应用实施科学框架来识别影响医疗服务提供者在哥伦比亚的艾滋病诊所提供暴露前预防（PrEP）护理并倡导PrEP的意愿的因素：一项横断面研究。
Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study.
作者信息
Martinez-Cajas Jorge Luis, Torres Julian, Mueses Hector Fabio, Plazas Pilar Camargo, Arrivillaga Marcela, Gomez Sheila Andrea, Galindo Ximena, Buitrago Ernesto Martinez, Llano Beatriz Eugenia Alvarado
机构信息
Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, K7L 3 N6, Canada.
Montefiore Medical Center, Moses Division, Albert Einstein College of Medicine, The Oval Center at Montefiore, 3230 Bainbridge Ave, Bronx, NY, 10467, USA.
出版信息
Implement Sci Commun. 2022 Mar 16;3(1):31. doi: 10.1186/s43058-022-00278-2.
BACKGROUND
Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP.
METHODS
We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks' domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation.
RESULTS
We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care.
CONCLUSION
Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system.
背景
很少有研究使用实施科学框架来确定医疗保健提供者开具暴露前预防（PrEP）处方的决定因素。在这项研究中，我们使用理论领域框架（TDF）和实施研究综合框架（CFIR）开发了一份问卷并对其进行了心理测量学检验。我们使用这份问卷来调查哪些因素会影响医疗保健提供者提供PrEP护理和倡导PrEP的意愿。
方法
我们在哥伦比亚的16个艾滋病医疗组织中进行了一项横断面研究。通过在线方式向129名医疗专业人员发放了一份包含98个条目的问卷。其中100人有完整数据用于本次分析。我们使用探索性因素分析来评估这两个框架的心理测量特性，并使用多项回归分析来评估框架各领域与两个结果之间的关联：（1）提供PrEP护理的意愿和（2）倡导实施PrEP的意愿。
结果
我们发现九个指标具有良好的内部一致性，这些指标反映了PrEP的特征、对人群需求的态度、对PrEP使用的担忧、对医疗系统作用的担忧、知识、对能力的信念、专业角色、社会影响以及对后果的信念。值得注意的是，只有57%的参与者可能有照顾PrEP使用者的计划，66.7%的参与者可能倡导PrEP。对人群中PrEP需求的认知、PrEP作为一种实践的价值、同事的影响以及将PrEP护理视为优先事项与不太可能不愿意提供或倡导PrEP护理有关。
结论
我们的研究结果表明，采取多层次策略以增加医疗保健提供者提供PrEP护理的重要性，这些策略包括获取新技能、培训PrEP倡导者以及加强卫生系统的能力。
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