Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Keppel Street, London, WC1E 7HT, UK.
Bruyère Research Institute, 85 Primrose Avenue, Room 308-B, Ottawa, ON, K1R 6M1, Canada.
Parasit Vectors. 2018 Mar 12;11(1):179. doi: 10.1186/s13071-018-2689-8.
The Global Programme to Eliminate Lymphatic Filariasis has set 2020 as a target to eliminate lymphatic filariasis (LF) as a public health problem through mass drug administration (MDA) to all eligible people living in endemic areas. To obtain a better understanding of compliance with LF treatment, a qualitative study using 43 in-depth interviews was carried out in Alor District, Indonesia to explore factors that motivate uptake of LF treatment, including the social and behavioural differences between compliant and non-compliant individuals. In this paper, we report on the findings specific to the role of family and gender relations and how they affect compliance.
The sample comprised 21 men and 22 women; 24 complied with treatment while 19 did not. Gender relations emerged as a key theme in access, uptake and compliance with MDA. The view that the husband, as head of household, had the power, control, and in some cases the responsibility to influence whether his wife took the medication was common among both men and women. Gender also affected priorities for health care provision in the household as well as overall decision making regarding health in the household. Four models of responsibility for health decision making emerged: (i) responsibility resting primarily with the husband; (ii) responsibility resting primarily with the wife; (iii) responsibility shared equally by both husband and wife; and (iv) responsibility autonomously assumed by each individual for his or her own self, regardless of the course of action of the other spouse.
(i) Gender relations and social hierarchy influence compliance with LF treatment because they inherently affect decisions taken within the household regarding health; (ii) health care interventions need to take account of the complexity of gender roles; (iii) the fact that women's power tends to be implicit and not overtly recognised in the household or the community has important implications for health care interventions; (iv) campaigns and other preventive interventions need to take account of the diversity of patterns of health care decision-making and responsibility in specific communities so that social mobilisation messages can be tailored appropriately.
全球消灭淋巴丝虫病规划将 2020 年定为目标，通过向流行地区所有符合条件的人提供大规模药物治疗（MDA），消除淋巴丝虫病（LF）这一公共卫生问题。为了更好地了解 LF 治疗的依从性，印度尼西亚阿拉尔区进行了一项使用 43 次深入访谈的定性研究，以探索促使 LF 治疗参与的因素，包括符合和不符合治疗条件的个人之间的社会和行为差异。本文报告了与家庭和性别关系作用以及它们如何影响依从性相关的发现。
样本包括 21 名男性和 22 名女性；24 人接受了治疗，19 人未接受。性别关系是影响 MDA 获得、参与和依从性的一个关键主题。丈夫作为家庭的负责人拥有权力、控制和在某些情况下有责任影响妻子是否服药的观点在男性和女性中都很普遍。性别还影响了家庭中医疗保健提供的优先事项以及家庭中整体健康决策。健康决策的责任模式有四种：（i）主要由丈夫承担责任；（ii）主要由妻子承担责任；（iii）丈夫和妻子共同承担责任；（iv）个人为自己的健康自主承担责任，而不考虑配偶的行为。
（i）性别关系和社会等级影响 LF 治疗的依从性，因为它们会影响家庭中关于健康的决策；（ii）卫生保健干预措施需要考虑到性别角色的复杂性；（iii）女性的权力在家庭或社区中往往是隐性的，而不是显性的，这对卫生保健干预措施有重要影响；（iv）运动和其他预防干预措施需要考虑特定社区中医疗保健决策和责任模式的多样性，以便适当调整社会动员信息。
