BACKGROUND A cluster-Randomised Controlled Trial evaluation of the impact of the Community Health Clubs (CHCs) in the Community Based Environmental Health Promotion Programme in Rwanda in 2015 appeared to find little uptake of 7 hygiene indicators 1 year after the end of the intervention, and low impact on prevention of diarrhoea and stunting. METHODS Monitoring data was revisited through detailed community records with all the expected inputs, outputs and external determinants analysed for fidelity to the research protocol. Five household inventory observations were taken over a 40-month period including 2 years after the end of the cRCT in a random selection of the 50 intervention CHCs and data compared to that of the trial. Focus Group Discussion with all Environmental Health Officers of the Ministry of Health provided context to understand the long-term community dynamics of hygiene behaviour change. RESULTS It was found that the intervention had been jeopardised by external determinants with only 54% fidelity to protocol. By the end of the designated intervention period in June 2014, the treatment had reached only 58% of households with 41% average attendance at training sessions by the 4056 registered members and 51% mean completion rate of 20+ sessions. Therefore only 10% of 50 CHCs provided the full so-called 'Classic' training as per-protocol. However, sustainability of the CHCs was high, with all 50 being active 2 years after the end of the cRCT and over 80% uptake of recommended practices of the same 7 key indicators as the trial was achieved by 2017. CONCLUSIONS The cRCT conclusion that the case study of Rusizi District does not encourage the use of the CHC model for scaling up, raises concerns over the possible misrepresentation of the potential of the holistic CHC model to achieve health impact in a more realistic time frame. It also questions the appropriateness of apparently rigorous quantitative research, such as the cluster-Randomised Controlled Trial as conducted in Rusizi District, to adequately assess community dynamics in complex interventions.

中文翻译：

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在社区卫生俱乐部进行的卫生行为变化过程评估中，监测数据的价值可解释卢旺达的一项集群随机对照试验的结果。

背景技术2015年在卢旺达实施的以社区为基础的环境健康促进计划中，对社区健康俱乐部（CHC）的影响进行了随机分组对照试验评估，发现干预结束1年后几乎没有7种卫生指标被采用，并且对预防腹泻和发育迟缓的影响很小。方法通过详细的社区记录重新审查监测数据，并分析所有预期的输入，输出和外部决定因素，以确保符合研究方案的要求。在cRCT结束后的2年内，在40个月的时间内进行了五次住户调查，随机选择了50个干预性CHC，并与试验进行了比较。与卫生部所有环境卫生官员进行的焦点小组讨论为了解卫生行为改变的长期社区动态提供了背景。结果发现干预措施受到外部决定因素的危害，对方案的忠诚度仅为54％。到2014年6月指定的干预期结束时，只有58％的家庭接受了这种治疗，其中4056名注册成员平均参加培训课程的平均比例为41％，平均完成20次以上的比例为51％。因此，只有50％的社区卫生服务中心按协议提供了完整的所谓“经典”培训。但是，社区卫生中心的可持续性很高，cRCT结束后的2年内，全部50个都处于活动状态，并且到2017年，采用了与该试验相同的7个关键指标的推荐做法超过了80％。结论cRCT的结论是，Rusizi区的案例研究不鼓励使用CRCT。使用CHC模型进行规模扩大，引起了人们对整体CHC模型在更现实的时间范围内对健康产生影响的潜在误解的担忧。它还质疑明显严格的定量研究的适当性，例如在Rusizi区进行的集群随机对照试验，以充分评估复杂干预措施中的社区动态。引起人们对整体CHC模型在更现实的时间范围内实现健康影响的潜力的误报。它还质疑明显严格的定量研究的适当性，例如在Rusizi区进行的集群随机对照试验，以充分评估复杂干预措施中的社区动态。引起人们对整体CHC模型在更现实的时间范围内实现健康影响的潜力的误报。它还质疑明显严格的定量研究的适当性，例如在Rusizi区进行的集群随机对照试验，以充分评估复杂干预措施中的社区动态。