Sun Kai Sing, Lam Tai Pong, Lam Kwok Fai, Lo Tak Lam, Chao David Vai Kiong, Lam Edmund Wing Wo
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
J Affect Disord. 2016 May 15;196:164-70. doi: 10.1016/j.jad.2016.02.041. Epub 2016 Feb 17.
Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong.
Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics.
Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems.
The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture.
Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help.
先前关于心理困扰求助行为的大多数研究都来自西方国家。本研究调查了香港中国基层医疗就诊者在心理困扰求助方面的障碍。
对有/无已知心理困扰的中国基层医疗就诊者、患者的重要他人和普通公众进行了9个焦点小组讨论和6次个人访谈。通过对来自13家私人诊所和6家公立诊所招募的1626名基层医疗就诊者的数据进行问卷调查，对识别出的障碍进行了调查。
在调查中，对药物副作用（79.9%，95%置信区间：(77.9%, 81.8%)）和药物依赖（74.7%，95%置信区间：(72.5%, 76.8%)）的担忧被评为首要障碍。定性访谈发现了对药物副作用的担忧和实际经历，这削弱了患者对治疗的信任。对所有障碍项目的因子分析表明有三个因素：1）对治疗的担忧，2）对基层医疗医生能力的不确定性，3）公众对心理困扰和求助来源的了解有限。心理困扰程度、教育水平和年龄与因素1相关，而心理困扰程度和医疗机构类型与其他两个因素相关。定性访谈显示，在公立医疗机构中没有固定的基层医疗医生会阻碍心理问题的披露。
研究结果基于受访者的自我报告数据。香港受到中西混合文化的影响。
在中文语境下的相关公众教育应旨在减少患者对药物治疗方法的担忧，并强化基层医疗医生作为可行求助来源的形象。
