Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.
Department of Psychiatry, University College London, London, W1T 7BN, UK.
Trans R Soc Trop Med Hyg. 2022 Apr 4;116(4):322-327. doi: 10.1093/trstmh/trab124.
Uptake of lumbar puncture (LP) remains low in regions with a high prevalence of central nervous system (CNS) infections like Zambia. Efforts to improve uptake are hindered by limited understanding of factors influencing LP uptake.
Semistructured qualitative interviews were conducted with patients with suspected CNS infection, caregivers, doctors and nurses at the University Teaching Hospitals in 2016. Questions focused on LP experiences, knowledge, the consent process and health system barriers to LP among patients with an LP indication. Interviews were transcribed, translated to English and analysed using a thematic approach.
We recruited 24 adult patients, 36 caregivers of adult patients, 63 caregivers of paediatric patients, 20 doctors and 30 nurses (173 in total). LP barriers arose from both patients/caregivers and health providers and included community apprehension about LP, proxy (family) consensus consent practices, competing clinical demands, wariness of patient/caregiver responses, limitations in consumables and time to complete the LP. This could result in consent not being obtained correctly. LP enablers included patient/caregiver perceived LP utility, provider comfort with LP and in-person counselling.
LP uptake is a complex sociocultural process influenced by patient, healthcare and community-level factors. Interventions to improve uptake must address multiple barriers to be successful.
在像赞比亚这样中枢神经系统 (CNS) 感染流行率高的地区，腰椎穿刺 (LP) 的普及率仍然很低。由于对影响 LP 普及率的因素缺乏了解，因此难以采取措施提高 LP 普及率。
2016 年，我们在赞比亚大学教学医院对疑似 CNS 感染的患者、患者照顾者、医生和护士进行了半结构式定性访谈。问题集中在 LP 经验、知识、知情同意过程以及 LP 指征患者的卫生系统障碍上。访谈内容被转录、翻译成英文，并采用主题分析方法进行分析。
我们共招募了 24 名成年患者、36 名成年患者照顾者、63 名儿科患者照顾者、20 名医生和 30 名护士（共 173 人）。LP 障碍既来自患者/照顾者，也来自卫生提供者，包括社区对 LP 的担忧、代理（家庭）共识同意做法、临床需求竞争、对患者/照顾者反应的警惕、耗材和完成 LP 的时间限制。这可能导致知情同意不正确。LP 的促成因素包括患者/照顾者感知的 LP 效用、提供者对 LP 的舒适度和面对面咨询。
LP 普及率是一个复杂的社会文化过程，受患者、医疗保健和社区层面因素的影响。要提高 LP 普及率，干预措施必须解决多个障碍才能成功。
