The impact of persistent precarity on patients' capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa.
The impact of persistent precarity on patients' capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa.
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DOI：
10.3389/fmed.2023.1061190
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发表时间：
2023
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
--
作者：
低收入和中等收入国家（LMICs）的多重疾病患者在努力满足自我管理需求方面工作量很大。在南非这样一个不平等的社会中，许多人面临着持续的经济不确定性，这可能影响他们管理疾病的能力，并导致不良的健康结果。本文以不稳定性——不确定性的真实和感知影响——为视角，旨在识别、描述和理解生活在南非城市和农村不稳定环境中的多重疾病患者与自我管理相关的工作量和能力。我们在2021年2月至4月期间对30名艾滋病毒和合并症患者进行了定性半结构化访谈。患者在开普敦（西开普省）和布隆古拉（东开普省）的公共诊所就诊。访谈记录和数据分析使用定性框架分析。治疗负担理论（BoTT）和累积复杂性模型（CuCoM）被用作概念化数据的理论透镜。南非农村和城市的多重疾病患者经历了多方面的不稳定，包括经济和住房不安全、危险的生活环境和遭受暴力。妇女在社区，有时在家中感到不安全，而男子则在药物使用和缺乏社会支持中挣扎。老年患者依赖小额收入补助，通常与他人分享，而年轻患者则努力寻找稳定的工作，并将自我管理与家庭责任结合起来。不稳定影响了获得保健服务和信息的机会，影响了人们购买健康食品和自付药品的能力，从而增加了他们的治疗负担，降低了他们的能力。这项研究强调，不稳定性降低了能力，增加了南非低收入环境中多病患者的治疗负担。不稳定性是累积性和周期性的，因为金融不安全影响着人们日常生活的方方面面。研究结果强调，目前检查治疗负担的模型需要进行调整，以适应低收入环境中患者的经历，并解决累积的不稳定性问题。了解中低收入国家患者的治疗负担和治疗能力是重新设计旨在改善自我管理和提供以人为本的全面护理的卫生系统的关键第一步。
People living with multimorbidity in low-and middle-income countries (LMICs) experience a high workload trying to meet the demands of self-management. In an unequal society like South Africa, many people face continuous economic uncertainty, which can impact on their capacity to manage their illnesses and lead to poor health outcomes. Using precariousness – the real and perceived impact of uncertainty – as a lens, this paper aims to identify, characterise, and understand the workload and capacity associated with self-management amongst people with multimorbidity living in precarious circumstances in urban and rural South Africa. We conducted qualitative semi-structured interviews with 30 patients with HIV and co-morbidities between February and April 2021. Patients were attending public clinics in Cape Town (Western Cape) and Bulungula (Eastern Cape). Interviews were transcribed and data analysed using qualitative framework analysis. Burden of Treatment Theory (BoTT) and the Cumulative Complexity Model (CuCoM) were used as theoretical lenses through which to conceptualise the data. People with multimorbidity in rural and urban South Africa experienced multi-faceted precariousness, including financial and housing insecurity, dangerous living circumstances and exposure to violence. Women felt unsafe in their communities and sometimes their homes, whilst men struggled with substance use and a lack of social support. Older patients relied on small income grants often shared with others, whilst younger patients struggled to find stable employment and combine self-management with family responsibilities. Precariousness impacted access to health services and information and peoples’ ability to buy healthy foods and out-of-pocket medication, thus increasing their treatment burden and reducing their capacity. This study highlights that precariousness reduces the capacity and increases treatment burden for patients with multimorbidity in low-income settings in South Africa. Precariousness is both accumulative and cyclic, as financial insecurity impacts every aspect of peoples’ daily lives. Findings emphasise that current models examining treatment burden need to be adapted to accommodate patients’ experiences in low-income settings and address cumulative precariousness. Understanding treatment burden and capacity for patients in LMICs is a crucial first step to redesign health systems which aim to improve self-management and offer comprehensive person-centred care.
影响因子：
3.7
作者：
Smith PJ;Davey DJ;Green H;Cornell M;Bekker LG
通讯作者：
Bekker LG