Attafuah Priscilla Yeye Adumoah, Everink Irma Hj, Lohrmann Christa, Abuosi Aaron, Schols Jos Mga
School of Nursing and Midwifery, University of Ghana, Legon, Ghana.
Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
Arch Public Health. 2023 Apr 27;81(1):74. doi: 10.1186/s13690-023-01056-9.
Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.
贫民窟居民缺乏一些基本生活设施（如水、卫生设施和电力），这使他们比非贫民窟居民更容易受到伤害。由于贫民窟几乎无法获得卫生和社会护理服务，预计贫民窟环境对老年人来说更加危险，会对他们的生活质量产生负面影响。为了概述所感知到的（未满足的）卫生和社会护理需求以及这些需求如何影响生活质量，本研究旨在探讨加纳城市贫民窟中老年人自我感知的健康和社会需求。采用现象学方法，于2021年5月至6月在加纳两个贫民窟的老年人家中进行了25次半结构化访谈。在对访谈记录进行编码和分析后，出现了五个主要主题：（a）健康认知；（b）使用卫生服务的（去）动机；（c）社会护理认知；（d）社会需求；（e）各种现象对生活质量的影响。结果显示，老年人认为精神力量导致疾病，并影响他们对正规卫生服务的使用。其他因素，如保险卡过期和医护人员的态度，成为使用卫生服务的阻碍因素。所感知到的健康需求主要是当前的疾病状况（关节炎、糖尿病、高血压、视力/听力问题）、医疗保险方面的问题、一些医护人员的行为、卫生设施的距离以及主要卫生设施不必要的排队现象。本研究确定的未满足的社会需求包括被家人忽视的感觉（需要陪伴）、日常生活活动需要帮助以及需要经济支持。参与者的健康需求比社会需求更多。卫生服务提供者通常不会优先照顾居住在贫民窟的老年人。大多数参与者在国家健康保险计划（NHIS）方面仍然存在困难。他们的社会需求主要与经济困难和一些日常生活活动需要帮助有关。参与者表示他们渴望陪伴（尤其是寡妇或离婚者），而缺乏陪伴让他们感到孤独和被忽视。应鼓励医护人员上门看望老年人，以监测他们的健康状况，并倡导家庭成员陪伴老年人。医护人员应表现出积极的态度，向老年患者宣传使用正规卫生服务的好处，以及尽早寻求治疗的必要性，因为这将在很大程度上影响他们的生活质量。
