Paulus-Mokgachane Thato M M, Visagie Surona J, Mji Gubela
Spinal cord injury rehabilitation Unit, Princess Marina Hospital, University of Botswana, Gaborone, Botswana.
Centre for Rehabilitation Studies, Stellenbosch University, Cape Town, South Africa.
Afr J Disabil. 2019 Sep 23;8(0):539. doi: 10.4102/ajod.v8i0.539. eCollection 2019.
People with spinal cord injury (SCI) often have great need for healthcare services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana.
This study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone area, Botswana.
A quantitative, cross-sectional, observational study was conducted. Data were collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive and inferential analysis was performed.
The male to female ratio was 2.8:1. The mean age of participants was 40 years (standard deviation 9.59). Road traffic crashes caused 85% of the injuries. Most participants visited primary care facilities between 2 and 10 times in the 6 months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated satisfaction with services. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height-adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs.
Primary care services were mostly affordable and adequate. Availability, acceptability and accessibility aspects created barriers.
脊髓损伤（SCI）患者通常对医疗服务有很大需求，但他们表示在获得医疗服务方面存在困难。博茨瓦纳尚未对脊髓损伤患者获得初级医疗服务的情况进行研究。
本研究旨在确定脊髓损伤患者在博茨瓦纳哈博罗内地区获得初级医疗服务时所经历的障碍和促进因素。
进行了一项定量、横断面观察性研究。使用结构化问卷从57名创伤性和非创伤性脊髓损伤患者中收集数据。进行了描述性和推断性分析。
男女比例为2.8:1。参与者的平均年龄为40岁（标准差9.59）。85%的损伤由道路交通事故导致。大多数参与者在研究前6个月内前往初级医疗设施就诊2至10次。参与者对服务感到满意（63%），并认为设施干净（95%）且维护良好（73.5%）。优惠待遇、尊重、等待时间短和营业时间便利促进了对服务的满意度。71.9%的参与者表示，提供者对脊髓损伤的知识不足以及耗材短缺（80.7%）阻碍了服务的可及性。结构方面的挑战（42.1%的人无法自行进入设施，56.5%的人无法使用卫生间）以及缺乏可调节高度的检查床（66.7%）妨碍了无障碍使用。当公共服务无法满足需求时，参与者（64.9%）使用私人医疗服务会产生费用。
初级医疗服务大多价格合理且足够。可及性、可接受性和无障碍性方面造成了障碍。
