护理学报 ›› 2022, Vol. 29 ›› Issue (11): 47-52.doi: 10.16460/j.issn1008-9969.2022.11.047
实施性研究的方法学综述
郑萍, 刘宁
- 遵义医科大学珠海校区 护理学系,广东 珠海 519041
摘要： 目的 实施科学为循证护理证据的转化和常态化开展提供了新思路和研究方法。护理领域尚缺乏系统的方法学文献探讨如何开展实施科学。方法 系统综述医疗健康领域中IS的相关方法学,各研究设计的优缺点、局限性及应用现状。结果 相关方法学主要包括效果-实施混合设计（Effectiveness Implementation Hybrid Designs,EIHD）、多阶段优化策略（Multiphase Optimization Strategy, MOST）、多重方案随机序贯试验（Sequential Multiple Assignment Randomized Trial, SMART）、阶梯设计（Stepped-Wedge Design, SWD）、阶梯设计集群随机试验（Stepped Wedge Cluster Randomized Trial, SWCRT）、中断时间序列（Interrupted Time Series Design, ITS）、断点回归设计（Regression Discontinuity Design, RDD）、质性研究设计和混合研究设计。结论 近些年有护理研究人员开始运用IS开展相关研究,建议在开展IS时应注意选择与研究问题相匹配的实施研究方法和设计,并采用合适的实施结局指标对实施情况进行概念化和评估,遵循实施性研究的报告规范（standards forreporting implementation studies,StaRI）进行全面报告。
中图分类号:
- R197.323.6
| [1] Williams LS,Vickrey BG.Implementation Science[J]. Stroke, 2021,52(12):4054-4056.DOI:10.1161/STROKEAHA.121.033971. [2] Theobald S, Brandes N, Gyapong M, et al.Implementation Research: New Imperatives and Opportunities in Global Health[J]. Lancet, 2018,392(10160):2214-2228.DOI:10.1016/S0140-6736(18)32205-0. [3] Boehm LM, Stolldorf DP, Jeffery AD.Implementation Science Training and Resources for Nurses and Nurse Scientists[J]. J Nurs Scholarsh, 2020, 52(1):47-54.DOI:10.1111/jnu.12510. [4] Bisken SA, Powell BJ, Shea CM, et al.Criteria for Selecting Implementation Science Theories and Frameworks: Results from an International Survey[J]. Implement Sci,2017,12(1): 124.DOI: 10.1186/s13012-017-0656-y. [5] 陶芳标,Shahirose Premji,伍晓艳,等.推进实施性研究在中国公共卫生领域的应用[J].中华预防医学杂志, 2020, 54(1):8-12.DOI: 10.3760/cma.j.issn.0253-9624.2020.01.004. [6] 谢润生,徐东,李慧. 医疗卫生领域中实施科学的研究方法[J].中国循证医学杂志, 2020, 20(9):1104-1110.DOI:10.7507/1672-2531.202003234. [7] Jabbour M, Newton AS, Johnson D,et al.Defining Barriers and Enablers for Clinical Pathway Implementation in Complex Clinical Settings[J]. Implement Sci, 2018, 13(1):139.DOI: 10.1186/s13012-018-0832-8. [8] McNulty M, Smith JD, Villamar J, et al. Implementation Research Methodologies for Achieving Scientific Equity and Health Equity[J]. Ethn Dis,2019,29(Suppl 1):83-92.DOI: 10.18865/ed.29.S1.83. [9] Lewis CC, Boyd MR, Walsh-Bailey C, et al.A Systematic Review of Empirical Studies Examining Mechanisms of Implementation in Health[J]. Implement Sci, 2020,15(1):21.DOI: 10.1186/s13012-020-00983-3. [10] Banerjee S, Taylor RS, Hellier J.Randomized Controlled Trials[J]. Chest, 2020, 158(1):S79-S87. DOI:10.1016/j.chest.2020.03.013. [11] Curran GM, Bauer M, Mittman B, et al.Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact[J]. Med Care, 2012, 50(3):217-226. DOI: 10.1097/MLR.0b013e3182408812. [12] Chirwa E, Kapito E, Jere DL, et al.An Effectiveness-implementation Hybrid Type 1 Trial Assessing the Impact of Group Versus Individual Antenatal Care on Maternal and Infant Outcomes in Malawi[J]. BMC Public Health, 2020, 20(1): 205.DOI:10.1186/s12889-020-8276-x. [13] Smith JD, Berkel C, Jordan N, et al.An Individually Tailored Family-centered Intervention for Pediatric Obesity in Primary Care: Study Protocol of A Randomized Type II Hybrid Effectiveness-implementation Trial (Raising Healthy Children study)[J]. Implement Sci, 2018, 13(1):11.DOI: 10.1186/s13012-017-0697-2. [14] Vaughn AE, Studts CR, Powell BJ, et al.The impact of Basic vs. Enhanced Go NAPSACC on Child Care Centers' HealthyEating and Physical Activity Practices: Protocol for A Type 3 Hybrid Effectiveness-implementation Cluster-randomized Trial[J]. Implement Sci, 2019, 14(1):101.DOI:10.1186/s13012-019-0949-4. [15] Landes SJ, Mcbain SA, Curran GM.Reprint of: An Introduction to Effectiveness-implementation Hybrid Designs[J]. Psychiatry Res, 2020, 283:112630.DOI:10.1016/j.psychres.2019.112513. [16] Collins LM, Murphy SA, Nair VN, et al.A Strategy for Optimizing and Evaluating Behavioral Interventions[J]. Ann Behav Med,2005,30(1):65-73.DOI:10.1207/s15324796abm3001_8. [17] Gwadz MV, Collins LM, Cleland CM, et al.Using the Multiphase Optimization Strategy (MOST) to Optimize an HIV Care Continuum Intervention for Vulnerable Populations: A Study Protocol[J]. BMC Public Health, 2017, 17(1):383.DOI: 10.1186/s12889-017-4279-7. [18] Gallis JA, Bennett GG, Steinberg DM, et al.Randomization Procedures for Multicomponent Behavioral Intervention Factorial Trials in the Multiphase Optimization Strategy Framework: Challenges and Recommendations[J]. Transl Behav Med,2019,9(6):1047-1056.DOI:10.1093/tbm/iby131. [19] Murphy SA.An Experimental Design for the Development of Adaptive Treatment Strategies[J]. Stat Med, 2005,24(10):1455-1481. DOI:10.1002/sim.2022. [20] Doorenbos AZ, Haozous EA, Jang MK, et al.Sequential Multiple Assignment Randomization Trial Designs for Nursing Research[J]. Res Nurs Health, 2019, 42(6):429-435.DOI: 10.1002/nur.21988. [21] Meurer WJ, Seewald NJ, Kidwell K.Sequential Multiple Assignment Randomized Trials: An Opportunity for Improved Design of Stroke Reperfusion Trials[J]. J Stroke Cerebrovasc Dis, 2017, 26(4):717-724. DOI:10.1016/j.jstrokecerebrovasdis.2016.09.010. [22] Candlish J, Teare MD, Cohen J, et al.Statistical Design and Analysis in Trials of Proportionate Interventions: A Systematic Review[J]. Trials,2019, 20(1):151.DOI:10.1186/s13063-019-3206-x. [23] The Gambia Hepatitis Intervention Study. The Gambia Hepatitis Study Group[J]. Cancer Res, 1987,47(21):5782-7. [24] Van Den Heuvel ER, Zwanenburg RJ, Van Ravenswaaij-Arts CM. A Stepped Wedge Design for Testing an Effect of Intranasal Insulin on Cognitive Development of Children with Phelan-McDermid Syndrome: A Comparison of Different Designs[J]. Stat Methods Med Res, 2017, 26(2): 766-775.DOI: 10.1177/0962280214558864 [25] Hemming K, Taljaard M, Marshall T, et al.Stepped-wedge Trials Should be Classified as Research for the Purpose of Ethical Review[J]. Clinical Trials,2019,16(6):580-588.DOI:10.1177//1740774519873322. [26] Hussey MA, Hughes JP.Design and Analysis of Stepped Wedge Cluster Randomized Trials[J]. Contemp Clin Trials, 2007, 28(2):182-191. DOI: 10.1016/j.cct.2006.05.007. [27] Ndejjo R, Wanyenze RK, Nuwaha F, et al.Barriers and Facilitators of Implementation of a Community Cardiovascular Disease Prevention Programme in Mukono and Buikwe Districts in Uganda Using the Consolidated Framework for Implementation Research[J]. Implement Sci, 2020, 15(1): 106.DOI:10.1186/s13012-020-01065-0. [28] Hartmann DP, Gottman JM, Jones RR, et al.Interrupted Time-series Analysis and Its Application to Behavioral Data[J]. J Appl Behav Anal, 1980, 13(4):543-559.DOI:10.1901/jaba.1980.13-543. [29] Liu B, Moore JE, Almaawiy U, et al.Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): A Multisite Interrupted Time Series Evaluation of an Implementation Intervention to Increase Patient Mobilisation[J]. Age Ageing, 2018, 47(1): 112-119.DOI: 10.1093/ageing/afx128. [30] Thistlethwaite DL, Campbell DT.Regression-discontinuity Analysis: An Alternative to the Ex Post Facto Experiment[J]. J Educa Psychol, 1960,51(6):309-317.DOI:10.1037/h0044319. [31] Anderson ML, Dobkin C, Gorry D.The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality: An Observational Study with A Regression Discontinuity Design[J]. Ann Intern Med, 2020, 172(7):445-452. DOI: 10.7326/M19-3075. [32] 张小艳,李学靖,周雅静,等.实施科学视角下最佳实践证据推广的范围综述[J].中国护理管理,2021, 21(10):1594-1600. [33] Hooley C, Winters AM, Pisciotta C, et al.Caregiver-relevant perspectives from A Multi-stakeholder Collaborative Advisory Board on Adapting A Child Mental Health Intervention to Be Delivered in Child-welfare Settings[J]. J Public Child Welf,2021,15(3):318-340.DOI:10.1080/15548732.2020.1724238. [34] 张秋雯,庞冬,胡嘉乐,等.实施性研究综合框架的发展及其应用[J].中国护理管理,2021,21(2):257-260. DOI:10.3969/j.issn.1672-1756.2021.02.020. [35] 翁瑛丽,赵博伦,周璇,等.实施性研究中保真度测评的研究进展[J].护理学报,2020,27(19):23-28. DOI:10.16460/j. issn1008-9969.2020.19.023. |
| [1] | 苏孟宇, 王真, 吴金凤, 李晓燕, 张玉玺. 临床护士开展哀伤辅导的现状及研究进展[J]. 护理学报, 2022, 29(9): 26-30. |
| [2] | 李翔, 冯英璞, 孟晓静, 周立民, 霍晓冉, 许梦敏, 王昊. 脑卒中患者口腔健康管理的最佳证据总结[J]. 护理学报, 2022, 29(9): 36-41. |
| [3] | 邹自玉, 唐红梅, 吴丽, 陈荣凤, 梅花. 乳腺癌相关健康教育材料可读性评估的范围综述[J]. 护理学报, 2022, 29(9): 42-46. |
| [4] | 刘天贶, 龙玉娟, 刘欢, 刘逸文. ICU患者不同部位黏膜压力性损伤的特征及护理研究进展[J]. 护理学报, 2022, 29(8): 35-39. |
| [5] | 陈芳芳, 叶灵晓, 胡雁, 郑亚华, 李娟, 楼钶楠, 刘梅, 胡康丽. 心脏起搏器术后患者早期运动康复的最佳证据总结[J]. 护理学报, 2022, 29(8): 53-58. |
| [6] | 朱展慧, 林征, 周美景, 王咪, 孙彩云, 顾珺怡. 决策辅助工具在炎症性肠病患者中应用的范围综述[J]. 护理学报, 2022, 29(7): 44-49. |
| [7] | 李珂, 韩舒羽, 杨振楠, 麦智德. 急诊给药安全护理干预策略的研究进展[J]. 护理学报, 2022, 29(7): 36-39. |
| [8] | 邱昌翠, 于晓丽, 冯亚婷, 杨正雄, 徐婷, 朱晓萍. ICU营养支持患者再喂养综合征风险评估及预防干预研究[J]. 护理学报, 2022, 29(7): 57-62. |
| [9] | 蔡莹莹, 张俊峰, 蔡艾芳, 曾雅燕, 李玲, 黄琼珊, 刘兴玲. 以培养护士核心能力为导向的循证护理查房模式探索[J]. 护理学报, 2022, 29(6): 50-54. |
| [10] | 任鹏娜, 胡小懿, 汤爱玲, 张月, 许方蕾. 基于循证构建老年尿失禁患者出院准备护理方案[J]. 护理学报, 2022, 29(6): 7-10. |
| [11] | 曹咪, 张军, 岳少婷. 早产儿出院后神经发育支持性照护的最佳证据总结[J]. 护理学报, 2022, 29(6): 44-49. |
| [12] | 杨阳, 刘宁. 支气管哮喘患者冬病夏治穴位敷贴护理评估及管理的最佳证据总结[J]. 护理学报, 2022, 29(5): 15-21. |
| [13] | 吴玉洁, 吴利平, 冷虹瑶, 王燕, 林光燕. 狗咬伤患者伤口感染预防及管理的最佳证据总结[J]. 护理学报, 2022, 29(5): 52-56. |
| [14] | 张娜, 朱丽辉, 罗听薇, 向玉琼, 熊月娥, 陈牡花, 唐倩. 儿童安宁疗护应用研究进展[J]. 护理学报, 2022, 29(4): 12-16. |
| [15] | 鹿笑寒, 宋洁, 王晋芳, 刘霖, 陈海雯, 姜倩倩. 置信职业行为在护理教育中的研究现状[J]. 护理学报, 2022, 29(3): 35-39. |
|