Coreil J, Augustin A, Holt E, Halsey N A
Department of Community and Family Health, College of Public Health, University of South Florida, Tampa 33612.
Int J Epidemiol. 1989;18(4 Suppl 2):S33-7. doi: 10.1093/ije/18.supplement_2.s33.
A rapid ethnographic assessment of barriers to health service utilization was conducted to identify maternal factors predicting use of child immunizations in Haiti. Methods included four focus group interviews, four natural group interviews, individual interviews with 14 health care providers and participant observation at vaccination posts. Analysis of qualitative data identified five categories of maternal factors associated with immunization use: competing priorities, low motivation, socioeconomic constraints, perceived accessibility of services, fears about health or social consequences and knowledge and folk beliefs related to vaccines. Selected variables among these factors were incorporated into a survey instrument designed to compare mothers of completely vaccinated children (cases) with mothers of incompletely vaccinated children (controls). The questionnaire was administered to 299 randomly selected mothers (217 cases, 82 controls). Bivariate and multivariate analyses found that of the factors identified through ethnographic research, only vaccine-related knowledge was significantly associated with immunization status. The utility and constraints of using ethnographic research for instrument development in epidemiological studies are discussed.
开展了一项关于卫生服务利用障碍的快速人种志评估，以确定预测海地儿童免疫接种使用情况的孕产妇因素。方法包括四次焦点小组访谈、四次自然小组访谈、对14名医疗服务提供者的个人访谈以及在疫苗接种点的参与观察。定性数据分析确定了与免疫接种使用相关的五类孕产妇因素：相互竞争的优先事项、积极性不高、社会经济限制、对服务可及性的认知、对健康或社会后果的担忧以及与疫苗相关的知识和民间信仰。这些因素中的选定变量被纳入一项调查工具，旨在比较完全接种疫苗儿童的母亲（病例）和未完全接种疫苗儿童的母亲（对照）。该问卷被发放给299名随机选择的母亲（217例病例，82名对照）。双变量和多变量分析发现，在通过人种志研究确定的因素中，只有与疫苗相关的知识与免疫接种状况显著相关。讨论了在流行病学研究中使用人种志研究进行工具开发的效用和局限性。
