Rachlis Beth, Naanyu Violet, Wachira Juddy, Genberg Becky, Koech Beatrice, Kamene Regina, Akinyi Jackie, Braitstein Paula
Academic Model Providing Access to Healthcare (AMPATH), PO-Box 4606, Eldoret, 30100, Kenya.
University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada.
BMC Public Health. 2016 Aug 8;16:741. doi: 10.1186/s12889-016-3462-6.
Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya.
In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization.
A total of 235 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support.
Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The findings of the present study suggest that interventions should consider the logistical aspects of accessing care in addition to predisposing and need factors that may affect an individuals' decision to seek out and remain in appropriate care.
撒哈拉以南非洲在为慢性病（包括传染病和非传染病）提供护理和治疗方面面临着越来越大的挑战。为应对慢性病管理中关联和留存方面的挑战，有必要了解可能影响就医参与度的因素。我们开展了一项定性研究，以确定肯尼亚西部“提供医疗服务学术模式”（AMPATH）项目中，艾滋病毒、结核病（TB）和高血压（HTN）慢性病护理关联和留存的障碍与促进因素。
2012年7月至2013年8月进行了深入访谈和焦点小组讨论。研究参与者从三个AMPATH诊所中进行目的性抽样，包括接受艾滋病毒、结核病和高血压护理的AMPATH项目患者，以及艾滋病毒感染儿童的照料者、社区领袖和医疗服务提供者。制定了一套访谈指南，以探讨慢性病管理中感知到的障碍和促进因素，特别是与艾滋病毒、结核病和高血压护理的关联和留存相关的因素。对数据进行编码并确定了各种主题。我们使用卫生服务利用的安徒生-纽曼框架对产生的概念和主题进行了组织。
共有235名参与者，包括110名艾滋病毒感染者（n = 50）、结核病患者（n = 39）或高血压患者（n = 21）；24名照料者；10名社区领袖；以及62名医疗服务提供者参与。障碍和促进因素被归类为易患特征、促成资源和需求因素。本研究中报告的许多促进因素和障碍在不同疾病类别中一致出现，包括个人动力、医患关系以及对社会和同伴支持的需求。
我们的研究结果深入了解了可能阻碍或鼓励关联和留存的个体以及更广泛的结构因素，这些因素在传染病和非传染病慢性病中都具有相关性。本研究结果表明，干预措施除了应考虑可能影响个人寻求并持续接受适当护理决策的易患因素和需求因素外，还应考虑获得护理的后勤方面。
