National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Building 62 Mills Road, Canberra, ACT, 2601, Australia.
Canberra Hospital, Canberra, ACT, Australia.
BMC Public Health. 2021 Mar 16;21(1):515. doi: 10.1186/s12889-021-10539-9.
Traffic injuries place a significant burden on mortality, morbidity and health services worldwide. Qualitative factors are important determinants of health but they are often ignored in the study of injury and corresponding development of prehospital Emergency Medical Services (EMS), especially in developing country settings. Here we report our research on sociocultural factors shaping pathways to hospital care for those injured on the roads and streets of Vietnam.
Qualitative fieldwork on pathways to emergency care of traffic injury was carried out from March to August 2016 in four hospitals in Vietnam, two in Ho Chi Minh City and two in Hanoi. Forty-eight traffic injured patients and their families were interviewed at length using a semi-structured topic guide regarding their journey to the hospital, help received, personal beliefs and other matters that they thought important. Transcribed interviews were analysed thematically guided by the three-delay model of emergency care.
Seeking care was the first delay and reflected concerns over money and possessions. The family was central for transporting and caring for the patient but their late arrival prolonged time spent at the scene. Reaching care was the second delay and detours to inappropriate primary care services had postponed the eventual trip to the hospital. Ambulance services were misunderstood and believed to be suboptimal, making taxis the preferred form of transport. Receiving care at the hospital was the third delay and both patients and families distrusted service quality. Request to transfer to other hospitals often created more conflict. Overall, sociocultural beliefs of groups of people were very influential.
Analysis using the three-delay model for road traffic injury in Vietnam has revealed important barriers to emergency care. Hospital care needs to improve to enhance patient experiences and trust. Socioculture affects each of the three delays and needs to inform thinking of future developments of the EMS system, especially for countries with limited resources.
交通伤害给全球的死亡率、发病率和卫生服务带来了巨大负担。定性因素是健康的重要决定因素，但在伤害研究和相应的院前急救医疗服务（EMS）发展中，这些因素往往被忽视，尤其是在发展中国家。在这里，我们报告了我们在越南道路和街道上发生交通伤害后，塑造通往医院治疗途径的社会文化因素的研究。
2016 年 3 月至 8 月，我们在越南的四家医院进行了定性实地研究，其中两家在胡志明市，两家在河内。使用半结构化主题指南，对 48 名交通伤害患者及其家属进行了详细访谈，内容涉及他们前往医院、获得帮助、个人信仰以及他们认为重要的其他事项。根据急救护理的三延误模型，对转录的访谈进行了主题分析。
寻求治疗是第一个延误，反映了对金钱和财产的关注。家庭在运送和照顾患者方面起着核心作用，但他们的迟到延长了在现场的时间。到达治疗是第二个延误，错误地去了初级保健服务，推迟了最终去医院的时间。对救护车服务的误解和认为其服务不佳，使得出租车成为首选的交通工具。在医院接受治疗是第三个延误，患者和家属都不信任服务质量。要求转院常常会引发更多的冲突。总的来说，人群的社会文化信仰具有很大的影响力。
使用三延误模型对越南道路交通伤害的分析揭示了紧急护理的重要障碍。医院护理需要改进，以提高患者的体验和信任。社会文化会影响三个延误中的每一个，这需要为未来 EMS 系统的发展提供信息，特别是对资源有限的国家。
