Moore Ramey, Callaghan-Koru Jennifer, Vincenzo Jennifer L, Patton Susan K, Spear Marissa J, Riklon Sheldon, Alik Eldon, Padilla Ramos Alan, Takamaru Stephanie, McElfish Pearl A, Curran Geoffrey M
Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States.
Geriatrics, College of Health Professions, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States.
Front Health Serv. 2024 Mar 11;4:1338622. doi: 10.3389/frhs.2024.1338622. eCollection 2024.
While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions.
This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members ( = 17).
All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators.
Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.
虽然组织之间的关系和联系已被纳入实施理论、模型和框架中，但实施科学中对健康公平性的日益关注凸显了理解实施组织外部关系作用的紧迫性。本文通过探讨外部关系在以社区为基础、以公平为重点的干预措施中的作用来填补这一空白。
本研究聚焦于阿肯色州一项以公平为重点、基于社区的 COVID-19 疫苗接种干预措施，该措施利用了阿肯色大学医学科学分校与西班牙裔和马绍尔群岛社区之间长期的社区参与关系。我们采用探索性定性描述设计，通过对实施团队成员（n = 17）进行深入定性访谈，来研究 COVID-19 疫苗接种活动实施的障碍和促进因素。
所有参与者都将实施组织、合作伙伴组织和社区之间预先存在的关系描述为这个以公平为重点项目的关键实施决定因素。在组织间层面，外部关系包括工作人员之间的正式联系和非正式关系（例如，先前合作伙伴关系中的沟通渠道）。在个人层面，与社区的牢固外部关系是促进因素，利用了长期参与、社区熟悉度以及来自重点社区的工作人员。牢固的外部关系通过三种机制促进了项目在服务不足社区的覆盖范围：（1）减少了合作伙伴之间建立有效工作关系所需的时间；（2）卫生服务的可及性和文化适应性；（3）增强了社区成员之间的信任。实施的障碍在外部关系中也存在，但影响小于促进因素。
在实施科学中实现健康公平需要更深入地理解外部关系作为实施决定因素的作用。这项探索性研究通过描述促进公平实施的外部关系类型并确定其可能发挥作用 的机制，为文献做出了重大贡献。我们认为，从社区参与研究方法中借鉴的社区参与方法可能会有所帮助，因为这些过程需要投入精力建立/维护正式和非正式的组织及人际关系。需要进一步研究以了解外部关系与其他实施决定因素之间的联系。
