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任务转移在高血压和糖尿病筛查及转诊中的原则:一项在乌干达农村地区探索患者、社区卫生工作者和医疗保健专业人员认知的定性研究。

Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda.

机构信息

Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda.

出版信息

BMC Public Health. 2023 May 12;23(1):881. doi: 10.1186/s12889-023-15704-w.


DOI:10.1186/s12889-023-15704-w
PMID:37173687
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10176286/
Abstract

BACKGROUND: A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS: This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS: Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION: CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.

摘要

背景:中低收入国家(LMICs)的医疗保健工作者短缺,加上高血压和糖尿病等非传染性疾病(NCDs)负担不断增加,导致 NCD 护理提供方面的差距越来越大。由于社区卫生工作者(CHWs)在 LMIC 医疗保健系统中通常发挥着既定的作用,因此可以利用这些计划来加强医疗保健的可及性。本研究的目的是探讨在乌干达农村地区将高血压和糖尿病的筛查和转诊任务转移给 CHWs 的看法。

方法:这是一项 2021 年 8 月在乌干达农村纳卡塞克进行的定性探索性研究,参与者包括患者、CHWs 和医疗保健专业人员。通过 24 次深入访谈和 10 次焦点小组讨论,我们调查了在乌干达农村,将 NCD 筛查和转诊任务转移给 CHWs 的看法。本研究采用整体方法,针对参与任务转移项目实施的利益相关者。所有访谈均进行了录音,并逐字记录下来,然后根据框架方法进行了主题分析。

结果:分析确定了在这种情况下成功实施计划所需的要素。CHW 计划的基本驱动因素包括结构化监督、患者通过 CHWs 获得医疗保健、社区参与、报酬和便利,以及通过培训提高 CHW 的知识和技能。其他促进因素包括 CHW 的具体特征,如信心、承诺和动力,以及社会关系和同理心。最后,报告称信任、良性行为、在社区中的认可以及相互尊重等社会情感方面对于任务转移计划的成功至关重要。

结论:当将高血压和糖尿病的 NCD 筛查和转诊任务从医疗机构的医疗保健工作者转移给 CHWs 时,CHWs 被认为是一种有用的资源。在实施任务转移计划之前,必须考虑本研究中描述的多层次需求。这确保了一个成功的计划,克服了社区的担忧,并可能为在类似环境中实施任务转移提供指导。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c8e/10176870/88517d009ee0/12889_2023_15704_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c8e/10176870/f0b13fcc0e1c/12889_2023_15704_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c8e/10176870/88517d009ee0/12889_2023_15704_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c8e/10176870/f0b13fcc0e1c/12889_2023_15704_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c8e/10176870/88517d009ee0/12889_2023_15704_Fig2_HTML.jpg

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[1]
A systematic review of research on empathy in health care.

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