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[秘鲁农村初级保健中的心理健康与远程医疗:耻辱感与接受度方面的影响及性别差异]

[Mental health and telemedicine in Peruvian rural primary care: Influence and gender differences in stigma and acceptance].

作者信息

Vásquez-Paredes Percy J, Esquivel-Cerquín José D

机构信息

Médico cirujano, MD EsSalud, Cusco, Perú.

Médico cirujano, MD MINSACajamarca, Perú.

出版信息

Aten Primaria. 2025 Feb 17;57(8):103229. doi: 10.1016/j.aprim.2025.103229.

Abstract

OBJECTIVE

To analyze gender differences in the perception of mental health-related stigma and the acceptance of telemedicine in rural Peruvian communities served at the primary care level.

DESIGN

Cross-sectional, correlational study.

SETTING

Two rural communities in Peru: Villa Salvación (Manu, Madre de Dios) and Hierba Buena (Cajabamba, Cajamarca).

PARTICIPANTS

A total of 339 individuals over 18 years old, selected through stratified probabilistic sampling (178 men and 161 women).

MAIN MEASUREMENTS

Outcome variables included perceptions of mental health (understanding, valuation), stigma (fear of social judgment), willingness to use telemedicine, and privacy concerns. Explanatory variables were sex, educational level, length of residence, and type of health insurance. Proportions and adjusted odds ratios (OR) with 95% confidence intervals were calculated using logistic regression.

RESULTS

Greater understanding and valuation of mental health were positively associated with educational level in both genders (P<.05). However, women showed greater concern about social stigma when seeking help (47% feared «what others might say» vs. 38% in men; adjusted OR=1.5; 95%CI: 1.0-2.4), while men were more skeptical about telemedicine's effectiveness (42% expressed doubts vs. 30% in women; adjusted OR=1.6; 95%CI: 1.0-2.5). No significant gender differences were observed in overall willingness to use telemedicine or in privacy concerns.

CONCLUSIONS

There are gender-related differences in perceptions of stigma and the evaluation of telemedicine in rural settings. While women face greater social pressure due to stigma, men are more likely to question the effectiveness of virtual care. These findings highlight the need for primary care interventions that consider gender dynamics to enhance the acceptance and effectiveness of telemedicine for mental health in rural communities.

摘要

目的

分析秘鲁农村初级保健服务社区中,与心理健康相关的耻辱感认知及对远程医疗接受度方面的性别差异。

设计

横断面相关性研究。

地点

秘鲁的两个农村社区:萨尔瓦ación村(马德雷德迪奥斯省马努)和耶尔瓦布埃纳村(卡哈马卡省卡亚班巴)。

参与者

通过分层概率抽样选取的339名18岁以上个体(178名男性和161名女性)。

主要测量指标

结果变量包括心理健康认知(理解、重视程度)、耻辱感(对社会评判的恐惧)、使用远程医疗的意愿以及隐私担忧。解释变量为性别、教育水平、居住时长和医疗保险类型。使用逻辑回归计算比例及调整后的优势比(OR)和95%置信区间。

结果

男女对心理健康的更高理解和重视程度均与教育水平呈正相关(P<0.05)。然而,女性在寻求帮助时对社会耻辱感更为担忧(47%担心“他人可能会说什么”,男性为38%;调整后的OR=1.5;95%CI:1.0 - 2.4),而男性对远程医疗效果更持怀疑态度(42%表示怀疑,女性为30%;调整后的OR=1.6;95%CI:1.0 - 2.5)。在使用远程医疗的总体意愿或隐私担忧方面未观察到显著的性别差异。

结论

农村地区在耻辱感认知和远程医疗评估方面存在与性别相关的差异。虽然女性因耻辱感面临更大的社会压力,但男性更有可能质疑虚拟护理的效果。这些发现凸显了初级保健干预措施考虑性别动态的必要性,以提高农村社区远程医疗在心理健康方面的接受度和有效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7f98/11875818/583e99dbba6b/gr1.jpg

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