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人道主义背景下的性与生殖健康实施研究:范围综述。

Sexual and reproductive health implementation research in humanitarian contexts: a scoping review.

机构信息

Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.

Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.

出版信息

Reprod Health. 2024 May 13;21(1):64. doi: 10.1186/s12978-024-01793-2.


DOI:10.1186/s12978-024-01793-2
PMID:38741184
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11089709/
Abstract

BACKGROUND: Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. METHODS: A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. RESULTS: Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. CONCLUSION: This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.

摘要

背景:满足受危机影响人群的健康需求是一个日益严峻的挑战,全球有 3.39 亿人在 2023 年需要人道主义援助。鉴于生活在人道主义环境中的四分之一人口是育龄妇女和女孩,性和生殖健康护理被视为基本的卫生服务和人道主义应对的最低标准。尽管越来越多的人呼吁增加在人道主义环境中实施研究的投资,但关于适当方法和分析框架的指导有限。

方法:进行了范围审查,以检查实施研究框架在多大程度上被用于评估人道主义环境中的性和生殖健康干预措施。通过相关系统评价和 Pubmed、Embase、PsycInfo、CINAHL 和全球健康数据库的文献检索,确定了 2013 年至 2022 年发表的同行评审论文。纳入的论文均为在人道主义环境中开展的性和生殖健康干预措施的原始定量或定性数据。

结果:筛选出 7036 份独特的记录纳入研究,其中 69 篇论文符合纳入标准。其中 6 篇论文明确描述了实施研究框架的使用情况,其中 3 篇引用了综合实施研究框架的使用情况。另外 3 篇论文提到了在其评估中使用的其他类型的框架。所有纳入研究中都提到了有助于干预措施存在的因素,以及阻碍其存在的因素,这些因素被综合到以下综合实施研究框架领域:系统特征、外部环境、内部环境、个体特征、干预措施特征和过程。

结论:本综述发现了广泛的方法,只有 69 篇研究中有 6 篇使用了实施研究框架,这突出了标准化的机会,以更好地为人道主义环境中的性和生殖健康干预措施提供证据和实施。增加使用实施研究框架,如经过修改的综合实施研究框架,可以同时扩大证据基础并提高标准化程度。全球有 3.39 亿人在 2023 年需要人道主义援助,满足受危机影响人群的健康需求是一个日益严峻的挑战。生活在人道主义环境中的四分之一人口是育龄妇女和女孩,提供性和生殖健康护理被视为人道主义应对的基本内容。实施研究可以帮助更好地了解现实环境如何影响健康改善工作。尽管越来越多的人呼吁增加在人道主义环境中实施研究的投资,但关于如何最好地进行投资的指导有限。本范围审查旨在检查实施研究框架在多大程度上被用于评估人道主义环境中的性和生殖健康干预措施。在符合审查纳入标准的 69 篇论文中,有 6 篇明确描述了实施研究框架的使用情况。其中 3 篇使用了综合实施研究框架,这是一个基于理论的框架,可以指导实施研究。另外 3 篇论文提到了在其评估中使用的其他类型的框架。本综述总结了纳入论文中与实施各个方面相关的因素如何使用综合实施研究框架进行组织。本综述的结果突出了标准化的机会,以更好地为人道主义环境中的性和生殖健康干预措施提供证据和实施。增加使用实施研究框架,如经过修改的综合实施研究框架,可以同时扩大证据基础并提高标准化程度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b195/11089709/d8eac82bf7bb/12978_2024_1793_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b195/11089709/d8eac82bf7bb/12978_2024_1793_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b195/11089709/d8eac82bf7bb/12978_2024_1793_Fig1_HTML.jpg

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本文引用的文献

[1]
Meeting the Sexual and Reproductive Health Needs of Internally Displaced Persons in Ethiopia's Somali Region: A Qualitative Process Evaluation.

Glob Health Sci Pract. 2022-10-31

[2]
The updated Consolidated Framework for Implementation Research based on user feedback.

Implement Sci. 2022-10-29

[3]
"A person who does not have money does not enter": a qualitative study on refugee women's experiences of respectful maternity care.

BMC Pregnancy Childbirth. 2022-10-5

[4]
Impact of counseling visual multimedia on use of family planning methods among displaced Nigerian families.

Health Promot Int. 2022-6-1

[5]
Mixed-methods findings from the Ngutulu Kagwero (agents of change) participatory comic pilot study on post-rape clinical care and sexual violence prevention with refugee youth in a humanitarian setting in Uganda.

Glob Public Health. 2023-1

[6]
Doctors' experiences providing sexual and reproductive health care at Catholic Hospitals in the conflict-affected North-West region of Cameroon: a qualitative study.

Reprod Health. 2022-5-28

[7]
Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum.

Implement Sci. 2022-1-22

[8]
Implementation of a three-pillar training intervention to improve maternal and neonatal healthcare in the Democratic Republic Of Congo: a process evaluation study in an urban health zone.

Glob Health Action. 2022-12-31

[9]
Implementation of a neonatal hepatitis B immunization program in rural Karenni State, Myanmar: A mixed-methods study.

PLoS One. 2021-12-20

[10]
Development and Testing of a Community-Based Intervention to Address Intimate Partner Violence among Rohingya and Syrian Refugees: A Social Norms-Based Mental Health-Integrated Approach.

Int J Environ Res Public Health. 2021-11-7

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