Asadi-Aliabadi Mehran, Karimi Seyed M, Mirbaha-Hashemi Fariba, Tehrani-Banihashemi Arash, Janani Leila, Babaee Ebrahim, Nojomi Marzieh, Moradi-Lakeh Maziar
Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Arch Public Health. 2023 Mar 10;81(1):37. doi: 10.1186/s13690-023-01047-w.
Non-communicable diseases behavioral risk factors can be improved if effective interventions are designed considering the health system's capabilities and local resources. This study evaluated the effectiveness of interventions that aimed at increasing non-physician community health workers' motivation in reducing non-communicable diseases behavioral risk factors in the community.
A randomized field trial study was conducted in 32 community health centers in 4 Iranian districts after a baseline population survey on the status of NCDs of 30-70-year-old individuals (n = 1225). The interventions were performed to improve insufficient physical activity, insufficient fruit consumption, insufficient vegetable consumption, high salt intake, and tobacco use. Four intervention packages were implemented in 24 community health centers; the other 8 centers were used as control groups. The non-physician community health workers performed the interventions. The packages additively included goal-setting, evidence-based education, operational planning, and incentive payments. A second survey was conducted 1 year after the start of the interventions to identify the effects on an independent random sample of 30-70-year-old individuals (n = 1221). Difference-in-difference method was used to quantify the interventions' effects.
The average age of participants in both surveys was about 49 years. Also, about half of the participants were female, and about 43% were illiterate or had a primary school education. The interventions had statistically significant effects only on decreasing the prevalence of insufficient physical activity. The package with all the intervention components decreased the odds of insufficient physical activity to 0.24 (95% CI, 0.08, 0.72). The package with operational planning but no performance-based financing did not change the odds of insufficient physical activity.
This study highlighted the importance of components, design, and implementation details of interventions intended to reduce NCDs behavioral risk factors. Some risk factors, such as insufficient physical activity, seem more easily modifiable with limited low-cost interventions in a one-year horizon. However, risk factors related to healthy food consumption and tobacco use need more extensive interventions.
This trial was registered on the Iranian Registry of Clinical Trials (IRCT20081205001488N2) on 3 June 2018 ( https://en.irct.ir/trial/774 ).
如果在设计有效干预措施时考虑到卫生系统的能力和当地资源，非传染性疾病的行为风险因素是可以改善的。本研究评估了旨在提高非医师社区卫生工作者积极性以减少社区中非传染性疾病行为风险因素的干预措施的有效性。
在对30至70岁个体的非传染性疾病状况进行基线人群调查（n = 1225）后，在伊朗4个地区的32个社区卫生中心进行了一项随机现场试验研究。实施干预措施以改善身体活动不足、水果摄入量不足、蔬菜摄入量不足、高盐摄入和吸烟情况。在24个社区卫生中心实施了四个干预包；另外8个中心用作对照组。非医师社区卫生工作者实施干预措施。这些包相加包括目标设定、循证教育、运营规划和激励支付。在干预开始1年后进行了第二次调查，以确定对30至70岁个体的独立随机样本（n = 1221）的影响。采用差分法来量化干预措施的效果。
两次调查中参与者的平均年龄约为49岁。此外，约一半的参与者为女性，约43%为文盲或小学文化程度。干预措施仅对降低身体活动不足的患病率有统计学显著影响。包含所有干预成分的包将身体活动不足的几率降至0.24（95%CI，0.08，0.72）。有运营规划但无基于绩效的融资的包并未改变身体活动不足的几率。
本研究强调了旨在减少非传染性疾病行为风险因素的干预措施的组成部分、设计和实施细节的重要性。一些风险因素，如身体活动不足，在一年的时间范围内，通过有限的低成本干预似乎更容易改变。然而，与健康食品消费和吸烟相关的风险因素需要更广泛的干预措施。
本试验于2018年6月3日在伊朗临床试验注册中心（IRCT20081205001488N2）注册（https://en.irct.ir/trial/774）。
