Reynolds Christopher W, Rha Jennifer Y, Lenselink Allison M, Asokumar Dhanya, Zebib Laura, Rana Gurpreet K, Giacona Francesca L, Islam Nowshin N, Kannikeswaran Sanjana, Manuel Kara, Cheung Allison W, Marzoughi Maedeh, Heisler Michele
Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, United States of America.
Physicians for Human Rights Student Advisory Board, New York, New York, United States of America.
PLOS Glob Public Health. 2024 Dec 2;4(12):e0003514. doi: 10.1371/journal.pgph.0003514. eCollection 2024.
Over 100 million displaced people rely on health services in humanitarian contexts, defined as unstable or transitory settings created in response to complex emergencies. While services are often described, there is a dearth of evidence on best practices for successful implementation to guide efforts to optimize health delivery. Implementation science is a promising but underutilized tool to address this gap. This scoping review evaluates implementation science in health services for forced migrants in humanitarian settings.
We conducted a scoping review according to JBI methodologies. A search of eight databases yielded 7,795 articles, after removal of duplicates, that were screened using PRISMA-ScR guidelines. Data extraction assessed study descriptors, implementation objects, barriers, facilitators, implementation strategies, and use of implementation frameworks in service delivery.
Data from 116 studies represented 37 countries and 11 topic areas. Methods were mainly cross-sectional with low-medium evidence rigor. Mental health programs (25%) and vaccination services (16%) were the most common objects of implementation. Thirty-eight unique barriers were identified including resource limitations (30%), health worker shortages (24%), and security risks (24%). Among 29 facilitators, the most common were health worker availability (25%), pre-existing partnerships (25%), and positive perceptions towards the intervention (20%). More than 90% of studies collectively identified 35 implementation strategies, the most common being capacity building (44%), stakeholder engagement (35%), information dissemination (38%), and feedback mechanisms (25%). Only 10 studies used formal implementation models, with RE-AIM (n = 3) and Intervention mapping (n = 2) being most frequent.
In this scoping review, we found similar barriers, facilitators, and implementation strategies across diverse humanitarian migrant settings and services. However, the use of rigorous methods and formal implementation models was rare. Frameworks included RE-AIM, CFIR, and Precede-Proceed. Increased use of implementation science frameworks and methods will help humanitarians more rigorously and systematically evaluate and develop best practices for implementation of health services for migrants in humanitarian settings.
超过1亿流离失所者在人道主义环境中依赖卫生服务，人道主义环境被定义为因复杂紧急情况而产生的不稳定或过渡性环境。虽然卫生服务经常被描述，但缺乏关于成功实施的最佳实践的证据来指导优化卫生服务提供的努力。实施科学是填补这一空白的一种有前景但未得到充分利用的工具。本范围综述评估了人道主义环境中为被迫移民提供卫生服务的实施科学。
我们根据JBI方法进行了范围综述。对八个数据库的搜索产生了7795篇文章，去除重复项后，使用PRISMA-ScR指南进行筛选。数据提取评估了研究描述符、实施对象、障碍、促进因素、实施策略以及服务提供中实施框架的使用情况。
来自116项研究的数据代表了37个国家和11个主题领域。研究方法主要是横断面研究，证据严谨程度为低到中等。心理健康项目（25%）和疫苗接种服务（16%）是最常见的实施对象。确定了38个独特的障碍，包括资源限制（30%）、卫生工作者短缺（24%）和安全风险（24%）。在29个促进因素中，最常见的是卫生工作者的可获得性（25%）、预先存在的伙伴关系（25%）以及对干预措施的积极看法（20%）。超过90%的研究共确定了35种实施策略，最常见的是能力建设（44%）、利益相关者参与（35%）、信息传播（38%）和反馈机制（25%）。只有10项研究使用了正式的实施模型，其中RE-AIM（n = 3）和干预映射（n = 2）最为常见。
在本范围综述中，我们发现在不同的人道主义移民环境和服务中存在类似的障碍、促进因素和实施策略。然而，使用严谨方法和正式实施模型的情况很少见。框架包括RE-AIM、CFIR和Precede-Proceed。更多地使用实施科学框架和方法将有助于人道主义者更严谨、系统地评估和制定人道主义环境中为移民提供卫生服务的最佳实施实践。
