Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala
Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala
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DOI：
10.1186/s13002-017-0170-y
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发表时间：
2017-08-08
影响因子：
3.6
通讯作者：
Krutli, Pius
中科院分区：
文献类型：
--
作者：
Hitziger, Martin;Gonzalez, Monica Berger;Krutli, Pius
背景资料：在非洲、亚洲和拉丁美洲，多达一半的人口几乎无法获得高质量的生物医学服务，只能依赖传统的保健系统。因此，在许多发展中国家，医疗多元化是一种规则，而不是例外，这就是为什么世界卫生组织呼吁建立跨文化伙伴关系，以改善这些地区的卫生保健。然而，由于不同的知识体系和缺乏信任阻碍了理解和协作，它们具有挑战性。我们开发了一个协作的，以病人为中心的边界机制，以克服这些挑战，并促进跨文化的伙伴关系，在医疗保健。为了评估其对跨文化的病人护理质量的影响，在一个医疗多元化的发展中国家，我们进行了评估的案例study.Methods：案例研究发生在危地马拉，因为以前的努力，在这个国家发起跨文化的医疗合作伙伴关系受到了严重的历史和社会冲突。它是由来自ETH苏黎世跨学科实验室、危地马拉国家癌症研究所、两个传统的长老理事会和25名来自Kaqchikel和Q 'eqchi语言群体的玛雅治疗师的团队设计的。2014年1月至2015年7月实施。科学家和传统的政治当局合作，促进由生物医学和传统从业人员联合举办的讲习班、比较诊断和病人转诊。传统的医疗做法进行了彻底的记录，因为是病人的健康寻求途径，和整体的影响进行了evaluated.Results：边界机制是成功的识别障碍的土著病人在生物医学卫生系统的访问，并在医生和治疗师之间建立信任。学习成果包括减少了对传统治疗师的陈规定型态度，由于医生加强了自我反省而改进了生物医学程序，以及由于改进了诊断和调整了治疗战略而改进了传统保健。在个别情况下，传统治疗的有益效果是显著的，医生在研究完成后继续与治疗师合作。两个语言组的比较表明，结果是高度依赖于context-dependent.Conclusions：如果很好地适应当地的情况下，以病人为中心的边界机制，可以使跨文化的伙伴关系，通过创建访问，建立信任和促进相互学习，即使在复杂的情况下，在危地马拉。因此，建立以患者为中心的多边边界机制是改善医疗多元化发展中国家卫生保健的一种有前途的方法。
Background: Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study.Methods: The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated.Results: The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent.Conclusions: If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.