Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa.
Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa.
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DOI：
10.1136/bmjgh-2016-000231
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发表时间：
2017
影响因子：
8.1
通讯作者：
Byass P
中科院分区：
文献类型：
--
作者：
Brooks C;D'Ambruoso L;Kazimierczak K;Ngobeni S;Twine R;Tollman S;Kahn K;Byass P
南非是一个面临复杂的健康和社会不平等的国家，艾滋病毒/艾滋病造成了毁灭性的影响。该研究旨在深入了解农村社区对艾滋病毒相关死亡率的看法。启动了一项参与式行动研究 (PAR) 流程，包括视觉参与式方法（Photovoice），以获取和组织当地知识，并确定在阿金库尔卫生和社会人口监测系统 (HDSS) 支撑下的农村分区的行动优先事项。我们召集了三个以村庄为基础的讨论小组，提供了与艾滋病毒相关的死亡率的 HDSS 数据，引出了关于艾滋病毒/艾滋病的主观观点，将这些观点系统化到集体账户中，并确定了行动的优先事项。对叙事和视觉数据进行框架分析，并使用实践理论来解释研究结果。一系列社会和卫生系统因素被确定为艾滋病毒死亡的原因和促成因素。这些问题包括酗酒/滥用、性别不平等、艾滋病毒感染状况披露带来的耻辱、非正式护理问题、卫生条件差、有害的传统习俗、治疗延误、药物问题以及员工与患者关系问题。为了解决这些问题，确定了在社区发展青年设施、改善就业机会、及时治疗以及扩大社区健康教育和健康促进范围。解决与艾滋病毒相关的死亡率相关的指责、耻辱和不信任的社会实践可能是政策和规划的一个有用的重点。让社区和当局共同提供证据的研究可以捕捉这些做法，改善沟通并建立信任。减少艾滋病毒的行动不应超越个人机构和结构性力量，而应关注社会实践如何体现这些要素。启动包含视觉方法的 PAR 可以建立对社会和卫生系统背景下疾病负担的共同理解。这可以建立共同的责任并改善员工与患者的关系，随着时间的推移，这可能会解决所发现的问题，这里涉及耻辱和指责。
South Africa is a country faced with complex health and social inequalities, in which HIV/AIDS has had devastating impacts. The study aimed to gain insights into the perspectives of rural communities on HIV-related mortality. A participatory action research (PAR) process, inclusive of a visual participatory method (Photovoice), was initiated to elicit and organise local knowledge and to identify priorities for action in a rural subdistrict underpinned by the Agincourt Health and Socio-Demographic Surveillance System (HDSS). We convened three village-based discussion groups, presented HDSS data on HIV-related mortality, elicited subjective perspectives on HIV/AIDS, systematised these into collective accounts and identified priorities for action. Framework analysis was performed on narrative and visual data, and practice theory was used to interpret the findings. A range of social and health systems factors were identified as causes and contributors of HIV mortality. These included alcohol use/abuse, gender inequalities, stigma around disclosure of HIV status, problems with informal care, poor sanitation, harmful traditional practices, delays in treatment, problems with medications and problematic staff–patient relationships. To address these issues, developing youth facilities in communities, improving employment opportunities, timely treatment and extending community outreach for health education and health promotion were identified. Addressing social practices of blame, stigma and mistrust around HIV-related mortality may be a useful focus for policy and planning. Research that engages communities and authorities to coproduce evidence can capture these practices, improve communication and build trust. Actions to reduce HIV should go beyond individual agency and structural forces to focus on how social practices embody these elements. Initiating PAR inclusive of visual methods can build shared understandings of disease burdens in social and health systems contexts. This can develop shared accountability and improve staff–patient relationships, which, over time, may address the issues identified, here related to stigma and blame.