McGowan Catherine R, Hellman Nora, Baxter Louisa, Chakma Sonali, Nahar Samchun, Daula Ahasan Ud, Rowe Kelly, Gilday Josie, Kingori Patricia, Pounds Rachel, Cummings Rachael
Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK.
Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Confl Health. 2020 Dec 14;14(1):86. doi: 10.1186/s13031-020-00331-8.
A patient charter is an explicit declaration of the rights of patients within a particular health care setting. In early 2020 the Save the Children Emergency Health Unit deployed to Cox's Bazar Bangladesh to support the establishment of a severe acute respiratory infection isolation and treatment centre as part of the COVID-19 response. We developed a charter of patient rights and had it translated into Bangla and Burmese; however, the charter remained inaccessible to Rohingya and members of the host community with low literacy.
To both visualise and contextualise the patient charter we undertook a graphic elicitation method involving both the Rohingya and host communities. We carried out two focus group discussions during which we discussed the charter and agreed how best to illustrate the individual rights contained therein.
Logistical constraints and infection prevention and control procedures limited our ability to follow up with the original focus group participants and to engage in back-translation as we had planned; however, we were able to elicit rich descriptions of each right. Reflecting on our method we were able to identify several key learnings relating to: 1) our technique for eliciting feedback on the charter verbatim versus a broader discussion of concepts referenced within each right, 2) our decision to include both men and women in the same focus group, 3) our decision to ask focus group participants to describe specific features of each illustration and how this benefited the inclusivity of our illustrations, and 4) the potential of the focus groups to act as a means to introduce the charter to communities.
Though executing our method was operationally challenging we were able to create culturally appropriate illustrations to accompany our patient charter. In contexts of limited literacy it is possible to enable access to critical clinical governance and accountability tools.
患者宪章是在特定医疗环境中对患者权利的明确声明。2020年初，救助儿童会紧急卫生股部署到孟加拉国科克斯巴扎尔，以支持建立一个严重急性呼吸道感染隔离和治疗中心，作为应对新冠疫情的一部分。我们制定了一份患者权利宪章，并将其翻译成孟加拉语和缅甸语；然而，识字率较低的罗兴亚人和当地社区成员仍然无法获取该宪章。
为了使患者宪章可视化并结合具体情境，我们采用了一种图形启发方法，涉及罗兴亚人和当地社区。我们进行了两次焦点小组讨论，期间讨论了宪章，并就如何最好地说明其中包含的各项权利达成了一致。
后勤限制以及感染预防和控制程序限制了我们按计划对原始焦点小组参与者进行跟进以及进行回译的能力；然而，我们能够获得对每项权利的丰富描述。反思我们的方法，我们能够确定与以下方面相关的几个关键经验教训：1）我们逐字征求对宪章反馈的技巧与对每项权利中所涉及概念进行更广泛讨论的技巧；2）我们将男性和女性纳入同一焦点小组的决定；3）我们要求焦点小组参与者描述每幅插图的具体特征以及这如何有利于插图的包容性的决定；4）焦点小组作为向社区介绍宪章的一种手段的潜力。
尽管实施我们的方法在操作上具有挑战性，但我们能够制作出符合文化背景的插图来配合我们的患者宪章。在识字率有限的情况下，有可能使人们能够获取关键的临床治理和问责工具。
