Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Implement Sci. 2024 Feb 8;19(1):10. doi: 10.1186/s13012-024-01345-z.
BACKGROUND: Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient's health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term-adjunctive interventions-to classify change methods that are distinct from the common intervention/strategy taxonomy. MAIN TEXT: Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients' motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention ("the thing"), as an adjunctive intervention, or an implementation strategy in different studies-further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients' attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients' utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided. CONCLUSION: Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.
背景:实施科学小组将方法分为两类:(1)针对接受者健康结果的临床、行为或生物医学干预,以及(2)针对交付系统的实施策略。根据其预期功能区分干预措施和策略对于准确将其效果归因于健康或实施结果至关重要。然而,在协调 200 多个艾滋病毒实施研究项目和进行系统审查时,我们发现了一些具有干预措施和策略特征的变革方法,这些方法的分类不一致。为了减轻混淆并提高变革方法的规范,我们建议实施科学应采用一个现有的但很少使用的术语——辅助干预——来对变革方法进行分类,这些方法与常见的干预/策略分类法不同。
主要文本:辅助干预作为变革方法,针对健康干预的接受者(例如,患者、参与者),但旨在随着时间的推移增加接受者启动、坚持、遵守或参与健康干预的动机、自我效能或能力。在我们关于艾滋病毒干预实施的两项已发表的审查中,45 个编码的变革方法中有 25 个属于策略和干预之间的灰色地带。我们还注意到在不同的研究中,同一个变革方法被标记为干预措施(“事物”)、辅助干预措施或实施策略的情况——进一步混淆了局面。辅助干预措施通过其预期目标、期望结果以及行动理论和因果过程与其他变革方法区分开来。虽然健康干预措施针对接受者,并对健康结果产生直接的、因果关系的影响,但辅助干预措施增强了接受者的态度和行为,以参与干预措施,并通过增加接受者对干预措施的利用和坚持的可能性,间接地对健康结果产生因果关系。辅助干预措施本身无法直接产生健康结果,并且需要实施策略才能有效地影响持续的吸收、利用和坚持。提供了辅助干预研究的案例示例、逻辑建模和考虑因素(例如,与消费者参与策略的关系)。
结论:将辅助干预概念化为一种单独的变革方法类型,将通过提高有效性测试以及规范机制和结果来推进实施研究。
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