Explanatory models of hypertension in Guatemala: recognizing the perspectives of patients, family members, health care providers and administrators, and national-level health system stakeholders.
Explanatory models of hypertension in Guatemala: recognizing the perspectives of patients, family members, health care providers and administrators, and national-level health system stakeholders.
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DOI：
10.1186/s12889-022-14668-7
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发表时间：
2022-12-12
影响因子：
4.5
通讯作者：
中科院分区：
文献类型：
--
作者：
在危地马拉和其他低收入和中等收入国家，失控的高血压是一个主要的公共卫生负担，也是心血管疾病最常见的可预防风险因素。在评估危地马拉农村地区高血压干预的初步试验之前，我们收集了关于危地马拉公共医疗系统内高血压护理需求和知识差距的定性信息。这项分析应用克莱曼的疾病解释模型来捕捉患者、家庭成员、社区、地区和省级卫生保健提供者和管理者以及国家级卫生保健系统利益相关者对高血压的理解。我们对三种类型的参与者进行了深入访谈：1)国家卫生系统利益相关者(n = 17)，2)来自地区和卫生岗位级别的地方卫生保健提供者和管理者(25)，3)危地马拉索洛拉省和萨卡帕省的患者和家庭成员(19)。所有的采访都是用西班牙语进行的，除了6次玛雅-卡奇克尔的采访。我们还与辅助护士(3名)和病人(3名)进行了焦点小组讨论，其中一人使用玛雅-茨图吉尔语，其余人使用西班牙语。通过框架和矩阵分析，我们使用疾病领域的解释模型--病因、症状、病理生理学、病程和治疗--按参与者类型比较了对高血压的理解。健康提供者和管理人员以及患者将高血压描述为一种由悲伤、愤怒和担忧等情绪状态引发的疾病；是遗传性的，与老年有关；会产生身体虚弱、神经衰弱、疼痛和头痛等症状。患者对高血压治疗的长期后果表示担忧，尽管他们试图遵守治疗。患者表示，他们将生物医学治疗(如果可用)与自然疗法(茶叶和植物)相结合。医疗服务提供者、管理人员和家庭成员表示，一旦患者感觉好一些，他们往往会放弃治疗。国家级卫生系统利益攸关方将生活方式因素视为重要原因，认为患者通常不遵守规定，并将预算限制确定为高血压护理的关键障碍。这三组参与者确定了有限高血压护理的结构性障碍(例如，获得健康食品的机会有限，药物负担不起)。由于不同类型的参与者对高血压的理解不同，考虑到每个参与者在卫生系统中所扮演的角色，描述他们的相似和不同是很重要的。考虑到对高血压的不同看法将使项目规划和实施工作更有见地。
Uncontrolled hypertension is a major public health burden and the most common preventable risk factor for cardiovascular diseases in Guatemala and other low- and middle-income countries. Prior to an initial trial that evaluated a hypertension intervention in rural Guatemala, we collected qualitative information on the needs and knowledge gaps of hypertension care within Guatemala’s public healthcare system. This analysis applied Kleinman’s Explanatory Models of Illness to capture how patients, family members, community-, district-, and provincial-level health care providers and administrators, and national-level health system stakeholders understand hypertension. We conducted in-depth interviews with three types of participants: 1) national-level health system stakeholders (n = 17), 2) local health providers and administrators from district, and health post levels (25), and 3) patients and family members (19) in the departments of Sololá and Zacapa in Guatemala. All interviews were conducted in Spanish except for 6 Maya-Kaqchikel interviews. We also conducted focus group discussions with auxiliary nurses (3) and patients (3), one in Maya-Tz’utujil and the rest in Spanish. Through framework and matrix analysis, we compared understandings of hypertension by participant type using the Explanatory Model of Illness domains -etiology, symptoms, pathophysiology, course of illness, and treatment. Health providers and administrators, and patients described hypertension as an illness that spurs from emotional states like sadness, anger, and worry; is inherited and related to advanced age; and produces symptoms that include a weakened body, nerves, pain, and headaches. Patients expressed concerns about hypertension treatment’s long-term consequences, despite trying to comply with treatment. Patients stated that they combine biomedical treatment (when available) with natural remedies (teas and plants). Health providers and administrators and family members stated that once patients feel better, they often disengage from treatment. National-level health system stakeholders referred to lifestyle factors as important causes, considered patients to typically be non-compliant, and identified budget limitations as a key barrier to hypertension care. The three groups of participants identified structural barriers to limited hypertension care (e.g., limited access to healthy food and unaffordability of medications). As understandings of hypertension vary between types of participants, it is important to describe their similarities and differences considering the role each has in the health system. Considering different perceptions of hypertension will enable better informed program planning and implementation efforts.
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DOI：
10.1016/s0140-6736(18)32225-6
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Risk Factor Collaborators
通讯作者：
GBD 2017 Risk Factor Collaborators
DOI：
10.1038/s41581-019-0244-2
发表时间：
2020-04
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Mills KT;Stefanescu A;He J
通讯作者：
He J
影响因子：
3.7
作者：
Fort, Meredith P.;Paniagua-Avila, Alejandra;Ramirez-Zea, Manuel
通讯作者：
Ramirez-Zea, Manuel
影响因子：
6
作者：
Miller AC;Tuiz E;Shaw L;Flood D;Garcia P;Dhaenens E;Thomson DR;Barnoya J;Montano CM;Rohloff P
通讯作者：
Rohloff P
影响因子：
3.6
作者：
Hitziger, Martin;Gonzalez, Monica Berger;Krutli, Pius
通讯作者：
Krutli, Pius