Lonnie Embleton, Pooja Shah, Allison Gayapersad, Reuben Kiptui, David Ayuku, Juddy Wachira, Edith Apondi, Paula Braitstein
Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.
Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada.
BMC Health Serv Res. 2021 Apr 20;21(1):363. doi: 10.1186/s12913-021-06376-6.
In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY's and healthcare provider's reflections on their interactions with each other.
This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY's experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness.
Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY's interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers' adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness.
This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY's experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.
在肯尼亚，与街头有联系的儿童和青年（SCY）健康状况不佳，因可预防的原因过早死亡。这表明他们无法获得或未得到足够的响应式医疗保健服务来预防发病和死亡。我们试图通过深入探究SCY和医疗服务提供者对彼此互动的看法，来深入了解肯尼亚卫生系统对SCY的响应情况。
这项定性研究于2017年5月至2018年9月在肯尼亚西部的5个县进行，采用多种方法来探索和描述公众对肯尼亚SCY现象的看法、已提出的和现有的应对措施。本分析聚焦于来自焦点小组讨论和深入访谈的一部分数据，这些数据涉及为SCY提供医疗保健服务、SCY与提供者之间的互动以及SCY在卫生系统中的经历。我们在卫生系统响应能力的概念框架内进行了主题分析。
通过“背景”“负面医患互动”和“正面医患互动”这三个主题，我们确定了影响肯尼亚卫生系统对SCY响应能力的因素。经济因素影响并限制了SCY与卫生系统的互动，并塑造了他们在尊严、基本便利设施质量、提供者选择和及时关注方面的体验。SCY所遭受的污名化和歧视是一个由肯尼亚社会文化背景塑造的社会学过程，导致他们在与卫生系统互动时感到屈辱且缺乏及时关注。医患互动受到医疗服务提供者对SCY的负面个人情绪和态度的极大影响，导致负面互动以及卫生系统缺乏响应能力。
本研究表明，肯尼亚的卫生系统对SCY的响应不足。增加公共卫生支出和扩大全民健康覆盖范围可能开始解决一些经济因素，如无力支付医疗费用，这些因素影响了SCY在提供者选择、及时关注和尊严方面的体验。为改善医患互动，需要解决提供者对SCY所表达的深深植根的负面情绪反应，这种反应与对这一人群的社会建构污名化有关。
