Chopel Alison M
a School of Public Health , University of California , Berkeley , CA , USA.
Ethn Health. 2014 Jun;19(3):270-96. doi: 10.1080/13557858.2013.771150. Epub 2013 Feb 27.
Indigenous peoples in the state of Chihuahua, Mexico, are known to outsiders as the Tarahumaras. The Tarahumaras are one of the few cultural groups known to have no traditional birth attendants, and Tarahumara women often give birth alone and outdoors. Currently, little is known about this group, their health status or their culture.
The objective of this study was to assess the state of reproductive health outcomes, risks, protective factors, beliefs and behaviors in the Tarahumara population.
This paper reports on the qualitative results of a mixed methods study, comprised of focus groups, interviews, participatory exploratory methods, ethnographic observation and household surveys investigating the reproductive health status of the Tarahumara peoples and contextual factors influencing it. Qualitative data is presented, supported by preliminary quantitative findings.
This study supports speculation that the Tarahumara population is burdened by severe maternal health problems. The sample size was too small to definitively assess risk factors for the outcome of maternal mortality, but qualitative findings point to some important contextual issues that contribute to participants' perceptions of susceptibility to and severity of the problem, their reproductive health beliefs and behaviors, and barriers to behavior change. Major issues included disparities in biomedical knowledge, trust between non-indigenous providers and indigenous patients, and structural issues including access to medical facilities and infrastructure.
Qualitative data is drawn upon to make recommendations and identify lessons applicable to similar situations where cultural minorities suffer serious health inequities. This study underscores the importance of needs and assets assessment, as it reveals unique contextual factors that must be taken into account in intervention design. Also, collaborative partnership with community members and leaders proved to be invaluable in the research, warranting further collaboration by both governmental and non-governmental groups attempting to improve the health of this population. This becomes especially important when making and enforcing health policy.
在墨西哥奇瓦瓦州，原住民被外界称为塔拉乌马拉人。塔拉乌马拉人是少数已知没有传统助产士的文化群体之一，塔拉乌马拉族女性通常独自在户外分娩。目前，对于这个群体、他们的健康状况或文化了解甚少。
本研究的目的是评估塔拉乌马拉人群的生殖健康结果、风险、保护因素、信仰和行为状况。
本文报告了一项混合方法研究的定性结果，该研究包括焦点小组、访谈、参与式探索方法、人种学观察以及家庭调查，旨在调查塔拉乌马拉人的生殖健康状况及其影响因素。文中呈现了定性数据，并辅以初步的定量研究结果。
本研究支持了这样一种推测，即塔拉乌马拉人群面临着严重的孕产妇健康问题。样本量过小，无法确切评估孕产妇死亡结果的风险因素，但定性研究结果指出了一些重要的背景问题，这些问题影响了参与者对该问题易感性和严重性的认知、他们的生殖健康信仰和行为，以及行为改变的障碍。主要问题包括生物医学知识的差异、非原住民医疗服务提供者与原住民患者之间的信任，以及包括获得医疗设施和基础设施在内的结构性问题。
利用定性数据提出建议，并确定适用于文化少数群体遭受严重健康不平等的类似情况的经验教训。本研究强调了需求和资产评估的重要性，因为它揭示了干预设计中必须考虑的独特背景因素。此外，与社区成员和领导人的合作关系在研究中被证明是非常宝贵的，这值得政府和非政府组织进一步合作，以改善这一人群的健康状况。在制定和执行卫生政策时，这一点尤为重要。
