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寄养照顾者对坚持儿童预约看法的定性研究

Qualitative Study of Foster Caregivers' Views on Adherence to Pediatric Appointments.

作者信息

Schneiderman Janet U, Kennedy Andrea K, Sayegh Caitlin S

出版信息

J Pediatr Health Care. 2017 Jan-Feb;31(1):104-110. doi: 10.1016/j.pedhc.2016.05.001. Epub 2016 Jun 9.

Abstract

The current study is a qualitative investigation of how foster caregivers, primarily Latinos, view adherence to pediatric appointments. Our purpose was to identify how the child welfare system, pediatric clinics, and pediatric health providers serving foster children might promote appointment attendance. Participants in the study had a return appointment at an outpatient pediatric clinic that served only children in the child welfare system. Twenty-eight caregivers (13 related and 15 unrelated) participated in telephone interviews after the date of their scheduled pediatric appointment; 32% missed their return appointment. Semistructured interview guides included general questions about what promotes attending the pediatric appointment, what makes it difficult to attend the pediatric appointment, and how pediatric care affects the foster child. Analysis of qualitative data using content analysis identified three themes: (a) Multiple Methods to Attend Appointments, which included caregivers' organizational and problem-solving skills; (b) Positive Health Care Experiences, which consisted of caregivers' personal relationships with providers and staff members and clinic organization; and (c) Necessity of Pediatric Care, which included recognition of the need for health care, especially timely immunizations. All caregivers also reported that appointment reminders would be helpful. Unrelated caregivers said more often than related caregivers that appointment attendance was facilitated by clinic organization. Nonadherent caregivers more than attenders mentioned their need to solve problems to attend appointments or reschedule appointments. In summary, caregivers said they valued regular pediatric health care to treat their children's chronic conditions and prevent illnesses, but they acknowledged that their home lives were hectic and that attending scheduled appointments was sometimes difficult. Foster caregivers in this study identified the ideal pediatric clinic environment that encourages adherence to health care appointments. This environment is an organized clinic with easy access including parking, engaged pediatric health providers, ability to reschedule appointments when necessary, and an individualized and consistent appointment reminder system.

摘要

本研究是一项定性调查,旨在了解主要为拉丁裔的寄养照顾者对按时带孩子赴儿科预约诊疗的看法。我们的目的是确定儿童福利系统、儿科诊所及为寄养儿童服务的儿科医疗服务提供者如何促进预约诊疗的按时出席。该研究的参与者在一家仅为儿童福利系统内儿童服务的门诊儿科诊所进行复诊预约。28名照顾者(13名亲属照顾者和15名非亲属照顾者)在其预定的儿科预约诊疗日期之后参加了电话访谈;32%的人错过了复诊预约。半结构化访谈指南包括一些一般性问题,如什么因素促使他们带孩子赴儿科预约诊疗、什么因素导致难以赴约,以及儿科护理如何影响寄养儿童。运用内容分析法对定性数据进行分析后确定了三个主题:(a)多种赴约方式,包括照顾者的组织能力和解决问题的能力;(b)积极的医疗保健体验,包括照顾者与医疗服务提供者及工作人员的个人关系以及诊所的组织情况;(c)儿科护理的必要性,包括认识到医疗保健的必要性,尤其是及时接种疫苗的必要性。所有照顾者均表示预约提醒会有所帮助。非亲属照顾者比亲属照顾者更常表示诊所的组织安排有助于按时赴约。未按时赴约的照顾者比按时赴约的照顾者更多地提到他们需要解决问题才能赴约或重新安排预约时间。总之,照顾者表示他们重视定期的儿科医疗保健,以治疗孩子的慢性病并预防疾病,但他们承认自己的家庭生活很忙碌,有时难以按时赴约。本研究中的寄养照顾者确定了理想的儿科诊所环境,这种环境有助于促使他们遵守医疗保健预约。这种环境是一个组织有序的诊所,交通便利,包括有停车位,有积极参与的儿科医疗服务提供者,必要时能够重新安排预约时间,以及有个性化且持续的预约提醒系统。

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