Table1_A community health worker led approach to cardiovascular disease prevention in the UK—SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project.docx

BackgroundThis paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions.
MethodsA type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework.
ResultsReach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme.
ConclusionCommunity-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.

【研究背景】本文介绍了一项基于英国的SPICES-Sussex研究，该研究旨在协同开发并实施基于社区的心血管疾病（Cardiovascular Disease, CVD）风险评估与防控干预方案，以支持处于中度CVD风险的服务不足人群。本研究的目标包括：提升利益相关方参与度；在四个研究站点实施该干预方案；评估志愿与社区社会企业（Voluntary and Community and Social Enterprises, VCSE）与社区健康工作者（Community Health Worker, CHW）的合作模式在健康干预中的应用效果。

【研究方法】本研究采用三类混合型实施研究设计，结合混合方法收集数据。本文聚焦SPICES-Sussex项目实施过程的过程评估，评估工作基于RE-AIM框架开展。

【研究结果】
覆盖范围：共计381名个体参与了风险评估问卷调研，其中41名女性与5名男性参与了健康辅导干预。
干预有效性：干预参与者的量化分析结果显示，多项心血管疾病行为风险因素均得到显著改善；质性研究数据则表明，该方案具有较高的可接受性，参与者对其整体性、个性化与以人为本的服务路径给予了高度认可。
采纳情况：共有50%的受邀VCSE参与了SPICES项目；CHW们反馈，依托VCSE合作搭建的坚实项目架构，他们能够有效开展高质量且互利共赢的辅导工作。
实施情况：联合设计会议推动了干预方案的本地化适配调整；29名（63%）参与者顺利完成了全部干预流程。实践层面的挑战主要包括：如何将CHW融入现有医疗服务体系、如何持续维系参与者的参与意愿，以及研究严谨性与志愿部门需求及期望之间的潜在张力。
可持续性：多家VCSE表示，愿在SPICES项目结束后继续推进该干预方案的落地。

【研究结论】社区参与式健康服务模式有望为特定群体的健康与福祉带来积极影响。此外，VCSE与CHW在英国仍是尚未被充分挖掘的重要健康资源。然而，仍需开展更多研究以明确如何打通不同部门间的协作壁垒，从而落地基于循证依据的高效预防性医疗服务。尽管依托嵌入社区的VCSE合作模式，触达脆弱人群仍是一项现实挑战。本项目通过复盘实践中的成败得失，可为未来社区健康参与类研究与实践提供参考指引。