BACKGROUND Various factors influence health service utilization at the community level. Research on the barriers to uptake of local health services is essential to reduce maternal and child mortality and morbidity. The Amazon region of Peru has some of the poorest health indicators in the country. The current study set out to better understand the health-seeking behavior and perspectives of mothers in Amazonian communities, exploring individual- and contextual-level barriers for seeking care at local health facilities for common maternal and child health issues. METHODS The study employed a mixed-methods design by conducting 50 structured interviews with mothers of children under the age of 4. The study took place in 5 communities in Loreto, Peru. The quantitative data was analyzed with descriptive statistics to identify participants' socio-demographic characteristics and reported utilization of health services. The qualitative data was analyzed in three rounds: inductive codebook development, application of the codebook, and thematic synthesis to contextualize the quantitative results and better understand the perspectives of the mothers regarding maternal and child health issues and the local health services. RESULTS Overall, reported health service utilization among study participants was relatively high. However, the mothers identified several individual- and contextual-level factors that may affect their experiences and the health-seeking behaviors of other mothers in their communities: (i) embarrassment, fear, and trust, (ii) insufficient number and poor attitudes of health personnel, (iii) limited supply of basic medicines and materials in the health facility, and (iv) low demand for family planning services and limited awareness of adolescent-specific services. CONCLUSION Several findings in the current study reflect the reduced conditions of health services, while others display that many mothers maintain a positive outlook on the health services available to them and are proactive in the care of their child. The study provides valuable insight into the use of local health services and the common perspectives that are hindering further uptake at the community level in the Amazon of Peru, with important implications for health policy.

中文翻译：

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一项混合方法研究，秘鲁亚马逊地区的妇幼保健服务的卫生服务利用，观点和寻求健康的行为。

背景技术各种因素影响社区一级的卫生服务利用。对减少当地卫生服务的障碍进行研究对于降低母婴死亡率和发病率至关重要。秘鲁的亚马逊地区有一些该国最贫困的健康指标。当前的研究着眼于更好地理解亚马逊社区母亲的健康行为和观点，探索在当地和母婴健康问题上在当地医疗机构寻求护理的个人和背景层面的障碍。方法该研究采用混合方法设计，对4岁以下儿童的母亲进行了50次结构化访谈。该研究在秘鲁洛雷托的5个社区进行。使用描述性统计数据对定量数据进行分析，以识别参与者的 社会人口统计学特征和报告的卫生服务利用情况。定性数据分三轮进行了分析：归纳密码本的开发，密码本的应用和主题综合，以定量化结果，并更好地理解母亲对母婴健康问题和当地卫生服务的看法。结果总体而言，研究参与者报告的医疗服务利用率相对较高。但是，母亲们发现了一些个人和背景层面的因素，这些因素可能会影响他们的经历以及其他母亲在社区中的健康追求行为：（i）尴尬，恐惧和信任，（ii）数量不足和态度不佳。 （iii）卫生机构中基本药物和材料的供应有限，（iv）对计划生育服务的需求低，对青少年服务的认识有限。结论当前研究中的一些发现反映出健康服务状况的下降，而另一些研究则表明，许多母亲对可利用的健康服务保持积极的态度，并积极地照顾孩子。这项研究提供了宝贵的见解，以了解当地卫生服务的使用以及阻碍秘鲁亚马逊河地区社区进一步采用的普遍观点，这对卫生政策具有重要意义。而另一些人则表明，许多母亲对她们所能获得的保健服务保持积极的态度，并积极地照顾自己的孩子。这项研究提供了宝贵的见解，以了解当地卫生服务的使用以及阻碍秘鲁亚马逊河地区社区进一步采用的普遍观点，这对卫生政策具有重要意义。而另一些人则表明，许多母亲对她们所能获得的保健服务保持积极的态度，并积极地照顾自己的孩子。这项研究提供了宝贵的见解，以了解当地卫生服务的使用以及阻碍秘鲁亚马逊河地区社区进一步采用的普遍观点，这对卫生政策具有重要意义。