Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias.
Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias.
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DOI：
10.1136/bmjopen-2022-069060
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发表时间：
2023-06-26
期刊：
影响因子：
2.9
通讯作者：
Lee A
中科院分区：
文献类型：
--
作者：
Joshi S;Karki A;Rushton S;Koirala B;Basnet S;Rijal B;Karki J;Pohl G;Baidya M;Chater T;Green D;Lee A
本研究探讨了提供者的观点：（1）为什么不平等的卫生服务使用持续存在;（2）他们的知识和理解的作用，病人的经验和隐性偏见（也称为无意识偏见）。一个三阶段，迭代定性研究进行了两轮深入访谈和培训会议与医护人员。访谈记录进行了分析，使用自反性的主题方法与研究的目的。参与者是从尼泊尔的农村山区（穆古、胡姆拉、巴朱拉、戈尔卡和辛杜帕尔乔克）招募的。来自22个农村卫生站的医务人员。医疗保健提供者对社区医疗保健使用不平等背后的文化、教育和社会经济因素有着高度的理解。然而，对病人经验的作用了解和理解较少，而且根本没有认识到内隐偏见的概念。隐性偏见很可能影响尼泊尔的提供者行为，就像在其他国家一样。然而，目前还没有一种文化来考虑病人的经历以及这可能对未来使用卫生服务产生的影响。对卫生专业学生和工作人员进行隐性偏见培训将有助于提高对非故意歧视行为的认识。这反过来可能会在改善患者体验和未来医疗保健使用方面发挥作用，特别是在弱势群体中。
This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias). A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study’s aims. Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal. Clinical staff from 22 rural health posts. Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience—and no recognition at all of the concept of implicit bias. It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.
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影响因子：
3.7
作者：
K C A;Moinuddin M;Kinney M;Sacks E;Gurung R;Sunny AK;Bhattarai P;Sharma S;Målqvist M
通讯作者：
Målqvist M
DOI：
10.1590/s0034-89102010000100001
发表时间：
2010-02-01
期刊：
Revista de Saúde Pública
影响因子：
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作者：
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作者：
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通讯作者：
Maldonado, Yvonne A.
影响因子：
3.7
作者：
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影响因子：
3.2
作者：
Pokhrel, S;Sauerborn, R
通讯作者：
Sauerborn, R