Johansson E, Long N H, Diwan V K, Winkvist A
Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, S-17176, Stockholm, Sweden.
Health Policy. 2000 May;52(1):33-51. doi: 10.1016/s0168-8510(00)00062-2.
This study explores the perspectives of tuberculosis patients on which factors influenced their health seeking behaviour, with special reference to gender differentials in terms of delays in health seeking. In 1996, a multi-disciplinary research team carried out 16 focus group discussions. The study was done in four districts in Vietnam, both in the south and north of the country and in urban and rural areas. Qualitative analysis of data was performed following general principles of modified grounded theory technique. Participants in the focus groups described three main factors as contributing to delay in health seeking. These were fear of social isolation, economic constraints and inadequate staff attitudes and poor quality of health services. A model illustrating different factors influencing health seeking was elaborated and served as a basis for discussion of the findings. The main factor contributing to delay among women was described as fear of social isolation from the family or the community. Stigma was described as closely related to contextual factors such as gender-roles, socio-economic status and level of education and seemed to be mediated via denial and concealment of tuberculosis diagnosis and disease, thus causing delay. The main factor contributing to delay among men was described as fear of individual costs of diagnosis and treatment. Staff attitudes and quality of health service facilities were described as not always corresponding to people's expectations of appropriate health services. Women saw themselves and were seen by others as being more sensitive than men to poor service conditions and staff attitudes. A typical feature of the described health seeking behaviour of men was that they neglected symptoms until the disease reached a serious stage, by which time they tended to go directly to public health services without first visiting private health practitioners. Women, on the other hand, were described as having a tendency to seek out private services and practice self-medication before seeking care at public services. In conclusion, there is a need for better understanding of behavioural factors and for developing strategies, that take these into account. Health workers need to better understand gender and social aspects of tuberculosis control, particularly aspects that influence the likelihood for achieving equity in diagnosis and cure.
本研究探讨了结核病患者对影响其就医行为的因素的看法，特别提及了就医延迟方面的性别差异。1996年，一个多学科研究团队进行了16次焦点小组讨论。该研究在越南的四个地区开展，涵盖该国南北部以及城乡地区。按照改良扎根理论技术的一般原则对数据进行了定性分析。焦点小组的参与者描述了导致就医延迟的三个主要因素。这些因素是对社会隔离的恐惧、经济限制以及医护人员态度欠佳和医疗服务质量低下。阐述了一个说明影响就医行为的不同因素的模型，并以此作为讨论研究结果的基础。导致女性就医延迟的主要因素被描述为害怕与家庭或社区产生社会隔离。耻辱感被描述为与性别角色、社会经济地位和教育水平等背景因素密切相关，并且似乎是通过否认和隐瞒结核病诊断及病情来介导的，从而导致延迟。导致男性就医延迟的主要因素被描述为担心诊断和治疗的个人费用。医护人员的态度和医疗服务设施的质量被描述为并不总是符合人们对适当医疗服务的期望。女性认为自己以及他人也认为她们比男性对恶劣的服务条件和医护人员态度更为敏感。所描述的男性就医行为的一个典型特征是，他们会忽视症状，直到疾病发展到严重阶段，此时他们往往会直接前往公共卫生服务机构，而不会先去看私人执业医生。另一方面，女性被描述为有在寻求公共服务机构的护理之前先寻求私人服务并自行用药的倾向。总之，有必要更好地理解行为因素并制定考虑到这些因素的策略。卫生工作者需要更好地理解结核病控制中的性别和社会方面，特别是那些影响在诊断和治愈方面实现公平可能性的方面。
