Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK.
Syst Rev. 2024 Feb 26;13(1):75. doi: 10.1186/s13643-024-02450-2.
Adolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts.
This realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory.
We reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired.
For community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts.
PROSPERO CRD42020205342.
青少年多重风险行为（MRB）是一个全球性的健康问题。大多数干预措施都集中在青少年 MRB 的近端原因上，例如同伴或家庭的影响，系统评价报告的有效性结果喜忧参半。越来越多的人认识到，社区动员方法可能有益于青少年健康。目前的文献、理论和实施存在差距，需要采用现实主义方法。我们使用理论驱动的证据综合评估社区动员干预措施如何以及为何能够预防青少年 MRB 以及在何种情况下有效/无效。
本真实审查采用六阶段迭代过程，由 RAMESES 框架指导。我们系统地检索了 PubMed、MEDLINE、PsycINFO、Web of Science、CINAHL 和 Sociological Abstracts，从其创建到 2021 年。研究根据与方案理论的相关性进行筛选，根据预先设定的标准评估严谨性并纳入。两位独立的审查员从纳入的研究中选择、筛选和提取数据。使用真实主义逻辑分析来开发有助于我们方案理论的背景-机制-结果配置。
我们审查了 35 份描述 22 项单独社区动员干预研究的文件。大多数研究（n=17）的质量评估得分为三或四分（满分四分）。我们根据三个中程理论分析了这些研究。为了维护我们的理论，即这些干预措施通过创造一个青少年不太可能从事 MRB 的社会环境来发挥作用，干预措施应该：（1）在整个社区中嵌入一套指导原则，（2）利用人口数据建立社区准备度，（3）确保在干预拥护者的支持下建立一个多元化的联盟。通过联盟对干预措施的交付拥有所有权、社区内的凝聚力以及共同努力改善青少年健康的动力等机制被触发，以实现社会环境的转变。然而，某些背景（例如资金有限）会限制干预措施的成功，因为这些机制无法启动。
为了减少青少年 MRB，社区动员干预措施中的联盟必须设法改变这些行为发生的社会环境。包括赋权、凝聚力和动力在内的机制会导致这种转变，但只有在某些情况下才会如此。
PROSPERO CRD42020205342。
