Rööst Mattias, Jonsson Cecilia, Liljestrand Jerker, Essén Birgitta
Department of Women's and Children's Health, Uppsala University, Sweden.
Reprod Health. 2009 Jul 29;6:13. doi: 10.1186/1742-4755-6-13.
Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia.
Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours.
The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system.
The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.
在低收入国家，孕产妇保健的使用与若干社会经济和人口因素相关，不过对后者的背景分析较少。先前一项研究表明，在玻利维亚拉巴斯各医院确诊的患有严重产科并发症（接近死亡）的妇女中，75%在抵达时就处于危急状况，这凸显了在这种提供免费且可及的孕产妇保健的环境中，院前障碍的重要性。本研究探讨了在玻利维亚拉巴斯，接近死亡并发症的就医行为是如何形成的。
对30名抵达医院时发生接近死亡事件的妇女进行主题访谈。接近死亡是根据临床和管理标准定义的。分析采用了改良的归纳法，进一步受到以下理论观点的影响，即就医行为由 predisposing characteristics（易患特征）、促成因素、感知需求以及社会塑造的习惯行为所形成。
那些习惯在家分娩且在产科紧急情况发生后延迟寻求医疗救助的妇女，典型地自我感觉与“其他人”（即那些利用医疗保健服务的人）有着根本的不同。这些妇女给出的其他解释包括对权威的不信任、工作人员的不当对待，比如未被告知自身病情或治疗过程，所有这些都强化了她们与医疗保健系统的脱节。
研究结果表明，就医行为是一种很大程度上受社会分化制约的行为。在玻利维亚，仅关注内生文化因素导致社会边缘化以及卫生机构在塑造就医行为中所起的作用被忽视了。
