9·11 恐怖袭击事件后世界贸易中心健康登记处参与者的健康和医疗保健利用情况的定性研究。
A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees.
机构信息
New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
出版信息
BMC Public Health. 2012 Aug 31;12:721. doi: 10.1186/1471-2458-12-721.
BACKGROUND
Many individuals who have 9/11-related physical and mental health symptoms do not use or are unaware of 9/11-related health care services despite extensive education and outreach efforts by the World Trade Center (WTC) Health Registry (the Registry) and various other organizations. This study sought to evaluate Registry enrollees' perceptions of the relationship between physical and mental health outcomes and 9/11, as well as utilization of and barriers to 9/11-related health care services.
METHODS
Six focus groups were conducted in January 2010 with diverse subgroups of enrollees, who were likely eligible for 9/11-related treatment services. The 48 participants were of differing race/ethnicities, ages, and boroughs of residence. Qualitative analysis of focus group transcripts was conducted using open coding and the identification of recurring themes.
RESULTS
Participants described a variety of physical and mental symptoms and conditions, yet their knowledge and utilization of 9/11 health care services were low. Participants highlighted numerous barriers to accessing 9/11 services, including programmatic barriers (lack of program visibility and accessibility), personal barriers such as stigmatization and unfamiliarity with 9/11-related health problems and services, and a lack of referrals from their primary care providers. Moreover, many participants were reluctant to connect their symptoms to the events of 9/11 due to lack of knowledge, the amount of time that had elapsed since 9/11, and the attribution of current health symptoms to the aging process.
CONCLUSIONS
Knowledge of the barriers to 9/11-related health care has led to improvements in the Registry's ability to refer eligible enrollees to appropriate treatment programs. These findings highlight areas for consideration in the implementation of the new federal WTC Health Program, now funded under the James Zadroga 9/11 Health and Compensation Act (PL 111-347), which includes provisions for outreach and education.
背景
尽管世界贸易中心（WTC）健康登记处（登记处）和其他各种组织进行了广泛的教育和外展工作，但仍有许多与 911 事件有关的身体和心理健康症状的个人没有使用或不知道与 911 有关的医疗服务。本研究旨在评估登记处参与者对身体和心理健康结果与 911 之间关系的看法，以及对与 911 有关的医疗服务的利用情况和障碍。
方法
2010 年 1 月，与登记处可能有资格获得与 911 有关的治疗服务的不同亚组进行了 6 次焦点小组讨论。48 名参与者在种族/族裔、年龄和居住的行政区方面存在差异。使用开放式编码和反复出现的主题识别对焦点小组记录进行定性分析。
结果
参与者描述了各种身体和心理症状和状况，但他们对 911 医疗服务的了解和利用程度很低。参与者强调了获得 911 服务的许多障碍，包括计划障碍（缺乏计划可见性和可及性）、个人障碍，如污名化和不熟悉与 911 有关的健康问题和服务，以及缺乏初级保健提供者的转介。此外，许多参与者由于缺乏知识、911 事件发生以来的时间流逝以及将当前健康症状归因于衰老过程，不愿将其症状与 911 事件联系起来。
结论
对与 911 有关的医疗保健障碍的了解导致登记处能够将合格的参与者转介到适当的治疗计划。这些发现突出了在实施新的联邦 WTC 健康计划（现根据《詹姆斯·扎德罗加 911 健康和赔偿法案》（PL 111-347）提供资金）时需要考虑的领域，该计划包括外展和教育的规定。
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