背景:在卢旺达,孕产妇社区卫生工作者在改善孕产妇,新生儿和儿童健康,但是对他们与青春期母亲的具体经历知之甚少,他们面临着独特的挑战,包括外伤,持续的暴力,污名,排斥,心理健康问题,医疗系统内的障碍,以及无法获得健康的社会决定因素。这项研究探讨了孕产妇社区卫生工作者在照顾卢旺达的青春期母亲时的经验,以告知在社区孕产妇服务中提供基于创伤和暴力的护理。
方法:使用解释性描述方法来了解12名社区卫生工作者因其管理角色而有意招募进行访谈的经验。为了获得关于上下文的更多见解,七名主要线人也接受了采访。
结果:孕产妇社区卫生工作者通过提供连续性护理,为青春期母亲提供个性化支持,作为联络员,参与关系和定制家访。他们报告说对自己的工作充满热情,互相支持,并得到其领导人的支持,作为照顾青春期母亲的促进者。他们工作中的挑战包括处理暴力披露,处理青春期母亲的经济限制,接触这些年轻母亲的困难,和交通问题。青少年母亲的情况通常很困难,导致这些工人样本中替代创伤的自我报告。
结论:孕产妇社区卫生工作者在解决卢旺达青春期母亲的复杂需求方面发挥着关键作用。然而,他们面临着个人和结构性挑战,突出了他们工作的复杂性。为了维持和加强他们的作用,政府和其他利益相关者必须投资资源,导师,和支持。此外,以公平为导向的方法培训,特别是创伤和暴力知情护理,对于确保为青春期母亲提供安全有效的护理以及减轻孕产妇社区卫生工作者的替代创伤至关重要。
BACKGROUND: In Rwanda, maternal community health workers play a critical role to improving maternal, newborn and child health, but little is known about their specific experiences with adolescent mothers, who face unique challenges, including trauma, ongoing violence, stigma, ostracism, mental health issues, barriers within the healthcare system, and lack of access to the social determinants of health. This study explored the experiences of maternal community health workers when caring for adolescent mothers in Rwanda to inform the delivery of trauma- and violence-informed care in community maternal services.
METHODS: Interpretive Description methodology was used to understand the experiences of 12 community health workers purposively recruited for interviews due to their management roles. To gain additional insights about the context, seven key informants were also interviewed.
RESULTS: Maternal community health workers provided personalized support to adolescent mothers through the provision of continuity of care, acting as a liaison, engaging relationally and tailoring home visits. They reported feeling passionate about their work, supporting each other, and receiving support from their leaders as facilitators in caring for adolescent mothers. Challenges in their work included handling disclosures of violence, dealing with adolescent mothers\' financial constraints, difficulties accessing these young mothers, and transportation issues. Adolescent mothers\' circumstances are generally difficult, leading to self-reports of vicarious trauma among this sample of workers.
CONCLUSIONS: Maternal community health workers play a key role in addressing the complex needs of adolescent mothers in Rwanda. However, they face individual and structural challenges highlighting the complexities of their work. To sustain and enhance their roles, it is imperative for government and other stakeholders to invest in resources, mentorship, and support. Additionally, training in equity-oriented approaches, particularly trauma- and violence-informed care, is essential to ensure safe and effective care for adolescent mothers and to mitigate vicarious trauma among maternal community health workers.