PDF(Pubmed)
Abstract：
BACKGROUND: Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs.
METHODS: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services.
RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases.
CONCLUSIONS: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
METHODS: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services.
RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases.
CONCLUSIONS: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
摘要：
背景：耳部和听力护理计划对于中耳炎（或中耳疾病）的早期发现和管理至关重要。中耳炎和相关听力损失不成比例地影响第一民族儿童。这会影响言语和语言的发展，社会和认知发展，反过来,教育和生活结果。这项范围审查旨在更好地了解高收入殖民地定居者国家的原住民儿童的耳朵和听力护理计划如何旨在减轻中耳炎的负担并增加公平获得护理的机会。具体来说,审查旨在制定计划战略，将每个项目的重点映射到护理路径的4个部分(预防，检测,诊断/管理，康复)，并确定表明计划长期可持续性和成功的因素。
方法：2021年3月使用Medline进行了数据库搜索，Embase,全球卫生,APAPsycInfo，CINAHL,WebofScience核心合集,Scopus,和学术搜索总理。如果计划在2010年1月至2021年3月之间的任何时间开发或运行，则符合资格或纳入。搜索术语包括第一民族儿童等术语，耳朵和听力护理，和健康计划，倡议,竞选活动,和服务。
结果：27篇文章符合纳入审查的标准，共描述了21项耳朵和听力护理计划。方案采用的策略是：(I)将患者与专科服务联系起来，（二）加强服务的文化安全，和(iii)增加获得耳部和听力保健服务的机会。然而,计划评估措施仅限于输出或服务水平结果的评估，而不是以患者为基础的结果。促进计划可持续性的因素包括资金和社区参与，尽管在许多情况下这些因素有限。
结论：这项研究的结果突出表明，项目主要在护理路径的两个方面运作-检测和诊断/管理，大概是最需要的地方。有针对性的策略被用来解决这些问题，一些在他们的方法中受到限制。许多程序的成功被评估为输出，许多项目依赖资金来源，这可能会限制长期可持续性。最后,第一民族人民和社区的参与通常只发生在实施期间，而不是整个方案的发展。未来的计划应该嵌入到一个互联的护理系统中，并与现有的政策和资金流挂钩，以确保长期的生存能力。方案应由第一民族社区管理和评估，以进一步确保方案是可持续的，旨在满足社区需求。
方法：2021年3月使用Medline进行了数据库搜索，Embase,全球卫生,APAPsycInfo，CINAHL,WebofScience核心合集,Scopus,和学术搜索总理。如果计划在2010年1月至2021年3月之间的任何时间开发或运行，则符合资格或纳入。搜索术语包括第一民族儿童等术语，耳朵和听力护理，和健康计划，倡议,竞选活动,和服务。
结果：27篇文章符合纳入审查的标准，共描述了21项耳朵和听力护理计划。方案采用的策略是：(I)将患者与专科服务联系起来，（二）加强服务的文化安全，和(iii)增加获得耳部和听力保健服务的机会。然而,计划评估措施仅限于输出或服务水平结果的评估，而不是以患者为基础的结果。促进计划可持续性的因素包括资金和社区参与，尽管在许多情况下这些因素有限。
结论：这项研究的结果突出表明，项目主要在护理路径的两个方面运作-检测和诊断/管理，大概是最需要的地方。有针对性的策略被用来解决这些问题，一些在他们的方法中受到限制。许多程序的成功被评估为输出，许多项目依赖资金来源，这可能会限制长期可持续性。最后,第一民族人民和社区的参与通常只发生在实施期间，而不是整个方案的发展。未来的计划应该嵌入到一个互联的护理系统中，并与现有的政策和资金流挂钩，以确保长期的生存能力。方案应由第一民族社区管理和评估，以进一步确保方案是可持续的，旨在满足社区需求。
