Office of Public Health Studies, University of Hawaii, 1960 East-West Road, Biomed T102, Honolulu, HI, 96822, USA.
Sector of Research on Non-Communicable Disease Policies, Department of Epidemiology and Health Systems, Institute of Public Health, Tirana, Albania.
Prev Sci. 2021 Jan;22(1):29-39. doi: 10.1007/s11121-018-0967-5.
Albania is a small country on the Balkan Peninsula that recently implemented an innovative primary healthcare program called "Si Je?" (How are you?) which allowed all Albanians aged 40-65 years to receive a free, yearly basic health examination at their local health center. Access to basic primary care is a critical component of a nationwide culture of prevention particularly for the non-communicable diseases that comprise 89% of total deaths in the country. Yet, as in many middle-income countries, a culture of prevention in Albania is often secondary to ensuring basic health infrastructure and healthcare access for those critically in need. Using the social-ecological model as our conceptual framework, this paper provides new insights into the culture of prevention in Albania by analyzing the need for, and implementation of, the Si Je? program using (1) findings from a critical literature review, (2) quantitative data from the database created from this program, and (3) qualitative data from key informant interviews from 15 health center directors. Positive developments towards a culture of prevention include the fact that the Si Je? program has been expanded to those 35-70 years, strengthened links between community and primary care, and participation among rural communities who traditionally have limited primary care access. Challenges include continued urgent health infrastructure needs, politicization of the Si Je? effort, limited participation by some groups (particularly urban men), and regional variations. Despite challenges, Albania appears to be building new infrastructure for a sustainable culture of prevention, particularly around chronic disease.
阿尔巴尼亚是巴尔干半岛上的一个小国，最近实施了一项名为“Si Je？”（你好吗？）的创新初级保健计划，允许所有 40-65 岁的阿尔巴尼亚人在当地的健康中心免费接受年度基本健康检查。获得基本初级保健是预防全国性文化的一个关键组成部分，特别是对于占该国总死亡人数 89%的非传染性疾病。然而，与许多中等收入国家一样，阿尔巴尼亚的预防文化往往次于为那些急需的人确保基本卫生基础设施和医疗保健服务。本文以社会生态模式为概念框架，通过分析 Si Je？计划的必要性和实施情况，为阿尔巴尼亚的预防文化提供了新的见解，使用了（1）批判性文献综述的结果，（2）该计划创建的数据库中的定量数据，以及（3）来自 15 名卫生中心主任的关键信息访谈的定性数据。朝着预防文化发展的积极趋势包括以下事实：Si Je？计划已经扩大到 35-70 岁的人群，加强了社区和初级保健之间的联系，以及农村社区的参与，这些社区传统上获得初级保健的机会有限。挑战包括持续的紧急卫生基础设施需求、Si Je？努力的政治化、一些群体（特别是城市男性）参与度有限以及区域差异。尽管存在挑战，但阿尔巴尼亚似乎正在为可持续的预防文化建立新的基础设施，特别是在慢性病方面。
