基于实施科学理论和框架的北京市校园流感疫苗接种项目质量改进策略构建及其评估

Development and evaluation of multifaceted strategies for the school-located influenza vaccination program in Beijing using implementation science theories and frameworks

目的构建和评估优化北京市校园流感疫苗接种(School-located influenza vaccination,SLIV)项目的实施策略。方法在北京市选择利益相关者开展定性访谈,基于实施性研究综合框架(Consolidated framework for implementation research,CFIR)分析SLIV项目学龄儿童接种流感疫苗(Influenza vaccine,InfV)的阻碍因素,应用CFIR-实施变革专家建议实施策略匹配工具构建质量改进策略。基于RE-AIM框架和常态化过程理论制订质量改进策略的评估指标,在北京市20所小学采用整群随机试验开展评估。结果学龄儿童接种InfV的阻碍因素包括工作规划不足、跨部门协作困难、学校工作人员知识和信息可及性不足、家长认识误区等。构建的多层次质量改进策略包括促进规划与协调、培训主管校长和校医、开展学龄儿童及其家长健康教育和提醒。多层次质量改进策略在RE-AIM的5个维度均呈积极效应,干预组和对照组学龄儿童在学校或其他场所的InfV接种率分别为75.96%(695/915)、71.26%(553/776)[调整OR(95%CI):1.49(1.12-1.99)]。73.33%的校医、87.18%的班主任和70.38%的家长愿意继续开展多层次质量改进策略。结论基于实施科学理论和框架构建的实施策略有助于促进SLIV项目实施和可持续性,提高学龄儿童流感疫苗接种率。

Objective To develop and evaluate implementation strategies for improving the school-located influenza vaccination(SLIV)program in Beijing.Methods We conducted qualitative interviews with selected stakeholders to identify barriers against influenza vaccine(InfV)vaccination of school-aged children in the SLIV program using the consolidated framework for implementation research(CFIR).We developed quality improvement strategies using the implementation strategies matching tool of CFIR-expert recommendations for implementing change(ERIC),generated evaluation indicators for the strategies using the reach effectiveness adoption implementation maintenance(RE-AIM)framework and the normalization process theory,and conducted a cluster-randomized evaluation trial in 20 primary schools of Beijing.Results Barriers for InfV vaccination included lack of work planning,difficulties in interdepartmental collaboration,inadequate access to knowledge and information for school implementers,and parental misconceptions.Multifaceted quality improvement strategies included promoting work planning and coordination,training headmasters and school doctors,and educating and reminding students and parents.The strategies showed positive effects in the five dimensions of the RE-AIM framework;InfV coverage was 75.96%(695/915)in the intervention group compared with 71.26%(553/776)in the control group[adjusted OR(95%CI):1.49(1.12-1.99)];73.33% of school doctors,87.18% of head teachers,and 70.38% of parents were willing to continue the multifaceted quality improvement strategies.Conclusions Implementation strategies,developed based on implementation science theories and frameworks,may facilitate implementation and sustainability of the SLIV program and increase InfV coverage among primary school students.