SSM - Health Systems最新文献_第3页

The regulation-practice gap, regulatory relationships, and quality improvement in resource-constrained health systems: Findings from a study of professional regulation for doctors and nurses in Uganda 资源有限的卫生系统中的监管与实践差距、监管关系和质量改进：乌干达医生和护士专业监管研究的结果

SSM - Health Systems

Pub Date : 2025-12-01 DOI: 10.1016/j.ssmhs.2025.100149

Gloria Seruwagi , Catherine Nakidde , Peter Waiswa , Francis Wafula , Anita Musiega , Dosila Ogira , Tina Kiefer , Michael J. Gill , Mike English , Gerry McGivern

Background

Regulation is a core mechanism for maintaining the availability and quality of the health workforce, underpinning a WHO building block for health system improvement, but often fails in resource-constrained health systems in the Global South. This paper examines views and experiences of professional regulation for doctors and nurses/midwives in Uganda, regulatory problems and opportunities for improvement.

Methods

We conducted focus groups, 60 interviews with Ugandan national regulatory stakeholders, doctors, and nurses/midwives, and a national survey completed by 2213 Ugandan doctors and nurses/midwives.

Results

With limited resources, staff, and significant responsibilities, Ugandan health regulators were perceived as focusing on collecting fees, registering, and licensing health practitioners, rather than ensuring high-quality professional practice. While Ugandan doctors, nurses and midwives support regulation in principle, they reported limited engagement with distant regulators, who rarely noticed or addressed malpractice. However, we found one positive case where nurses described good personal relationships with a local regulator, who supported, mentored and explained to nurses what regulation and compliance meant in practice, and here nurses viewed regulation as working well. Thus, we explain how regulatory relationships can bridge the geographical gap between regulators and health professionals and the interpretive gap between written standards and practice.

Conclusion

Improving relationships between regulators and regulated health workers holds potential to address the regulation-practice gap, which is generally undermining regulation and professionals’ practice in resource-constrained countries in the Global South. However, regulatory relationships must be supported by adequate resources and transparent mechanisms to prevent local-level regulatory capture, politics, and corruption.

监管是维持卫生人力资源的可用性和质量的核心机制，是世卫组织改善卫生系统的基石，但在资源有限的全球南方国家卫生系统中往往失灵。本文考察了乌干达医生和护士/助产士专业监管的观点和经验，监管问题和改进的机会。方法：我们开展了焦点小组，对乌干达国家监管利益相关者、医生和护士/助产士进行了60次访谈，并对2213名乌干达医生和护士/助产士进行了全国调查。结果由于资源、人员和责任有限，乌干达卫生监管机构被认为专注于收取费用、注册和许可卫生从业人员，而不是确保高质量的专业实践。虽然乌干达的医生、护士和助产士原则上支持监管，但他们报告说，他们与遥远的监管机构的接触有限，后者很少注意到或处理不当行为。然而，我们发现了一个积极的案例，护士描述了与当地监管机构的良好个人关系，他们支持、指导并向护士解释什么是监管和合规在实践中意味着什么，在这里，护士认为监管运作良好。因此，我们解释了监管关系如何弥合监管机构与卫生专业人员之间的地理差距以及书面标准与实践之间的解释差距。改善监管机构和受监管的卫生工作者之间的关系有可能解决监管与实践之间的差距，这一差距普遍破坏了南半球资源受限国家的监管和专业人员的实践。然而，监管关系必须得到充足资源和透明机制的支持，以防止地方层面的监管俘获、政治和腐败。

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引用次数: 0

Health financing and systems in African small and island states: Unique challenges and opportunities in achieving universal health coverage. 非洲小岛屿国家的卫生筹资和卫生系统：实现全民健康覆盖的独特挑战和机遇。

SSM - Health Systems

Pub Date : 2025-12-01 DOI: 10.1016/j.ssmhs.2025.100104

Finn McGuire, Sakshi Mohan, Megha Rao, Juliet Nabyonga-Orem, Ajoy Nundoochan, Issiaka Sombie, Edward Kataika, Simon Bland, Paul Revill

While Africa has made substantial health progress, small and island states face distinct vulnerabilities and threats, demanding focused attention. Employing WHO building blocks, this study explores the health systems and financing status of small and island states in Africa, emphasizing their unique challenges in achieving universal health coverage. We undertake a comparative analysis of health systems and financing between African small and island states and larger counterparts within the region. Despite their unique challenges, African small and island states appear to perform comparatively well both in terms of health financing and for a number of key health system inputs. These findings suggest that the hypothesized structural impediments facing small and island states may be less severe than anticipated, or that good policies may have effectively mitigated these challenges within the health sector. However, many small and island states remain understudied, and further health research must be undertaken to better understand the nuances of health systems in these countries.

虽然非洲在卫生方面取得了重大进展，但小国和岛屿国家面临着明显的脆弱性和威胁，需要得到重点关注。本研究利用世卫组织的基本要素，探讨了非洲小国和岛屿国家的卫生系统和筹资状况，强调了它们在实现全民健康覆盖方面面临的独特挑战。我们对非洲小国和岛屿国家与该地区较大的国家之间的卫生系统和融资进行了比较分析。尽管面临着独特的挑战，但非洲小岛屿国家在卫生筹资和一些关键卫生系统投入方面的表现似乎相对较好。这些发现表明，小国和岛屿国家面临的假设结构性障碍可能没有预期的那么严重，或者良好的政策可能有效地缓解了卫生部门内的这些挑战。然而，许多小国和岛屿国家仍未得到充分研究，必须开展进一步的卫生研究，以便更好地了解这些国家卫生系统的细微差别。

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引用次数: 0

Shifting care into the community: Using Ostrom to explore collaborative care delivery with shared resources in English NHS Integrated Care Systems 将护理转移到社区：使用Ostrom探索英国NHS综合护理系统中共享资源的协作式护理交付

SSM - Health Systems

Pub Date : 2025-12-01 DOI: 10.1016/j.ssmhs.2025.100157

Mhorag Goff , Marie Sanderson , Donna Bramwell , Kath Checkland , Pauline Allen , Rachel Meacock

Enabling the delivery of efficient and effective healthcare services within a constrained financial environment is an enduring challenge. Shifting care from hospital to community settings is therefore a priority in many countries where it is hoped that they will reduce demand on hospital services and overall health system costs. In English Integrated Care Systems (ICSs) this is being done through new collaborative care processes involving community health services such as virtual wards. However, despite their critical role in integrated care, community health services have been relatively under-researched.

Using Ostrom’s theories of common pool resources, including principles for the use of finite resources for shared action, we examine whether ICSs in England can self-govern shared resources for collaborative services delivery. Drawing on the perspectives of community health services providers and ICS stakeholders who commission and manage them, we find a lack of proportional equivalence between costs and benefits for community health services providers. An enduring lack of visibility of community health services within the system suggest that the conditions for sustained collaboration between providers are not being met. This means that the policy intent for ICSs to facilitate more collaborative care and shift care from hospital to the community may not be realised.

在有限的财政环境下提供高效和有效的医疗保健服务是一项持久的挑战。因此，在许多国家，将护理从医院转移到社区环境是一项重点工作，希望这些国家能够减少对医院服务的需求和卫生系统的总体成本。在英语综合护理系统（ics）中，这是通过涉及虚拟病房等社区卫生服务的新的协作护理过程来完成的。然而，尽管社区卫生服务在综合护理中发挥了关键作用，但对它们的研究相对不足。利用奥斯特罗姆的公共资源池理论，包括将有限资源用于共同行动的原则，我们研究了英国的社会服务体系是否能够自主管理协作服务提供的共享资源。根据社区卫生服务提供者和委托和管理他们的ICS利益相关者的观点，我们发现社区卫生服务提供者的成本和收益之间缺乏比例对等。系统内社区卫生服务的长期缺乏可见性表明，提供者之间持续合作的条件没有得到满足。这意味着国际社会促进更多协作护理和将护理从医院转移到社区的政策意图可能无法实现。

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引用次数: 0

Exploring the role of healthcare affordability in lifetime HIV testing among young adults in Tennessee, United States 探索医疗负担能力在美国田纳西州年轻人终身艾滋病毒检测中的作用

SSM - Health Systems

Pub Date : 2025-11-20 DOI: 10.1016/j.ssmhs.2025.100156

Mustapha Aliyu Muhammad , Derrick Nyantakyi Owusu , Hopelyn Mooney , Peter Olaoluwa Adediji , Heather Elizabeth Wingate , Amanda Kate Goodin , Nikita Cudjoe , Bless-me Ajani , Bill Brooks

Background

HIV remains a major public health challenge in the United States, with about 20,000 of Tennesseans living with HIV and 14 % unaware of their status. Young adults aged 18–34 years are disproportionately affected, and barriers such as healthcare affordability limit HIV testing rates. This study examines the relationship between healthcare affordability and lifetime HIV testing among young adults in Tennessee using the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data.

Methods

We conducted a cross-sectional analysis of 918 respondents aged 18–34 years from the Tennessee BRFSS 2023 survey, representing a weighted population of 1.4 million. The BRFSS uses a state-based random-digit dialing sampling design to collect data through telephone interviews. Weighted logistic regression was performed to assess associations between healthcare affordability and lifetime HIV testing, adjusting for key sociodemographic covariates. Interaction terms were included to assess effect modification by sex, race/ethnicity, age group, and general health status. Statistical significance was set at p < 0.05.

Results

Healthcare affordability was significantly associated with lifetime HIV testing. Participants reporting financial barriers were 42 % less likely to undergo testing compared to those without affordability issues (OR = 0.58; 95 % CI: 0.37–0.89; p-value = 0.014). Testing rates were higher among females, White non-Hispanics, and 30–34 age-group. Statistically significant interaction effects were observed for 25–29 age-group and the Asian non-Hispanic population.

Conclusion

Healthcare affordability plays a critical role in lifetime HIV testing among young adults in Tennessee. Public health interventions should prioritize reducing financial barriers and targeting underserved populations to improve HIV testing.

艾滋病毒仍然是美国一个主要的公共卫生挑战，田纳西州约有20,000人感染艾滋病毒，14% %不知道自己的状况。18-34岁的年轻人受到的影响尤为严重，医疗负担能力等障碍限制了艾滋病毒检测率。本研究利用2023年行为风险因素监测系统（BRFSS）数据，调查了田纳西州年轻人的医疗负担能力与终生艾滋病毒检测之间的关系。方法：我们对来自田纳西州BRFSS 2023调查的918名年龄在18-34岁的受访者进行了横断面分析，代表140万加权人口。BRFSS采用基于状态的随机数字拨号抽样设计，通过电话采访收集数据。采用加权逻辑回归来评估医疗负担能力与终生艾滋病毒检测之间的关系，并对关键的社会人口统计协变量进行调整。纳入相互作用项以评估性别、种族/民族、年龄组和一般健康状况对效果的影响。p <； 0.05。结果医疗负担能力与终生HIV检测显著相关。报告经济困难的参与者接受检测的可能性比没有负担能力问题的参与者低42% % （OR = 0.58; 95% % CI: 0.37-0.89； p值= 0.014）。女性、非西班牙裔白人和30-34岁年龄组的检测率较高。在25-29岁年龄组和亚裔非西班牙裔人群中观察到统计学上显著的相互作用效应。结论医疗负担能力在田纳西州年轻人终生HIV检测中起关键作用。公共卫生干预措施应优先考虑减少财政障碍和针对服务不足的人群，以改善艾滋病毒检测。

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引用次数: 0

Balancing autonomy and collaboration: Acompañantes’ perspectives on health system partnerships for medication abortion care in three Mexican states 平衡自主与协作：Acompañantes对墨西哥三个州药物流产护理卫生系统伙伴关系的看法

SSM - Health Systems

Pub Date : 2025-11-17 DOI: 10.1016/j.ssmhs.2025.100154

Laura E. Jacobson , Blair G. Darney , Maribel Campos Muñuzuri , Suzanne Veldhuis

Introduction

Acompañantes are feminist activists who accompany pregnant individuals through medication abortions outside of clinical settings. This model is safe, holistic, and destigmatizing. In Mexico, where abortion law varies by state and access to public services is limited, self-managed medication abortion with acompañantes is common. This study examines how acompañantes perceive their relationship with the public health system, exploring collaboration opportunities and challenges.

Methods

We conducted semi-structured interviews with acompañantes from Baja California, Chiapas, and Mexico City—Mexican states with diverse abortion laws, in 2022–2023. The World Health Organization’s Health System Strengthening framework guided the analysis, focusing on stakeholder engagement and innovation. We analyzed the interviews using a qualitative, codebook thematic approach, incorporating both deductive and inductive methods.

Results

Seventeen interviews with acompañantes revealed key themes: 1) Acompañantes expressed a tension between operating autonomously and seeing value in collaboration —but not integration— with the formal system for legitimacy, validation, and to improve care experiences for people who access abortion; 2) In a health system where person-centered care is lacking, acompañantes fill this gap and feel a responsibility to do so; and 3) Knowledge gaps, trust issues, and political differences are barriers for acompañantes collaborating with the public health system.

Conclusion

Aligning acompañante-supported self-managed abortion with institutional services presents challenges but also opportunities for enhancing care quality and accessibility. Innovative collaborations that respect acompañantes' autonomy and expertise, while addressing systemic barriers, could strengthen health systems and align with WHO guidelines for safe self-managed abortion, including health system referrals if needed or wanted.

IntroductionAcompañantes是女权主义者，她们陪伴孕妇在临床环境之外进行药物流产。这种模式是安全的、整体的、去污名化的。在墨西哥，堕胎法因州而异，获得公共服务的机会有限，通过acompañantes进行自我管理的药物流产很常见。本研究考察acompañantes如何看待他们与公共卫生系统的关系，探索合作机会和挑战。方法：我们在2022-2023年间对来自下加利福尼亚州、恰帕斯州和墨西哥城的acompañantes进行了半结构化访谈，这些州有不同的堕胎法。世界卫生组织的卫生系统加强框架指导了分析，重点是利益攸关方的参与和创新。我们使用定性、密码本主题方法分析访谈，结合演绎和归纳方法。结果对acompañantes的17次访谈揭示了关键主题：1)Acompañantes表达了自主运作与看到合作（而非整合）价值之间的紧张关系，与正式系统的合法性、有效性和改善堕胎者的护理体验；2)在缺乏以人为本的卫生保健的卫生系统中，acompañantes填补这一空白，并感到有责任这样做；3)知识差距、信任问题和政治分歧是acompañantes与公共卫生系统合作的障碍。结论将acompañante-supported自我管理堕胎与机构服务相结合对提高护理质量和可及性提出了挑战，但也带来了机遇。在解决系统性障碍的同时，尊重acompañantes自主权和专业知识的创新合作可以加强卫生系统，并与世卫组织关于安全自我管理堕胎的指南保持一致，包括在需要或希望时向卫生系统转诊。

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引用次数: 0

Enhancing accountability in maternal and newborn health referrals through a network of care: A mixed methods implementation research in Makueni, Kenya 通过护理网络加强孕产妇和新生儿卫生转诊的问责制：在肯尼亚Makueni开展的一项混合方法实施研究

SSM - Health Systems

Pub Date : 2025-11-16 DOI: 10.1016/j.ssmhs.2025.100155

Jefferson Mwaisaka , Melanie Olum , Patricia Owira , Dennis Mulwa , Mwatha Stephen , Samuel Mwaura , Osborn K. Kiptoo , Lisa Noguchi , Anne Hyre , Pooja Sripad

Effective coordination and timely action are crucial for preventing and managing maternal and newborn health (MNH) complications. In low- and middle-income countries, these elements are often inadequate given complexity in health systems dynamics. A major challenge is the lack of accountability for actions and outcomes across interconnected health facilities alongside inefficient MNH referral systems. This study assessed changes in accountability within a broader implementation research effort assessing the feasibility, acceptability, and effectiveness of integrating a Network of Care (NoC) in Kenya. This mixed methods study assessed whether establishing a County-level NoC enhanced accountability in MNH referrals and relationships among health facilities. Quantitative data were collected through six rounds of phone surveys with MNH healthcare providers, while qualitative data was collected from focus group discussions with MNH healthcare providers and key informant interviews with county health managers at baseline, midline, and endline. Accountability outcomes were categorized under three themes: Proactive and Efficient MNH Referral Systems, Collaboration and Communication, and Trust among providers. Quantitative analysis indicated significant improvements (p < 0.05) in 12 out of 17 accountability measures. Qualitative data highlighted enhanced referral systems, clarity of roles, peer learning, teamwork, respect, confidence and transparency within and across facilities, presenting an opportunity to enhance inter-facility accountability through a well-coordinated NoC. Study findings suggest that NoCs, which support efficient collaborative health systems decision-making and action to optimize person-centered outcomes, can enhance accountability in MNH and offer a transferable model for similar settings.

有效的协调和及时的行动对于预防和管理孕产妇和新生儿健康并发症至关重要。在低收入和中等收入国家，鉴于卫生系统动态的复杂性，这些要素往往不足。一项主要挑战是缺乏对相互关联的卫生设施的行动和结果的问责制，以及国家卫生保健机构转诊系统效率低下。本研究评估了在肯尼亚整合护理网络（NoC）的可行性、可接受性和有效性的更广泛实施研究工作中问责制的变化。这项混合方法研究评估了建立县级NoC是否加强了MNH转诊的问责制以及卫生设施之间的关系。定量数据是通过与MNH医疗保健提供者的六轮电话调查收集的，而定性数据是通过与MNH医疗保健提供者的焦点小组讨论和与县卫生管理人员在基线、中线和终末的关键信息提供者访谈收集的。问责制成果分为三个主题：积极有效的MNH转诊系统、协作与沟通以及提供者之间的信任。定量分析表明，17项问责措施中有12项显著改善（p <； 0.05）。定性数据强调了转诊系统的改进、角色的明确、同侪学习、团队合作、尊重、信任和设施内部和设施之间的透明度，这为通过协调良好的NoC加强设施间问责提供了机会。研究结果表明，noc支持有效的协作卫生系统决策和行动，以优化以人为本的结果，可以加强MNH的问责制，并为类似环境提供可转移的模式。

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引用次数: 0

A critical assessment of strategic health purchasing in Benin's health financing schemes and the implications for universal health coverage 对贝宁保健筹资计划中的战略性保健采购及其对全民健康覆盖的影响进行批判性评估

SSM - Health Systems

Pub Date : 2025-11-12 DOI: 10.1016/j.ssmhs.2025.100152

Cossi Xavier Agbeto , Christelle Boyi , Noudéhouénou Credo Adelphe Ahissou , Hashim Hounkpatin , Nihad Jessica Eyitayo Agoligan Tometin , Arsène Yades , Agnes Gatome-Munya , Jean-Paul Dossou

Several reforms are underway in Benin to improve strategic health purchasing. This study examines th⁠e extent to which purchasing mechanisms in Benin are strategic, highlighting pr⁠ogress made, persistent challenges, and implications for achieving universal health coverage (UHC) in the context of national health financing reforms. We emplo⁠yed a single embedded case study design, collecting data through document rev⁠iew and informal interviews conducted between⁠ September⁠ 2019 and March 2020. Three major schemes w⁠ere assessed: the health insurance component of the Human Cap⁠ital Strengthening Insurance (AM-ARCH)⁠, the Special Regime for Civil S⁠ervants, and the National C⁠esarean-Section Exemption Scheme.

Our findings show that while mandates for pur⁠chasers are defined, overlaps per⁠sist. Publi⁠c providers⁠ have limited autonomy in decision-making and financial management. Benefits packages are specified but no⁠t aligned with service delivery guidelines, and contrac⁠ting is largely non-selective, involving mainly public and⁠ faith-based facilities. Provider payment remains predominantly fee-for-service, and performance monit⁠ori⁠ng is fragmented with minimal automation.

Overall, evid⁠ence⁠ of strategic purchasing in Ben⁠in rem⁠ains limited despite ongoing reforms. To advance progress, Benin should prioritize the d⁠evelopment of a coherent health financing strategy supported by clear legal and regulatory frameworks. Key a⁠ctions i⁠nclude promoting community participation in defining benefit packages, redesigning provider pay⁠ment mechanisms beyond open-ended fee-for-service, an⁠d strengthening contracting with both public and private providers. Incorp⁠orating performance⁠-based elements into payment systems w⁠ill be crucial for enhancing accountability and incentivizing the quality of care.

贝宁正在进行若干改革，以改善战略性保健采购。本研究考察了贝宁采购机制在多大程度上具有战略意义，强调了在国家卫生筹资改革背景下实现全民健康覆盖（UHC）所取得的进展、持续的挑战和影响。我们采用了单一嵌入式案例研究设计，通过2019年9月至2020年3月期间进行的文档回顾和非正式访谈收集数据。我们评估了三个主要方案：人类资本强化保险（AM-ARCH）的健康保险组成部分，公民福利特别制度和国家福利部分豁免计划。我们的研究结果表明，虽然对追逐者的授权是明确的，但仍然存在重叠。公共提供者在决策和财务管理方面的自主权有限。福利待遇有明确规定，但没有与服务提供指南保持一致，合同签订在很大程度上是非选择性的，主要涉及公共设施和基于信仰的设施。供应商的支付仍然主要是按服务收费，而绩效监控则是分散的，自动化程度最低。总体而言，尽管正在进行改革，但在实物中进行战略采购的证据仍然有限。为了取得进展，贝宁应优先考虑在明确的法律和监管框架的支持下制定连贯的卫生筹资战略。关键行动包括促进社区参与确定福利方案，重新设计提供者支付机制，而不是无限制的按服务收费，以及加强与公共和私营提供者的合同。将基于绩效的要素纳入支付系统对于加强问责制和激励医疗质量至关重要。

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引用次数: 0

Barriers and facilitators to collaboration between traditional and biomedical mental health services in a post-conflict healthcare system: A qualitative study in Tigray, Ethiopia 冲突后医疗保健系统中传统和生物医学精神卫生服务之间合作的障碍和促进因素：埃塞俄比亚提格雷的一项定性研究

SSM - Health Systems

Pub Date : 2025-11-11 DOI: 10.1016/j.ssmhs.2025.100153

Kenfe Tesfay Berhe , Hailay Abrha Gesesew , Lillian Mwanri , Paul Ward

Background

The World Health Organisation advocates a biopsychosocial model combining traditional and biomedical care to address mental health gaps, especially in low-resource, conflict-affected health systems. This study explores the factors influencing collaboration between traditional and biomedical mental health services in Tigray, where research on such collaborative care remains limited.

Methods

In-depth interviews were conducted with 50 participants, including biomedical practitioners, traditional healers, and service users from both modalities of care in Tigray, Ethiopia. Interviews focused on perspectives of the need for more collaboration and the barriers and enablers to achieving a collaborative mental health system. A thematic framework analysis approach was employed for data analysis, utilising NVivo qualitative data analysis software.

Results

Traditional practitioners, biomedical practitioners, and their service users recognised the value of collaboration in mental health care in a post-conflict Tigray context, despite acknowledging the presence of challenges. Safety concerns, unclear roles, coordination gaps, and fear of combined treatment effects were barriers to collaboration. Facilitators include opportunities arising from experience sharing by international organisations, as well as existing psychosocial and spiritual rituals.

Conclusion

The study revealed opportunities for collaboration between traditional and biomedical mental health services within post-conflict healthcare systems. Despite existing challenges, both practitioners and service users demonstrated a strong willingness to collaborate and utilise these services. These findings showed the need for contextual collaborative care strategies to enhance mental health care and foster community healing in post-conflict settings.

世界卫生组织提倡一种结合传统和生物医学护理的生物-心理-社会模式，以解决精神卫生差距，特别是在资源匮乏、受冲突影响的卫生系统中。本研究探讨了影响提格雷传统和生物医学精神卫生服务之间合作的因素，在那里对这种合作护理的研究仍然有限。方法对埃塞俄比亚提格雷的50名参与者进行了深入访谈，其中包括生物医学从业者、传统治疗师和两种护理方式的服务使用者。访谈的重点是需要更多合作的观点，以及实现协作精神卫生系统的障碍和促进因素。数据分析采用专题框架分析方法，利用NVivo定性数据分析软件。结果传统从业者、生物医学从业者及其服务使用者认识到冲突后提格雷背景下精神卫生保健合作的价值，尽管承认存在挑战。安全问题、不明确的角色、协调差距和对联合治疗效果的恐惧是合作的障碍。促进因素包括国际组织的经验分享带来的机会，以及现有的社会心理和精神仪式。结论：该研究揭示了冲突后医疗保健系统中传统和生物医学精神卫生服务之间合作的机会。尽管存在挑战，但从业人员和服务用户都表现出合作和利用这些服务的强烈意愿。这些发现表明，需要制定情境协作护理策略，以加强冲突后环境中的精神卫生保健和促进社区康复。

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引用次数: 0

A mixed methods evaluation of 99DOTS digital adherence technology uptake among adolescents treated for pulmonary tuberculosis in Uganda 对乌干达接受肺结核治疗的青少年采用99DOTS数字依从性技术的混合方法评估

SSM - Health Systems

Pub Date : 2025-11-07 DOI: 10.1016/j.ssmhs.2025.100151

P. Wambi , S.N. West , J. Nabugoomu , A. Kityamuwesi , R. Crowder , L. Kunihira , E. Wobudeya , A. Cattamanchi , D. Jaganath , A. Katamba

Background

Adolescents are at risk of poor adherence to tuberculosis (TB) treatment and subsequently worse treatment outcomes. Digital adherence technologies, including the mobile phone-based 99DOTS platform, can support TB treatment, but there is limited data on their use among adolescents. We evaluated factors associated with uptake of 99DOTS among adolescents with TB.

Methods

We conducted an explanatory sequential mixed methods study that utilized quantitative data from adolescents collected at 30 health facilities in Uganda, in-depth and key informant interviews with adolescents diagnosed for TB who were offered 99DOTS, and healthcare workers at participating facilities. Findings were further mapped onto the Capability, Opportunity, Motivation, and Behavior model.

Results

Overall, 299/410 (73 %) adolescents were enrolled in 99DOTS. Older adolescents 15–19 years old were more likely to enroll in 99DOTS than younger adolescents 10–14 years [aPR= 1.88, 95 % CI: (1.54–2.33)]. Conversely, adolescents treated at Health Center IV and General Hospitals were less likely to be enrolled compared to Health Center III (aPR= 0.8, 95 % CI, 0.67–0.94, and aPR= 0.71, 95 % CI 0.58–0.85, respectively). Technological savviness among older adolescents, access to training, caregiver involvement, and desire for wellness facilitated uptake of 99DOTS. In contrast, variable mobile phone access, concerns about TB status disclosure, and health worker workload in hospitals were barriers to the uptake of 99DOTS.

Conclusion

99DOTS uptake was high among adolescents with TB. Increased access to mobile phones, and appropriate support from care givers and health workers enable adolescents to engage more effectively with digital adherence technologies like 99DOTS.

背景：青少年面临结核病治疗依从性差以及随后治疗结果较差的风险。数字坚持治疗技术，包括基于手机的99DOTS平台，可以支持结核病治疗，但关于青少年使用这些技术的数据有限。我们评估了与青少年结核病患者服用99DOTS相关的因素。方法我们进行了一项解释性顺序混合方法研究，该研究利用了从乌干达30个卫生机构收集的青少年的定量数据，对被诊断为结核病并接受99DOTS治疗的青少年以及参与机构的卫生保健工作者进行了深入和关键的信息提供者访谈。研究结果进一步映射到能力、机会、动机和行为模型。结果共有299/410（73% %）青少年参加了99DOTS。年龄较大的15-19岁青少年比年龄较小的10-14岁青少年更有可能参加99DOTS [aPR= 1.88,95 % CI:(1.54-2.33)]。相反，与健康中心III相比，在健康中心IV和综合医院接受治疗的青少年更不可能入组（aPR分别= 0.8,95 % CI, 0.67-0.94, aPR= 0.71,95 % CI 0.58-0.85）。年龄较大的青少年对技术的了解、获得培训的机会、照顾者的参与以及对健康的渴望促进了99DOTS的接受。相比之下，不同的移动电话接入、对结核病状况披露的担忧以及医院卫生工作者的工作量是采用99DOTS的障碍。结论青少年结核病患者99dots吸收率较高。增加对移动电话的使用，并得到护理人员和卫生工作者的适当支持，使青少年能够更有效地使用99DOTS等数字依从性技术。

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引用次数: 0

Adolescent preferences for health services delivery in Uasin Gishu county Kenya: A mixed methods analysis 肯尼亚瓦辛吉舒县青少年对保健服务的偏好：一项混合方法分析

SSM - Health Systems

Pub Date : 2025-11-01 DOI: 10.1016/j.ssmhs.2025.100150

L. Embleton , C. Ashimosi , S. Kirwa , A. Boal , A. Chory , M.A. Ott , R.C. Vreeman , I. Marete

To ensure adolescent and young adult (AYA) perspectives are centered in efforts to improve adolescent and youth-friendly health services (AYFHS) in Uasin Gishu (UG) county, Kenya, we sought to identify and explore AYA preferences for models of health services delivery in this context, taking into consideration age, sex, and geographic location. This mixed methods analysis draws on cross-sectional survey and focus group discussion (FGD) from AYA aged 10–24 years collected from January to June 2024. The data were collected in parallel, analyzed separately, then merged for interpretation. In total, there were 127 AYA participants, with a median age of 17 years (IQR: 14–19 years). Most AYA (87 %) reported that they would most prefer to access health services at a public health facility, and this did not differ substantially by age or sex. AYA expanded upon these findings in FGDs, where preference for dedicated space and a standalone AYA clinic were favored. Participants were divided about using school-based health services (79 %); with 91 % of females and 67 % of males supporting this model. Lower proportions of AYA indicated they would be very likely/likely to use health services delivered via mobile bus (42 %) or virtual services (31 %). Ultimately, AYA are a heterogenous and diverse population who need tailored AYFHS with multiple service delivery models to improve access to care. Despite this, the present analysis demonstrates a strong preference among AYA for accessing AYFHS in public health facilities with dedicated space or a standalone building.

为了确保青少年和年轻人（AYA）的观点集中在改善肯尼亚瓦辛吉舒（UG）县青少年和青年友好型卫生服务（AYFHS）的努力中，我们试图在考虑年龄、性别和地理位置的情况下，确定和探索AYA对这种情况下卫生服务提供模式的偏好。这项混合方法分析利用了横断面调查和焦点小组讨论（FGD），这些调查来自2024年1月至6月收集的10-24岁的AYA。数据是并行收集的，分别分析，然后合并解释。总共有127名AYA参与者，中位年龄为17岁（IQR: 14-19岁）。大多数亚裔美国人（87% %）报告说，他们最愿意在公共卫生机构获得保健服务，这一点在年龄或性别方面差别不大。AYA将这些发现扩展到fgd中，其中偏爱专用空间和独立的AYA诊所。参与者在使用校本保健服务方面存在分歧（79 %）；91% %的女性和67% %的男性支持这一模式。AYA比例较低的人表示，他们很可能/很可能使用通过移动公共汽车（42% %）或虚拟服务（31% %）提供的保健服务。归根结底，AYA是一个异质性和多样化的人群，他们需要量身定制的AYFHS和多种服务提供模式，以改善获得医疗服务的机会。尽管如此，目前的分析表明，在有专用空间或独立建筑的公共卫生设施中，AYA强烈倾向于使用AYFHS。

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引用次数: 0