Ahmed Shahira, Bärnighausen Till, Daniels Norman, Marlink Richard, Roberts Marc J
Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Africa Centre for Population Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
Implement Sci. 2016 Feb 11;11:18. doi: 10.1186/s13012-015-0361-7.
Understanding the motivations and perspectives of providers in following guidance and evidence-based policies can contribute to the evidence on how to better implement and deliver care, particularly in resource-constrained settings. This study explored how providers' attitudes and behaviors influenced the implementation of an intervention, provider-initiated HIV testing and counseling, in primary health care settings in Botswana.
Using a grounded-theory approach, we purposively selected and interviewed 45 providers in 15 facilities in 3 districts and inductively analyzed data for themes and patterns.
We found that nurses across facilities and districts were largely resistant to offering and delivering provider-initiated testing and counseling for HIV (PITC) for three reasons: (1) they felt they were overworked and had no time, (2) they felt it was not their job, and (3) they were afraid to counsel patients, particularly fearing a positive HIV test. These factors were largely related to health system constraints that affected the capacity of providers to do their job. An important underlying themes emerged: nurses and lay counselors were unsatisfied with pay and career prospects, which made them unmotivated to work in general. Variations were seen by urban and rural areas: nurses in urban areas felt generally overworked and PITC was seen as contributing to the workload. While nurses in rural areas did not feel overworked, they felt that PITC was not their job and they were unmotivated because of general unhappiness with their rural posts.
The attitudes and behaviors of providers and barriers they faced played a critical role in whether and how PITC was being implemented in Botswana. Provider factors should be considered in the improvement of existing PITC programs and design of new ones. Addressing constraints faced by providers can do more to improve supply of human resources than merely recruiting more providers.
了解医疗服务提供者遵循指南和循证政策的动机及观点，有助于获取关于如何更好地实施和提供医疗服务的证据，尤其是在资源有限的环境中。本研究探讨了医疗服务提供者的态度和行为如何影响一项干预措施——由医疗服务提供者发起的艾滋病毒检测与咨询在博茨瓦纳初级卫生保健机构中的实施情况。
采用扎根理论方法，我们有目的地从3个地区的15个机构中选取了45名医疗服务提供者进行访谈，并对数据进行归纳分析以找出主题和模式。
我们发现，各机构和地区的护士大多抵制由医疗服务提供者发起的艾滋病毒检测与咨询（PITC），原因主要有三点：（1）他们觉得自己工作负担过重，没有时间；（2）他们认为这不是自己的工作；（3）他们害怕为患者提供咨询，尤其是害怕艾滋病毒检测呈阳性的结果。这些因素在很大程度上与影响医疗服务提供者工作能力的卫生系统限制有关。一个重要的潜在主题浮现出来：护士和非专业咨询师对薪酬和职业前景不满意，这使他们总体上工作积极性不高。城乡地区存在差异：城市地区的护士普遍觉得工作负担过重，PITC被视为加重了工作量。而农村地区的护士虽然不觉得工作负担过重，但他们认为PITC不是自己的工作，并且由于对农村岗位普遍不满而缺乏工作动力。
医疗服务提供者的态度和行为以及他们面临的障碍，对博茨瓦纳PITC的实施与否及实施方式起着关键作用。在改进现有PITC项目和设计新项目时，应考虑医疗服务提供者因素。解决医疗服务提供者面临的限制，比单纯招聘更多医疗服务提供者更有助于改善人力资源供应。
