Girgis Labib, Van Gurp Gerald, Zakus David, Andermann Anne
Department of Family Medicine, McGill University, Montreal, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BMC Health Serv Res. 2018 Aug 7;18(1):614. doi: 10.1186/s12913-018-3408-z.
While it is increasingly recognized that social determinants influence the health of patients and populations, little is known about how doctors in the Eastern Mediterranean Region can help their patients with these issues. Our study aimed to identify common social challenges faced by patients in Eastern Mediterranean countries, to assess what doctors are already doing to address these challenges, and to identify barriers and facilitators for addressing the social causes of poor health in Eastern Mediterranean countries with shedding some light on how does this compare to a developed country like Canada.
We conducted a qualitative research study employing qualitative descriptive methodology. A purposeful sample as well as snowballing technique were used to recruit 18 physicians who were trained in Eastern Mediterranean countries but have since moved to Canada. Recruitment continued until data saturation was reached. A content analysis was carried out after transcribing the interviews.
The main social challenges identified in clinical care in Eastern Mediterranean Regions include poverty, illiteracy, domestic violence, and food insecurity. Doctors attempted to help their patients by providing free medical services and free medications, establishing a donation box, and referring to social workers and support services, where available. Cultural constraints, lack of time, and unavailability of referral resources were often cited as important barriers. Our participants stated that Canada is generally better in dealing with the social challenges than their countries of origin.
Most study participants expressed their willingness to help patients in dealing with social challenges, and shared their experiences of tackling such issues, though there were also important barriers reported that would need to be overcome. Participants suggested that better addressing social challenges in clinical care would require educating both health care providers and patients about the importance of discussing the patient's social environment as part of the health care encounter, as well as advocating for broader policy approaches by governments to address the underlying social problems.
虽然社会决定因素对患者和人群健康的影响日益受到认可，但对于东地中海区域的医生如何帮助患者应对这些问题却知之甚少。我们的研究旨在确定东地中海国家患者面临的常见社会挑战，评估医生为应对这些挑战已采取的措施，并确定在东地中海国家解决健康状况不佳的社会原因的障碍和促进因素，同时探讨与加拿大等发达国家相比情况如何。
我们采用定性描述方法进行了一项定性研究。采用目的抽样和滚雪球技术招募了18名在东地中海国家接受培训但后来移居加拿大的医生。招募工作持续进行，直至达到数据饱和。访谈转录后进行了内容分析。
东地中海区域临床护理中确定的主要社会挑战包括贫困、文盲、家庭暴力和粮食不安全。医生试图通过提供免费医疗服务和免费药物、设立捐款箱以及转介给现有的社会工作者和支持服务机构来帮助患者。文化限制、时间不足和转介资源不可用常被视为重要障碍。我们的参与者表示，加拿大在应对社会挑战方面总体上比他们的原籍国做得更好。
大多数研究参与者表示愿意帮助患者应对社会挑战，并分享了应对此类问题的经验，不过也报告了一些需要克服的重要障碍。参与者建议，要在临床护理中更好地应对社会挑战，需要教育医疗服务提供者和患者，让他们认识到在医疗服务过程中讨论患者社会环境的重要性，同时倡导政府采取更广泛的政策措施来解决潜在的社会问题。
