Department of Global Health, University of Washington, Seattle, WA, USA.
Possible, Kathmandu, Nepal.
BMJ Open. 2019 Apr 3;9(4):e026020. doi: 10.1136/bmjopen-2018-026020.
The study aimed to qualitatively examine the perspectives of US-based physicians and academic global health programme leaders on how global health work shapes their viewpoints, values and healthcare practices back in the USA.
A prospective, qualitative exploratory study that employed online questionnaires and open-ended, semi-structured interviews with two participant groups: (1) global health physicians and (2) global health programme leaders affiliated with USA-based academic medical centres. Open coding procedures and thematic content analysis were used to analyse data and derive themes for discussion.
159 global health physicians and global health programme leaders at 25 academic medical institutions were invited via email to take a survey and participate in a follow-up interview. Twelve participants completed online questionnaires (7.5% response rate) and eight participants (four survey participants and four additionally recruited participants) participated in in-depth, in-person or phone semi-structured interviews.
Five themes emerged that highlight how global health physicians and academic global health programme leaders perceive global health work abroad in shaping USA-based medical practices: (1) a sense of improved patient rapport, particularly with low-income, refugee and immigrant patients, and improved and more engaged patient care; (2) reduced spending on healthcare services; (3) greater awareness of the social determinants of health; (4) deeper understanding of the USA's healthcare system compared with systems in other countries; and (5) a reinforcement of values that initially motivated physicians to pursue work in global health.
A majority of participating global health physicians and programme leaders believed that international engagements improved patient care back in the USA. Participant responses relating to the five themes were contextualised by highlighting factors that simultaneously impinge on their ability to provide improved patient care, such as the social determinants of health, and the challenges of changing USA healthcare policy.
本研究旨在定性探讨美国医生和学术全球卫生计划领导者的观点，即全球卫生工作如何塑造他们在美国的观点、价值观和医疗实践。
前瞻性、定性探索性研究，采用在线问卷和对两组参与者的开放式、半结构化访谈：（1）全球卫生医生和（2）与美国学术医疗中心有关联的全球卫生计划领导者。采用开放式编码程序和主题内容分析来分析数据并得出讨论主题。
通过电子邮件邀请 25 所学术医疗机构的 159 名全球卫生医生和全球卫生计划领导者参加调查并参与后续访谈。12 名参与者完成了在线问卷（响应率为 7.5%），8 名参与者（4 名调查参与者和另外 4 名招募参与者）参加了深入的面对面或电话半结构化访谈。
出现了五个主题，突出了全球卫生医生和学术全球卫生计划领导者如何看待在国外开展全球卫生工作，以塑造美国的医疗实践：（1）与低收入、难民和移民患者建立更好的医患关系，并改善和更积极参与的患者护理；（2）减少医疗服务支出；（3）提高对健康决定因素的认识；（4）更深入地了解美国的医疗保健系统与其他国家的系统；（5）加强最初促使医生从事全球卫生工作的价值观。
大多数参与的全球卫生医生和计划领导者认为国际参与改善了美国的患者护理。与五个主题相关的参与者反应通过突出同时影响他们提供改善的患者护理能力的因素进行了背景化，例如健康决定因素和改变美国医疗保健政策的挑战。
