Improving pathways to care through interventions cocreated with communities: a qualitative investigation of men's barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi.
Improving pathways to care through interventions cocreated with communities: a qualitative investigation of men's barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi.
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DOI：
10.1136/bmjopen-2020-044944
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发表时间：
2021-06-30
期刊：
影响因子：
2.9
通讯作者：
MacPherson EE
中科院分区：
文献类型：
--
作者：
Phiri MM;Makepeace E;Nyali M;Kumwenda M;Corbett L;Fielding K;Choko A;MacPherson P;MacPherson EE
男性未确诊结核病的患病率高于女性，在接受治疗之前，可能会在社区中持续传播长达一年的时间。生活在非正规住区的结核病患者，特别是男性，健康结果往往更糟。本研究旨在了解阻碍男性寻求结核病护理的障碍，并共同制定干预措施来解决这些障碍。我们采用了定性研究方法，包括深入访谈和参与式研讨会。研究人员与生活在马拉维布兰太尔的一个非正式定居点Bangwe的妇女和男子合作，制定反映他们生活现实的干预措施。该研究分两个阶段进行，在第一阶段，我们对男性和女性进行了访谈，以探讨寻求护理的障碍，在第二阶段，我们使用参与式研讨会来共同创建干预措施，以解决障碍，并对研讨会中出现的问题进行进一步的访谈。共进行了30次访谈，23名参与者参加了参与式讲习班。该小组使用专题分析来分析数据。三个相互关联的主题领域塑造了男性健康结核病寻求行为：不稳定的社会经济条件;性别社会规范;以及卫生系统的限制。没有病假的无保障的日工、养家糊口的压力、不想显得软弱的性别愿望以及资源严重不足的卫生系统，都是造成男子在这方面拖延护理的原因。已确定的干预措施包括改善保健系统内病人与提供者的关系、改善工人的健康权利和扩大对家庭的社会支助。改善男子获得护理的途径需要采取干预措施，通过解决个人一级的社会经济因素以及性别社会动态和卫生系统环境的更广泛的结构性因素，考虑背景问题。
Men have a higher prevalence of undiagnosed tuberculosis (TB) than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment. Health outcomes are often worse for patients with TB living in informal settlements especially men. This study aimed to understand the barriers preventing men from seeking care for TB and cocreate interventions to address these barriers. We used qualitative research methods including in-depth interviews and participatory workshops. Researchers worked with women and men living in Bangwe, an informal settlement in Blantyre, Malawi to develop interventions that reflected their lived realities. The study took place over two phases, in the first phase we undertook interviews with men and women to explore barrier to care seeking, in the second phase we used participatory workshops to cocreate interventions to address barriers and followed up on issues emerging from the workshops with further interviews. In total, 30 interviews were conducted, and 23 participants joined participatory workshops. The team used a thematic analysis to analyse the data. Three interconnected thematic areas shaped men’s health TB seeking behaviour: precarious socioeconomic conditions; gendered social norms; and constraints in the health system. Insecurity of day labour with no provision for sick leave; pressure to provide for the household and a gendered desire not to appear weak and a severely under-resourced health system all contributed to men delaying care in this context. Identified interventions included improved patient–provider relations within the health-system, improved workers’ health rights and broader social support for households. Improving mens’ pathways to care requires interventions that consider contextual issues by addressing individual level socioeconomic factors but also broader structural factors of gendered social dynamics and health systems environment.
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影响因子：
5
作者：
Dodd PJ;Looker C;Plumb ID;Bond V;Schaap A;Shanaube K;Muyoyeta M;Vynnycky E;Godfrey-Faussett P;Corbett EL;Beyers N;Ayles H;White RG
通讯作者：
White RG
影响因子：
11.1
作者：
Baker P;Dworkin SL;Tong S;Banks I;Shand T;Yamey G
通讯作者：
Yamey G
DOI：
10.2471/blt.06.033167
发表时间：
2007-08-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Kemp, Julia R;Mann, Gillian;Squire, Stephen Bertel
通讯作者：
Squire, Stephen Bertel
影响因子：
3.2
作者：
Cashin, CE;Borowitz, M;Zuess, O
通讯作者：
Zuess, O
影响因子：
2.8
作者：
Abiiro GA;Mbera GB;De Allegri M
通讯作者：
De Allegri M