Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda.
BMC Health Serv Res. 2021 Oct 26;21(1):1163. doi: 10.1186/s12913-021-07204-7.
The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. We argue that health care delivery has multiple intersections that are experientially complex, multi-layered and multi-dimensional to the disadvantage of vulnerable population segments of society in the study area.
We used a cross-sectional qualitative exploratory design. Qualitative methods facilitated an in-depth exploration and understanding of this island dispersed and peripheral setting. Data sources included a review of relevant literature and an ethnographic exploration of the lived experiences of community members while seeking and accessing health care. Data collection methods included in-depth interviews (IDI) from selected respondents, observation, focus group discussions (FGDs) and key informant interviews (KII).
We report based on the health care systems model which posits that, health care activities are diverse but interconnected in a complex way. The identified themes are; the role of geography, access (geographical and financial) to health services, demand and utilization, Supplies, staffing and logistical barriers and a permissive and transient society. When and how to travel for care was beyond a matter of having a health need/ being sick and need arising. A motivated workforce is as critical as health facilities themselves in determining healthcare outcomes.
Geography doesn't work and affect health outcomes in isolation. Measures that target only individuals will not be adequate to tackle health inequalities because aspects of the collective social group and physical environment may also need to be changed in order to reduce health variations.
本研究旨在深入探讨与地理、医疗供应和利用相关的因素在岛屿环境中的相互关系，这一分析以社会流行病学为依据。我们深入解释了获得、利用和结果与健康相关的背景。我们认为，医疗服务提供存在多个交叉点，这些交叉点在经验上是复杂的、多层次的和多维度的，对研究区域社会中弱势人群群体不利。
我们使用了横断面定性探索性设计。定性方法促进了对这个分散和边缘岛屿环境的深入探索和理解。数据来源包括对相关文献的回顾和对社区成员在寻求和获得医疗保健时生活经历的民族志探索。数据收集方法包括从选定的受访者进行深入访谈（IDI）、观察、焦点小组讨论（FGD）和关键知情人访谈（KII）。
我们根据医疗保健系统模型进行报告，该模型假设医疗保健活动是多样化的，但以复杂的方式相互关联。确定的主题是：地理的作用、获取（地理和财务）医疗服务、需求和利用、供应、人员配备和后勤障碍以及许可和短暂的社会。何时以及如何为护理而旅行不仅仅是因为有健康需求/生病和需求出现。一个有动力的劳动力与医疗设施本身一样，对于确定医疗保健结果至关重要。
地理并不是孤立地影响健康结果。仅针对个人的措施将不足以解决健康不平等问题，因为集体社会群体和物理环境的各个方面也可能需要改变，以减少健康差异。
