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Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage

BACKGROUND: There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing to...

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Autores principales: Faruqui, Neha, Bernays, Sarah, Martiniuk, Alexandra, Abimbola, Seye, Arora, Ramandeep, Lowe, Jennifer, Denburg, Avram, Joshi, Rohina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607709/
https://www.ncbi.nlm.nih.gov/pubmed/33143668
http://dx.doi.org/10.1186/s12889-020-09758-3
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author Faruqui, Neha
Bernays, Sarah
Martiniuk, Alexandra
Abimbola, Seye
Arora, Ramandeep
Lowe, Jennifer
Denburg, Avram
Joshi, Rohina
author_facet Faruqui, Neha
Bernays, Sarah
Martiniuk, Alexandra
Abimbola, Seye
Arora, Ramandeep
Lowe, Jennifer
Denburg, Avram
Joshi, Rohina
author_sort Faruqui, Neha
collection PubMed
description BACKGROUND: There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS: This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS: Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant’s cadre: the nature of the participant’s role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION: Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-020-09758-3.
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spelling pubmed-76077092020-11-03 Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage Faruqui, Neha Bernays, Sarah Martiniuk, Alexandra Abimbola, Seye Arora, Ramandeep Lowe, Jennifer Denburg, Avram Joshi, Rohina BMC Public Health Research Article BACKGROUND: There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS: This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS: Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant’s cadre: the nature of the participant’s role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION: Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-020-09758-3. BioMed Central 2020-11-03 /pmc/articles/PMC7607709/ /pubmed/33143668 http://dx.doi.org/10.1186/s12889-020-09758-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Faruqui, Neha
Bernays, Sarah
Martiniuk, Alexandra
Abimbola, Seye
Arora, Ramandeep
Lowe, Jennifer
Denburg, Avram
Joshi, Rohina
Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage
title Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage
title_full Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage
title_fullStr Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage
title_full_unstemmed Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage
title_short Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage
title_sort access to care for childhood cancers in india: perspectives of health care providers and the implications for universal health coverage
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607709/
https://www.ncbi.nlm.nih.gov/pubmed/33143668
http://dx.doi.org/10.1186/s12889-020-09758-3
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