自助小组的健康分层：对印度比哈尔邦生殖、孕产妇、新生儿和儿童健康与营养的影响。
Health layering of self-help groups: impacts on reproductive, maternal, newborn and child health and nutrition in Bihar, India.
机构信息
Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
出版信息
J Glob Health. 2020 Dec;10(2):021007. doi: 10.7189/jogh.10.021007. Epub 2020 Dec 19.
BACKGROUND
Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs.
METHODS
A model for health layering of SHGs - - was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKAHL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering ( SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression.
RESULTS
In 2014, 64% of indicators were significantly higher in members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members ( or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks.
CONCLUSIONS
Health layering of SHGs was demonstrated by an NGO-led model (), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change.
STUDY REGISTRATION
ClinicalTrials.gov number NCT02726230.
背景
自助小组（SHG）干预措施在中低收入国家已得到广泛研究。然而，关于在主要为经济赋权而成立的现有 SHG 基础上增加健康教育模块的健康分层的具体影响的数据很少。我们检验了印度比哈尔邦 2012-2017 年的三个 SHG 干预措施，以检验这样一个假设，即 SHG 的健康分层将导致 SHG 中的妇女改善与健康相关的行为。
方法
非营利组织（非政府组织）Project Concern International 开发了一个 SHG 健康分层模型 - 。分层包括健康模块、社区活动和审查机制。该健康分层模型经过调整，用于比哈尔邦 37 个其他区的政府主导的 SHG，称为 JEEViKAHL。同期在 433 个其他区开展了没有健康分层的政府主导的 SHG（JEEViKA）的扩大规模工作，这为其提供了一个自然的对照组。通过 CARE India 进行的基于社区的家庭调查（CHS，第 6-9 轮），比较了有健康分层的 SHG（ SHG 和 JEEViKA+HL SHG）与没有健康分层的 SHG 的 62 项生殖、孕产妇、新生儿和儿童健康与营养（RMNCHN）和卫生指标。我们使用 surveymeans 和 survey logistic 回归计算了指标的平均值、标准差和优势比。
结果
2014 年，64%的指标在居住在同一街区的成员中明显高于非成员。在扩大规模期间，即 2015-17 年，有一半（50%）的指标在 101 个区的有健康分层的 SHG 成员（或 JEEViKA+HL）中的优势比高于 433 个区中没有健康分层的 SHG 成员（JEEViKA）的优势比高。
结论
由非政府组织主导的模式（）证明了 SHG 的健康分层，由政府主导的模式（JEEViKA+HL）对其进行了调整和扩大规模，与非健康分层的 SHG（JEEViKA）相比，这与健康的显著改善相关。这些结果为在 SHG 平台上进一步分层健康以实现规模层面的健康变化提供了更强有力的证据。
研究注册
ClinicalTrials.gov 编号 NCT02726230。
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