Chiu Simon Keith, Hall Alix, Freebairn Louise
Hunter Medical Research Institute, The Population Health Research Program, New Lambton Heights, New South Wales, Australia.
Faculty of Health and Medicine, University of Newcastle, School of Medicine and Public Health, Callaghan, New South Wales, Australia.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2025 May 30. doi: 10.1007/s00103-025-04069-7.
Noncommunicable diseases (NCDs) cause an estimated 41 million deaths globally each year, with cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes being the leading contributors. Modifiable risk factors elevate the risk of NCDs. Despite the availability of effective prevention programs, their consistent implementation remains limited, highlighting the need for strategies to improve delivery and reduce costs. The reach, efficacy, adoption, implementation, and maintenance (RE-AIM) framework and system modelling can help in understanding and improvement of the implementation and maintenance of public health initiatives.
This research used a system dynamics model to explore hypothetical pathways between reach, maintenance, and the cost-related components of implementation within the RE-AIM framework. Scenarios explored the influence of strategies for enhancing reach and maintenance and the resulting impact on participation and cost.
Scenarios that considered alternative pathways to engagement (i.e. enhanced reach strategies) and re-engagement led to higher participation rates by utilising alternative pathways and reducing dependence on initial reach. However, this increased overall program costs due to the population cycling between engagement and disengagement.
This modelling study highlights the complex non-linear relationships that affect the implementation of public health prevention, emphasising the need for support strategies to maintain engagement. The study shows that while alternative pathways to reach can improve participation, disengagement remains a significant challenge, impacting overall costs. Sustainment strategies that are both effective and cost-efficient are crucial for maintaining engagement and enhancing the effectiveness of public health programs.
据估计，全球每年有4100万人死于非传染性疾病，其中心血管疾病、癌症、慢性呼吸道疾病和糖尿病是主要死因。可改变的风险因素会增加患非传染性疾病的风险。尽管有有效的预防计划，但这些计划的持续实施仍然有限，这凸显了制定改善实施和降低成本策略的必要性。覆盖范围、效果、采用率、实施和维持（RE-AIM）框架以及系统建模有助于理解和改进公共卫生举措的实施和维持。
本研究使用系统动力学模型，在RE-AIM框架内探索覆盖范围、维持以及实施成本相关组成部分之间的假设路径。情景分析探讨了增强覆盖范围和维持的策略的影响以及对参与度和成本的最终影响。
考虑替代参与途径（即增强覆盖范围策略）和重新参与的情景，通过利用替代途径和减少对初始覆盖范围的依赖，导致更高的参与率。然而，由于人群在参与和退出之间循环，这增加了总体项目成本。
本建模研究突出了影响公共卫生预防实施的复杂非线性关系，强调需要支持策略来维持参与度。研究表明，虽然替代覆盖途径可以提高参与度，但退出仍然是一个重大挑战，影响总体成本。既有效又具成本效益的维持策略对于维持参与度和提高公共卫生项目的有效性至关重要。
