Analysis of the current status and influencing factors of multi-actor participation in community health governance based on the consolidated Framework for Implementation Research (CFIR)
基于实施研究综合框架（CFIR）的多主体参与社区健康治理的现况与影响因素分析

摘要

目的 了解社区健康治理中多元主体的参与现况及关键因素，为优化基层健康治理路径提供依据。方法 于2025年3-6月，采用目的性抽样与滚雪球抽样相结合的方法，在杭州市3个区6个街道（镇）选取社区卫生服务中心工作人员12人、社区居（村）委会工作人员11人、居民10人进行半结构化访谈。以实施研究综合框架（CFIR）为分析框架，采用主题框架分析法分析资料。结果 共编码632条有效语句，形成46个初始范畴和19个主范畴，纳入CFIR的5个维度。发现干预方案来源行政单一，考核导向压缩了服务按需调适的空间；外部协作网络初步形成但缺乏制度化保障；内部资源硬件改善而人力、信息利用等软件相对滞后；个体特征维度编码密度最低（17个参考点，占2.7%），居民治理主体的作用尚未显现；动员与执行环节较为活跃，效果评估与反馈薄弱，供需错位难以及时校正。结论 当前社区健康治理仍呈任务驱动特征。应调整绩效评估体系，建立制度化协同平台，推动人才与技术协同赋能，激活居民主体性，推动治理动力由任务驱动向需求牵引转变。

Abstract

Objective To investigate the current status and key factors of multi-stakeholder participation in community health governance, so as to provide evidence for optimizing grassroots health governance pathways.
Methods From March to June 2025, a combination of purposive sampling and snowball sampling was used to select participants from 6 subdistricts (towns) across 3 districts in Hangzhou, including 12 staff members from community health service centers, 11 staff members from community (village) committees, and 10 residents. Semi-structured interviews were conducted, and the data were analyzed using framework analysis based on the Consolidated Framework for Implementation Research (CFIR).
Results A total of 632 valid statements were coded, yielding 46 initial categories and 19 main categories, all of which were mapped onto the five CFIR domains. The findings showed that the sources of intervention programs were administratively singular, with assessment orientation constraining the space for demand-based service adaptation; an external collaboration network had been preliminarily established but lacked institutionalized safeguards; internal resources showed improved hardware but relatively lagging software, such as human resources and information utilization; the individual characteristics domain had the lowest coding density (17 reference points, 2.7%), indicating that residents’ role as governance subjects had not yet emerged; and the mobilization and implementation phases were relatively active, while effectiveness evaluation and feedback were weak, making supply-demand mismatches difficult to correct in a timely manner.
Conclusion   Current community health governance remains task-driven. It is necessary to restructure the performance evaluation system, establish institutionalized collaboration platforms, promote the synergistic empowerment of talent and technology, activate residents’ agency, and shift the driving force of governance from task-driven to demand-driven.