以新冠疫情为例探索完善公共卫生事件中家庭服务的定性研究

On the improvement of family services in public health events:a qualitative case study based on COVID-19 responses

目的了解上海市现阶段家庭服务现状及居民服务需求,完善并构建公共卫生事件中家庭服务的关键要素。方法采用个人深入访谈和焦点小组访谈相结合的方式,访谈对象包括国内外公共卫生、健康服务、教育、安全等领域的专家,社区工作人员和社区居民,内容涉及家庭服务存在的问题、居民对家庭服务的需求和建议等。结果上海市公共卫生事件中家庭服务存在7个主要问题:“上下级部门权责不够明确”“社区层面公共卫生专业人才队伍建设存在缺陷”“疫情期间上下级医疗机构之间对接不足”“居民对于社区可以提供家庭服务项目知晓度较低”“公共空间存在卫生死角,小区应急设备维护需要加强”“舆情疏导的渠道有待完善,老年人群体缺乏信息获取的有效媒介”“缺乏实行封闭式管理后一些实际问题的应急预案”。居民需求包括6个方面:“整体家庭服务”“基本生活物资和特殊物资的供应和保障”“专业人员作为支持开展家庭服务”“急症医疗服务”“接受心理干预和了解心理知识”“食品和食品供应链安全”。结论“政府主导”“跨界合作”“执行主体明确”“居民需求为基础”是关键要素,建议将家庭服务纳入政府常态化建设。

Objective To understand the status of family services and residents’demands for services in Shanghai in order to construct and improve the key elements of family services in public health events.Methods We used a combining method of individual in-depth interviews and focused group interviews.The informants were domestic and foreign experts in public health,health services,education,safety,etc.,community workers and residents.The interview questions were as follow:problems in family services,residents’demands and suggestions for family services,etc.Results We found 7 major family services problems in Shanghai’s response to public health events:The boundary of authorities and responsibilities were not clearly defined between the upper and lower departments.The team construction of public health professions at the community level was flawed.There were miscommunications between upper and lower medical institutions during the epidemic outbreaks.Residents were not aware of the available family services provided by their communities.Unnoticed insanitary spots still existed in public spaces,and the maintenance of residential emergence equipment needs to be strengthened.The public opinion guidance required further strengthening,and the elderly people lack an effective medium for information acquisition.The emergency plan of closed management to solve practical problems after Shanghai’s COVID lockdown was insufficient.The residents’demands included the following 6 aspects:comprehensive family services,supply and guarantee of basic living materials and special materials,professionals providing family services as a means of support,emergency medical services,receiving psychological intervention and understanding knowledge of mental health,security of food and food supply chain security.Conclusion‘Government led’‘cross-border cooperation’‘clear executive body’and‘based on the needs of residents’were key factors.Therefore,we suggest family services are included in the normalizing construction of government.