冰山一角：肯尼亚医护人员对儿科风湿病学认知的定性研究
An iceberg I can't handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya.
机构信息
International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Department of Paediatrics and Child Health, Aga Khan University, Medical College East Africa, Nairobi, Kenya.
出版信息
Pediatr Rheumatol Online J. 2023 Jan 21;21(1):6. doi: 10.1186/s12969-023-00790-2.
BACKGROUND
Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management.
PURPOSE
We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya.
METHODS
We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software.
RESULTS
A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31-40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities.
CONCLUSION
There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.
背景
在撒哈拉以南非洲，许多患有风湿性疾病的儿童和年轻人都面临着诊断延误和难以获得专科治疗的问题。大多数有风湿性疾病症状的儿童都在非专科医疗机构接受治疗。因此，迫切需要了解和扩大非专科医疗工作者的儿科风湿病知识和技能，以促进早期诊断、及时转诊和管理。
目的
我们评估了肯尼亚卫生保健工作者在儿科风湿病患者的诊断和护理方面的知识、态度和实践。
方法
我们在肯尼亚的 6 个地区进行了 12 次临床医生（第三级社区卫生工作者）、护士、全科医生和儿科医生的焦点小组讨论。访谈通过 zoom 进行，录音，转录，并使用 NVIVO 软件进行分析。
结果
共有 68 人参加；11 名临床医生、12 名护士、10 名全科医生、27 名儿科医生和 7 名其他人员。大多数参与者（n=53）为女性，中位年龄为 36 岁（范围为 31-40 岁）。50%的参与者（68 名中的 34 名）在公共卫生机构工作。我们的研究揭示了卫生保健工作者在儿科风湿病知识方面的差距，这导致了诊断延误和治疗效果不佳。卫生保健工作者对儿科风湿病患者的诊断和护理持有积极和消极的态度。诊断、管理方面的复杂性和知识缺乏，以及缺乏卫生系统临床路径，使所有医疗工作者都感到无助、沮丧、不足和无法胜任管理儿科风湿病患者。积极的态度源于一种感觉，即儿科风湿病患者带来了独特的挑战和学习机会。
结论
迫切需要教育卫生保健工作者并改善卫生系统，以优化儿科风湿病患者的临床护理。
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