Mapping low-resource contexts to prepare for lung health interventions in four countries (FRESH AIR): a mixed-method study
Mapping low-resource contexts to prepare for lung health interventions in four countries (FRESH AIR): a mixed-method study
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DOI：
10.1016/s2214-109x(21)00456-3
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发表时间：
2022-01-01
影响因子：
34.3
通讯作者：
Reis, Ria
中科院分区：
文献类型：
--
作者：
Brakema, Evelyn A.;van der Kleij, Rianne M. J. J.;Reis, Ria
背景当卫生方案的实施与当地的信仰和行为不一致时，其有效性就会受到损害。要设计上下文驱动的实施策略，我们探讨了信念和行为慢性呼吸道疾病（CRD）在不同的低resource settings.Methods这种观察混合方法的研究进行了在非洲（乌干达），亚洲（吉尔吉斯斯坦和越南）和欧洲（农村希腊和罗姆人营地）。我们使用SETTING工具系统地绘制了信念和行为。在有目的地选择的社区成员，卫生保健专业人员和关键的线人之间的多重定性方法进行了三角与一个有代表性的群体的社区成员和卫生保健专业人员之间的定量调查。我们采用专题分析和描述性statistics.Findings我们包括定性数据从340线人（77次访谈，45焦点小组讨论，83观察社区成员的家庭和医疗保健专业人员的咨询）和定量数据从1037社区成员和204医疗保健专业人员。我们确定了三个关键主题的设置;即，（1）感知CRD身份（社区成员在所有设置，除了农村希腊强烈归因于长期的呼吸道症状感染，主要是结核病）;（2）信念的原因（682[65]。8%]的1037名社区成员强烈同意吸烟会导致症状，这一数字为198 [19。家庭空气污染;典型的感知原因从巫术[乌干达]到冷热失衡[越南]）;（3）规范与社会结构（例如，真实的男人吸烟[吉尔吉斯斯坦和越南]）。解释在这些全球环境中为CRD相关干预措施设计背景驱动的实施战略时，应解决三个一致的主题，每个人都有共同的和特定的信仰和行为。根据具体情况制定的战略可以减少执行失败的风险，从而优化资源使用，使健康成果受益。版权所有（C）2021作者。由爱思唯尔有限公司发布
Background Effectiveness of health programmes can be undermined when the implementation misaligns with local beliefs and behaviours. To design context-driven implementation strategies, we explored beliefs and behaviours regarding chronic respiratory disease (CRD) in diverse low-resource settings.Methods This observational mixed-method study was conducted in Africa (Uganda), Asia (Kyrgyzstan and Vietnam) and Europe (rural Greece and a Roma camp). We systematically mapped beliefs and behaviours using the SETTING tool. Multiple qualitative methods among purposively selected community members, health-care professionals, and key informants were triangulated with a quantitative survey among a representative group of community members and health-care professionals. We used thematic analysis and descriptive statistics.Findings We included qualitative data from 340 informants (77 interviews, 45 focus group discussions, 83 observations of community members' households and health-care professionals' consultations) and quantitative data from 1037 community members and 204 health-care professionals. We identified three key themes across the settings; namely, (1) perceived CRD identity (community members in all settings except the rural Greek strongly attributed long-lasting respiratory symptoms to infection, predominantly tuberculosis); (2) beliefs about causes (682[65. 8%] of 1037 community members strongly agreed that tobacco smoking causes symptoms, this number was 198 [19. 1%] for household air pollution; typical perceived causes ranged from witchcraft [Uganda] to a hot-cold disbalance [Vietnam]); and (3) norms and social structures (eg, real men smoke [Kyrgyzstan and Vietnam]).Interpretation When designing context-driven implementation strategies for CRD-related interventions across these global settings, three consistent themes should be addressed, each with common and context-specific beliefs and behaviours. Context-driven strategies can reduce the risk of implementation failure, thereby optimising resource use to benefit health outcomes. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.