尼泊尔中部老年人获取卫生服务的挑战：利用获取领域框架的定性研究。
Older people's challenges accessing health services in central Nepal: a qualitative study using the domain of access framework.
机构信息
Shree Medical and Technical College, Purbanchal University, Bharatpur, Nepal.
School of Health Science, Council for Technical Education and Vocational Training (CTEVT), Bharatpur, Nepal.
出版信息
BMC Health Serv Res. 2024 Oct 23;24(1):1273. doi: 10.1186/s12913-024-11717-2.
BACKGROUND
Low- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.
METHODS
This qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.
RESULTS
Hypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.
CONCLUSIONS
This study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.
背景
中低收入国家正面临人口快速老龄化。然而，医疗体系在很大程度上尚未做好准备，无法为老龄化人口提供医疗服务。随着尼泊尔人口的迅速老龄化，医疗服务提供者应该关注他们所面临的挑战和经验，以解决这些问题。尼泊尔老年人获取医疗服务的障碍和促进因素的证据很少。本研究旨在调查尼泊尔中部老年人在获取医疗服务时所面临的挑战。
方法
本定性研究于 2023 年 4 月至 6 月在尼泊尔中部一个直辖市进行。对该直辖市的老年人进行了深入访谈，采用基于准入理论的演绎-归纳方法进行主题分析。
结果
高血压和糖尿病是参与者最常见的健康问题。尽管尼泊尔政府有医疗保险计划和普及全民健康覆盖的主要重点，但医疗服务的可负担性仍是一个主要问题。其他问题包括可接受性差、老年人与医务人员之间沟通不畅以及缺乏老年人友好型服务，包括诊所等待时间长，导致住宿条件差。与家人同住是获得医疗服务的主要促进因素，与多个准入领域相互关联。
结论
本研究确定了尼泊尔老年人获取医疗服务的障碍。我们发现，医疗服务的可负担性、可接受性差、老年人与医生之间沟通不畅以及缺乏老年人友好型服务是老年人面临的主要挑战。老年人认为，当他们得到家人的支持时，这些障碍更容易克服。因此，对于那些与子女同住的老年人来说，家庭支持被报告为主要的促进因素。
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