泰国董里府地区领导人对管理泰国董里府直接观察治疗项目的看法。

Thai district Leaders' perceptions of managing the direct observation treatment program in Trang Province, Thailand.

作者信息

Choowong Jiraporn, Tillgren Per, Söderbäck Maja

机构信息

School of Health, Care and Social Welfare, Mälardalen University, PO Box 883, SE 721-23, Mälardalen, Sweden.

Boromarajonani College of Nursing Trang, Praboromarajchanok Institute for Health Workforce Development (PIHWD), Ministry of Public Health, 92000, Trang, Thailand.

出版信息

BMC Public Health. 2016 Jul 28;16:653. doi: 10.1186/s12889-016-3341-1.

DOI:10.1186/s12889-016-3341-1

PMID:27464758

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4964034/

Abstract

BACKGROUND

Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand.

METHODS

A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories.

RESULTS

The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines.

CONCLUSION

Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.

摘要

背景

泰国是结核病负担最高的22个国家中的第18位。对泰国来说，实现联合国千年发展目标中的结核病目标以及世界卫生组织到2035年消除结核病的新目标将是一项挑战。应对泰国直接观察治疗（DOT）项目管理中的复杂挑战需要更多知识和新方法。背景因素在很大程度上影响着证据在实际中的本地实施。利用促进卫生服务中基于证据的实践（PARIHS）模型，旨在探究泰国董里府地区领导人对DOT项目管理的看法。

方法

采用现象学方法探究董里府地区DOT项目领导人的看法。我们对负责五个区DOT项目管理的地区领导人进行了半结构化访谈。通过对看法的异同进行分组来分析数据转录内容，这些看法构建在一个分层结果空间中，该空间展示了一组描述性类别。

结果

第一个描述性类别揭示了领导人在其所在地区管理和实施DOT项目时对自身职责的共同看法以及遵守国家结核病防治规划（NTP）指南的意愿。领导人之间关于如何实现成功治疗的看法更为多样。其他看法涉及实际困境，包括对感染的恐惧、相互不信任以及对结核病知识的不足。此外，领导人认为在实施结核病指南时需要改进管理做法。