Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD, USA.
Johns Hopkins Center for Communication Programs-Guinea, Conakry, Guinea.
Glob Health Sci Pract. 2022 Feb 28;10(1). doi: 10.9745/GHSP-D-21-00429.
Lack of trust in the health care system can serve as a barrier to service utilization, especially in pandemic and postemergency settings. Although previous research has identified domains of trust that contribute to individuals' trust in the health system, little research exists from low- and middle-income countries, particularly during and after infectious disease outbreaks. The current study-conducted to inform activities for a post-Ebola program-explored perceptions and experiences of health care provision in post-Ebola Guinea, with particular attention to trust. Researchers conducted in-depth interviews with health workers (n=15) and mothers of young children (n=29) along with 12 focus group discussions with grandmothers of young children and 12 with male heads of household. The study occurred in Basse Guinée and Guinée Forestière-2 areas hardest hit by Ebola. Respondents identified a breach of trust during the epidemic, with several domains emerging as relevant for renewed trust and care-seeking practices. At the core of a trusting client-provider relationship was the inherent belief that providers had an intrinsic duty to treat clients well. From there, perceived provider competence, the hospitality at the facility, provider empathy, transparency about costs, and commitment to confidentiality emerged as relevant influences on participant trust in providers. Community members and providers expressed similar viewpoints regarding trust and discussed the role of open communication and community mobilization in rebuilding trust. Study findings informed a variety of program activities, including the development of campaign messages and interpersonal communication trainings for health workers. This study provides valuable insight about some underlying components of trust that can provide key leverage points to rebuild trust and promote care seeking in postemergency settings. This insight is informing program activities in the current Ebola response in Guinea and could be useful in other crises, such as the global coronavirus disease (COVID-19) pandemic.
对医疗保健系统的信任缺失可能会成为服务利用的障碍，尤其是在大流行和紧急情况后时期。尽管之前的研究已经确定了构成个人对卫生系统信任的信任领域，但来自中低收入国家的研究甚少，尤其是在传染病爆发期间和之后。本研究旨在为埃博拉后项目的活动提供信息，探讨了埃博拉后几内亚的医疗服务提供情况的看法和经验，特别关注信任问题。研究人员对卫生工作者（n=15）和幼儿的母亲（n=29）进行了深入访谈，对幼儿的祖母进行了 12 次焦点小组讨论，对男户主进行了 12 次焦点小组讨论。研究发生在受埃博拉影响最严重的巴塞几内亚和几内亚森林区 2 区。受访者在疫情期间发现了信任的破裂，出现了几个与重新建立信任和寻求护理行为相关的领域。在信任的医患关系核心是提供者有一种内在的责任，即必须善待客户。从那里，感知到的提供者能力、机构的接待、提供者的同理心、成本透明度和对保密性的承诺，都成为参与者信任提供者的相关影响因素。社区成员和提供者对信任表达了类似的观点，并讨论了公开沟通和社区动员在重建信任方面的作用。研究结果为各种项目活动提供了信息，包括制定宣传信息和卫生工作者人际沟通培训。这项研究提供了有关信任的一些基本组成部分的宝贵见解，这些见解可以为在紧急情况后时期重建信任和促进寻求护理提供关键的杠杆作用。这一见解正在为当前几内亚的埃博拉应对行动提供方案活动，并可能在其他危机中（如全球冠状病毒病（COVID-19）大流行）有用。
