Tune Samiun Nazrin Bente Kamal, Hoque Roksana, Naher Nahitun, Islam Nazia, Mazedul Islam Md, Ahmed Syed Masud
Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
BMJ Open. 2020 Oct 7;10(10):e035663. doi: 10.1136/bmjopen-2019-035663.
This study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention.
A qualitative exploratory study of a sample of street dwellers of Dhaka City.
Samples were taken from three purposively selected spots of Dhaka City with a high concentration of the target population.
Fifteen in-depth interviews and six informal group discussions with 40 street dwellers (≥18 years), and key informant interviews with service providers (n=6) and policymakers (n=3) were conducted during January-June 2019 to elicit necessary data.
Qualitative narrative of illness experiences of the sampled street dwellers, relevant healthcare-seeking behaviour and experiences of interactions with health systems.
We focused on three main themes, namely, reported illnesses, relevant healthcare-seeking behaviour and health system experiences of the street dwellers. Findings reveal that most of the street dwellers suffered from fever and respiratory illnesses in the last 6 months; however, a majority did not visit formal facilities. They preferred visiting retail drug shops for advice and treatment or waited for self-recovery. Formal facilities were visited only when treatment from drug shops failed to cure them or they suffered serious illnesses or traumatic injury. The reproductive-age women did not seek pregnancy care and most deliveries took place in the street dwellings. Lack of awareness, financial constraints and fear of visiting formal facilities were some of the reasons mentioned. Those who visited formal facilities faced barriers like the cost of medicines and diagnostic tests, long waiting time and opportunity cost.
The street dwellers lacked access to formal health systems for needed services as the latter lags far behind to outreach this extremely vulnerable population. What they need is explicit targeting with a customised package of services based on their illness profile, at a time and place convenient to them with minimum or no cost implications.
本研究探讨了达卡市一部分街头居民的患病经历和就医行为，以便设计定制化干预措施。
对达卡市街头居民样本进行定性探索性研究。
样本取自达卡市三个经过有目的选择、目标人群高度集中的地点。
2019年1月至6月期间，对40名街头居民（≥18岁）进行了15次深入访谈和6次非正式小组讨论，并对服务提供者（n = 6）和政策制定者（n = 3）进行了关键信息访谈，以获取必要数据。
抽样街头居民患病经历的定性叙述、相关就医行为以及与卫生系统互动的经历。
我们重点关注了三个主要主题，即街头居民报告的疾病、相关就医行为以及卫生系统体验。研究结果显示，大多数街头居民在过去6个月中患有发烧和呼吸道疾病；然而，大多数人并未前往正规医疗机构就诊。他们更倾向于去零售药店咨询和治疗，或者等待自愈。只有在药店治疗无效、患有严重疾病或遭受创伤性损伤时，才会去正规医疗机构。育龄妇女不寻求孕期护理，大多数分娩在街头住所进行。提到的一些原因包括缺乏意识、经济限制以及害怕前往正规医疗机构。那些前往正规医疗机构的人面临着药品和诊断检查费用、长时间等待以及机会成本等障碍。
街头居民无法获得正规卫生系统提供的所需服务，因为后者远远落后于覆盖这一极其脆弱的人群。他们需要的是根据其疾病情况，在方便他们的时间和地点，以定制化服务包进行明确的针对性服务，且成本最低或无成本。
