背景:原始的“BETTER”(建立在现有的工具上,以改善初级保健中的慢性病预防和筛查)方法包括在40-65岁的参与者之间进行以预防为重点的访问,以及“预防从业者”(PP),授权参与者为癌症和慢性病设定可实现的预防和筛查目标。BETTER成功适应加拿大经济贫困社区(BETERHEALTH)。我们的目标是对指南进行审查,为18-39岁收入较低的年轻人采用“更好的健康”方法做准备。由于可预防的慢性病的患病率高于收入较高的同龄人,因此已知死亡率较早。
方法:我们搜索了多个电子数据库和灰色文献,以获取有关预防/筛查的临床实践指南,并包括符合以下标准的指南:2008-2020年在加拿大或以下任何国家以英文出版(澳大利亚,爱尔兰,新西兰,苏格兰,美国和英国);并解决了预防或筛查问题。我们使用研究与评估指南(AGREE)II工具和提取的数据(出版物细节,recommendations,和质量/作者报告的证据水平)来自总得分为5或更高的来源。最终建议是在与不同利益攸关方的投入协调后汇编的(共同调查员,PPs,和社区咨询委员会)。
结果:我们总共纳入了85个指南,并为18-39岁的21个主题制定了42项建议的最终列表。具体建议属于以下主题:癌症,心血管疾病,糖尿病,肥胖,生活方式(酒精;健康的营养/身体活动);健康的关系和健康的性行为,免疫接种,口腔健康,健康的社会决定因素,和物质使用。
结论:我们确定了针对18-39岁成年人的个人水平预防/筛查行动的循证指南,并与低收入人群相关,这将直接为制定和实施更好的生活干预措施提供信息。
BACKGROUND: The original \'BETTER\' (Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care) approach consisted of a prevention-focused visit between participants aged 40-65 years and a \"Prevention Practitioner\" (PP), who empowered the participant to set achievable prevention and screening goals for cancers and chronic diseases. BETTER was successfully adapted for economically deprived communities (BETTER HEALTH) in Canada. Our objective was to conduct a review of
guidelines in preparation for adapting the \'BETTER HEALTH\' approach for younger adults aged 18-39 years living with lower income, a group known to have earlier mortality due to a higher prevalence of preventable chronic diseases than their peers with higher income.
METHODS: We searched multiple electronic databases and grey literature for clinical practice
guidelines on prevention/screening and included those that met the following criteria: published in English from 2008-2020 in Canada or any of the following countries (Australia, Ireland, New Zealand, Scotland, United States and England); and addressed prevention or screening. We assessed quality using the Appraisal of
Guidelines for Research and Evaluation (AGREE) II tool and extracted data (publication details, recommendations, and Quality/Level of evidence as reported by authors) from sources with overall scores of 5 or higher. Final recommendations were compiled after harmonization with input from diverse stakeholders (co-investigators, PPs, and the Community Advisory Committee).
RESULTS: We included a total of 85
guidelines, and developed a final list of 42 recommendations for 18-39 year-olds across 21 topics. Specific recommendations fell under the following topics: cancers, cardiovascular disease, diabetes, obesity, lifestyle (alcohol; healthy nutrition/physical activity); healthy relationships and healthy sexuality, immunization, oral health, social determinants of health, and substance use.
CONCLUSIONS: We identified evidence-based
guidelines on individual-level prevention/screening actions for adults 18-39 years old and relevant for those living with lower income which will directly inform development and implementation of the BETTER LIFE intervention.