A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China

被引：12

作者：

Haldane, Victoria ^{[1
]}

Zhang, Zhitong ^{[2
]}

Ma, Qi ^{[1
]}

Yin, Tingting ^{[3
]}

Zhang, Bei ^{[3
]}

Li, Yinlong ^{[4
]}

Pan, Qiuyu ^{[5
]}

Dainty, Katie N. ^{[1
]}

Rea, Elizabeth ^{[2
]}

Pasang, Pande ^{[6
]}

Wei, Xiaolin ^{[2
]}

Hu, Jun ^{[7
]}

机构：

[1] Univ Toronto, Inst Hlth Policy Management & Evaluat, 155 Coll St, Toronto, ON M5T 3M6, Canada

[2] Univ Toronto, Dalla Lana Sch Publ Hlth, 155 Coll St, Toronto, ON M5T 3M7, Canada

[3] Weifang Med Coll, Weifang, Shandong, Peoples R China

[4] Jining Med Univ, Jining, Shandong, Peoples R China

[5] North Sichuan Med Coll, Nanchong, Sichuan, Peoples R China

[6] Xigaze Ctr Dis Control & Prevent, 7 Keji Rd, Xizang, Xizang, Peoples R China

[7] Shandong Univ Tradit Chinese Med, Jinan 250355, Peoples R China

来源：

INFECTIOUS DISEASES OF POVERTY | 2021年 / 10卷 / 01期

关键词：

Tuberculosis; Access; Quality of care; Qualitative research; Rural health; China; MIDDLE-INCOME COUNTRIES; PULMONARY TUBERCULOSIS; RURAL CHINA; DIAGNOSIS; PATIENT; CARE; BARRIERS; DELAYS; TB; PREVALENCE;

D O I：

10.1186/s40249-021-00906-4

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: Tuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB. Methods: We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al. Results: Overall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment. Conclusions: We identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.

引用

页数：12

共 67 条

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