NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
Health Promot J Austr. 2022 Jul;33(3):810-828. doi: 10.1002/hpja.562. Epub 2021 Dec 8.
ISSUE ADDRESSED: One in four Australian children aged between the ages of two and four are affected by overweight. In New South Wales, the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial delivered an intervention to pregnant women and women with infants via telephone calls and text messages. The focus of the intervention was on infant feeding and establishing healthy habits for infants by building the capacity of mothers. This study investigates trial collaborators' perspectives concerning the implementation of this intervention, to obtain insights that will support future translation and scale-up. METHODS: This research was undertaken during the intervention phase of the trial. Twenty trial collaborators involved in the planning, implementation or delivery of the CHAT trial were invited to participate. Qualitative interviews were conducted with collaborators using open-ended questions based on Steckler and Linnan's process evaluation framework and the Consolidated Framework for Implementation Research. Inductive thematic analysis was employed to identify themes from the interview data. RESULTS: Fourteen trial collaborators were interviewed. Collaborators included child and family health nurses (intervention providers), nurse managers with extensive child and family health nursing experience, a paediatrician, dietitians, health promotion experts, health service managers, health and nursing executives, program personnel (project coordinator, research fellow and evaluation officer) and university researchers. Following coding of qualitative data, themes were realised from the data as a result of active co-production on the part of the researcher. Five themes were identified: (a) context (organisational support, engagement and partnerships, communication and project leadership); (b) program receipt, benefit and reach; (c) program delivery (intervention providers' experience and skills, mode of intervention delivery, referral to other services, support and training for intervention providers); (d) implementation (program delivered as planned); (e) opportunities for scale-up. Collaborators perceived that the program was implemented and delivered as planned. This specific research addresses the success of the process of implementing and delivering interventions for infant feeding and establishing healthy habits for children by building the capacity of mothers. Collaborators attributed successful program implementation to contextual factors: strong support by the host organisation; good project leadership; clear communication; collaborative internal and external partnerships; intervention provision by experienced nurses. Remote delivery was convenient to program participants and participants were able to resolve other personal concerns in addition to direct immediate benefits. Because of their capacity to influence policy decisions, the absence of policymakers at project meetings was a shortcoming. Collaborative partnerships with health and research partners, understanding of contextual issues and consumer involvement could lead to program expansion. The program has the potential to be scaled up through integration with existing services and gradual expansion into other health districts prior to state-wide rollout. CONCLUSIONS: The CHAT trial delivered the Healthy Beginnings intervention which resulted in improvements in infant feeding, active play and sedentary behaviours. This evaluation demonstrated that the involvement of key stakeholders from early planning stages through to implementation of the program and the partnerships that evolved contributed to the successful implementation of the program. An unintended benefit to participants from this program was the social support that was provided. Intervention delivery via telephone and text messages enabled easy access to the program. Most importantly, the program has the potential to be scaled up through integration into existing services and gradual expansion prior to state-wide rollout. SO WHAT?: Strong internal and external partnerships, effective communication systems and integration with existing services create the context for potential translation and scaling up of the program to other health promotion settings.
问题解决:四分之一的澳大利亚 2 至 4 岁儿童超重。在新南威尔士州,通过电话和短信向孕妇和有婴儿的妇女提供的“通过电话交流健康开端建议”(CHAT)试验实施了一项干预措施。该干预措施的重点是通过增强母亲的能力,对婴儿喂养和建立健康习惯。本研究调查了试验合作者对该干预措施实施的看法,以获得支持未来翻译和扩大规模的见解。
方法:本研究是在试验的干预阶段进行的。邀请了 20 名参与 CHAT 试验规划、实施或提供的试验合作者参与。根据 Steckler 和 Linnan 的过程评估框架和综合实施研究框架,对合作者进行了基于开放式问题的定性访谈。采用归纳主题分析从访谈数据中识别主题。
结果:对 14 名试验合作者进行了访谈。合作者包括儿童和家庭健康护士(干预提供者)、具有丰富儿童和家庭健康护理经验的护士经理、儿科医生、营养师、健康促进专家、卫生服务经理、卫生和护理主管、项目人员(项目协调员、研究员和评估官员)和大学研究人员。在对定性数据进行编码后,由于研究人员的积极合作,从数据中得出了主题。确定了五个主题:(a)背景(组织支持、参与和伙伴关系、沟通和项目领导);(b)计划收益、受益和覆盖面;(c)计划交付(干预提供者的经验和技能、干预交付模式、转介给其他服务、干预提供者的支持和培训);(d)实施(按计划交付计划);(e)扩大规模的机会。合作者认为该计划按计划实施和交付。这项具体研究旨在解决通过增强母亲的能力来实施和提供婴儿喂养和建立儿童健康习惯的干预措施的成功问题。合作者将成功的计划实施归因于以下背景因素:主办组织的大力支持;良好的项目领导;清晰的沟通;内部和外部合作的伙伴关系;经验丰富的护士提供干预措施。远程交付对计划参与者来说很方便,参与者除了直接获得即时利益外,还能够解决其他个人问题。由于他们能够影响政策决策,因此项目会议上没有决策者是一个缺点。与卫生和研究伙伴的合作伙伴关系、对背景问题的理解和消费者的参与,可能会导致计划的扩大。该计划有可能通过与现有服务的整合以及在全州推广之前逐步扩展到其他卫生区来扩大规模。
结论:CHAT 试验提供了“健康开端”干预措施,这导致婴儿喂养、积极玩耍和久坐行为得到改善。这项评估表明,从早期规划阶段到项目实施阶段以及合作伙伴关系的参与,关键利益相关者的参与有助于项目的成功实施。该计划对参与者的一个意外好处是提供了社会支持。通过电话和短信提供的干预措施使人们更容易获得该计划。最重要的是,该计划有可能通过与现有服务的整合以及在全州推广之前逐步扩展来扩大规模。
那么重点是什么?强大的内部和外部伙伴关系、有效的沟通系统以及与现有服务的整合为该计划在其他健康促进环境中的翻译和扩大规模创造了条件。
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