背景:关于复杂的基于社区的计划如何成功实现长期影响,仍然未知。需要更多的洞察力来了解这些方案运作的关键机制。因此,我们在五个实施健康青年的社区进行了深入研究,健康未来(JOGG)方法,荷兰基于社区的肥胖预防计划。我们旨在确定当地利益相关者之间的感知结果和长期影响,并探索潜在的因果途径和工作机制。
方法:我们使用了波纹效应映射(REM),一种定性的参与式方法来绘制结果图并确定因果路径,在五个社区。我们涉及26个利益相关者,与当地JOGG方法相关的专业人士和政策制定者,分布在八个REM会议上,并与另外24个利益相关者进行了单独访谈。为了揭示工作机制,我们比较了不同社区的结果和因果途径.
结果:实施了5-9年,参与者认为JOGG改善了对当地利益相关者的所有权,卫生政策,促进健康生活方式的部门间合作和社会规范。因果途径包括微小的初始结果,这些结果创造了实现长期影响的先决条件。尽管社区之间确切的JOGG行动差异很大,我们确定了五种共同的工作机制,通过这些机制,JOGG方法有助于因果途径:(1)用JOGG创造积极的内涵,(2)动员利益相关者参与JOGG方法,(3)促进项目,以提高利益相关者的知识和意识,同时创造促进健康生活方式的成功经验,(4)连接利益相关者,从而促进部门间合作和(5)分享利益相关者的成功,促进健康的生活方式,逐渐形成了参与的社会规范。
结论:JOGG方法似乎通过激活最初的利益相关者参与和加强所有权过程来发挥作用,政策变化,和部门间合作,以促进健康的生活方式。关键的工作机制可以为JOGG的进一步发展以及其他复杂的基于社区的预防计划提供信息。
BACKGROUND: Much remains unknown about how complex community-based programmes can successfully achieve long-term impact. More insight is needed to understand the key
mechanisms through which these programmes work. Therefore, we conducted an in-depth study in five communities that implemented the Healthy Youth, Healthy Future (JOGG) approach, a Dutch community-based obesity prevention programme. We aimed to identify perceived outcomes and long-term impacts among local stakeholders and explore potential causal pathways and working
mechanisms.
METHODS: We used ripple effects mapping (REM), a qualitative participatory method to map outcomes and identify causal pathways, in five communities. We involved 26 stakeholders, professionals and policy-makers affiliated with the local JOGG approach, spread over eight REM sessions and conducted individual interviews with 24 additional stakeholders. To uncover working
mechanisms, we compared outcomes and causal pathways across communities.
RESULTS: Over 5-9 years of implementation, participants perceived that JOGG had improved ownership of local stakeholders, health policies, intersectoral collaboration and social norms towards promoting healthy lifestyles. Causal pathways comprised small initial outcomes that created the preconditions to enable the achievement of long-term impact. Although exact JOGG actions varied widely between communities, we identified five common working
mechanisms through which the JOGG approach contributed to causal pathways: (1) creating a positive connotation with JOGG, (2) mobilizing stakeholders to participate in the JOGG approach, (3) facilitating projects to promote knowledge and awareness among stakeholders while creating successful experiences with promoting healthy lifestyles, (4) connecting stakeholders, thereby stimulating intersectoral collaboration and (5) sharing stakeholder successes that promote healthy lifestyles, which gradually created a social norm of participation.
CONCLUSIONS: The JOGG approach seems to work through activating initial stakeholder participation and bolstering the process towards ownership, policy change, and intersectoral collaboration to promote healthy lifestyles. Key working
mechanisms can inform further development of JOGG as well as other complex community-based prevention programmes.