School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
Clin Transl Sci. 2014 Feb;7(1):6-11. doi: 10.1111/cts.12127. Epub 2013 Nov 8.
The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo. Community health representatives (CHRs) led 14 one-hour focus group sessions at which a total of 112 people participated posed unique questions that took into account the Zuni culture to elicit information on perceived barriers to healthcare. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program. We identified nine themes emerged regarding the barriers experienced in receiving healthcare and adhering to medical advice. These included distance; transportation; embarrassment; relating to healthcare professionals; navigating the medical system; awareness of available resources; waiting times; adhering to medication; and incentives in health promotion. In conclusion the implementation of culturally appropriate community-based health promotion programs and preventive screening techniques will improve access to healthcare and diminish health disparities.
祖尼族 Pueblo 是一个经济困难的人群的家园，他们面临着肥胖症、糖尿病和肾病这三种相互关联的流行病带来的公共卫生挑战。减少这些流行病影响的努力受到历史、经济和文化障碍的复杂化，这些障碍可能会限制医疗保健的利用。美国国立卫生研究院支持的祖尼族卫生倡议 (Zuni Health Initiative, ZHI) 进行了一项研究，以确定祖尼 Pueblo 医疗保健的障碍。社区健康代表 (Community Health Representatives, CHR) 主持了 14 次为时一小时的焦点小组会议，共有 112 人参加，提出了独特的问题，这些问题考虑到了祖尼文化，以引出关于医疗保健障碍的看法。双语 ZHI 工作人员对录音带进行了翻译和转录。我们将文本简化为主题类别，构建了编码字典，并将文本插入到 NVivo 9 程序中。我们确定了在接受医疗保健和遵守医疗建议方面存在的九个障碍主题。这些主题包括距离、交通、尴尬、与医疗保健专业人员的关系、了解医疗系统、对可用资源的认识、等待时间、遵守药物治疗和健康促进的激励措施。总之，实施文化上适当的基于社区的健康促进计划和预防性筛查技术将改善获得医疗保健的机会，并减少健康差距。
