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从医疗服务提供者的视角剖析以色列阿拉伯贝都因人群的就医障碍

Unpacking access barriers through the health providers' lens among the Arab Bedouin population in Israel.

作者信息

Shibli Haneen, Aharonson-Daniel Limor, Daoud Nihaya, Feder-Bubis Paula

机构信息

Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

出版信息

Soc Sci Med. 2025 Jan;364:117536. doi: 10.1016/j.socscimed.2024.117536. Epub 2024 Nov 22.

Abstract

The Arab Bedouin ethnic minority is considered one of the most vulnerable populations in Israel due to socio-cultural factors that affect their healthcare utilization patterns. By adopting the intersectionality perspective, this research aims to identify gaps and barriers to Bedouins' healthcare services (HCS) utilization, as perceived by healthcare professionals (HCP) serving this community. A qualitative study was conducted from June 2019 to January 2022, involving in-depth semi-structured interviews with thirty-two HPCs working in hospitals and community health centers/clinics in Bedouin villages and towns in Southern Israel. Reflective Thematic Analysis (RTA) was used to analyze the collected data, and trustworthiness was ensured through audit, reflexivity, and peer debriefing. Findings revealed that healthcare professionals noted gaps that hinder HCS accessibility and utilization. This study found that the intersection of physical, financial, language, health literacy, and gender barriers with issues of trust, stigma, and deep-rooted socio-cultural norms and beliefs affect Bedouin healthcare accessibility. Additionally, Bedouin women are particularly vulnerable subgroups who were impacted differently by these barriers. In conclusion, our research highlights the necessity of targeted interventions to improve healthcare access for Bedouin minority populations, particularly tailoring HCS to the women subgroup within the Bedouin community. Suggested interventions include health literacy-enhancing educational initiatives, addressing medication affordability, and approaches to mitigate cultural and gendered hindrances to HCS. These insights have broader relevance for shaping health policies and strategies that bridge healthcare disparities among global minority populations.

摘要

阿拉伯贝都因少数民族被认为是以色列最脆弱的群体之一,因为社会文化因素影响着他们的医疗服务利用模式。本研究采用交叉性视角,旨在确定为该社区服务的医疗保健专业人员(HCP)所认为的贝都因人医疗保健服务(HCS)利用方面的差距和障碍。2019年6月至2022年1月进行了一项定性研究,对在以色列南部贝都因村庄和城镇的医院及社区卫生中心/诊所工作的32名HPC进行了深入的半结构化访谈。采用反思性主题分析(RTA)对收集的数据进行分析,并通过审核、反思和同行汇报确保可信度。研究结果显示,医疗保健专业人员指出了阻碍HCS可及性和利用的差距。本研究发现,身体、经济、语言、健康素养和性别障碍与信任、耻辱以及根深蒂固的社会文化规范和信仰问题的交叉,影响了贝都因人的医疗保健可及性。此外,贝都因女性是特别脆弱的亚群体,受到这些障碍的影响各不相同。总之,我们的研究强调了针对性干预措施对于改善贝都因少数民族人口医疗保健可及性的必要性,特别是为贝都因社区内的女性亚群体量身定制HCS。建议的干预措施包括提高健康素养的教育举措、解决药物可负担性问题,以及减轻文化和性别对HCS的阻碍的方法。这些见解对于制定弥合全球少数民族人口医疗保健差距的卫生政策和战略具有更广泛的相关性。

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