基于RE-AIM框架儿童青少年近视与肥胖共病综合干预实施性研究结局指标的构建

doi:10.19723/j.issn.1671-167X.2025.03.005

摘要/Abstract

摘要：

目的: 构建儿童青少年近视与肥胖共病综合干预实施性研究结局指标，为儿童青少年多病共防及实施性研究结局测量提供依据。方法: 基于RE-AIM框架初步构建指标集，采用德尔菲法(Delphi method)，通过函询问卷对初步制定的指标集进行评分和建议征询，每一轮专家咨询结束后计算专家积极指数、专家权威程度、专家意见协调程度和专家意见集中程度，整理专家意见，结合专家咨询结果和筛选标准修改、删除或新增指标，并进行下一轮专家咨询，经过两轮专家咨询，意见一致后形成最终指标集。结果: 两轮专家咨询实际纳入专家28名，Kendall协调系数W分别为0.352 (χ²=413.952，P < 0.001)和0.499 (χ²= 405.044，P < 0.001)，经检验差异均具有统计学意义，结果可取。最终构建的儿童青少年近视与肥胖共病综合干预实施性研究结局指标包含人群覆盖、干预效果、机构采纳、干预实施和效果维持5个(维度)一级指标下13条二级指标和20条三级指标。人群覆盖维度包括参与项目儿童青少年人数、项目参与者代表性和项目全程参与者代表性；干预效果维度包括共病新发率、近视新发率、等效球镜度数、体重指数(body mass index，BMI)、超重肥胖患病率、腰围身高比、综合健康知识水平得分和综合健康行为水平得分；机构采纳维度包括参与项目学校的代表性和参与项目执行的校医、教师代表性；干预实施维度包括保真度、内容调整和成本；效果维持维度包括个体健康结局和机构持续采用。结论: 构建了基于RE-AIM框架的儿童青少年近视与肥胖共病综合干预实施性研究结局指标，可以为中国儿童青少年常见多病干预策略优化提供借鉴。

关键词: 近视, 肥胖, 儿童青少年, RE-AIM框架, 德尔菲法

Abstract:

Objective: To develop outcome indicators for the implementation of comprehensive interventions targeting the multimorbidity of myopia and obesity in children and adolescents, providing a basis for the co-prevention of multimorbidity and the outcome measurement of implementation research in children and adolescents. Methods: Based on the RE-AIM framework, a preliminary set of indicators was constructed. The Delphi method was employed, with experts scoring and providing feedback on the proposed indicators via questionnaires. After each round of consultation, expert enthusiasm index, authority coefficient, coordination degree, and consensus level were calculated. Expert opinions were collected and analyzed to modify, delete, or add indicators based on consultation results and screening criteria. Two Delphi rounds were conducted until consensus was achieved. Results: A total of 28 experts participated actually in both rounds. The Kendall' s W coefficients for the two rounds of expert consultation were 0.352 (χ²=413.952, P < 0.001) and 0.499 (χ²=405.044, P < 0.001), both statistically significant. The final outcome indicators for implementation research on comprehensive interventions for myopia and obesity comorbidity in children and adolescents included five primary dimensions with 13 secondary and 20 tertiary indicators. The dimension of reach included the number of children and adolescents involved, participant representativeness, and full-course participation representativeness. The dimension of effectiveness included multimorbidity incidence, myopia incidence, spherical equivalent, body mass index (BMI), overweight and obesity prevalence, waist-to-height ratio, comprehensive health knowledge score, and comprehensive health behavior score. The dimension of adoption covered school representativeness and representativeness of school nurses and teachers involved in implementation. The dimension of implementation included fidelity, content modification, and cost. The dimension of maintenance included individual health outcomes and organizational sustainment. Conclusion: This study developed implementation outcome indicators for comprehensive interventions targeting multimorbidity of myopia and obesity among the children and adolescents based on the RE-AIM framework. These indicators can serve as a reference for optimizing intervention research strategies related to common multimorbidity among children and adolescents in China.

Key words: Myopia, Obesity, Child and adolescent, RE-AIM framework, Delphi method

中图分类号:

R179

张依航, 蔡珊, 陈子玥, 刘云飞, 党佳佳, 师嫡, 李佳欣, 黄天彧, 宋逸. 基于RE-AIM框架儿童青少年近视与肥胖共病综合干预实施性研究结局指标的构建[J]. 北京大学学报（医学版）, 2025, 57(3): 436-441.

Yihang ZHANG, Shan CAI, Ziyue CHEN, Yunfei LIU, Jiajia DANG, Di SHI, Jiaxin LI, Tianyu HUANG, Yi SONG. Establishment of outcome indicators for the implementation of comprehensive intervention for multimorbidity of myopia and obesity among children and adolescents based on the RE-AIM framework[J]. Journal of Peking University (Health Sciences), 2025, 57(3): 436-441.

图/表 2

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Variables	n (%)
Gender
Man	15 (53.6)
Woman	13 (46.4)
Working experience/years
< 10	8 (28.6)
10-20	9 (32.1)
> 20	11 (39.3)
Major
Child and adolescent health	8 (28.6)
Clinical medicine	2 (7.1)
Health management	4 (14.3)
School nurse	6 (21.4)
Teacher	8 (28.6)
Education
Doctor	6 (21.4)
Master	2 (7.1)
Bachelor	18 (64.4)
Junior college	2 (7.1)
Title
Senior	2 (7.1)
Deputy senior	5 (17.9)
Intermediate	13 (46.4)
Junior	4 (14.3)
None	4 (14.3)

Primary indicator	Secondary indicator	Tertiary indicator	Mean	Standard deviation	Coefficient of variation	Full score frequency/%
Reach	Number of children and adolescents enrolled		4.86	0.36	0.07	85.7
	Representativeness of participants	Baseline representativeness	4.96	0.19	0.04	96.4
		Full-course representativeness	4.93	0.26	0.05	92.9
Effectiveness	Primary disease outcomes	Incidence of multimorbid conditions	5.00	0	0	100.0
	Secondary disease outcomes	Incidence rate of myopia	5.00	0	0	100.0
		Spherical equivalent	4.89	0.31	0.06	89.3
		Body mass index	4.96	0.19	0.04	96.4
		Prevalence of overweight and obesity	4.93	0.26	0.05	92.9
		Waist-to-height ratio	5.00	0	0	100.0
	Health literacy	Comprehensive health knowledge score	4.59	0.43	0.1	61.2
	Health behaviors	Comprehensive health behavior score	4.93	0.26	0.05	92.9
Adoption	Organizational level	Representativeness of participating schools	4.86	0.36	0.07	85.7
	Individual level	Representativeness of school nurses/teachers	4.75	0.44	0.09	75.0
Implementation	Fidelity		4.96	0.19	0.04	96.4
	Content modifications		4.31	0.47	0.11	30.4
	Cost		4.50	0.48	0.11	52.7
Maintenance	Individual health outcomes	Prevalence of comorbid conditions	5.00	0	0	100.0
		Prevalence of myopia	4.96	0.19	0.04	96.4
		Prevalence of overweight and obesity	5.00	0	0	100.0
	Organizational sustainment		4.93	0.26	0.05	92.9