运用 CFIR 框架进行种族（主义）意识适应，以理解基于学校的公平导向干预措施的实施。
Applying a Race(ism)-Conscious Adaptation of the CFIR Framework to Understand Implementation of a School-Based Equity-Oriented Intervention.
机构信息
University of Minnesota Medical School Department of Family Medicine and Community Health, Program in Health Disparities Research, Minneapolis, MN.
SoLaHmo Partnership for Health and Wellness/ Community University Health Care Center, Minneapolis, MN.
出版信息
Ethn Dis. 2021 May 20;31(Suppl 1):375-388. doi: 10.18865/ed.31.S1.375. eCollection 2021.
OBJECTIVES
To use the Consolidated Framework for Implementation Research (CFIR) adapted to a race-conscious frame to understand ways that structural racism interacts with intervention implementation and uptake within an equity-oriented trial designed to enhance student-school connectedness.
DESIGN
Secondary analysis of qualitative implementation data from Project TRUST (Training for Resiliency in Urban Students and Teachers), a hybrid effectiveness-implementation, community-based participatory intervention.
SETTING
Ten schools across one urban school district.
METHODS
We analyzed qualitative observational field notes, youth and parent researcher reflections, and semi-structured interviews with community-academic researchers and school-based partners within CFIR constructs based on framing questions using a Public Health Critical Race Praxis approach.
RESULTS
Within most CFIR constructs and sub-constructs, we identified barriers to implementation uptake not previously recognized using standard race-neutral definitions. Themes that crossed constructs included: 1) Leaders' willingness to examine Black, Indigenous, People of Color (BIPOC) student and parent experiences of school discrimination and marginalization had a cascading influence on multiple factors related to implementation uptake; 2) The race/ethnicity of the principals was related to intervention engagement and intervention uptake, particularly at the extremes, but the relationship was complex; 3) External change agents from BIPOC communities facilitated intervention uptake in indirect but significant ways; 4) Highly networked implementation champions had the ability to enhance commitment to intervention uptake; however, perceptions of these individuals and the degree to which they were networked was highly racialized.
CONCLUSIONS
Equity-oriented interventions should consider structural racism within the CFIR model to better understand intervention uptake.
目的
利用适应种族意识框架的实施研究综合框架（CFIR），了解结构种族主义如何与旨在增强学生与学校联系的公平导向试验中的干预措施实施和采用相互作用。
设计
对项目信任（培训以增强城市学生和教师的适应力）的定性实施数据进行二次分析，这是一项混合有效性实施的社区参与式干预措施。
设置
一个城市学区的十所学校。
方法
我们根据公共卫生关键种族实践方法的框架问题，在 CFIR 结构中分析了定性观察现场记录、青年和家长研究人员的反思，以及与社区学术研究人员和学校合作伙伴的半结构化访谈，使用 CFIR 构建基于框架问题进行分析。
结果
在大多数 CFIR 结构和子结构中，我们确定了以前使用标准的非种族定义未识别到的实施采用障碍。跨越结构的主题包括：1）领导者愿意检查黑人、原住民、有色人种（BIPOC）学生和家长在学校受到歧视和边缘化的经历，对与实施采用相关的多个因素产生了级联影响；2）校长的种族/民族与干预参与和干预采用有关，尤其是在极端情况下，但关系很复杂；3）来自 BIPOC 社区的外部变革推动者以间接但重要的方式促进了干预措施的采用；4）高度联网的实施拥护者有能力增强对干预措施采用的承诺；然而，这些人以及他们的网络程度的看法是高度种族化的。
结论
公平导向的干预措施应该在 CFIR 模型中考虑结构性种族主义，以更好地了解干预措施的采用。
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