Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
London School of Hygiene and Tropical Medicine, London, UK.
BMC Public Health. 2020 Nov 3;20(1):1641. doi: 10.1186/s12889-020-09758-3.
BACKGROUND: There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS: This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS: Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant's cadre: the nature of the participant's role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION: Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.
背景:印度卫生系统存在多种阻碍儿童癌症治疗的障碍。了解这些障碍是什么、不同利益相关者如何看待这些障碍以及哪些因素影响他们的看法,对于改善治疗机会、实现全民健康覆盖(UHC)至关重要。本研究旨在从印度医疗服务提供者的角度探讨获取儿童癌症治疗的挑战。
方法:本研究在德里和海得拉巴的 7 家三级癌症医院(3 家公立医院、3 家私立医院和 1 家慈善信托医院)进行。我们招募了 27 名参与儿童癌症治疗的医疗服务提供者。在获得知情同意后,对参与者进行了半结构化访谈,并使用 NVivo 11 软件进行主题和归纳内容分析。
结果:参与者描述了一系列相互关联的获取治疗障碍,例如基础设施和支持性护理不足、患者知识和意识、社会文化信仰以及薄弱的转诊途径。然而,这些障碍因参与者的感知而存在差异,这主要取决于三个关键影响因素:1)医院类型:公立医院存在更多的障碍,例如患者导航问题和卫生人力不足,而慈善信托和私立医院则更有能力提供服务。2)参与者的职级:参与者的角色性质意味着他们对家庭所面临挑战的接触程度不同,例如,社会工作者在与家庭的日常互动中提供了更多关于障碍的深入描述,而肿瘤学家则不然。3)不同职级中的个人认知:无论医院类型或职级如何,参与者对障碍都有不同的个人看法,例如对延迟的接受和对利益相关者责任的认可,其中治理是一个主要问题。这些影响不仅暗示了有形和结构性障碍,还暗示了服务提供和利益相关者关系中的无形障碍。
结论:尽管参与者承认印度获取儿童癌症治疗的机会受到多种障碍的限制,但他们对这些障碍的看法存在差异。我们的研究结果表明,医疗服务提供者的看法受到他们的经验、利益和立场的影响,这对于在 UHC 框架内为儿童癌症制定政策具有重要意义。
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