社会决定因素在查加斯病获得医疗保健方面的作用:玻利维亚科恰班巴“瓦尔阿尔托”地区家庭生活的定性研究。
Social determinants in the access to health care for Chagas disease: A qualitative research on family life in the "Valle Alto" of Cochabamba, Bolivia.
机构信息
Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
Fundación Ciencia y Estudios Aplicados para el Desarrollo en Salud y Medio Ambiente (CEADES Foundation), Cochabamba, Bolivia.
出版信息
PLoS One. 2021 Aug 12;16(8):e0255226. doi: 10.1371/journal.pone.0255226. eCollection 2021.
INTRODUCTION
Chagas disease is caused by the Trypanosoma cruzi infection. It is a neglected tropical disease with considerable impact on the physical, psychological, familiar, and social spheres. The Valle Alto of Cochabamba is a hyperendemic region of Bolivia where efforts to control the transmission of the disease have progressed over the years. However, many challenges remain, above all, timely detection and health-care access.
METHODS
Following the Science Shop process, this bottom-up research emerged with the participation of the civil society from Valle Alto and representatives of the Association of Corazones Unidos por el Chagas from Cochabamba. The aim of this study is to explore the social determinants in the living realities of those affected by Chagas disease or the silent infection and how families in the Valle Alto of Cochabamba cope with it. An interdisciplinary research team conducted a case study of the life stories of three families using information from in-depth interviews and performed a descriptive qualitative content analysis and triangulation processes.
FINDINGS
Findings provide insights into social circumstances of the research subjects' lives; particularly, on how exposure to Trypanosoma cruzi infection affects their daily lives in terms of seeking comprehensive health care. Research subjects revealed needs and shared their experiences, thus providing an understanding of the complexity of Chagas disease from the socioeconomic, sociocultural, political, and biomedical perspectives. Results enlighten on three dimensions: structural, psychosocial, and plural health system. The diverse perceptions and attitudes toward Chagas within families, including the denial of its existence, are remarkable as gender and ethnocultural aspects. Findings support recommendations to various stakeholders and translation materials.
CONCLUSIONS
Intersectional disease management and community involvement are essential for deciding the most appropriate and effective actions. Education, detection, health care, and social programs engaging family units ought to be the pillars of a promising approach.
简介
恰加斯病由克氏锥虫感染引起。它是一种被忽视的热带病,对身体、心理、家庭和社会都有相当大的影响。玻利维亚的瓦尔阿尔托是一个高度流行区,多年来,该地区一直在努力控制该病的传播。然而,仍存在许多挑战,尤其是及时发现和获得医疗保健的机会。
方法
本研究采用自下而上的方法,按照科学商店的流程进行,瓦尔阿尔托的民间社会和科恰班巴“同心协力治疗恰加斯病协会”的代表参与其中。本研究旨在探讨受恰加斯病或隐匿性感染影响的人以及瓦尔阿尔托的家庭在现实生活中的社会决定因素,以及他们如何应对这种疾病。一个跨学科的研究团队对三个家庭的生活故事进行了案例研究,这些信息来自深入的访谈,并进行了描述性定性内容分析和三角分析过程。
发现
研究结果深入了解了研究对象生活的社会环境;特别是,了解克氏锥虫感染如何影响他们在寻求全面医疗保健方面的日常生活。研究对象揭示了他们的需求并分享了他们的经验,从而从社会经济、社会文化、政治和生物医学等方面对恰加斯病的复杂性有了深入的了解。结果从三个维度说明了恰加斯病:结构、心理社会和多元卫生系统。家庭中对恰加斯病的不同看法和态度值得注意,包括对该病存在的否认,这与性别和民族文化有关。研究结果支持向各利益攸关方提出建议,并提供了翻译材料。
结论
交叉疾病管理和社区参与对于决定最合适和最有效的行动至关重要。教育、检测、医疗保健和让家庭参与的社会项目应该是一个有前途的方法的支柱。
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