Kwok Wilson Yeung Yuk, Wong Frances Kam Yuet, Wong Arkers Kwan Ching, Bayuo Jonathan
School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China.
Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China.
BMC Public Health. 2025 May 7;25(1):1678. doi: 10.1186/s12889-025-22846-6.
The global ageing population imposes increasing demands on healthcare and social systems. Integrating the health and social service sectors has been proposed as a preferred solution to support healthy ageing, yet implementation in real settings remains challenging. Using an implementation science framework, this protocol outlines a Type-2 hybrid effectiveness-implementation design to adopt localized strategies for a Community-Based Health-Social Partnership Programme (C-HSPP) and test its effectiveness in enhancing self-care management among older adults in the community.
This study has two primary foci: to evaluate both the effectiveness and the implementation outcomes of C-HSPP in a non-governmental organization that operates seven community elderly centres across Hong Kong. A cluster randomized controlled trial (CRCT) with a two-arm, matched-pair, pragmatic design has been adopted to evaluate the programme's effectiveness. Regarding implementation outcomes, the reach, adoption, implementation, and maintenance of the programme will be examined using multiple data sources with quantitative and qualitative data. The trial will include 732 older adults aged 60 or above from four matched pairs of community centres, with each paired centre randomly assigned to either the 12-week C-HSPP intervention or to the usual community services. The C-HSPP intervention features a comprehensive assessment-intervention-evaluation framework using the Omaha System with health-social case management. Data will be collected at three time-points: baseline, post-intervention, and three months post-intervention, with self-efficacy as the primary outcome and other health indicators as secondary outcomes. An effectiveness analysis will be conducted using mixed-effects models and generalized estimating equations, incorporating degrees-of-freedom corrections and adjustments for clustering. Regarding the implementation outcome analysis, quantitative data including service statistics and a satisfaction survey will be presented using descriptive analysis. Qualitative data involving interview transcripts will be analysed using directed content analysis.
By simultaneously evaluating both clinical effectiveness and implementation outcomes, this study will validate the evidence-based intervention and identify facilitators and barriers in the implementation process. The findings will support the adoption of an effective evidence-based programme in real-world settings, provide insights on the implementation process to ensure its sustainability, and furnish evidence for policymakers to adopt an integrated health-social partnership programme in the community.
ClinicalTrials.gov, NCT05621720, First Posted on 2022-11-18.
全球人口老龄化对医疗保健和社会系统的需求日益增加。整合卫生和社会服务部门被提议作为支持健康老龄化的首选解决方案，但在实际环境中的实施仍然具有挑战性。本方案使用实施科学框架，概述了一种2型混合效果-实施设计，以采用本地化策略实施基于社区的健康-社会伙伴关系计划（C-HSPP），并测试其在提高社区老年人自我护理管理方面的有效性。
本研究有两个主要重点：评估C-HSPP在一个在香港运营七个社区老年中心的非政府组织中的有效性和实施结果。采用双臂、配对、实用设计的整群随机对照试验（CRCT）来评估该计划的有效性。关于实施结果，将使用包含定量和定性数据的多个数据源来检查该计划的覆盖范围、采用情况、实施情况和维持情况。该试验将包括来自四对匹配社区中心的732名60岁及以上的老年人，每对配对中心随机分配接受为期12周的C-HSPP干预或常规社区服务。C-HSPP干预采用综合评估-干预-评估框架，使用奥马哈系统进行健康-社会个案管理。数据将在三个时间点收集：基线、干预后和干预后三个月，以自我效能感为主要结果，其他健康指标为次要结果。将使用混合效应模型和广义估计方程进行有效性分析，并纳入自由度校正和聚类调整。关于实施结果分析，包括服务统计数据和满意度调查在内的定量数据将使用描述性分析呈现。涉及访谈记录的定性数据将使用定向内容分析进行分析。
通过同时评估临床有效性和实施结果，本研究将验证基于证据的干预措施，并确定实施过程中的促进因素和障碍。研究结果将支持在现实环境中采用有效的基于证据的计划，为确保其可持续性的实施过程提供见解，并为政策制定者在社区采用综合健康-社会伙伴关系计划提供证据。
ClinicalTrials.gov，NCT05621720，首次发布于2022年11月18日。
