加强卫生系统以遏制全球残疾负担：制定改善肌肉骨骼健康全球战略优先组成部分的实证研究。
Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health.
作者信息
Briggs Andrew M, Huckel Schneider Carmen, Slater Helen, Jordan Joanne E, Parambath Sarika, Young James J, Sharma Saurab, Kopansky-Giles Deborah, Mishrra Swatee, Akesson Kristina E, Ali Nuzhat, Belton Joletta, Betteridge Neil, Blyth Fiona M, Brown Richard, Debere Demelash, Dreinhöfer Karsten E, Finucane Laura, Foster Helen E, Gimigliano Francesca, Haldeman Scott, Haq Syed A, Horgan Ben, Jain Anil, Joshipura Manjul, Kalla Asgar A, Lothe Jakob, Matsuda Shuichi, Mobasheri Ali, Mwaniki Lillian, Nordin Margareta C, Pattison Marilyn, Reis Felipe J J, Soriano Enrique R, Tick Heather, Waddell James, Wiek Dieter, Woolf Anthony D, March Lyn
机构信息
Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
出版信息
BMJ Glob Health. 2021 Jun;6(6). doi: 10.1136/bmjgh-2021-006045. Epub 2021 Jun 18.
INTRODUCTION
Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.
METHODS
Design: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1-2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.
RESULTS
Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.
CONCLUSION
An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.
引言
尽管疾病负担沉重，但全球仍缺乏优化肌肉骨骼（MSK）健康并指导国家层面卫生系统强化重点的战略应对措施。在全球肌肉骨骼健康联盟（G-MUSC）的支持下，我们旨在通过实证得出战略应对措施的必要重点和组成部分，以指导全球和国家层面关于MSK健康的行动。
方法
设计：混合方法，三阶段设计。
第1阶段：对包括患者代表和有实际经验者在内的国际关键信息提供者（KI）进行定性研究。KI描述了MSK健康的当代状况以及全球战略应对的重点。
第2阶段：对国家卫生政策进行范围审查，以确定当代MSK政策趋势和重点。
第3阶段：在第1 - 2阶段的基础上，开展全球电子德尔菲法，多部门小组成员对重点和详细组成部分/行动框架进行评分并反复讨论。
结果
第1阶段：从20个国家（40%为低收入和中等收入国家（LMIC））抽取了代表25个组织的31名KI。归纳得出的主题用于构建一个逻辑模型，为后续阶段提供支撑，该模型包括五项指导原则、八个战略重点领域和七个行动促进因素。
第2阶段：在识别出的165份文件中，来自22个国家（88%为高收入国家）和2个地区的41份（24.8%）符合纳入标准。得出了八个总体政策主题，由47个子主题支持，与逻辑模型密切契合。
第3阶段：来自72个国家（46%为LMIC）的674名小组成员参与了电子德尔菲法的第1轮，439名（65%）参与了第2轮。保留了59个组成部分，其中10个（17%）被确定为卫生系统的关键要素。97.6%和94.8%的人分别同意或强烈同意该框架对加强卫生系统具有价值和可信度。
结论
一个由多部门利益相关者共同设计并得到大力支持的实证得出的框架，现在可作为全球和国家层面应对措施的蓝图，以改善MSK健康并优先开展系统强化举措。
Zotero 插件