This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g., treatment, counseling). Peer-reviewed quantitative and qualitative literature from PubMed, Embase, Cochrane Register of Controlled Trials, and PsycINFO published between February 2012 and February 2023 was examined. The PRISM framework was used to systematically assess the reach of key populations, effectiveness of the intervention, and effects on the adoption, implementation, and maintenance within routine sexual health care. Of 730 uniquely identified records, 93 were selected for extraction. Of these studies, 60% reported actual interventions and 40% described the acceptability and feasibility. Studies were mainly based in Europe or North America and were mostly targeted to MSM (59%; 55/93) (R). Overall, self-sampling or self-testing was highly acceptable across key populations. The effectiveness of most studies was (expected) increased HIV testing. Adoption of the home-based CSH was acceptable for care providers if linkage to care was available, even though a minority of studies reported adoption by care providers and implementation fidelity of the intervention. Most studies suggested maintenance of home-based CSH complementary to clinic-based care. Context and mechanisms were identified which may enhance implementation and maintenance of home-based CSH. When providing the individual with a choice of testing, clear instructions, and tailored dissemination successful uptake of STI and HIV testing may increase. For implementers perceived care and treatment benefits for clients may increase their willingness to implement home-based CSH. Therefore, home-based CSH may determine more accessible sexual health care and increased uptake of STI and HIV testing among key populations.

OBJECTIVE: To determine the theoretical framework that explains the mechanisms of the success of breathing exercise interventions in people with chronic obstructive pulmonary disease.
METHODS: A realist review.
METHODS: Seven bibliographic databases and the grey literature were searched from 2015-January 2020 to identify the studies of breathing exercises.
METHODS: The evaluation criteria of realist review and the mixed method appraisal tool were both used to evaluate the included studies. We extracted and integrated the context-mechanism-outcome strings of each study to form the theoretical framework.
RESULTS: Six theoretical mechanisms that affected the success of the intervention were articulated: Wide acceptance of training methods, Integration of the intervention with life, Self-management of the participants, Confidence in controlling symptoms, Participation and support of practitioners, Motivation for intervention. Conversely, the other two mechanisms including the gap between implementation and training and the duration of the intervention, had negative impacts on the implementation of breathing exercises.
CONCLUSIONS: This review updates and expands the previous literature review on the impact of breathing exercises in people and provides researchers and clinical practitioners with theoretical mechanisms to ensure that the interventions achieve expected effects.
CONCLUSIONS: When formulating or selecting breathing exercise interventions, our theoretical framework will guide researchers and clinical practitioners to ensure that the intervention will have practical effects.
目的: 确定解释慢性阻塞性肺疾病患者呼吸功能锻炼干预成功机制的理论框架。 设计: 一项实际评估。 数据来源: 2015年至2020年1月共检索了7个书目数据库和灰色文献, 以查明呼吸功能锻炼的研究。 评估方法: 我们采用实际评估的评价标准和混合法评价工具对纳入的研究进行评价。我们提取并整合了每项研究的背景--机制--结果字符串, 形成理论框架。 结果: 阐明了影响干预成功的6项理论机制: 广泛接受训练方法、干预与生活相结合、参与者自我管理、对控制症状的信心、参与和支持从业者、干预动机。相反, 其他两个机制 (包括实施与训练之间的差距以及干预的时间长短) 对呼吸功能锻炼的实施产生了负面影响。 结论: 本项评估更新和扩展了之前关于呼吸功能锻炼对人体影响的文献综述, 为研究者和临床实践者提供了确保干预达到预期效果的理论机制。 影响: 在制定或选择呼吸功能锻炼干预措施时, 我们的理论框架将为研究者和临床实践者提供了确保干预措施具有实际效果的指导。.