Sword W
School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton-Wentworth Region Department of Public Health Services, Hamilton, Ontario, Canada.
J Adv Nurs. 1999 May;29(5):1170-7. doi: 10.1046/j.1365-2648.1999.00986.x.
This paper critically examines the notion of barriers as conceptualized in the literature and suggests an expanded orientation to more fully appreciate its complexity. This alternative approach not only takes into account factors and processes relevant to the individual that create constraints to utilization, but also acknowledges influences on the design and delivery of health care. These latter considerations determine the availability and characteristics of programmes and services that may or may not encourage or enable participation by persons of low income. A socio-ecological model is proposed that compels health care practitioners and researchers to acknowledge the many influences on utilization behaviour. The literature on barriers to prenatal care is subsequently reviewed and evaluated, with consideration given to the range of behavioural determinants suggested by the model. Finally, a case is made for qualitative methods for inquiry to further enhance knowledge about factors and processes influencing use of the health care system, including prenatal care. It is argued that these approaches lead to enhanced appreciation of behaviour as a social product and are consistent with the ideology of health promotion.
本文批判性地审视了文献中概念化的障碍概念，并提出了一种扩展的取向，以更全面地理解其复杂性。这种替代方法不仅考虑了与个体相关的、对利用产生限制的因素和过程，还承认了对医疗保健设计和提供的影响。后一种考虑因素决定了可能鼓励或不鼓励低收入人群参与，以及可能或不可能使他们参与的项目和服务的可用性和特征。本文提出了一种社会生态模型，促使医疗保健从业者和研究人员认识到对利用行为的多种影响。随后，对产前保健障碍的文献进行了回顾和评估，并考虑了该模型所提出的一系列行为决定因素。最后，提出采用定性研究方法，以进一步增进对影响医疗保健系统利用（包括产前保健利用）的因素和过程的了解。本文认为，这些方法能够提高人们将行为视为一种社会产物的认识，并且与健康促进的理念相一致。
