Kasehagen Laurin J, Brandert Kathleen, Nickol Brenda, Gatere Maureen, Hanson Piia, Bambace Jane, Beam Rita, Chao Shin Margaret, Clark Cheryl L, Hepburn Carrie Y, Jocson Maria A L, Jones Millie, McManus Patricia
MCH Epidemiology Program, Field Support Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention & Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS F74, Chamblee, GA 30341, USA.
CityMatCH, University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170, USA.
J Racial Ethn Health Disparities. 2014 Jun;1(2):69-84. doi: 10.1007/s40615-014-0008-4. Epub 2014 Feb 11.
This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM).
Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process.
Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61.
Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or system-wide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community's control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.
本研究旨在确定社区层面减少婴儿死亡率（IM）种族差异的行动。
六个城市多学科团队采用混合方法概念映射方法，提出减少IM种族差异的想法。参与者对每个想法的必要性和行动潜力进行评分，并按主题对想法进行分组。聚类分析产生了一系列直观表示，展示了已确定行动之间的关系以及行动按主题的聚类情况。使用多维缩放技术进行分析，描述实施所提想法的必要性和行动潜力。参与者确定了社区为减少IM种族差异可采取的行动，并建议应用从映射过程中获得的知识。
参与者共提出128项行动，分属11个主题类别，以减少IM的种族差异。主题类别包含一系列要素，旨在促进对健康与种族主义关系的认识和理解；改善教育系统和社区机会；促进社区主导的健康促进、营销和研究；改善妇女的医疗服务；解决影响社区健康的物理和社会环境问题；优先分配社区服务资源；将促进所有系统公平的战略制度化；制定并支持解决健康社会决定因素的立法和政策。各聚类的相关系数在0.17至0.90之间。平均必要性评分在2.17至3.73之间；平均行动潜力评分在1.64至3.61之间。
研究结果表明，具有高行动潜力的主题类别通常代表正在进行的社区活动或社区能够轻松启动的行动。社区规模、现有项目、伙伴关系、政策和有影响力的倡导者是被提及的影响实施可行性的因素。行动潜力较低的聚类需要更广泛、更长期的政策、机构或全系统变革以及大量资源。高必要性聚类通常包含被视为变革必不可少但有时超出社区控制范围的行动。参与者确定了一些被认为对个人、社区和机构变革具有潜力的实际行动，这些变革可能导致减少IM的种族差异。
