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社区联络人跨越边界的实践,旨在使“难以接触”的人群参与到卫生服务中。

Boundary spanning practices of community connectors for engaging 'hardly reached' people in health services.

机构信息

Swinburne University of Technology, Melbourne, Australia.

出版信息

Soc Sci Med. 2019 Jul;232:366-373. doi: 10.1016/j.socscimed.2019.05.034. Epub 2019 May 21.

Abstract

Global health policies direct health services to improve access and health outcomes of people who are 'hardly reached' by services. The institutionalised nature of health services with associated professional and organisational boundaries create ongoing challenges to achieving this policy aim. We present an approach to this challenge by exploring how health services can tap into the existing boundary spanning activities of community members we term as 'community connectors' who undertake valuable boundary work within the community to include people who are hardly reached. We address the research questions: what are the behaviours and characteristics of community connectors?; to what extent are they motivated to help out with health?; and how can health service personnel identify community connectors? We conducted an instrumental case study during 2017 in Victoria, Australia in the catchment area of a rural health service. Interviews with 17 key informants and eight staff members led to a further 15 interviews with community connectors. We identified the three key roles of 'noticer and responder', 'connector' and 'provider' that make connectors a valuable asset for health services. Community connectors seek opportunities to negotiate new boundaries with health services that support their boundary spanning with people hardly reached and also enable health services to transgress their own boundaries and access people who are hardly reached. We conclude that by paying attention to their own production, maintenance and transgression of boundaries, health services can apply this approach, noting that the local and iterative nature of identifying community connectors means that each cohort of community connectors will be unique as determined by local boundaries and relationships.

摘要

全球卫生政策指导卫生服务改善那些难以获得服务的人群的可及性和健康结果。卫生服务的制度化性质及其相关的专业和组织边界,给实现这一政策目标带来了持续的挑战。我们通过探索卫生服务如何利用我们称之为“社区联络人”的社区成员现有的跨越边界的活动来应对这一挑战,这些社区联络人在社区内开展有价值的边界工作,包括接触那些难以获得服务的人群。我们提出了三个研究问题:社区联络人的行为和特征是什么?他们在多大程度上有帮助健康的动机?卫生服务人员如何识别社区联络人?我们在 2017 年澳大利亚维多利亚州的一个农村卫生服务机构进行了一项工具性案例研究。对 17 名关键信息提供者和 8 名工作人员进行了访谈,随后又对 15 名社区联络人进行了访谈。我们确定了社区联络人的三个关键角色,即“发现者和响应者”、“联络人”和“提供者”,这使得社区联络人成为卫生服务的宝贵资产。社区联络人寻求与卫生服务建立新边界的机会,这有助于他们与难以接触到的人群进行边界跨越,同时也使卫生服务能够跨越自身边界,接触到那些难以接触到的人群。我们的结论是,卫生服务可以通过关注自身边界的产生、维护和跨越来应用这种方法,需要注意的是,识别社区联络人的本地和迭代性质意味着每一批社区联络人都将是独特的,这取决于本地边界和关系。

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