BACKGROUND The burden of non-communicable diseases is growing rapidly in low- and middle-income countries. Research suggests that health interventions that aim to improve patient self-management and empower patients to care actively for their disease will improve health outcomes over the long-term. There is, however, a gap in the literature about the potential role of the inpatient setting in supporting chronic care. This is particularly important in low-and-middle income countries where hospitals may be a rare prolonged point of contact between patient and health provider. The aim of this small scale, exploratory study was to understand what factors within the inpatient setting may affect patients' feelings of empowerment in relation to their chronic disease care and provides recommendations for future inpatient-based interventions to support self-management of disease. METHODS This study was based in a public, academic hospital in South Africa. Eighteen qualitative, semi-structured interviews were conducted with multiple participants with experience of diabetes care: inpatients and health professionals such as nurses, endocrinologists, and dieticians. Findings were analysed using a broad, exploratory, thematic approach, guided by self-management and chronic care literature. RESULTS Interviews with both patients and providers suggest that patients living in low socio-economic contexts are likely to struggle to access appropriate healthcare information and services, and may often have financial and emotional priorities that take precedence over their chronic illness. Younger people may also be more dependent on their family and community, giving them less ability to take control of their disease care and lifestyle. In addition, hospital care remains bound by an acute care model; and the inpatient setting of focus is characterised by perceived staff shortages and ineffective communication that undermine the implementation of patient empowerment-focused interventions. CONCLUSIONS Patient and provider contexts are likely to make supporting patient engagement in long-term chronic care difficult in lower income settings. However, knowledge of these factors can be harnessed to improve chronic care interventions in South Africa and other similar countries.

中文翻译：

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影响住院病人长期护理中患者能力的因素：南非对糖尿病护理干预的早期思考。

背景技术非传染性疾病的负担在中低收入国家中迅速增长。研究表明，旨在改善患者自我管理并授权患者积极护理自己疾病的健康干预措施将长期改善健康状况。但是，关于住院环境在支持慢性病治疗中的潜在作用的文献中尚存在空白。这在中低收入国家中尤其重要，在这些国家中，医院可能是患者与医疗服务提供者之间罕见的长期接触点。这项小型探索性研究的目的是了解住院环境中的哪些因素可能会影响患者的 与他们的慢性病护理相关的授权感，并为未来基于住院患者的干预措施提供建议，以支持疾病的自我管理。方法该研究基于南非一家公立的学术医院。与多位具有糖尿病护理经验的参与者进行了18次定性，半结构化访谈，包括住院患者和卫生专业人员，例如护士，内分泌学家和营养师。在自我管理和长期护理文献的指导下，使用广泛的探索性主题方法对发现进行了分析。结果对患者和提供者的访谈都表明，生活在低社会经济背景下的患者可能难以获得适当的医疗保健信息和服务，并且可能经常在财务和情感上优先于慢性病。年轻人也可能更依赖于家庭和社区，从而使他们失去控制疾病护理和生活方式的能力。此外，医院护理仍然受急性护理模式的约束；住院重点的特点是工作人员短缺和沟通不畅，破坏了以患者赋权为重点的干预措施的实施。结论患者和医疗提供者的背景可能使支持低收入人群长期参与长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。年轻人也可能更依赖于家庭和社区，从而使他们失去控制疾病护理和生活方式的能力。此外，医院护理仍然受急性护理模式的约束；住院重点的特点是工作人员短缺和沟通不畅，破坏了以患者赋权为重点的干预措施的实施。结论患者和医疗提供者的背景可能使支持低收入人群长期参与长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。年轻人也可能更依赖于家庭和社区，从而使他们失去控制疾病护理和生活方式的能力。此外，医院护理仍然受急性护理模式的约束；住院重点的特点是工作人员短缺和沟通不畅，破坏了以患者赋权为重点的干预措施的实施。结论患者和医疗提供者的背景可能使支持低收入人群长期参与长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。医院护理仍然受急性护理模式的约束；住院重点的特点是工作人员短缺和沟通不畅，破坏了以患者赋权为重点的干预措施的实施。结论患者和医疗提供者的背景可能使支持低收入人群长期参与长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。医院护理仍然受急性护理模式的约束；住院重点的特点是工作人员短缺和沟通不畅，破坏了以患者赋权为重点的干预措施的实施。结论患者和医疗提供者的背景可能使支持低收入人群长期参与长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。结论患者和医疗提供者的背景可能使支持低收入人群长期参与长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。结论患者和医疗提供者的背景可能使支持低收入人群长期从事长期护理的工作变得困难。但是，可以利用这些因素的知识来改善南非和其他类似国家的长期护理干预措施。