Lombardo Anthony P, Angus Jan E, Lowndes Ruth, Cechetto Naomi, Khattak Shamal, Ahmad Farah, Bierman Arlene S
University of Toronto, Toronto, Ontario, Canada.
Health Soc Care Community. 2014 Nov;22(6):575-87. doi: 10.1111/hsc.12093. Epub 2014 Jan 10.
As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta-synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta-study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer-reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self-management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long-term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.
作为一项关于加拿大安大略省女性获取医疗保健系统情况的混合方法研究的一部分，我们进行了一项定性元综合研究，以更好地了解女性获取医疗保健的背景条件。该综合研究的早期阶段表明了一系列使安大略省女性获取医疗保健变得复杂的因素。在此，我们考虑女性应对这些因素的能动性。我们使用元研究方法综合了2002年1月至2010年12月期间发表的定性研究结果。通过搜索众多数据库来识别研究，这些数据库包括护理学与健康领域数据库（CINAHL）、医学文献数据库（MEDLINE）、Scopus数据库、性别研究数据库和LGBT生活数据库。纳入标准包括采用定性研究设计；在指定时间段内在同行评审期刊上发表；样本至少部分在安大略省招募；包括针对女性参与者的不同研究结果；以及为英文。在使用定性研究评估工具进行评估后，研究被纳入最终样本。我们发现，女性对限制获取医疗保健的力量采取了一系列应对措施：调动财务、社会和人际资源；通过凑合、不使用以及情绪自我管理来应对不足；以及避免生病和保持健康。在各项研究中，女性描述了她们为克服获取医疗保健的挑战所做的努力。然而，女性的能动性存在明显局限，她们的许多策略只是临时措施而非可行的长期解决方案。虽然女性在克服获取医疗保健的差距方面可能足智多谋且坚韧不拔，但系统性问题仍需解决。女性需要参与设计和实施干预措施，以改善获取医疗保健的机会，并解决这些问题的根本原因。
