采用数字健康干预措施支持幼儿教育和保育中饮食指南实施的障碍和促进因素：横断面研究。
Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study.
机构信息
School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
Population Health, Hunter New England Local Health District, Wallsend, Australia.
出版信息
J Med Internet Res. 2020 Nov 20;22(11):e22036. doi: 10.2196/22036.
BACKGROUND
Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users.
OBJECTIVE
This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions.
METHODS
A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions.
RESULTS
Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization's capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions.
CONCLUSIONS
A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.
背景
在澳大利亚的儿童保育中心，很少有机构提供符合行业饮食指南的食物。数字健康技术是一种很有前途的媒介，可以改善该环境下循证指南的实施。尽管这些技术广泛普及，但由于最终用户采用率低，其对人群的影响有限。
目的
本研究旨在对澳大利亚全国范围内的儿童保育中心（1）采用数字健康干预措施以支持饮食指南实施的意向进行评估，（2）报告该环境下采用数字健康干预措施的障碍和促进因素，以及（3）与高采用数字健康干预措施意向相关的障碍和促进因素。
方法
2018 年，采用横断面电话或在线调查的方式，对从公开的全国性登记册中随机抽取的 407 家儿童保育中心进行了调查。评估中心采用新的数字健康干预措施支持该行业饮食指南实施的意向，以及基于健康和护理技术非采用、放弃、扩展、传播和可持续性（NASSS）框架内的七个子领域的个人、组织和背景因素，这些因素可能影响采用情况。采用多变量线性模型确定与高数字健康干预措施采用意向相关的因素。
结果
结果表明，58.9%（229/389）的儿童保育中心有很高的意向采用数字健康干预措施来支持指南的实施。团队互动子领域所需的变化最低，这表明可能存在障碍（平均 3.52，SD 1.30），组织的创新能力最高，这表明可能存在促进因素（平均 5.25，SD 1.00）。NASSS 框架中的两个子领域，即采用决策的便利性（P<.001）和确定实施工作和相关人员（P=.001），与采用数字健康干预措施的高意向显著相关。
结论
澳大利亚的儿童保育中心有很大一部分有很高的意向采用新的数字健康干预措施来支持饮食指南的实施。鉴于数字健康干预措施的有效性证据，这些发现表明，此类干预措施可能对改善儿童早期公共卫生营养状况做出重要贡献。
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