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Abstract：
A rapid ethnographic assessment of barriers to health service utilization was conducted to identify maternal factors predicting use of child immunizations in Haiti. Methods included four focus group interviews, four natural group interviews, individual interviews with 14 health care providers and participant observation at vaccination posts. Analysis of qualitative data identified five categories of maternal factors associated with immunization use: competing priorities, low motivation, socioeconomic constraints, perceived accessibility of services, fears about health or social consequences and knowledge and folk beliefs related to vaccines. Selected variables among these factors were incorporated into a survey instrument designed to compare mothers of completely vaccinated children (cases) with mothers of incompletely vaccinated children (controls). The questionnaire was administered to 299 randomly selected mothers (217 cases, 82 controls). Bivariate and multivariate analyses found that of the factors identified through ethnographic research, only vaccine-related knowledge was significantly associated with immunization status. The utility and constraints of using ethnographic research for instrument development in epidemiological studies are discussed.
A rapid ethnographic assessment consisting of 4 focus groups, 4 natural group interviews, 14 provider interviews and participant observation rally posts was combined into a questionnaire which was tested by chi square for use in predicting which Haitian mothers utilize immunization services. The study population were mothers of 1800 children 12-23 months old in the Mirebalais Area Community Health program in the central highlands of Haiti. The program uses the rally post system, with teams visiting villages at 6-week intervals. Audio tapes and written notes were reduced to lists of all possible barriers to maternal utilization, and then regrouped into 16 categories, under 5 topics: competing priorities, lack of motivation, socioeconomic constraints, perceived accessibility of posts, fears of health consequences and knowledge of folk beliefs about vaccines. 22 questionnaire items were then developed, which were edited by the overall project director without input from the ethnographer. The questions were administered to 299 mothers, 82 with incompletely immunized, and 217 with completely immunized children. The questions which significantly predicted complete vaccination by bivariate analysis were knowledge of the name of 1 or more vaccines or illnesses, the recommended number of doses, and the correct age to begin vaccinations. It was likely that time demands from subsistence farming and income generating activities also affected service utilization, but the women probably interpreted the question on employment incorrectly.
A rapid ethnographic assessment consisting of 4 focus groups, 4 natural group interviews, 14 provider interviews and participant observation rally posts was combined into a questionnaire which was tested by chi square for use in predicting which Haitian mothers utilize immunization services. The study population were mothers of 1800 children 12-23 months old in the Mirebalais Area Community Health program in the central highlands of Haiti. The program uses the rally post system, with teams visiting villages at 6-week intervals. Audio tapes and written notes were reduced to lists of all possible barriers to maternal utilization, and then regrouped into 16 categories, under 5 topics: competing priorities, lack of motivation, socioeconomic constraints, perceived accessibility of posts, fears of health consequences and knowledge of folk beliefs about vaccines. 22 questionnaire items were then developed, which were edited by the overall project director without input from the ethnographer. The questions were administered to 299 mothers, 82 with incompletely immunized, and 217 with completely immunized children. The questions which significantly predicted complete vaccination by bivariate analysis were knowledge of the name of 1 or more vaccines or illnesses, the recommended number of doses, and the correct age to begin vaccinations. It was likely that time demands from subsistence farming and income generating activities also affected service utilization, but the women probably interpreted the question on employment incorrectly.
摘要：
对卫生服务利用障碍进行了快速的人种学评估，以确定预测海地使用儿童免疫接种的孕产妇因素。方法包括四次焦点小组访谈，四次自然小组访谈，对14名卫生保健提供者进行个人访谈，并在疫苗接种站观察参与者。对定性数据的分析确定了与免疫接种相关的五类孕产妇因素：相互竞争的优先事项，低动机,社会经济约束，感知到的服务可访问性，对健康或社会后果的恐惧，以及与疫苗相关的知识和民间信仰。将这些因素中的选定变量纳入调查工具，该工具旨在比较完全接种疫苗的儿童（病例）的母亲与未完全接种疫苗的儿童（对照）的母亲。随机抽取299名母亲(217例,82个控件）。双变量和多变量分析发现，在通过人种学研究确定的因素中，只有疫苗相关知识与免疫状态显著相关.讨论了在流行病学研究中使用人种学研究进行仪器开发的实用性和局限性。
由4个焦点小组组成的快速人种学评估，4次自然小组访谈，将14个提供者访谈和参与者观察集会职位合并为问卷，并通过卡方进行了测试，以预测哪些海地母亲使用免疫服务。研究人群是海地中部高地Mirebalais地区社区卫生计划中12-23个月大的1800名儿童的母亲。该程序使用集会后系统，团队每隔6周访问村庄。录音带和书面笔记被减少到列出了所有可能阻碍孕产妇利用的障碍，然后重组为16个类别，在5个主题下：相互竞争的优先事项，缺乏动力,社会经济约束，感知到的帖子可访问性，对健康后果的恐惧和对疫苗的民间信仰的了解。然后编制了22个问卷项目，由整体项目总监编辑，没有人种学家的投入。这些问题是针对299位母亲的，82不完全免疫，217名完全免疫的儿童。通过双变量分析显著预测完全疫苗接种的问题是对一种或多种疫苗或疾病的名称的了解，推荐的剂量数量，以及开始接种疫苗的正确年龄。自给农业和创收活动的时间需求也可能影响服务利用，但是女性可能错误地解释了就业问题。
由4个焦点小组组成的快速人种学评估，4次自然小组访谈，将14个提供者访谈和参与者观察集会职位合并为问卷，并通过卡方进行了测试，以预测哪些海地母亲使用免疫服务。研究人群是海地中部高地Mirebalais地区社区卫生计划中12-23个月大的1800名儿童的母亲。该程序使用集会后系统，团队每隔6周访问村庄。录音带和书面笔记被减少到列出了所有可能阻碍孕产妇利用的障碍，然后重组为16个类别，在5个主题下：相互竞争的优先事项，缺乏动力,社会经济约束，感知到的帖子可访问性，对健康后果的恐惧和对疫苗的民间信仰的了解。然后编制了22个问卷项目，由整体项目总监编辑，没有人种学家的投入。这些问题是针对299位母亲的，82不完全免疫，217名完全免疫的儿童。通过双变量分析显著预测完全疫苗接种的问题是对一种或多种疫苗或疾病的名称的了解，推荐的剂量数量，以及开始接种疫苗的正确年龄。自给农业和创收活动的时间需求也可能影响服务利用，但是女性可能错误地解释了就业问题。
