Understanding how low-income communities gain access to healthcare services: A qualitative study in Sao Paulo, Brazil
Understanding how low-income communities gain access to healthcare services: A qualitative study in Sao Paulo, Brazil
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DOI：
10.1016/j.jth.2019.100658
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发表时间：
2019-12-01
影响因子：
3.6
通讯作者：
Timms, Paul
中科院分区：
文献类型：
--
作者：
Guimaraes, Thiago;Lucas, Karen;Timms, Paul
导言：获得医疗保健被认为是获得医疗保健的一个重要组成部分。可及性差距可能会加剧健康不平等，并加重社会弱势群体的负担，他们患病率较高，寿命较短。本研究的目的是确定，从低收入的人的角度来看，他们容易获得医疗保健的决定因素，以及如何影响后，短期和长期的流动性战略activityparticipation.Methods：本研究采取了定性的方法，指导下的概念框架，结合交通劣势和社会排斥的角度与人类需求的理论。我们聘请焦点小组收集的意见和经验，从114名居民的12个低收入社区在圣保罗（巴西）的医疗服务可及性。结果：五个新兴的主题包括医疗服务的主要障碍，即：接近和偏远，步行安全，公共交通服务，个人安全问题，和医疗服务的质量。与会者解释了获得医疗保健的困难，而不仅仅是地理位置和距离等因素。一系列相互关联的多方面因素影响着圣保罗穷人获得医疗保健的机会。即使在严重的财政和时间限制下，人们也可能要花更长的时间才能到达被认为足以满足其保健需要的设施。参与者的叙述表明，医疗保健不足对流动战略产生了强烈的影响，例如患者与提供者关系的质量差以及接受医疗护理所需的时间长。在巴西的政策制定议程中，对人们获得医疗保健能力的“客观”评估往往过分强调患者家庭所在地与医疗保健服务实际所在地之间的空间分隔，最显著的是在行进时间或距离方面。解决健康不平等问题需要规划者设计综合运输和健康政策，同时考虑到运输和保健服务的充足性和质量。
Introduction: Accessibility to healthcare is recognised as an important component in the uptake of healthcare. Accessibility gaps may underpin health inequalities and the burden often born by socially disadvantaged groups who experience higher levels of disease and have shorter lives. This study aims to identify, from the perspective of people on low incomes, the determinants of their ease of access to healthcare, and how this impacts upon short- and long-term mobility strategies for activity participation.Methods: The research takes a qualitative approach, guided by a conceptual framework that combines transport disadvantage and social exclusion perspectives with human needs theories. We employed focus groups to gather views and experiences on healthcare accessibility from 114 residents of 12 low-income neighbourhoods in Sao Paulo (Brazil).Results: Five emergent themes encompass the main barriers to healthcare accessibility, namely: proximity and remoteness, walking safety, public transport services, personal security issues, and quality of healthcare services. Participants explained the difficulties of gaining access to healthcare beyond factors such as location and distance. A range of inter-related, multi-dimensional factors shapes the accessibility of the poor to healthcare in Sao Paulo. Even under severe financial and time constraints, people may travel longer to access facilities perceived as adequate to respond to their health needs. Participants' narratives suggest a strong effect of healthcare inadequacies, such as the poor quality of the patient-provider relationship and the long times needed to receive medical care, on mobility strategies.Conclusions: Within policy setting agendas in Brazil, "objective" assessments of people's ability to access healthcare tend to over-emphasise the spatial separation between patients' home locations and the physical location of healthcare services, most notably in terms of travel time or distance. Tackling health inequalities requires planners to design integrated transport and health policies taking into consideration the adequacy and quality of both transport and healthcare services.