Distrusting community health workers with confidential health information: a convergent mixed-methods study in Swaziland
Distrusting community health workers with confidential health information: a convergent mixed-methods study in Swaziland
复制标题
DOI：
10.1093/heapol/czx036
复制
发表时间：
2017-07-01
影响因子：
3.2
通讯作者：
Baernighausen, Till
中科院分区：
文献类型：
--
作者：
Geldsetzer, Pascal;Vaikath, Maria;Baernighausen, Till
背景如果患者不相信这些信息会保密，他们就不太可能分享对有效医疗至关重要的个人信息。在与社区卫生工作者（CHW）的互动中，对保密性的信任可能特别低，因为CHW在诊所环境之外提供医疗保健。本研究的目的是确定斯威士兰的人口比例，不信任的国家CHW干部与机密的医疗信息，并确定原因不信任。方法采用两阶段整群随机抽样，我们进行了一项家庭调查，涵盖2000户100个普查查点地区在斯威士兰的四个地区。为了确认和解释的定量调查结果，我们使用了定性数据从19个半结构化的焦点小组讨论在同一population.Results49%的家庭调查参与者表示，他们不信任的国家卫生保健干部与保密的健康信息。曾经被CHW访问过与信任呈正相关（aOR：2.11; P < 0.001），而受访者的较高教育水平呈负相关（中学以上教育与未接受教育的aOR：0.21; P < 0.001）。在定性分析中出现了以下三个不信任CHW的主要原因：（1）社区保健工作者与其客户属于同一社区，因此可能会与认识客户的人分享信息，（2）社区保健工作者大多数是妇女，一些焦点小组参与者认为妇女比男子更有可能与其他社区成员分享信息，和（3）CHW没有得到足够的培训，在保密issues.Conclusion我们的研究结果表明，保密问题可能是一个重大的障碍，成功推出CHW服务的污名化条件在斯威士兰。增加社区卫生工作者方案的覆盖面，提高民众对社区卫生工作者培训的信心，将社区卫生工作者分配到他们居住的社区以外的社区工作，改变社区卫生工作者的性别构成，以及解决性别偏见问题，都可能增加对保密的信任。
Background Patients are unlikely to share the personal information that is critical for effective healthcare, if they do not trust that this information will remain confidential. Trust in confidentiality may be particularly low in interactions with community health workers (CHW) because CHW deliver healthcare outside the clinic setting. This study aims to determine the proportion of Swaziland's population that does not trust the national CHW cadre with confidential medical information, and to identify reasons for distrust.Methods Using two-stage cluster random sampling, we carried out a household survey covering 2000 households across 100 census enumeration areas in two of Swaziland's four regions. To confirm and explain the quantitative survey results, we used qualitative data from 19 semi-structured focus group discussions in the same population.Results 49% of household survey participants stated that they distrust the national CHW cadre with confidential health information. Having ever been visited by a CHW was positively associated with trust (aOR: 2.11; P < 0.001), while higher levels of schooling of the respondent were negatively associated (aOR for more than secondary schooling versus no schooling: 0.21; P < 0.001). The following three primary reasons for distrusting CHW with confidential health information emerged in the qualitative analyses: (1) CHW are members of the same community as their clients and may thus share information with people who know the client, (2) CHW are mostly women and several focus group participants assumed that women are more likely than men to share information with other community members, and (3) CHW are not sufficiently trained in confidentiality issues.Conclusion Our findings suggest that confidentiality concerns could be a significant obstacle to the successful rollout of CHW services for stigmatized conditions in Swaziland. Increasing coverage of the CHW program, raising the population's confidence in CHWs' training, assigning CHW to work in communities other than the ones in which they live, changing the CHW gender composition, and addressing gender biases may all increase trust with regards to confidentiality.