弥合恰加斯病管理方面的差距：在巴西初级卫生保健系统内使用实施科学方法的混合方法研究——“Implementa-Chagas/SaMi-Trop项目”

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-06-07 DOI:10.1016/j.lana.2025.101136

Carlos Henrique Valente Moreira , Laura Azevedo , Ariela Mota Ferreira , Ana Carolina Gonçalves Oliveira , Andréia Brito de Souza , Desirée Sant’Ana Haikal , Cláudia Di Lorenzo Oliveira , Clareci Silva Cardoso , Matthew Spinelli , Ana Luiza Bierrenbach , Nayara Dornela Quintino , Nayara Ragi Baldoni , Renata Fiuza Damasceno , Malu Ribeiro Drumond , Thallyta Maria Vieira , Dardiane Santos Cruz , Sâmara Fernandes Leite , Ana Clara de Jesus Santos , Léa Campos de Oliveira Silva , Renata Buccheri , Ester Cerdeira Sabino

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引用次数: 0

摘要

恰加斯病（ChD）是拉丁美洲普遍存在的一种被忽视的热带病，影响着数百万人，并对巴西的初级卫生保健系统构成重大挑战。尽管有诊断工具和有效药物，但筛查和治疗率仍然低得惊人。本研究旨在确定冠心病管理的障碍和促进因素，重点是将服务纳入日常医疗保健操作。方法采用探索性顺序混合方法，将焦点小组与初级保健医生、深度访谈和卫生保健专业人员的定量调查相结合。理论领域框架（TDF）和能力-机会-动机-行为（COM-B）模型指导了冠心病管理决策过程的分析。使用行为改变轮（BCW）框架制定了干预策略，强调教育计划、实践培训和基础设施改善。该研究确定了主要障碍，包括卫生保健专业人员对冠心病的认识有限，对症状诊断的依赖，环境限制以及公众和专业人员对冠心病的参与不足。我们提出了量身定制的干预措施，通过教育、培训和基础设施调整来提高初级卫生保健人员的能力。本研究提倡将冠心病的管理模式转变为早期干预和综合护理。它强调了与世卫组织被忽视的热带病路线图保持一致的以团队为基础的战略的重要性，特别是在偏远地区。这种方法解决了卫生保健工作者的挑战，促进了更积极主动和知情的冠心病管理策略。NIH在Sami-Trop队列研究（资助号：U01AI168383）下支持这项研究。

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Bridging the gap in Chagas disease management: a mixed-methods study using an implementation science approach within the Brazilian primary health care system—‘Implementa-Chagas/SaMi-Trop project’

Background

Chagas Disease (ChD), a prevalent Neglected Tropical Disease in Latin America, affects millions and poses significant challenges in Brazil's primary healthcare system. Despite the availability of diagnostic tools and effective drugs, screening and treatment rates remain alarmingly low. This study aims to identify barriers and facilitators in ChD management, focusing on integrating services into routine healthcare operations.

Methods

An exploratory sequential mixed-methods approach was used, combining focus groups with primary care physicians, in-depth interviews, and quantitative surveys with healthcare professionals. The Theoretical Domains Framework (TDF) and the Capability Opportunity Motivation-Behaviour (COM-B) model guided the analysis of decision-making processes in ChD management. Intervention strategies were developed using the Behaviour Change Wheel (BCW) framework, emphasizing educational programmes, hands-on training, and infrastructural improvements.

Findings

The study identified key barriers, including limited awareness of ChD among healthcare professionals, reliance on symptomatic diagnosis, environmental constraints, and inadequate public and professional engagement with ChD. We proposed tailored interventions to enhance primary healthcare personnel competencies through education, training, and infrastructure adjustments.

Interpretation

The study advocates for a paradigm shift in ChD management towards early intervention and comprehensive care. It highlights the importance of a team-based strategy aligned with the WHO's Neglected Tropical Diseases roadmap, particularly in remote areas. This approach addresses healthcare workers' challenges, fostering a more proactive and informed ChD management strategy.

Funding

The NIH supported the study under the Sami-Trop cohort study (Grant n. U01AI168383).

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.