Meuwissen Liesbeth E, Gorter Anna C, Kester Arnold D M, Knottnerus J A
Department of General Practice, University of Maastricht, The Netherlands.
Trop Med Int Health. 2006 Jun;11(6):889-98. doi: 10.1111/j.1365-3156.2006.01632.x.
To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices.
The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n = 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods.
The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P = 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P = 0.003); and some attitudinal changes were observed (0 = 0.046 and P = 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme.
This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change.
评估参与一项旨在改善性与生殖健康护理（SRH护理）的可及性和质量的竞争性代金券计划是否会促使医生的知识、态度和行为发生改变。
该代金券计划为青少年提供免费的SRH护理。医生接受了关于如何应对青少年的培训和指导方针、一份治疗方案，以及为每位就诊青少年提供的经济激励。为了评估该干预措施对医生的影响，几乎所有参与的医生（n = 37）在干预前接受了访谈，23名医生在干预后接受了访谈。答案被分组为子主题，并使用非参数方法比较得分。
初始访谈揭示了医生在与青少年SRH问题相关的知识、态度和行为方面存在不足。医生的性别和年龄与初始得分无关。比较干预前后的得分发现，医生在避孕药具（P = 0.003）和性传播感染（P < 0.001）方面的知识有显著增加；避孕药具使用的障碍显著减少（P < 0.001和P = 0.003）；并且观察到了一些态度上的变化（P = 0.046和P = 0.11）。医生更加意识到需要提高他们的沟通技巧，并且对该计划持积极态度。
本研究证实了尼加拉瓜青少年可能面临的与医疗服务提供者相关的障碍，并强化了关注护理质量和加强医生培训的重要性。参与代金券计划导致了知识的增加、行为的改善，以及在较小程度上态度的改变。一项为参与医生提供技术支持的竞争性代金券计划可能是促使改变的一个有前景的策略。
