公平与地方卫生系统:对国家医疗服务系统低热量饮食计划试点头两年期间地方卫生服务牵头机构的经验进行定性评估

IF 0.4 Q4 ENDOCRINOLOGY & METABOLISM
Kevin Drew, Catherine Homer, Duncan Radley, Charlotte Freeman, Karina Kinsella, Maria Maynard, C. Bakhai, Louisa J Ells
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引用次数: 0

摘要

背景:肥胖症和 2 型糖尿病(T2DM)都会对健康和福祉产生深远影响。它们的发病率主要呈社会梯度分布。英格兰国民健康服务低热量饮食计划旨在支持人们实现 T2DM 的缓解,同时减少健康不平等。我们旨在探索当地医疗服务领导者的经验,并找出与公平动员低热量饮食计划有关的障碍和促进因素。研究方法在低热量饮食计划实施的头两年,我们对 24 名地方领导进行了 20 次半结构式访谈。受访者是从开展低热量饮食计划试点的 10 个地方有目的地抽取的。每次访谈都会探讨一些感兴趣的话题,包括转介、培训、沟通、激励、管理和参与,然后进行专题分析。结果:从数据中确定了七个核心主题:COVID-19 与初级保健能力和参与;沟通方法;培训方法;激励方法;转诊方法;转诊障碍;以及合作的重要性。COVID-19 对低热量饮食计划的动员和实施提出了具体的挑战;然而,我们的研究结果表明,在 10 个地理位置和人口结构不同的试点地点实施该计划时,所采取的方法存在很大的差异和不同。我们还发现,在低热量饮食计划的动员和实施支持方面缺乏公认的方法或策略,例如适度普遍主义,这是一种通过确保服务提供的公平性来解决健康不平等问题的社会政策应对措施。结论健康不平等仍是一项重大挑战,医疗服务领导者有可能在计划动员之初就采用公平观点。这样一来,他们所掌握的资源就能得到公平管理,从而有助于减少因干预而可能产生的不平等现象。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Equity and local health systems: a qualitative evaluation of the experiences of local health service leads during the first two years of the NHS Low Calorie Diet programme pilot
Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.
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来源期刊
British Journal of Diabetes
British Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
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16.70%
发文量
15
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