运用实施研究综合框架（CFIR）探索严重精神疾病社区康复服务实施的障碍与促进因素：一项定性研究

Exploring barriers to and facilitators of the implementation of community-based rehabilitation service delivery for severe mental illness using the consolidated framework for implementation research (CFIR): a qualitative study.

作者信息

Zhu Jianwen, Fu Jie, Wang Yang, Dong Jiajia, Zhang Xia, Wang Sizhe, Wen Lu, Fan Hong

机构信息

School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, China.

School of Public Health, Nanjing Medical University, Nanjing, China.

出版信息

BMC Health Serv Res. 2025 Jul 1;25(1):864. doi: 10.1186/s12913-025-13052-6.

DOI:10.1186/s12913-025-13052-6

PMID:40598438

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220214/

Abstract

BACKGROUND

Community-based rehabilitation (CBR) services are crucial for improving the prognosis of people with severe mental illness (SMI) in China and other developing countries. However, these services face limitations and a lack of stakeholders’ insights. This study examines the barriers and facilitators to implementing CBR services for people with SMI in China to inform future improvements.

METHODS

This study employed a descriptive qualitative design guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were conducted with 32 stakeholders (16 mental health practitioners, 11 people with SMI, and 5 family caregivers) to explore their perceptions of factors influencing the implementation of CBR services for people with SMI. The interview data were analyzed and reported using the updated CFIR, with MAXQDA 2022 software facilitating the analysis process.

RESULTS

Within the CFIR, the following key constructs were identified as critical to CBR services implementation for people with SMI: (1) innovation—considering the evidence base, complexity, and cost of the intervention; (2) outer setting—encompassing critical incidents, local attitudes and conditions, partnerships and connections, policies and laws, financing, and external Pressure; (3) inner setting—reflecting structural characteristics, relational connections, communications, and culture; (4) individuals—encompassing both innovation deliverers and recipients; (5) process—focusing on assessing needs and engaging stakeholders.

CONCLUSIONS

Implementing sustainable and effective CBR services for people with SMI in China and similar settings requires early stakeholder involvement and attention to several key factors. These include a robust evidence base, readily accessible and standardized CBR services, enhanced training and team development for service providers, precise service needs assessment, active community engagement, and sustained policy and financial support.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12913-025-13052-6.

摘要

背景

在中国和其他发展中国家，基于社区的康复（CBR）服务对于改善重度精神疾病（SMI）患者的预后至关重要。然而，这些服务面临着限制，且缺乏利益相关者的见解。本研究探讨在中国为SMI患者实施CBR服务的障碍和促进因素，以为未来的改进提供参考。

方法

本研究采用了以实施研究综合框架（CFIR）为指导的描述性定性设计。对32名利益相关者（16名心理健康从业者、11名SMI患者和5名家庭照顾者）进行了半结构化访谈，以探讨他们对影响为SMI患者实施CBR服务的因素的看法。使用更新后的CFIR对访谈数据进行分析和报告，MAXQDA 2022软件辅助分析过程。

结果

在CFIR框架内，确定了以下关键结构对为SMI患者实施CBR服务至关重要：（1）创新——考虑干预措施的证据基础、复杂性和成本；（2）外部环境——包括关键事件、当地态度和条件、伙伴关系和联系、政策和法律、融资以及外部压力；（3）内部环境——反映结构特征、关系联系、沟通和文化；（4）个体——包括创新的提供者和接受者；（5）过程——侧重于评估需求和让利益相关者参与。