，健康方面的差距依然存在，医疗保健系统未能按需惠及处境不利的家庭。高收入国家已实施多项家访干预措施，为父母提供同伴支持，以经济有效的方式弥合健康差距。然而，干预设计缺乏标准导致所采用的策略种类繁多。本文的目的是对高收入国家针对父母和儿童的同伴支持家访干预措施进行综述，旨在评估所采用的策略、其效果以及同伴支持者面临的挑战。
使用PubMed检索2004年1月至2019年8月期间发表的英文相关文章，并查阅参考文献列表以识别其他文章。纳入的研究需报告针对高收入国家社会经济处境不利的父母在家中提供的个体同伴支持健康干预措施。共找到19项符合纳入标准的研究，并提取了有关研究特征、干预设计和结果的数据。对干预设计数据进行迭代分析，以生成项目中使用的总体策略类别。
大多数研究利用医疗保健机构进行招募，即使干预措施并非由正规医疗保健系统提供。用于吸引受支持父母的策略包括：（1）以情感支持、建立关系和背景匹配的形式建立联系；（2）在内容、强度、地点和联系模式方面保持灵活性；（3）通过转介和促进其他联系建立关联。可以证明有一些显著的可量化改善。由于结果的异质性很大，无法进行荟萃分析。同伴支持者在让受支持父母以外的其他家庭成员参与以及在与其他支持结构相关的角色定位方面面临挑战。
作为家访干预措施提供的同伴支持已在各种高收入环境中用于难以接触到的父母，并涉及多种健康问题。总体而言，尽管干预设计存在差异，但所采用的策略遵循共同主题，且普遍受到好评。
