CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland.
BMJ Open. 2022 Sep 1;12(9):e057597. doi: 10.1136/bmjopen-2021-057597.
The aim of this review is to map out the use of process evaluation (PE) in complex interventions that address non-communicable diseases (NCDs) and neglected tropical diseases (NTDs) to identify gaps in the design and conduct, as well as strengths, limitations and implications, of this type of research in low- and middle-income countries (LMICs).
Scoping review of PE studies of complex interventions implemented in LMICs. Six databases were searched focused on studies published since 2008.
Embase, PubMed, EbscoHost, Web of Science (WOS), Virtual Health Library (VHL) Regional Portal and Global Index Medicus: Regional Indexes AIM (AFRO), LILACS (AMRO/PAHO), IMEMR (EMRO), IMSEAR (SEARO), WPRIM (WPRO) Global Index Regional Indexes, MEDLINE, SciELO.
Studies conducted in LMICs on PEs of randomised controlled trials (RCTs) and non-RCTs published between January 2008 and January 2020. Other criteria were studies of interventions for people at risk or having physical and mental NCDs, and/or NTDs, and/or their healthcare providers and/or others related to achieve better health for these two disease groups. Studies were excluded if they were not reported in English or Spanish or Portuguese or French, not peer-reviewed articles, not empirical research and not human research.
Data extracted to be evaluated were: available evidence in the utilisation of PE in the areas of NCDs and NTDs, including frameworks and theories used; methods applied to conduct PEs; and in a subsample, the barriers and facilitators to implement complex interventions identified through the PE. Variables were extracted and categorised. The information was synthesised through quantitative analysis by reporting frequencies and percentages. Qualitative analysis was also performed to understand facilitators and barriers presented in these studies. The implications for PEs, and how the information from the PE was used by researchers or other stakeholders were also assessed in this approach.
303 studies were identified, 79% were for NCDs, 12% used the label 'PE', 27% described a theory or framework for the PE, and 42% used mixed methods to analyse their findings. Acceptability, barriers and facilitators to implement the interventions, experiences and perceptions, and feasibility were the outcomes most frequently evaluated as part of the PEs. Barriers and facilitators themes identified were contextual factors, health system factors, human resources, attitudes and policy factors.
PEs in NCDs and NTDs are used in LMICs with a wide variety of methods. This review identified many PEs that were not labelled by the authors as such, as well as a limited application of PE-related theories and frameworks, and heterogeneous reporting of this type of study.
本综述旨在绘制在中低收入国家（LMIC）实施的针对非传染性疾病（NCDs）和被忽视的热带病（NTDs）的复杂干预措施中使用的过程评估（PE），以确定此类研究在设计和实施中的差距，以及优势、局限性和影响，以及在设计和实施中的差距，以及优势、局限性和影响。
对在 LMIC 实施的复杂干预措施的 PE 研究进行范围界定综述。搜索了六个数据库，重点是自 2008 年以来发表的研究。
Embase、PubMed、EbscoHost、Web of Science（WOS）、虚拟健康图书馆（VHL）区域门户和全球索引医学：区域索引 AFR（AFRO）、LILACS（AMRO/PAHO）、IMEMR（EMRO）、IMSEAR（SEARO）、WPRIM（WPRO）全球索引区域索引、MEDLINE、SciELO。
在 LMIC 进行的针对 2008 年 1 月至 2020 年 1 月期间发表的随机对照试验（RCT）和非 RCT 的 PE 研究。其他标准是针对有风险或患有身体和精神 NCDs 和/或 NTDs 以及/或其医疗保健提供者和/或与实现这两个疾病群体更好健康相关的其他人的干预措施的研究。如果研究不是用英语、西班牙语或葡萄牙语或法语报告的，如果不是同行评议的文章，如果不是实证研究，如果不是人类研究，则将其排除在外。
评估的数据包括：在 NCDs 和 NTDs 领域利用 PE 的现有证据，包括使用的框架和理论；用于进行 PE 的方法；以及在一个子样本中，通过 PE 确定的实施复杂干预措施的障碍和促进因素。提取变量并进行分类。通过报告频率和百分比，通过定量分析综合信息。还进行了定性分析，以了解这些研究中提出的促进因素和障碍。还评估了 PE 的影响，以及研究人员或其他利益相关者如何使用 PE 中的信息。
确定了 303 项研究，其中 79%用于 NCDs，12%使用了“PE”标签，27%描述了 PE 的理论或框架，42%使用混合方法分析研究结果。接受度、实施干预措施的障碍和促进因素、经验和看法以及可行性是作为 PE 一部分最常评估的结果。确定的障碍和促进因素主题包括背景因素、卫生系统因素、人力资源、态度和政策因素。
在 LMIC 中，NCDs 和 NTDs 中使用了各种方法的 PE。本综述确定了许多作者没有标记为 PE 的 PE，以及对 PE 相关理论和框架的应用有限，以及对这种类型的研究的报告存在异质性。
