Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention.
Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention.
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DOI：
10.1136/bmjopen-2021-049900
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发表时间：
2021-10-01
期刊：
影响因子：
2.9
通讯作者：
Wingfield T
中科院分区：
文献类型：
--
作者：
Dixit K;Biermann O;Rai B;Aryal TP;Mishra G;Teixeira de Siqueira-Filha N;Paudel PR;Pandit RN;Sah MK;Majhi G;Levy J;Rest JV;Gurung SC;Dhital R;Lönnroth K;Squire SB;Caws M;Sidney K;Wingfield T
社会心理和经济（社会经济）障碍，包括贫困、耻辱和灾难性费用，阻碍了低收入国家获得结核病（TB）服务。我们的目的是描述尼泊尔获得结核病服务的社会经济障碍和促进因素，为受结核病影响的家庭设计适合当地的社会经济支持干预措施提供信息。从 2018 年 8 月到 2019 年 7 月，我们进行了一项探索性定性研究，其中包括与有意选择的多部门利益相关者进行半结构化焦点小组讨论 (FGD)。数据在 NVivo V.12 中进行管理，按共识进行编码并按主题进行分析。这项研究是在贫困和结核病发病率较高的马克万普尔、奇旺、达努沙和马霍塔里四个地区进行的。 7 次 FGD 与 54 个国内利益相关者一起进行，这些利益相关者按利益相关者分组，包括结核病患者 (n=21)、社区利益相关者 (n=13) 和来自国家结核病规划的多学科结核病医疗保健专业人员 (n=20)。获得结核病服务的社会经济障碍包括： 结核病知识和宣传不足；高昂的食品和运输成本；收入损失和耻辱。人们认为获得结核病护理和服务的促进因素包括： 加强对结核病和结核病服务的宣传和认识；社会保护，包括健康保险；现金、代金券和/或营养津贴，用于支付食品和旅行费用；社会心理支持和咨询与国家结核病规划现有的依从性咨询相结合。这些结果表明，整合结核病教育、社会心理咨询和扩大现有现金转移计划的支持干预措施将适合当地情况，并且可以解决尼泊尔结核病家庭在获得和参与结核病服务方面面临的社会经济障碍。研究结果已用于为受结核病影响的家庭设计社会经济支持干预措施。目前，尼泊尔的一项试点实施研究正在评估这种干预措施的可接受性、可行性以及对结核病相关费用、耻辱感和结核病治疗结果的影响。
Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.
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DOI：
10.4103/0970-2113.217577
发表时间：
2017-11
期刊：
Lung India : official organ of Indian Chest Society
影响因子：
--
作者：
Anand T;Babu R;Jacob AG;Sagili K;Chadha SS
通讯作者：
Chadha SS
影响因子：
8.1
作者：
de Cuevas RM;Lawson L;Al-Sonboli N;Al-Aghbari N;Arbide I;Sherchand JB;Nnamdi EE;Aseffa A;Yassin MA;Abdurrahman ST;Obasanya J;Olanrewaju O;Datiko D;Theobald SJ;Ramsay A;Squire SB;Cuevas LE
通讯作者：
Cuevas LE
影响因子：
3.7
作者：
Khanal, Sudeepa;Elsey, Helen;Newell, James N.
通讯作者：
Newell, James N.
影响因子：
8.1
作者：
Gurung, Suman Chandra;Dixit, Kritika;de Siqueira-Filha, Noemia Teixeira
通讯作者：
de Siqueira-Filha, Noemia Teixeira
影响因子：
56.3
作者：
Arinaminpathy, Nimalan;Batra, Deepak;Khaparde, Sunil;Vualnam, Thongsuanmung;Maheshwari, Nilesh;Sharma, Lokesh;Nair, Sreenivas A.;Dewan, Puneet
通讯作者：
Dewan, Puneet