Duke University School of Medicine, US.
Duke Global Health Institute, US.
Ann Glob Health. 2020 Oct 6;86(1):127. doi: 10.5334/aogh.2978.
Traumatic brain injury (TBI) is a life-altering condition, and delays to care can significantly impact outcomes. In Uganda, where nurse shortages are prevalent, patients' family members are the primary caretakers of these patients and play an important role in ensuring patients' access to timely care. However, caretakers often have little or no knowledge of appropriate patient care. Caretakers' ability to navigate the healthcare system and find and use health information to support their patients can impact delays in seeking, reaching, and receiving care.
This study seeks to determine the factors that impact TBI patient caretakers' health literacy and examine how these factors influence delays in care.
This study was carried out in the Mulago National Referral Hospital neurosurgical ward, where 27 adult caretakers were interviewed using semi-structured, in-depth, qualitative interviews. "The Three Delay Framework" was utilized to understand participants' experiences in seeking, reaching, and receiving care for TBI patients. Thematic content analysis and manual coding was used to analyze interview transcripts and identify overarching themes in participant responses.
The main health literacy themes identified were Extrinsic, Intrinsic and Health System Factors. Nine sub-themes were identified: Government Support, Community Support, Financial Burdens, Lack of Medical Resources, Access to Health Information, Physician Support, Emotional Challenges, Navigational Skills, and Understanding of Health Information. These components were found to influence the delays to care to varying degrees. Financial Burdens, Government Support, Emotional Challenges, Physician Support and Lack of Medical Resources were recurring factors across the three delays.
The health literacy factors identified in this study influence caretakers' functional health literacy and delays to care in a co-dependent manner. A better understanding of how these factors impact patient outcomes is necessary for the development of interventions targeted at improving a caretaker's ability to maneuver the healthcare system and support patients in resource-poor settings.
创伤性脑损伤（TBI）是一种改变生活的疾病，护理延迟会对结果产生重大影响。在乌干达，护士短缺普遍存在，患者的家属是这些患者的主要照顾者，在确保患者及时获得护理方面发挥着重要作用。然而，照顾者通常对适当的患者护理知之甚少或一无所知。照顾者在医疗保健系统中的导航能力，以及寻找和使用健康信息来支持患者，可能会影响寻求、到达和接受护理的延迟。
本研究旨在确定影响 TBI 患者照顾者健康素养的因素，并研究这些因素如何影响护理延迟。
本研究在穆拉戈国家转诊医院神经外科病房进行，对 27 名成年照顾者进行了半结构化、深入的定性访谈。利用“三延迟框架”来理解参与者在创伤性脑损伤患者的寻求、到达和接受护理方面的经验。使用主题内容分析和手动编码对访谈记录进行分析，以确定参与者回答中的总体主题。
确定的主要健康素养主题是外在、内在和医疗系统因素。确定了九个子主题：政府支持、社区支持、经济负担、医疗资源匮乏、获取健康信息、医生支持、情绪挑战、导航技能和理解健康信息。这些因素在不同程度上影响了护理延迟。经济负担、政府支持、情绪挑战、医生支持和医疗资源匮乏是贯穿三个延迟的反复出现的因素。
本研究确定的健康素养因素以相互依存的方式影响照顾者的功能性健康素养和护理延迟。为了制定干预措施，以改善照顾者在资源匮乏环境中驾驭医疗保健系统和支持患者的能力，有必要更好地了解这些因素如何影响患者的结果。
