Godoi Lidia, Schenkman Simone, Baumann Ana A, Bousquat Aylene, Buccini Gabriela
Department of Policy, Management and Health, School of Public Health, University of São Paulo, São Paulo, Brazil.
Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, United States.
Front Public Health. 2024 Aug 30;12:1365763. doi: 10.3389/fpubh.2024.1365763. eCollection 2024.
During the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for evidence-based responses and preparedness, we analyzed adaptations in NCIs' implementation strategies during COVID-19 according to the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS).
We conducted a global scoping review including peer-reviewed and non-peer-reviewed literature. The databases searched were PubMed, Embase, Scopus, BVS, Scielo, and Web of Science. This search was complemented by an extensive examination of relevant websites and an additional internet search via Google Scholar. We extracted and analyzed the data following the seven modules of the FRAME-IS.
Out of 20 records, 27 NCI were identified across Africa ( = 3), Asia ( = 7), Europe ( = 3), North America ( = 11), Oceania ( = 1), and South America ( = 2). NCIs adapted their content (e.g., adding elements), evaluation (e.g., conducting needs assessment), training (e.g., using experts), and context (e.g., setting-shifting from in-person to remote, and population-expanding interventions' reach). Adaptation goals were to increase acceptability ( = 9, 32.1%), adoption ( = 5, 17.8%), appropriateness ( = 10, 35.7%), feasibility ( = 25, 89.3%), penetration ( = 15, 53.6%), sustainability ( = 23, 82.1%), and fidelity ( = 1, 3.7%). The rationale to adapt varied from sociopolitical ( = 6, 21.4%), organizational ( = 13, 46.4%), implementer ( = 11, 39.3%), practitioner ( = 15, 53.6%), and recipient ( = 11, 39.3%). A quarter were reactive planned adaptations and 75.0% were unplanned modifications. Decisions were led by program leaders ( = 21, 75.0%), funders ( = 9, 32.1%), partners ( = 3, 10.7%), researchers ( = 1, 3.6%), and practitioners ( = 3, 10.7%). Adaptations were widespread from unit (e.g., hospital) ( = 1, 3.6%), organization ( = 4, 14.3%), and community system (e.g., countrywide) ( = 14, 50.0%).
The results from our global scoping review show that it is possible for NCIs to continue and even improve their delivery despite the global crisis, suggesting that remote delivery is feasible and can work as an alternative when in lockdown. Strategic planning taking advantage of existing structures and partnerships may have allowed NCI adaptations to be sustainable as well as facilitated replication within the organization network system.
在新冠疫情期间，儿童面临着营养不良和健康状况不佳的沉重负担。养育照护干预措施（包括促进健康、提供充足营养、给予积极回应、提供早期学习机会以及保障安全等行动）对于促进公平至关重要。由于需要基于证据的应对措施和准备工作，我们根据《基于证据的实施策略调整与修改报告框架》（FRAME-IS）分析了新冠疫情期间养育照护干预措施实施策略的调整情况。
我们进行了一项全球范围的综述，纳入了经过同行评审和未经同行评审的文献。检索的数据库包括PubMed、Embase、Scopus、BVS、Scielo和Web of Science。通过广泛查阅相关网站以及利用谷歌学术进行额外的互联网搜索对此次检索进行补充。我们按照FRAME-IS的七个模块提取并分析了数据。
在20条记录中，共识别出27项养育照护干预措施，分布在非洲（3项）、亚洲（7项）、欧洲（3项）、北美洲（11项）、大洋洲（1项）和南美洲（2项）。养育照护干预措施对其内容（如增加元素）、评估（如进行需求评估）、培训（如利用专家）和背景（如从面对面转向远程实施，扩大干预措施覆盖人群）进行了调整。调整的目标包括提高可接受性（9项，32.1%）、采用率（5项，17.8%）、适宜性（10项，35.7%）、可行性（25项，89.3%）、渗透率（15项，53.6%）、可持续性（23项，82.1%）和保真度（1项，3.7%）。调整的理由包括社会政治因素（6项，21.4%）、组织因素（13项，46.4%）、实施者因素（11项，39.3%）、从业者因素（15项，53.6%）和接受者因素（11项，39.3%）。四分之一是被动计划调整，75.0%是无计划修改。决策由项目负责人（21项，75.0%）、资助者（9项，32.1%）、合作伙伴（3项，10.7%）、研究人员（1项，3.6%）和从业者（3项，10.7%）主导。调整在单位（如医院）（1项，3.6%）、组织（4项，14.3%）和社区系统（如全国范围）（14项，50.0%）中广泛存在。
我们全球范围综述的结果表明，尽管面临全球危机，养育照护干预措施仍有可能继续甚至改进其实施，这表明远程实施是可行的，并且在封锁期间可以作为一种替代方式。利用现有结构和伙伴关系进行战略规划可能使养育照护干预措施的调整具有可持续性，并促进在组织网络系统内的推广。
