基于项目理论的怒江儿童健康综合干预评估框架

文章回顾了项目评估的相关理论和框架,以及儿童健康干预评估的研究实践,并结合怒江当地儿童卫生工作现状,基于项目理论初步构建了怒江儿童健康综合干预评估框架。该框架包括项目外环境、儿童健康综合干预行动模块、儿童健康综合干预作用模块和评估技术环境等方面,涉及到领导机构、执行机构、协调机构、协调/执行人员、干预和服务标准、环境和氛围、目标人群、干预活动、决定因素以及结果或效果等要素。     

卫生项目评估的有关问题研究

本文介绍了卫生项目评估起源及发展情况,阐述了卫生项目评估的有关概念,包括卫生项目,卫生干预,项目费用支付分析,卫生项目评估,过程评估,产出评估等.这些卫生项目评估概念的讨论和明确对于卫生项目评估活动的进一步开展将是有益的.     

行为决策的评估理论构建研究

本研究构建了行为决策的评估理论,揭示人类行为发生、发展和改变的规律,为开展健康相关行为干预提供科学依据。本理论认为,所有的人类行为都是个体为了生存和发展,在对内、外部刺激进行评估后所做出的主动反应。个体以基因遗传、自我图式、群体规范和直觉为参照系,对内、外部刺激的重要性、安全性威胁和获益性,以及个体所拥有的行为资源进行感觉性评估和社会性评估,用以做出生理性反应和社会性行为决策,并通过感受器、中枢神经和效应器,形成“刺激-评估-行为决策-行为”循环。开展行为干预时,应通过与个体进行讨论和分析,帮助其发现和确认刺激的重要性、安全性、获益性及其拥有的行为资源。     

基于智能健康管理App的妊娠期评估与干预

目的 以母子健康手册App为载体,对孕妇群体进行妊娠高血压评估及血压控制和体重控制.方法 以2016年1月—5月下载母子健康手册的孕妇为研究对象,采用基于临床知识库的智能健康管理App,对孕妇群体进行妊娠期高血压评估和血压、体重干预.通过分析评估结果 及干预结果 ,检验评估模型的准确性和干预模型的有效性.结果 2016年1—5月期间共856名孕妇用智能健康管理系统评估妊娠期高血压疾病,评估结果 与临床诊断结果 相比较的准确率达99%;采用移动健康管理系统进行健康教育,相关孕期健康知识问卷平均得分(总分100)和合格率(80分为合格)均有显著提高(P<0.05).结论 智能健康评估模型和移动健康干预手段有效,能够实现孕妇妊娠期高血压疾病的准确评估和孕期健康的有效干预.     

家长参与评估儿童生长发育对促进儿童生长的效果评估

目的通过家长参与对儿童生长发育的观察和评估,提高家长对健康育儿知识和技能的认知,促进儿童健康生长发育水平。方法采用整群随机抽样的方法,抽取黄浦区6个社区1,400位0~6月龄的儿童及其家长,随机分为干预组与对照组。通过培训儿童家长参与儿童生长曲线图的绘制与评估,使家长能积极参与儿童生长发育的健康教育与健康促进。结果干预组的家长对儿童健康生长发育知识的认知率比对照组的家长高,干预组儿童在末评时,身高测体重生长曲线P10的儿童比干预前减少,而处于P50~P97百分区间的儿童增加;从年龄测体重生长曲线看,P3和P97的儿童比干预前减少。结论家长参与的模式在促进儿童健康生长发育方面具有一定的作用。     

CHARTS项目促进我国艾滋病防治督导与评估体系建设的分析

目的分析中英艾滋病防治策略项目（CHARTS）促进艾滋病防治督导与评估体系建设情况。方法利用CHARTS项目战略管理能力评估工具,通过深入访谈和小组讨论收集数据,并通过查阅项目计划和进展报告以及有关工作报告、研究报告和文件等资料收集相关信息,采取定量和定性相结合的分析方法。结果国家和省级的艾滋病防治督导与评估系统建设目标实现程度在CHARTS项目基期、中期和终期的中位数分别是20%（1%-53.8%）、37.1%（29.5%-71%）和74.9%（56.7%-83.2%）,表明达到了＂系统地实现＂目标的阶段。CHARTS项目通过技术和资金支持了涵盖国家级和省级督导与评估体系的八个方面。结论国家和省级的艾滋病防治督导与评估系统建设具有明显进步,CHARTS项目通过技术和资金支持,发挥了促进督导与评估体系建设的作用。     

应用研究在妇幼保健项目中的应用

目的 通过应用研究的推广应用,提高当地卫生管理和专业技术人员分析问题、解决问题的能力.方法 利用应用研究的方法 对宁夏4个项目县开展项目活动.各项目县根据各自特点,在专家组的指导下首先自行制定了应用研究的题目,并进行了基础调查和问题分析,根据基础调查的结果,制定了相应的干预措施和实施计划,并在实施过程中进行了监督指导和评估.在最后评价干预效果时又发现了新的问题,提出了新的解决办法,即建立起循环往复的理念.结果 该项目评估显示新生儿早期接触率由基础调查的12.0%提高到64.6%,早开奶率由基础调查的23.0%提高到87.7%.6个月以内婴儿纯母乳喂养率为68.4%,在基线调查42.9%的基础上提高了25.5%,干预后取得了明显的效果.结论 通过应用研究,充分调动了县级管理者和专业技术人员的积极性和主动性,实现从被动执行项目到主动设计和实施项目活动的转变.为今后项目的 可持续发展打下了基础,即在项目结束后,当地妇幼卫生人员有能力自行发现妇女儿童的健康问题,找到解决办法,最终实现提高当地妇女儿童健康水平的目标.     

云南怒江儿童健康综合干预效果评价

目的:评价云南怒江儿童健康综合干预项目的效果。方法:通过调查获得的定量和定性资料,从活动、产出和结果3个层面客观评价项目效果。结果:项目干预活动在怒江顺利实施,相关评价指标均达到项目目标;怒江妇幼卫生服务可及性和覆盖率有所提高,需方健康知识知晓率和生活行为显著改善;7岁以下儿童佝偻病、生长迟缓、低体重和6～24月龄儿童贫血患病率显著降低。结论与建议:云南怒江儿童健康综合干预项目在合作机制建设、能力建设、健康教育和儿童营养素补充等方面取得显著效果,建议西部贫困少数民族地区采用综合策略实施儿童健康干预项目,建立公共部门、社会组织、私人机构和公民协作机制,开展以参与式培训为主要方法的能力建设活动,结合当地文化特点和居民受教育水平开发适宜的健康传播材料。     

伤害干预项目评估指标体系的制定

目的制定一套适于我国的伤害干预评估的指标体系,为今后伤害干预项目的评估提供借鉴。方法通过文献回顾、项目梳理、专家咨询、项目点测试及SMART标准筛选,逐步完善指标体系。结果共收集了23篇文章/书籍章节/规范、4位专家反馈表以及22份项目报告/总结,形成34个伤害干预评估初级指标。通过试点及专家对指标补充及合并,形成40个备选指标。通过SMART标准筛选及专家论证,最终确立了伤害干预评估指标体系框架,包括伤害干预评估指标共33个,其中一级指标4个,二级指标21个,三级指标8个。结论该指标体系适用于评估我国伤害干预项目,在实际应用中,应根据具体项目适当调整。     

数据包络分析法在国家自然科学基金项目结题评估中的应用

目的 尝试运用数据包络分析对国家自然科学基金项目的结题绩效进行评估.方法以北京大学人民医院某一年度结题的国家自然科学基金项目为对象,建立结题绩效评估指标体系,并应用数据包络分析输出模型进行计算和分析.结果 基于所应用的方法,得到了各个项目的绩效评估结果和产出不足量、投入冗余量.结论 数据包络分析法在项目结题绩效中的运用是可行的,通过数据包络法可以对项目进行有效的结题绩效评估,为项目负责人的项目实施和管理部门的策略制定提供依据.     

民族地区妇幼卫生工作绩效考核项目实施效果评估

目的:对民族地区妇幼卫生工作绩效考核项目实施效果进行评估,推动民族地区妇幼卫生工作绩效考核工作。方法:制定评估方案,成立国家级评估组,采用座谈会、现场考查、个人技术考核、个人定性访谈等方法,对项目县绩效考核项目实施效果进行现场评估。结果:通过项目实施,提高了当地对妇幼卫生绩效考核工作的认识;帮助当地掌握绩效考核标准和考核方法;项目地区绩效考核工作初见成效。结论:通过项目实施在一定程度上促进了当地政府对妇幼卫生工作的重视,加大了对妇幼卫生工作的支持力度,促进了当地妇幼卫生体系建设与发展,规范了妇幼保健服务。     

Health demonstration projects: Evaluating a community-based health intervention programme to improve young people's sexual health

There has been criticism of systematic reviews and meta-analyses that have shown little evidence of effect of interventions to improve teenage sexual health. Moreover, there is considerable controversy surrounding the validity of outcomes and rigour of design in evaluation methods for community-based programmes. In this climate, Scotland launched Healthy Respect, one of four community-based national Demonstration Projects, to address teenage sexual health. Healthy Respect is a complex and multi-stranded intervention in Lothian Region that includes education and health-promotion activities and alternative ways to provide sexual health services for young people. A multidisciplinary research team at the University of Aberdeen was appointed to undertake an independent evaluation of this demonstration project. Challenging some aspects of theory-based evaluation, it is argued that adopting both quantitative and qualitative methods will provide an understanding of both the context and process of this Health Demonstration Project, as well as tracking outcomes, including behavioural change, in the target population. The authors’ evaluation includes: examining the process of implementation; comparative regional mapping of the service context including inter-agency partnership working; and assessing effectiveness using a quasi-experimental design and adjusted, population-based, behavioural and sexual health outcomes. Evaluation from these key perspectives contributes to a balanced appraisal of a complex, community-based health promotion and service delivery intervention.     

Sustainability: the elusive dimension of international health projects

OBJECTIVE: The Canada-China Yunnan Maternal and Child Health Project (1997-2003) sought to improve the quality of village life and promote development of productivity and social prosperity in Yunnan province, China. PARTICIPANTS: The project targeted grassroots maternal and child health workers: new and in-service village doctors; traditional village midwives; doctors at township health centres; doctors at county maternal and child health hospitals; and provincial health staff. SETTING: Ten impoverished counties (population 2.2 million) in Yunnan province with high proportions of ethnic minority populations. INTERVENTION: There were three major innovations: training grassroots maternal and child health workers in participatory and community-based approaches and clinical skills; designing a model comprehensive referral system including provision of basic equipment; and introducing participatory monitoring and evaluation methods. Strategies to support sustainability were built into the project from the outset. OUTCOMES: Over 4,000 village, township, and county health workers received training. Maternal, infant, and under-five mortality rates declined over 30% in project counties. Project innovations were disseminated throughout the province, into other donor-funded initiatives, and integrated into national health projects by local partners. CONCLUSION: Maintaining the long-term benefits of international health interventions depends on sustaining innovations beyond short project timelines. Achieving sustainability poses a conundrum to implementing agencies. Three mechanisms influenced uptake in the Yunnan project: maintaining a good fit between core project elements and the existing health system; developing adequate organizational supports; and creating a handover plan from the outset. This project highlights some of the ways in which sustainability can be operationalized.     

成本效用分析在艾滋病行为干预效果评价中的应用

预防艾滋病的卫生资源是有限的，为了使这些有限的卫生资源获得最大的效果，需要从经济学角度对备选干预方案进行评价，选择最经济的方案。着重介绍了目前国外应用较多和较成熟的评价艾滋病行为干预效果的成本效用分析方法。     

Development of a theory-based (PEN-3 and Health Belief Model), culturally relevant intervention on cervical cancer prevention among Latina immigrants using intervention mapping

The development of efficacious theory-based, culturally relevant interventions to promote cervical cancer prevention among underserved populations is crucial to the elimination of cancer disparities. The purpose of this article is to describe the development of a theory-based, culturally relevant intervention focusing on primary (sexual risk reduction) and secondary (Pap smear) prevention of cervical cancer among Latina immigrants using intervention mapping (IM). The PEN-3 and Health Belief Model provided theoretical guidance for the intervention development and implementation. IM provides a logical five-step framework in intervention development: delineating proximal program objectives, selecting theory-based intervention methods and strategies, developing a program plan, planning for adoption in implementation, and creating evaluation plans and instruments. We first conducted an extensive literature review and qualitatively examined the sociocultural factors associated with primary and secondary prevention of cervical cancer. We then proceeded to quantitatively validate the qualitative findings, which led to development matrices linking the theoretical constructs with intervention objectives and strategies as well as evaluation. IM was a helpful tool in the development of a theory-based, culturally relevant intervention addressing primary and secondary prevention among Latina immigrants.     

Environmental health impact assessment: evaluation of a ten-step model.

"Environmental impact assessment" denotes the attempt to predict and assess the impact of development projects on the environment. A component dealing specifically with human health is often called an "environmental health impact assessment." It is widely held that such impact assessment offers unique opportunities for the protection and promotion of human health. The following components were identified as key elements of an integrated environmental health impact assessment model: project analysis, analysis of status quo (including regional analysis, population analysis, and background situation), prediction of impact (including prognosis of future pollution and prognosis of health impact), assessment of impact, recommendations, communication of results, and evaluation of the overall procedure. The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project. Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate. Environmental health impact assessment as a tool for health protection and promotion is underutilized. It would be useful to achieve consensus on a comprehensive generic concept. An international initiative to improve the situation seems worth some consideration.     

山东省优生示范工程方案制订及推广应用研究

目的:通过制订并推广应用山东省优生示范工程方案,探讨降低出生缺陷的发生干预模式。方法:在山东省9个优生示范工程试点县、市进行婴儿出生缺陷和遗传性疾病的基线调查,制订降低出生缺陷三级干预方案。以现有的计划生育四级服务网络为基础,推广应用新的检测技术和治疗方法,建立三级干预质量评估体系。结果:初步形成了以山东省计划生育科研所优生优育重点实验室为龙头,市、地、县、乡计划生育服务网络为基础的三级干预体系和评估体系;实施优生优育示范工程的9个示范县(市)新生儿先天性缺陷发生率明显降低。结论:将优生优育适宜技术推广应用于基层,建立三级干预网络是降低出生缺陷、提高人口素质的重要方法。     

Health promotion in kindergarten children: an assessment of evaluated projects in Germany

Aim Health problems in childhood, which can be altered by basic preventive measures, are dramatically increasing. Therefore, effective primary prevention programmes beginning in early childhood are increasingly regarded as important. In this field a great deal of action, activities and interventions exist. The kindergarten setting is a particular field for integrated intervention. The special public health focus is to involve not only the children but also their parents, siblings, and teachers.Methods The aim of the project was to establish an inventory of health promotion measures as well as prevention programmes in kindergartens in Germany. The objective was a stock-taking and a critical assessment of evaluated programmes for preschool children with a main focus on obesity prevention, promotion of physical activity and nutrition education. This complete overview involved extensive literature research, internet research and interviews with experts.Results Regarding obesity prevention intervention programmes, only 13 evaluated measures were identified. Concerning promotion of physical activity and nutrition education, 41 measures were listed. A programme evaluation has been carried out very rarely. Only nine projects have had a documented qualified evaluation. With regard to cooperation with a research institution, the evaluation were competent. Nevertheless, the proportion of integrated projects with a sustainable character was quite small. For the most part, interventions are aimed at prevention at the behavioural level; activities at the conditional level are uncommon.Conclusion The results show an enormous demand on evaluated intervention programmes for kindergarten children, their relatives, and teachers. For future intervention programmes an evaluation is obligatory. Standardized measures are justified, because only such evaluated interventions were proved effective and successful. It is necessary to link existing projects, and not to create new programmes. A scientific analysis has shown that success is possible.