基于家庭的彝族健康素养改善项目（FAMILY）：一项开放队列、阶梯式楔形群随机对照试验方案。
Family-based improvement for health literacy among the Yi nationality (FAMILY) in Liangshan: protocol of an open cohort stepped wedge cluster randomized controlled trial.
机构信息
Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Renmin South Road 3rd Section NO.16, Chengdu, 610041, Sichuan Province, China.
Liangshan Prefecture Center for Disease Control and Prevention, Xichang, 615000, Sichuan Province, China.
出版信息
BMC Public Health. 2022 Aug 13;22(1):1543. doi: 10.1186/s12889-022-13782-w.
BACKGROUND
Improvement of health literacy constitutes a cornerstone to improving public health. However, the overall health literacy of Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in the southwest Sichuan Province of China has kept extremely low for a long time. How to improve health literacy of the Yi nationality residents is key to be urgently solved. Notably, Family Branch System is a distinctive patrilineal bloodline organization of Yi nationality, which plays an important role in the daily life of Yi nationality. Meanwhile, Contracted Family Doctor Services is conducted in Liangshan Prefecture. Therefore, this study proposes an intervention model of health education based on Family Branch System and Contracted Family Doctor Services, which is a Family-based Improvement for Health Literacy among the Yi nationality (FAMILY) in Liangshan, when improving traditional Innovative Care for Chronic Conditions Framework (ICCC) framework.
METHODS
An open cohort stepped wedge cluster randomized trial design is used to implement health literacy education interventions including project preparation, core group building, promotion within family branch and competition between family branches while using Contracted Family Doctor Services as control measure. The study will be conducted among Yi nationality residents in Meigu County and Yanyuan County, with health literacy level of residents as the primary outcome. Finally, mixed-effects model and causal inference method will be used to evaluate intervention effect.
DISCUSSION
This study highlights family, using the unique Family Branch System and Contracted Family Doctor Services in Liangshan Prefecture to design intervention among improved ICCC framework, and combines the mixed-effects model with complier average causal effects (CACE) to estimate the intervention effect under non-compliance for the first time. Besides, other key technologies to be adopted include construction of electronic questionnaire quality control system, with quality control based on artificial intelligence. This trial contributes to exploring an effective way to improve health literacy of Yi nationality residents in Liangshan Prefecture, which will provide reference for other areas, especially poor areas, to improve residents' health literacy.
TRIAL REGISTRATION
ISRCTN11299863 on June 1, 2022; https://www.isrctn.com/ .
背景
提高健康素养是改善公共卫生的基石。然而，中国四川西南部凉山彝族自治州（凉山州）的整体健康素养一直极低。如何提高彝族居民的健康素养是亟待解决的关键。值得注意的是，家族分支制度是彝族特有的一种父系血缘组织，在彝族的日常生活中发挥着重要作用。同时，凉山州正在开展家庭医生签约服务。因此，本研究提出了一种基于家族分支制度和家庭医生签约服务的健康教育干预模式，即凉山彝族家庭健康素养提升模式（FAMILY），以改进传统的慢性病综合管理创新框架（ICCC）。
方法
采用开放队列分步楔形集群随机试验设计，在开展家庭医生签约服务的同时，实施健康教育干预措施，包括项目准备、核心小组建设、家族分支内推广和家族分支间竞争。本研究将在美姑县和盐源县的彝族居民中进行，以居民的健康素养水平为主要结局。最后，将采用混合效应模型和因果推理方法评价干预效果。
讨论
本研究以家庭为重点，利用凉山特有的家族分支制度和家庭医生签约服务，在改进的 ICCC 框架下设计干预措施，首次结合混合效应模型和遵从平均因果效应（CACE）估计非遵从情况下的干预效果。此外，还将采用其他关键技术，包括构建基于人工智能的电子问卷质量控制系统。本试验旨在探索提高凉山彝族居民健康素养的有效途径，为其他地区，特别是贫困地区提高居民健康素养提供参考。
试验注册
ISRCTN63545104 于 2022 年 6 月 1 日注册；https://www.isrctn.com/ 。
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