Barriers to seeking care for accidental bowel leakage: a qualitative study.
Barriers to seeking care for accidental bowel leakage: a qualitative study.
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DOI：
10.1007/s00192-016-3195-1
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发表时间：
2017-04
影响因子：
1.8
通讯作者：
Wise ME
中科院分区：
文献类型：
--
作者：
Brown HW;Rogers RG;Wise ME
不到50%的尿失禁(UI)女性和30%的意外肠漏(ABL)女性寻求治疗。我们试图描述护理障碍，寻求ABL为测量这些障碍的工具的开发提供信息。我们招募了有不同求医经历的ABL女性参加焦点小组和认知访谈，这样我们就可以了解可能阻止或推迟求医的因素。重点小组继续进行，直到使用常规内容分析达到主题饱和。最终主题被建立，并通过比较焦点组内部和跨焦点组以及与先前描述的UI和ABL护理寻求障碍进行比较来表征。认知访谈是确认性的。39名女性(年龄在46-85岁)参加了6个焦点小组和10个认知访谈；89%是白人，8%是非裔美国人，3%是拉丁裔。我们确定了寻求ABL治疗的12个障碍：(1)缺乏对疾病的了解；(2)缺乏治疗知识；(3)对检测/治疗的恐惧；(4)规范思维；(5)回避/拒绝；(6)对生活的影响；(7)尴尬/羞耻；(8)自责；(9)耻辱；(10)孤立；(11)提供者障碍；(12)准入限制。这12个障碍包括三个主要主题：与ABL相关的内化自我；对ABL及其治疗的看法；以及与医疗系统的互动。ABL寻求护理的障碍类似于为UI所描述的障碍，但值得注意的是，他们缺乏对ABL是其他人经历的一种医学状况的了解。促进获得有效治疗ABL的干预措施应包括有关患病率和可治性的信息。
Fewer than 50 % of women with urinary incontinence (UI) and 30 % of women with accidental bowel leakage (ABL) seek care. We sought to describe barriers to care seeking for ABL to inform development of an instrument to measure these barriers. We recruited women with ABL with varied prior care-seeking experiences to participate in focus groups and cognitive interviews so we could understand factors that may have prevented or delayed care seeking. Focus groups continued until thematic saturation was reached using conventional content analysis. Final themes were established and characterized by comparing within and across the focus groups and with previously described UI and ABL care-seeking barriers. Cognitive interviews were confirmatory. Thirty-nine women (aged 46–85) participated in six focus groups and ten cognitive interviews; 89 % were white, 8 % African American, and 3 % Latina. We identified 12 barriers to seeking care for ABL: (1) Lack of knowledge about the condition; (2) Lack of knowledge about treatment; (3) Fear of testing/treatment; (4) Normative thinking; (5) Avoidance/ denial; (6) Life impact; (7) Embarrassment/shame; (8) Self-blame; (9) Stigma; (10) Isolation; (11) Provider barriers; (12) Access limitations. These 12 barriers encompassed three overarching themes: the internalized self in relation to ABL; perceptions about ABL and its treatments; and interaction with the healthcare system. ABL care-seeking barriers are similar to those described for UI, with the notable addition of lack of knowledge that ABL is a medical condition experienced by others. Interventions to promote access to effective treatments for ABL should include information about prevalence and treatability.