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Abstract：
BACKGROUND: This study presents a way for health services to improve service access for hardly reached people through an exploration of how staff can find and collaborate with citizens (referred to as connectors) who span socio-cultural boundaries in their community. The study explored the local socio-cultural contexts of connectors\' boundary spanning activities and if they are health related; boundary spanning occurring between connectors and health professionals at the interface of health systems and community; and the opportunities and barriers to actively seeking out and collaborating with community connectors to access marginalised and hardly reached people.
METHODS: We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes.
RESULTS: We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout.
CONCLUSIONS: Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system.
METHODS: We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes.
RESULTS: We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout.
CONCLUSIONS: Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system.
摘要：
背景：这项研究提出了一种方法，通过探索工作人员如何找到跨越社会文化界限的公民（称为连接器）并与之合作，为几乎没有接触到的人提供医疗服务。他们的社区。该研究探讨了连接器边界跨越活动的当地社会文化背景，以及它们是否与健康相关；在卫生系统和社区的界面上，连接器和卫生专业人员之间发生边界跨越；以及积极寻找和与社区连接器合作以接触边缘化和难以接触的人群的机会和障碍。
方法：我们进行了来自爱尔兰和澳大利亚农村的定性病例比较。遵循有目的的雪球采样技术来招募参与者，对34名社区线人进行了半结构化访谈，21名医护人员和32个连接器。使用归纳方法对成绩单进行编码和分析，以确定类别和总体主题。
结果：我们发现了与异质，小的和当地不同的群体很难达到的人。共有26个连接器在卫生服务和社区之间的接口上活跃，这在不同的情况下是如何发生的。大多数（21）描述了一种或多种与健康有关的活动，几乎没有达到的人。所有联络人都表示愿意就他们认为相关的问题与当地卫生服务发展关系。连接器和与官僚机构有关的卫生服务之间合作的障碍，工作量,和倦怠。
结论：与连接器合作有可能成为改善难以接触人群获得卫生服务的策略之一。为了制定这个，卫生工作人员需要确定当地的社会文化界限和相关的连接器，促进卫生服务与社区之间的双向联系，并通过参加社区的活动来实现合作，在卫生服务和社区之间的接口，在卫生系统内。
方法：我们进行了来自爱尔兰和澳大利亚农村的定性病例比较。遵循有目的的雪球采样技术来招募参与者，对34名社区线人进行了半结构化访谈，21名医护人员和32个连接器。使用归纳方法对成绩单进行编码和分析，以确定类别和总体主题。
结果：我们发现了与异质，小的和当地不同的群体很难达到的人。共有26个连接器在卫生服务和社区之间的接口上活跃，这在不同的情况下是如何发生的。大多数（21）描述了一种或多种与健康有关的活动，几乎没有达到的人。所有联络人都表示愿意就他们认为相关的问题与当地卫生服务发展关系。连接器和与官僚机构有关的卫生服务之间合作的障碍，工作量,和倦怠。
结论：与连接器合作有可能成为改善难以接触人群获得卫生服务的策略之一。为了制定这个，卫生工作人员需要确定当地的社会文化界限和相关的连接器，促进卫生服务与社区之间的双向联系，并通过参加社区的活动来实现合作，在卫生服务和社区之间的接口，在卫生系统内。
