基于社区的教育对乌干达本科卫生专业学生在服务欠缺地区工作决策的影响。
Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda.
作者信息
Kizito Samuel, Baingana Rhona, Mugagga Kintu, Akera Peter, Sewankambo Nelson K
机构信息
Makerere University College of Health Sciences, Kampala, Uganda.
Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
出版信息
BMC Res Notes. 2017 Dec 8;10(1):726. doi: 10.1186/s13104-017-3064-0.
BACKGROUND
Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students' perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students' attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas.
RESULTS
Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1-0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1-0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0-3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5-35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3-1.0) and Internet (IRR = 1.5; 95% CI 1.0-2.3), high salary (IRR = 0.4; 95% CI 0.3-0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3-3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3-0.8) and long distance courses (IRR = 2.1; 95% CI 1.4-3.1) were significant motivators after having undergone the COBERS placement.
CONCLUSIONS
The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health professionals to rural areas thus addressing the maldistribution of health workers in Uganda.
背景
乌干达面临卫生工作者短缺的问题，且现有的少数卫生工作者分布不均。通过社区教育提供农村实习机会可能会积极影响学生对农村地区工作的看法。我们旨在评估基于社区的教育与研究（COBERS）对卫生专业学生在农村地区工作态度的影响。这是一项对乌干达4所医科大学的525名学生进行的前后对照研究。数据通过自行填写的纸质问卷收集。分别使用逻辑回归和泊松回归来评估在农村地区工作的意愿以及预期工作年限。
结果
在COBERS项目实施前，518名学生中有228名（44.0%）表示他们打算在农村地区工作，而在COBERS项目实施后，506名学生中有245名（48.4%）表示有此打算。在COBERS项目实施前，与学生考虑在农村地区工作相关的因素有：额外津贴（比值比[OR]=0.2；95%置信区间[CI]0.1 - 0.6）以及社会便利设施的可用性（OR = 0.2；95% CI 0.1 - 0.7）。在他们参与COBERS项目后，相关因素变为：能够参加远程课程（OR = 2.0；95% CI 1.0 - 3.7）以及被分配到农村地区的机构工作（OR = 15.0；95% CI 6.5 - 35.5）。在COBERS项目实施前，影响学生认为自己愿意在农村环境工作时长的因素有：可靠的电力供应（发病率比值比[IRR]=0.6；95% CI 0.3 - 1.0）和互联网（IRR = 1.5；95% CI 1.0 - 2.3）、高工资（IRR = 0.4；95% CI 0.3 - 0.7）以及具备在农村地区执业的技能（IRR = 2.0；95% CI 1.3 - 3.1）。在参与COBERS项目后，可靠的电力供应（IRR = 0.5；95% CI 0.3 - 0.8）和远程课程（IRR = 2.1；95% CI 1.
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