资源匮乏环境下知情选择的思考：以坦桑尼亚 PMTCT 项目中的婴儿喂养咨询为例。
Reflections on informed choice in resource-poor settings: the case of infant feeding counselling in PMTCT programmes in Tanzania.
机构信息
Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway.
Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Faculty of Health and Social Science, Bergen University College, P.O. Box 7030, 5020 Bergen, Norway.
出版信息
Soc Sci Med. 2014 Mar;105:22-9. doi: 10.1016/j.socscimed.2014.01.005. Epub 2014 Jan 18.
A growing emphasis on patient involvement in health care has brought 'informed choice' to the core of the debate on provider-patient interaction in global health-care programmes. How the principles of patient involvement and informed choice are implemented and experienced in diverging health systems and cultural contexts are issues of increasing interest. Infant feeding and infant feeding counselling of HIV-positive women have posed particular challenges related to choice. Based on ethnographic research conducted from 5 November 2008 to 5 August 2009 within prevention of mother-to-child transmission of HIV (PMTCT) programmes in two hospitals in rural and semi-urban Tanzania, this study explores nurse counsellors' and HIV-positive women's experiences of infant feeding counselling and patient choice. One of the hospitals (hospital A) promoted exclusive breastfeeding as the only infant feeding option, while the other hospital (hospital B) aimed to follow the Tanzanian PMTCT infant feeding guidelines of 2007 promoting patient choice in infant feeding methods. Women in hospital A expressed trust in the advice given and confidence in their own ability to practice exclusive breastfeeding, while women in hospital B expressed great uncertainty and confusion about how best to feed their infants. This paper reflects on the feasibility of a counselling procedure that promotes choice of infant feeding methods in PMTCT programmes in severely resource-poor settings where HIV-positive women have limited access to resources and to up-to-date knowledge on HIV and infant feeding outside the counselling room. We suggest that a universalistic procedure presenting the same unambiguous message on infant feeding to all women enrolled in the PMTCT programme in this and similar settings is likely to produce more confidence, less confusion and, hence, better results in terms of HIV-free survival of the baby.
越来越重视患者在医疗保健中的参与，使得“知情选择”成为全球医疗保健计划中医患互动辩论的核心。在不同的医疗体系和文化背景下，患者参与和知情选择的原则是如何实施和体验的，这是一个日益引起关注的问题。婴儿喂养和艾滋病毒阳性妇女的婴儿喂养咨询提出了与选择相关的特别挑战。本研究基于 2008 年 11 月 5 日至 2009 年 8 月 5 日在坦桑尼亚农村和半城市的两家医院进行的预防母婴传播艾滋病毒（PMTCT）计划中的民族志研究，探讨了护士顾问和艾滋病毒阳性妇女在婴儿喂养咨询和患者选择方面的经验。其中一家医院（医院 A）提倡纯母乳喂养作为唯一的婴儿喂养方式，而另一家医院（医院 B）则旨在遵循 2007 年坦桑尼亚 PMTCT 婴儿喂养指南，提倡患者在婴儿喂养方法方面做出选择。医院 A 的妇女对所提供的建议表示信任，并对自己实施纯母乳喂养的能力充满信心，而医院 B 的妇女则对如何最好地喂养婴儿感到非常不确定和困惑。本文反思了在资源严重匮乏的环境中，PMTCT 计划中促进婴儿喂养方法选择的咨询程序的可行性，在这些环境中，艾滋病毒阳性妇女获得资源和有关艾滋病毒和婴儿喂养的最新知识的机会有限，超出了咨询室的范围。我们建议，在这种情况下以及类似情况下，为所有参加 PMTCT 计划的妇女提供一种普遍的程序，该程序向所有妇女提供关于婴儿喂养的相同明确信息，这可能会产生更多的信心，减少困惑，从而在婴儿无艾滋病毒生存方面取得更好的结果。
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