Using guidelines to improve neonatal health in China and Vietnam: a qualitative study.
Using guidelines to improve neonatal health in China and Vietnam: a qualitative study.
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DOI：
10.1186/s12913-016-1900-x
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发表时间：
2016-11-11
影响因子：
2.8
通讯作者：
Martineau T
中科院分区：
文献类型：
--
作者：
Raven J;Liu X;Hu D;Zhu W;Hoa DT;Thi LM;Duong DT;Alonso-Garbayo A;Martineau T
新生儿健康（NH）在许多国家仍然是一个主要问题。在28天内死亡的儿童往往患有可预防或通过已证实的、具有成本效益的干预措施可治疗的疾病。知识差距不再在于应该做什么，而是在于理解为什么包含这些干预措施的指南没有得到遵循。本研究利用一个行为改变框架，探讨了中国和越南两个农村地区新生儿健康指南的使用情况以及管理在支持有效使用方面的作用。
对政策制定者、医疗保健管理者和提供者（n = 49）进行了半结构化访谈，并与在过去一年中经历过孕产妇和新生儿健康护理服务的妇女、丈夫和祖母（n = 7）进行了焦点小组讨论。使用框架分析法对数据进行了分析。
在中国的研究地点，县、乡和村各级不容易获取指南，而在越南，指南在医疗机构层面是可获取的、被接受的且正在被使用。两个地区在实施方面都有改进的空间。两个地区共同影响指南使用的因素包括：设备和物资缺乏；有新生儿健康护理经验的人员短缺；指南与患者的实际做法不符。中国特有的因素包括：指南传播不力；对指南存在异议。在中国，社区对新生儿健康服务的参与有限，而在越南，社区成员积极参与决策和服务提供。管理者在通过以下方式支持新生儿健康指南的使用方面起着重要作用：确保指南可获取；分配适当的资源；支持和监督员工使用指南；以及与当地社区合作以推广有效的做法。
让管理者参与支持实施至关重要。需要有提供必要资源、有能力的工作人员以及监测、监管和激励框架以及社区参与的管理系统来促进指南的采用。需要进一步研究如何最好地加强地方层面的管理，以便他们根据自身的具体情况调整干预措施以支持指南的使用。这将确保采用已证实的干预措施来解决新生儿健康问题，并且各国更接近实现新的可持续发展目标3的指标。
本文的网络版（doi:10.1186/s12913 - 016 - 1900 - x）包含补充材料，授权用户可获取。
Neonatal health (NH) remains a major problem in many countries. Children dying before 28 days often suffer from conditions that are preventable or treatable with proven, cost-effective interventions. The knowledge gaps are no longer about what should be done, but to understand why guidelines including these interventions are not followed. Using a behaviour change framework, this study explores neonatal health guidelines use and the role of management in supporting effective usage in two rural settings in China and Vietnam. Semi-structured interviews with policy makers, health care managers and providers (n = 49) and focus group discussions with women, husbands and grandmothers who had experienced maternal and NH care services within the last year (n = 7) were conducted. Data were analysed using the framework approach. Guidelines are not readily available at county, township and village levels in the study sites in China, whereas, in Vietnam, guidelines are available, accepted and being used at facility level. Improvements in implementation could be made in both settings. Factors influencing guidelines use common to both settings included: lack of equipment and supplies; shortage of staff with NH care experience; and guidelines not in line with patient practices. Factors specific to China included: poor guidelines dissemination; and disagreement with guidelines. There was limited community engagement in NH services in China, whereas in Vietnam, community members were actively involved in decision making and provision of services. Managers have an important role in supporting NH guidelines use through: ensuring guidelines are available; allocating appropriate resources; supporting and monitoring staff in their use; and engaging with local communities to promote effective practices. Engaging managers to support implementation is crucial. Management systems that provide the necessary resources, competent staff, and monitoring, regulatory and incentive frameworks as well as community engagement are needed to promote adoption of guidelines. Further research on how best to strengthen local level management so that they tailor interventions to support guideline use to their specific context is needed. This will ensure that proven interventions to address NH problems are used, and that countries move closer to achieving the new Sustainable Development Goal 3 target. The online version of this article (doi:10.1186/s12913-016-1900-x) contains supplementary material, which is available to authorized users.
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