University of Liverpool, UK.
Soc Sci Med. 2011 Mar;72(5):763-72. doi: 10.1016/j.socscimed.2010.11.027. Epub 2010 Dec 21.
Equitable access to primary care for people with common mental health problems in the UK remains problematic. The experiences of people from hard-to-reach groups offer important insights into barriers to accessing care. In this study, we report on secondary analysis of qualitative data generated within seven previously-reported studies. Thirty-three of ninety-two available transcripts were re-analysed using a new heuristic of access, generated to frame narrative-based comparative case analysis. The remaining transcripts were used to triangulate the findings via a process of collaborative analysis between a secondary researcher, naïve to research findings of the original studies, and primary researchers involved in data generation and analysis within the original studies. This method provided a rich body of 'fine grain' insights into the ways in which problem formulation, help-seeking, use of services and perceptions of service quality are interlinked in a recursive and socially embedded matrix of inequitable access to primary mental health care. The findings indicate both extensive commonalities between experiences of people from different 'hard-to-reach groups', and considerable diversity within each group. An idiographic generalisation and aggregation of this variety of experiences points to one main common facilitator (communicated availability of acceptable mental health services) and two main common barriers (lack of effective information and multiple forms of stigma) to equitable access to primary mental health care. We conclude that there is a need to provide local care that is pluralistic, adaptive, holistic, resonant and socially conscious in order to ensure that equitable access to mental health services can become a reality.
在英国，患有常见精神健康问题的人群公平获得初级保健的机会仍然存在问题。来自难以接触到的群体的人们的经历为了解获得护理的障碍提供了重要的见解。在这项研究中，我们报告了对先前报告的七项研究中生成的定性数据进行的二次分析。使用一种新的获取启发式方法重新分析了 92 个可用转录本中的 33 个，该启发式方法是为了构建基于叙事的比较案例分析而生成的。其余的转录本用于通过二次研究人员（对原始研究的研究结果一无所知）与原始研究中参与数据生成和分析的主要研究人员之间的协作分析过程，通过三角测量来验证发现。这种方法提供了大量关于问题表述、寻求帮助、服务使用和服务质量感知如何在递归和社会嵌入的不公平获得初级心理健康护理的矩阵中相互关联的“细粒度”见解。研究结果表明，来自不同“难以接触到的群体”的人们的经历之间既有广泛的共性，也有每个群体内部的相当大的多样性。对这种各种经历的个体化概括和综合表明，公平获得初级心理健康护理主要有一个共同的促进因素（可接受的心理健康服务的沟通可用性）和两个主要的共同障碍（缺乏有效的信息和多种形式的污名化）。我们得出的结论是，需要提供多元化、适应性、整体性、共鸣性和具有社会意识的本地护理，以确保公平获得心理健康服务成为现实。
