Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors.

IF 5.6 1区 医学 Q1 NUTRITION & DIETETICS
Harriet Koorts, Jiani Ma, Christopher T V Swain, Harry Rutter, Jo Salmon, Kristy A Bolton
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引用次数: 0

Abstract

Background: Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up.

Method: Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines.

Results: Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up.

Conclusion: In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice.

Trial registration: PROSPERO (CRD42021287265).

扩大规模的系统方法:关于体育活动和其他行为性非传染性疾病风险因素证据的系统综述和叙述性综述。
背景:非传染性疾病 (NCD) 是全球死亡的主要原因。系统方法具有创造大规模可持续成果的潜力,但很少被用于支持体育锻炼/营养促进或更广泛的非传染性疾病预防工作。本综述旨在(i) 综合系统方法在扩大针对四种非传染性疾病行为风险因素的干预措施中的应用证据;(ii) 探讨系统方法在干预措施的实施和扩大中是如何被概念化和使用的:检索了七个电子数据库中 2016-2021 年发表的研究。符合条件的研究至少针对四种 NCD 行为风险因素(缺乏运动、吸烟、饮酒、饮食)中的一种,或描述了对计划实施或推广的干预措施的评估。研究分为 (i) 高度、(ii) 中度或 (iii) 未使用系统方法。根据 PRISMA 指南,对系统方法在推广中的操作方法进行叙述性综合:结果:共纳入 21 项干预研究。只有 19% 的干预研究(n = 4)明确使用了系统思维来指导干预设计、实施和推广(针对所有四种风险因素 n = 2,饮食 n = 1,烟草使用 n = 1)。五项研究("高度使用")在计划和实施扩大规模时明确关注系统要素之间的关系,并利用系统变化来推动影响的扩大。七项研究("中度使用")考虑了影响扩大规模过程或结果的系统要素,但不要求从一开始就实现系统层面的变革。九项研究("未使用")的目的是在干预环境中的多个机构之间开展多层次的工作,但没有阐明系统的复杂性和系统要素之间的关系。我们综合了所报告的扩大规模的障碍和促进因素,以及每组研究如何构思和使用系统方法、扩大规模的方法、框架和原则:在体育活动研究以及更广泛的非传染性疾病预防领域,系统方法在扩大规模中的应用仍处于起步阶段。对于希望采用系统方法大规模实施干预措施的研究人员、从业人员和政策制定者来说,需要就如何在研究和实践中交流和运用系统方法提供指导:prospero(CRD42021287265)。
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来源期刊
CiteScore
13.80
自引率
3.40%
发文量
138
审稿时长
4-8 weeks
期刊介绍: International Journal of Behavioral Nutrition and Physical Activity (IJBNPA) is an open access, peer-reviewed journal offering high quality articles, rapid publication and wide diffusion in the public domain. IJBNPA is devoted to furthering the understanding of the behavioral aspects of diet and physical activity and is unique in its inclusion of multiple levels of analysis, including populations, groups and individuals and its inclusion of epidemiology, and behavioral, theoretical and measurement research areas.
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