寻找失踪的男性结核病患者:在乌干达采用参与式方法确定优先干预措施。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Jasper Nidoi, Justin Pulford, Tom Wingfield, Rachael Thomson, Beate Ringwald, Winceslaus Katagira, Winters Muttamba, Milly Nattimba, Zahra Namuli, Bruce Kirenga
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引用次数: 0

摘要

性别会影响结核病的暴露和易感性,男性结核病发病率和结核病漏诊率较高就是证明,而男性是结核病新发感染的主要人群。我们介绍了一项研究的形成性研究阶段,该研究采用参与式方法来确定针对不同性别的干预措施,以便对乌干达男性进行结核病系统筛查。我们在乌干达的四家综合医院(Kawolo、Gombe、Mityana 和 Nakaseke)收集了 70 名结核病利益相关者(包括医护人员、结核病幸存者、政策制定者和研究人员)在医疗机构层面的数据。他们利用健康求医路径,划分并比较了男性理想的和实际的结核病健康求医步骤,以确定结核病治疗的障碍。他们采用阶石法,将障碍描绘成一条 "河流",而每块 "阶石 "都是一个解决方案,从而确定了有助于将有肺结核症状的男性与治疗联系起来的干预措施。然后,与包括各医疗机构代表在内的 17 位与会者召开了一次共同分析会议,对这些见解进行综合,以便就建议的干预措施达成共识。各地的数据显示,由于医疗系统、社区、医疗工作者和个人层面的障碍,如就医时间延迟、医疗机构工作时间不利、等待时间过长与男性的工作时间冲突等,实际的结核病治疗路径与理想的路径有所偏离。利益相关者建议通过以下措施来解决这些障碍:引入男性专用服务;优先为咳嗽男性进行 X 光筛查的结核病综合服务;医护人员关于男性友好型综合服务的培训模块;培训和支持结核病卫士为求医者提供健康教育;让私人医生参与结核病筛查。总之,我们的参与式共同设计方法促进了不同医疗参与者之间的对话、学习,并就针对具体情况、以人为本的乌干达男性结核病干预措施达成了共识。现在,我们将在一项试点研究中对这套方案的可接受性、有效性和成本效益进行评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Finding the Missing Men with Tuberculosis: A Participatory Approach to Identify Priority Interventions in Uganda.

Gender impacts exposure and vulnerability to TB, evidenced by a higher prevalence of both TB disease and missed TB diagnoses among men, who significantly contribute to new TB infections. We present the formative research phase of a study which used participatory methods to identify gender-specific interventions for systematic screening of TB among men in Uganda. Health facility level data was collected at four Ugandan general hospitals (Kawolo, Gombe, Mityana, and Nakaseke) among 70 TB stakeholders, including healthcare workers, TB survivors, policymakers, and researchers. Using health seeking pathways, they delineated and compared men's ideal and actual step-by-step TB health seeking processes to identify barriers to TB care. The stepping stones method, depicting barriers as a 'river' and each 'steppingstone' as a solution, was employed to identify interventions which would help link men with TB symptoms to care. These insights were then synthesized in a co-analysis meeting with 17 participants including representatives from each health facility to develop a consensus on proposed interventions. Data across locations revealed the actual TB care pathway diverted from the ideal pathway due to health system, community, health worker and individual level barriers such as delayed health seeking, unfavourable facility operating hours and long waiting times that conflicted with men's work schedules. Stakeholders proposed to address these barriers through the introduction of male-specific services; integrated TB services that prioritize X-ray screening for men with cough; healthcare worker training modules on integrated male-friendly services; training and supporting TB champions to deliver health education to people seeking care; and engagement of private practitioners to screen for TB. In conclusion, our participatory co-design approach facilitated dialogue, learning, and consensus between different health actors on context-specific, person-centred TB interventions for men in Uganda. The acceptability, effectiveness and cost effectiveness of the package will now be evaluated in a pilot study.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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