PDF(Pubmed)
Abstract：
Engaging communities is an important component of multisectoral action to address the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. We conducted research with non-communicable disease stakeholders in Bangladesh to understand how a community-led intervention which was shown to reduce the incidence of type 2 diabetes in rural Bangladesh could be scaled-up.
We purposively sampled any actor who could have an interest in the intervention, or that could affect or be affected by the intervention. We interviewed central level stakeholders from donor agencies, national health policy levels, public, non-governmental, and research sectors to identify scale-up mechanisms. We interviewed community health workers, policy makers, and non-governmental stakeholders, to explore the feasibility and acceptability of implementing the suggested mechanisms. We discussed scale-up options in focus groups with community members who had attended a community-led intervention. We iteratively developed our data collection tools based on our analysis and re-interviewed some participants. We analysed the data deductively using a stakeholder analysis framework, and inductively from codes identified in the data.
Despite interest in addressing NCDs, there was a lack of a clear community engagement strategy at the government level, and most interventions have been implemented by non-governmental organisations. Many felt the Ministry of Health and Family Welfare should lead on community engagement, and NCD screening and referral has been added to the responsibilities of community health workers and health volunteers. Yet there remains a focus on reproductive health and NCD diagnosis and referral instead of prevention at the community level. There is potential to engage health volunteers in community-led interventions, but their present focus on engaging women for reproductive health does not fit with community needs for NCD prevention.
Research highlighted the need for a preventative community engagement strategy to address NCDs, and the potential to utilise existing cadres to scale-up community-led interventions. It will be important to work with key stakeholders to address gender issues and ensure flexibility and responsiveness to community concerns. We indicate areas for further implementation research to develop scaled-up models of community-led interventions to address NCDs.
We purposively sampled any actor who could have an interest in the intervention, or that could affect or be affected by the intervention. We interviewed central level stakeholders from donor agencies, national health policy levels, public, non-governmental, and research sectors to identify scale-up mechanisms. We interviewed community health workers, policy makers, and non-governmental stakeholders, to explore the feasibility and acceptability of implementing the suggested mechanisms. We discussed scale-up options in focus groups with community members who had attended a community-led intervention. We iteratively developed our data collection tools based on our analysis and re-interviewed some participants. We analysed the data deductively using a stakeholder analysis framework, and inductively from codes identified in the data.
Despite interest in addressing NCDs, there was a lack of a clear community engagement strategy at the government level, and most interventions have been implemented by non-governmental organisations. Many felt the Ministry of Health and Family Welfare should lead on community engagement, and NCD screening and referral has been added to the responsibilities of community health workers and health volunteers. Yet there remains a focus on reproductive health and NCD diagnosis and referral instead of prevention at the community level. There is potential to engage health volunteers in community-led interventions, but their present focus on engaging women for reproductive health does not fit with community needs for NCD prevention.
Research highlighted the need for a preventative community engagement strategy to address NCDs, and the potential to utilise existing cadres to scale-up community-led interventions. It will be important to work with key stakeholders to address gender issues and ensure flexibility and responsiveness to community concerns. We indicate areas for further implementation research to develop scaled-up models of community-led interventions to address NCDs.
摘要：
背景：社区参与是解决低收入和中等收入国家非传染性疾病（NCDs）日益增加的负担的多部门行动的重要组成部分。我们与孟加拉国的非传染性疾病利益相关者进行了研究，以了解如何扩大社区主导的干预措施，该措施已被证明可以降低孟加拉国农村地区2型糖尿病的发病率。
方法：我们有目的地对任何可能对干预感兴趣的参与者进行了抽样，或者可能影响干预或受到干预的影响。我们采访了来自捐助机构的中央利益相关者，国家卫生政策水平，public,非政府组织,和研究部门确定扩大规模的机制。我们采访了社区卫生工作者，政策制定者,和非政府利益相关者，探讨实施建议机制的可行性和可接受性。我们与参加过社区主导干预的社区成员讨论了焦点小组的扩大选择。我们根据分析反复开发了数据收集工具，并重新采访了一些参与者。我们使用利益相关者分析框架对数据进行了演绎分析，并从数据中识别的代码中归纳出来。
结果：尽管有兴趣解决非传染性疾病，在政府层面缺乏明确的社区参与战略，大多数干预措施都是由非政府组织实施的。许多人认为卫生和家庭福利部应该领导社区参与，社区卫生工作者和卫生志愿者的职责中增加了非传染性疾病筛查和转诊。然而，仍然侧重于生殖健康和非传染性疾病的诊断和转诊，而不是社区一级的预防。有可能让卫生志愿者参与社区主导的干预措施，但是他们目前的重点是让妇女参与生殖健康，这不符合社区对非传染性疾病预防的需求。
结论：研究强调需要采取预防性社区参与战略来应对非传染性疾病，以及利用现有干部扩大社区主导干预措施的潜力。重要的是与主要利益攸关方合作，解决性别问题，确保对社区关切的灵活性和反应能力。我们指出了进一步实施研究的领域，以开发社区主导的干预措施的扩大模型，以解决非传染性疾病。
方法：我们有目的地对任何可能对干预感兴趣的参与者进行了抽样，或者可能影响干预或受到干预的影响。我们采访了来自捐助机构的中央利益相关者，国家卫生政策水平，public,非政府组织,和研究部门确定扩大规模的机制。我们采访了社区卫生工作者，政策制定者,和非政府利益相关者，探讨实施建议机制的可行性和可接受性。我们与参加过社区主导干预的社区成员讨论了焦点小组的扩大选择。我们根据分析反复开发了数据收集工具，并重新采访了一些参与者。我们使用利益相关者分析框架对数据进行了演绎分析，并从数据中识别的代码中归纳出来。
结果：尽管有兴趣解决非传染性疾病，在政府层面缺乏明确的社区参与战略，大多数干预措施都是由非政府组织实施的。许多人认为卫生和家庭福利部应该领导社区参与，社区卫生工作者和卫生志愿者的职责中增加了非传染性疾病筛查和转诊。然而，仍然侧重于生殖健康和非传染性疾病的诊断和转诊，而不是社区一级的预防。有可能让卫生志愿者参与社区主导的干预措施，但是他们目前的重点是让妇女参与生殖健康，这不符合社区对非传染性疾病预防的需求。
结论：研究强调需要采取预防性社区参与战略来应对非传染性疾病，以及利用现有干部扩大社区主导干预措施的潜力。重要的是与主要利益攸关方合作，解决性别问题，确保对社区关切的灵活性和反应能力。我们指出了进一步实施研究的领域，以开发社区主导的干预措施的扩大模型，以解决非传染性疾病。
