Hengel Belinda, Guy Rebecca, Garton Linda, Ward James, Rumbold Alice, Taylor-Thomson Debbie, Silver Bronwyn, McGregor Skye, Dyda Amalie, Knox Janet, Kaldor John, Maher Lisa
Apunipima Cape York Health Council, Cairns, PO Box 12045, Earlville, Qld 4870, Australia.
Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia.
Sex Health. 2015 Mar;12(1):4-12. doi: 10.1071/SH14080.
Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting.
A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project; a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia.
Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks.
Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of individuals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.
背景 澳大利亚偏远地区的原住民社区细菌性性传播感染（STI）发病率很高。减少性传播感染的一项关键策略是增加初级卫生保健中心的检测。本研究旨在探讨在这种情况下提供和开展性传播感染检测的障碍。
作为偏远社区性传播感染、改善和加强初级卫生保健（STRIVE）项目的一部分，开展了一项定性研究；这是一项关于性健康质量改进项目的大型整群随机对照试验。我们在澳大利亚北部和中部四个地区的22个参与卫生中心进行了36次深入访谈。
参与者指出了一些障碍，包括要求性别隔离的原住民文化规范以及阻止一些工作人员和患者互动的传统亲属制度，而男性工作人员的短缺加剧了这两种情况。其他常见障碍包括对客户保密性的担忧（缺乏私人咨询空间以及生活在小社区）、工作人员提供检测的能力受到工作人员时间竞争需求的影响，以及人员流动率高导致对诊所系统的了解不足。许多参与者还表达了对管理阳性检测结果的担忧。为了克服其中一些障碍，参与者透露了一些非正式策略，如团队合作、在诊所以外进行检测以及利用成人健康检查。
研究结果表明，文化、结构和卫生系统问题是在偏远社区提供性传播感染检测的障碍，其中一些障碍是通过个人的创造力和热情而非正式系统得以克服的。通过加强现有的文化和临床培训体系以及教育工作人员从人群健康框架的角度看待性传播感染，许多这些障碍都可以很容易地得到解决。然而，其他一些障碍，特别是与文化、亲属关系以及生活在小社区相关的问题，可能需要不依赖与卫生工作人员或诊所环境直接接触的检测方式。
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