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目的 本研究旨在确定缅甸社区卫生护士(community health nurses,CHNs)在提供有效的社区卫生服务以实现全民健康覆盖(universal health coverage,UHC)方面所面临的挑战.方法 采用目的 抽样方法从缅甸东北部、南部和西部地区的乡镇卫生中心招募了30名CHNs,进行量性资料调查和质性访谈.使用Excel软件处理量性数据,使用主题分析法对质性资料进行分析.结果 全国范围内的30名CHNs表述了实施初级保健以实现UHC方面的困难.超过90％的研究参与者认同卫生基础设施不足的问题;当他们遇到作为卫生保健提供者的不同角色冲突和职业晋升机会不足时,一半人感到缺乏动力.主要问题源于进入社区卫生机构工作时缺乏标准的专业教育,大多数CHNs没有经过公共卫生保健方面的专业培训.随之而来的是他们不能为政策制定进行卫生保健服务评估,也无法进行相关研究以发展循证实践.缺乏保障的工作和生活条件、缺乏支持性的社区关系以及在职教育不足是CHNs揭示的主要主题,这有助于更深入地了解实现UHC的障碍.不仅卫生系统本身,人口和其他地理因素也给CHNs带来诸多挑战.结论 缅甸CHNs在实现UHC过程中面临许多挑战.这些挑战不仅限于卫生部门,诸如地理和交通不便的问题仍然是卫生保健工作者持续面对的挑战.此研究强调了加强当前卫生系统要解决的实际问题,包括卫生保健工作者资质和基础设施配备.同时,对公众赋能在促进健康发展中也发挥关键作用.“,”Objective:This study aimed to identify the challenges of community health nurses (CHNs) in delivering effective community health care to achieve universal health coverage (UHC) in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90％ of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evalu-ating health services for policy-making and the inability to conduct health research to develop evidence-based practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar's CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.