Gupta Archna, Prasad Ramakrishna, Abraham Sunil, Nedungalaparambil Nisanth Menon, Bhattacharyya Onil, Landes Megan, Sridharan Sanjeev, Gray Carolyn Steele
Department of Family and Community Medicine, St. Michaels Hospital, Toronto, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
PLOS Glob Public Health. 2023 May 12;3(5):e0001848. doi: 10.1371/journal.pgph.0001848. eCollection 2023.
Countries globally are introducing family medicine to strengthen primary health care; however, for many, that process has been slow. Understanding the implementation of family medicine in a national context is complex but critical to uncovering what worked, the challenges faced, and how the process can be improved. This study explores how family medicine was implemented in India and how early cohort family physicians supported the field's emergence. In this qualitative descriptive study, we interviewed twenty family physicians who were among the first in India and recognized as pioneers. We used Rogers's Diffusion of Innovation Theory to describe and understand the roles of family physicians, as innovators and early adopters, in the process of implementation. Greenhalgh's Model of Diffusion in Service Organizations is applied to identify barriers and enablers to family medicine implementation. This research identifies multiple mechanisms by which pioneering family physicians supported the implementation of family medicine in India. They were innovators who developed the first family medicine training programs. They were early adopters willing to enter a new field and support spread as educators and mentors for future cohorts of family physicians. They were champions who developed professional organizations to bring together family physicians to learn from one another. They were advocates who pushed the medical community, governments, and policymakers to recognize family medicine's role in healthcare. Facilitators for implementation included the supportive environment of academic institutions and the development of family medicine professional organizations. Barriers to implementation included the lack of government support and awareness of the field by society, and tension with subspecialties. In India, the implementation of family medicine has primarily occurred through pioneering family physicians and supportive educational institutions. For family medicine to continue to grow and have the intended impacts on primary care, government and policymaker support are needed.
全球各国都在引入家庭医学以加强初级卫生保健；然而，对许多国家来说，这一进程一直很缓慢。在国家层面理解家庭医学的实施情况很复杂，但对于揭示哪些措施有效、面临哪些挑战以及如何改进这一进程至关重要。本研究探讨了家庭医学在印度是如何实施的，以及早期一批家庭医生如何支持该领域的兴起。在这项定性描述性研究中，我们采访了印度最早一批且被公认为先驱的20位家庭医生。我们运用罗杰斯的创新扩散理论来描述和理解家庭医生作为创新者和早期采用者在实施过程中的作用。应用格林哈尔格的服务组织中的扩散模型来确定家庭医学实施的障碍和促进因素。本研究确定了先驱家庭医生支持印度家庭医学实施的多种机制。他们是创新者，开发了首个家庭医学培训项目。他们是早期采用者，愿意进入一个新领域，并作为教育者和导师支持未来一批批家庭医生的发展。他们是倡导者，成立了专业组织，将家庭医生聚集在一起相互学习。他们是推动者，促使医学界、政府和政策制定者认识到家庭医学在医疗保健中的作用。实施的促进因素包括学术机构的支持环境和家庭医学专业组织的发展。实施的障碍包括政府支持的缺乏、社会对该领域的认知不足以及与专科的紧张关系。在印度，家庭医学的实施主要是通过先驱家庭医生和支持性的教育机构实现的。为使家庭医学持续发展并对初级保健产生预期影响，需要政府和政策制定者的支持。
