Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Fifth Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
BMC Health Serv Res. 2024 Apr 4;24(1):427. doi: 10.1186/s12913-024-10853-z.
The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews.
We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method.
Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals.
Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention.
#NCT03052959, 10/02/2017.
BETTER 干预措施是一种通过经过培训的预防从业者（PP）提供的针对慢性病预防和筛查（CDPS）的有效综合循证方案，这是初级保健中的一个新角色。最近，一项经过改编的计划 BETTER HEALTH 由公共卫生护士作为低收入社区居民的 PP 提供，已被证明可以有效改善 CDPS 措施。为了更深入地了解社区居民的 CDPS 需求以及居民对 BETTER HEALTH 干预措施的看法，我们研究了干预措施如何适应公共卫生环境，然后通过焦点小组和访谈对居民进行了访问后的定性评估。
我们首先使用 ADAPT-ITT 模型将 BETTER 改编为加拿大安大略省的公共卫生环境。在 PP 访问后的定性评估中，我们询问了接受过 PP 访问的社区居民，了解他们为改善身心健康而采取的步骤以及 BETTER HEALTH 干预措施。在这两个阶段，我们都进行了焦点小组和访谈；使用恒定性比较法分析转录本。
共有 38 名社区居民参加了适应（n=14，64%为女性；平均年龄 54 岁）或评估（n=24，83%为女性；平均年龄 60 岁）阶段。在适应和评估中，居民都描述了一些重大挑战，包括贫困、社会孤立和日常压力，这些因素使得慢性病预防成为次要事项。适应结果表明，居民重视了解 CDPS，并且愿意与公共卫生护士进行保密访问，他们认为公共卫生护士值得信赖。尽管存在挑战，但许多接受 BETTER HEALTH 的人认为他们在接受 PP 访问后至少实现了一个个人 CDPS 目标。居民描述了访问的关键关系方面，包括感到被重视、被倾听和被 PP 理解。PP 还提供了克服预防目标障碍的实用建议。
生活在低收入社区的居民面临着日常压力，这降低了他们进行预防性生活方式改变的能力。BETTER HEALTH 的关键适应功能，例如公共卫生护士作为 PP，得到了居民的高度支持。该干预措施通过提供疾病预防服务，被社区认为是有价值的。
#NCT03052959，2017 年 10 月 2 日。
