乌干达一个非洲农村地区的围产期心理健康护理：对障碍、促进因素和需求的定性研究
Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.
作者信息
Nakku Juliet E M, Okello Elialilia S, Kizza Dorothy, Honikman Simone, Ssebunnya Joshua, Ndyanabangi Sheila, Hanlon Charlotte, Kigozi Fred
机构信息
Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda.
Makerere University, Kampala, Uganda.
出版信息
BMC Health Serv Res. 2016 Jul 22;16:295. doi: 10.1186/s12913-016-1547-7.
BACKGROUND
Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda.
METHODS
Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach.
RESULTS
Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training.
CONCLUSION
This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.
背景
围产期精神疾病是一个常见且重要的公共卫生问题，在低收入和中等收入国家（LMICs）尤为突出。本研究旨在探讨乌干达一个低收入农村地区在基层医疗环境中提供围产期心理健康护理计划的障碍与促进因素，以及对其可行性和可接受性的看法。
方法
使用主题指南，以当地语言对六组焦点小组进行了讨论，分别包括孕妇和产后妇女以及乡村卫生团队，还进行了八次关键信息访谈。转录的数据被翻译成英文，进行分析和编码。采用主题分析方法确定关键主题。
结果
参与者认为该地区围产期心理健康护理存在重要的未满足需求。有证据表明，在心理健康问题知识方面存在重大差距，母亲和医疗服务提供者对患者存在负面态度。贫困、无力支付前往服务机构的交通费用、伴侣支持不足和耻辱感被认为增加了围产期妇女获得护理的困难。人们意识到需要采取干预措施来应对这一被忽视的公共卫生问题，并且社区和医疗机构的医疗服务提供者都愿意在接受充分培训后为有心理健康问题的母亲提供护理。
结论
本研究强调了围产期心理健康护理在农村低收入国家社区的可接受性和相关性。它还强调了在基层医疗环境中提供此类护理的一些关键障碍和潜在促进因素。本研究结果对乌干达围产期人群的心理健康服务规划和发展具有启示意义，将有助于为该农村地区以及其他低收入和中等收入国家类似环境中综合孕产妇心理健康护理的发展提供参考。
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