Houghton Natalia, Bascolo Ernesto, Coitiño Andrés, Koller Theadora S, Fitzgerald James
Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America.
World Health Organization Geneva Switzerland World Health Organization, Geneva, Switzerland.
Rev Panam Salud Publica. 2023 Aug 21;47:e117. doi: 10.26633/RPSP.2023.117. eCollection 2023.
This report describes the experience and lessons learnt from designing and implementing a combined quantitative and qualitative method to assess barriers to accessing health services. This approach was developed to study barriers to access in five dimensions: availability; geographical, financial, and organizational accessibility; acceptability; contact; and effective coverage. The study design was used in six countries in the World Health Organization Region of the Americas. The findings highlight the importance of having a well defined analysis framework and the benefits of adopting a mixed-methods approach. Using existing data and contextualizing findings according to specific population groups and geographical areas were essential for relevance and utilization of the study outcomes. The findings demonstrate the feasibility of using mixed methods to understand the complexity of access problems faced by different subpopulations. By involving decision-makers from the beginning and allowing flexibility for sustained discussions, the analysis and findings had an impact. The engagement of health authorities and key stakeholders facilitated the use of the findings for collaborative identification of policy options to eliminate access barriers. Lessons learnt from the study emphasized the need for active participation of decision-makers, flexibility in the process, and sustained opportunities for discussion to ensure impact. Giving consideration to local priorities and adapting the methods accordingly were important for the relevance and use of the findings. Future efforts could consider incorporating mixed methods into national and local monitoring and evaluation systems.
本报告描述了设计和实施定量与定性相结合的方法来评估获得卫生服务的障碍的经验和教训。开发这种方法是为了从五个维度研究获得服务的障碍：可及性；地理、经济和组织可及性；可接受性；接触；以及有效覆盖。该研究设计在世界卫生组织美洲区域的六个国家使用。研究结果突出了拥有明确分析框架的重要性以及采用混合方法的益处。利用现有数据并根据特定人群和地理区域对研究结果进行情境化分析对于研究结果的相关性和实用性至关重要。研究结果表明使用混合方法来理解不同亚人群面临的获得服务问题的复杂性是可行的。从一开始就让决策者参与并为持续讨论留出灵活性，使得分析和研究结果产生了影响。卫生当局和关键利益相关者的参与促进了将研究结果用于合作确定消除获得服务障碍的政策选项。从该研究中学到的经验教训强调了决策者积极参与的必要性、过程中的灵活性以及持续讨论的机会以确保产生影响。考虑当地优先事项并相应调整方法对于研究结果的相关性和应用很重要。未来的努力可以考虑将混合方法纳入国家和地方监测与评价系统。
