Feron Jean-Marc, Tan Lac Hong Nguyen, Pestiaux Dominique, Lorant Vincent
Centre Academique de Medecine Generale Universite Catholique de Louvain, Brussels.
Int J Prison Health. 2008;4(3):146-55. doi: 10.1080/17449200802264696.
High and variable rates of attendance at GP consultations in prisons are observed. The aim of the study is to have a clearer understanding of social factors influencing inmates' help-seeking behaviour and demand for primary health care.
A qualitative study was carried out in five Belgian prisons (three Dutch-speaking and two French-speaking). Twenty-five male inmates were interviewed face-to-face and 18 caregivers (7 nurses and 11 GPs) in focus groups.
Five main social factors explain inmates' help-seeking behaviour and demand for primary health care: (1) inmates' negative perception of imprisonment increases help-seeking behaviour; (2) inmates use their rights to health care as strategies to maintain some form of control over their lives; (3) the doctor's role distorts expression of need and demand; (4) health professionals' control over inmates' lives creates mistrust and a controlling therapeutic relationship; and (5) lack of alternatives to health care. These factors are mutually dependent and cause a confrontation in the inmates' and clinicians' agendas.
The most important recommendation is to understand what the inmates are really seeking in their demands. This information can be used to develop appropriate alternatives in terms of human support and well-being facilities. The therapeutic and security roles of health care workers should be separated, in order to increase the trust that is central to the therapeutic relationship between them and inmates.
监狱中全科医生会诊的就诊率高且波动不定。本研究的目的是更清楚地了解影响囚犯求助行为及初级卫生保健需求的社会因素。
在比利时的五所监狱（三所讲荷兰语的和两所讲法语的）开展了一项定性研究。对25名男性囚犯进行了面对面访谈，并对18位照料者（7名护士和11名全科医生）进行了焦点小组访谈。
有五个主要社会因素可解释囚犯的求助行为及初级卫生保健需求：（1）囚犯对监禁的负面认知增加了求助行为；（2）囚犯将其获得卫生保健的权利作为对自己生活保持某种控制形式的策略；（3）医生的角色扭曲了需求的表达；（4）卫生专业人员对囚犯生活的控制造成了不信任以及一种控制性的治疗关系；（5）缺乏卫生保健的替代选择。这些因素相互依存，并导致囚犯与临床医生议程上的冲突。
最重要的建议是了解囚犯在其需求中真正寻求的是什么。这些信息可用于在人力支持和福利设施方面开发适当的替代方案。卫生保健工作者的治疗和安保角色应分开，以增强他们与囚犯之间治疗关系核心的信任。
