Dodd Warren, King Nia, Humphries Sally, Little Matthew, Dewey Cate
Department of Population Medicine, University of Guelph, Canada.
Department of Population Medicine, University of Guelph, Canada.
Soc Sci Med. 2016 Jul;161:118-25. doi: 10.1016/j.socscimed.2016.05.035. Epub 2016 May 25.
In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability.
在印度泰米尔纳德邦，已在发展高质量、全民可及的医疗体系方面取得了进展。然而，一些农村居民在获得医疗服务方面仍面临重大障碍。本研究的主要目的是调查自我报告的发病率、健康素养以及医疗偏好、利用情况和体验，以便确定政府卫生政策和项目的优先领域。通过对泰米尔纳德邦克里希纳吉里区26个乡村进行的66次半结构化访谈和300户家庭调查（包括1693人），我们发现自我报告的主要健康状况患病率为22.3%。非传染性和慢性疾病负担沉重，最常见的主要疾病为：结缔组织问题（7.6%）、神经系统和感觉器官疾病（5.0%）以及循环系统和呼吸系统疾病（2.5%）。年龄增长和教育水平降低与报告大多数疾病的较高几率相关。低健康素养导致个体仅在疼痛干扰日常活动时才寻求治疗。因此，个体的就医行为取决于哪种策略被认为能以最少资源最快恢复工作。尽管政府医疗机构是最常见的医疗服务获取点，但它们不受信任；分别有48.8%和19.2%的受访者认为公共医疗机构存在不适当的治疗方案和腐败问题。相反，93.3%的受访者报告高治疗成本是获取私立医疗机构服务的主要障碍。我们的结果表明，在此背景下应对农村人口中的慢性和非传染性疾病负担，将需要卫生政策和村级项目来解决低健康素养以及农村医疗可及性和可接受性问题。
