4

Social factors influencing treatment interruption in Tuberculosis Patients:

A qualitative study

Mustafa Jiba1*, Fereshteh Zamani-Alavijeh2, Marzieh Araban3, Arash Salahshoori4, Mobarak Jiba5,
Javad Haroni6

1. Ms.c of Health Education, Department of Public Health, and Infectious and Tropical Diseases Research Center, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran.
2. Assistant Professor, Department of Public Health, Esfahan University of Medical Sciences, Esfahan, Iran.
3. Assistant Professor, Department of Public Health, and Infectious and Tropical Diseases Research Center, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran
4. PhD Student, Department of Public Health, and Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran
5. Expert of Occupational Health, Lenjan Health Center, Esfahan University of Medical Sciences, Esfahan, Iran.
6. PhD Student, Department of Public Health, School of public Health, Shahid Beheshti University of medical sciences,
Tehran, Iran.

ABSTRACT
Background and Aims: Positive smear pulmonary Tuberculosis (TB) patients sometimes interrupt their
treatment. They may consequently result in the prevalence of antibiotic resistant strains (MDR-TB) in the
community. This study was aimed to explore social factors influencing the treatment interruption in these
patients.
Materials and Methods: Purposeful sampling method with maximum variance was employed in this qualitative
research. Data gathering process were included unstructured in-depth interviews with totally 37 persons (26
patients, 5 their family members and 6 concerning therapy supervisors), patients’ medical records, as well as
recorded information in both Tuberculosis register program and Tuberculosis registration office kept in health
care centers. Concurrently with data gathering, they were analyzed through ongoing comparisons. Also the
participants in the study informed consent was obtained.
Results: Based on the findings of this study, social factors influencing treatment interruption in Tuberculosis
patients were included six sub-categories: lack of social support, TB-related stigma, work issues, poverty, as
well as imprisonment and drug abuse during the course of treatment.
Conclusion: Results from this study demonstrated that family members and therapy supervisors need
appropriate interventions in order to decrease social factors influencing treatment interruption in Tuberculosis
patients.

Key words: Social Factors, Tuberculosis Treatment Interruption, Qualitative Study

*Corresponding Author:
Department of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Email: mostafa_jiba@yahoo.com

Received: 3 February 2015

Accepted: 6 October 2015
 ‫ﻓﺼﻠﻨﺎﻣﻪ ﺑﻬﺪﺍﺷﺖ ﺩﺭ ﻋﺮﺻﻪ‬
‫ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ ـ ﺩﺍﻧﺸﻜﺪﻩ ﺑﻬﺪﺍﺷﺖ‬
‫ﺩﻭﺭﻩ ‪ ،2‬ﺷﻤﺎﺭﻩ ‪ ،4‬ﺯﻣﺴﺘﺎﻥ ‪ ،1393‬ﺻﻔﺤﺎﺕ ‪ 26‬ﺗﺎ ‪34‬‬

‫ﺗﺒﻴﻦ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ‪ :‬ﻳﻚ ﺗﺤﻠﻴﻞ ﻛﻴﻔﻰ‬
‫‪6‬‬
‫ﻣﺼﻄﻔﻲ ﺟﻴﺒﺎ‪ ،*1‬ﻓﺮﺷﺘﻪ ﺯﻣﺎﻧﻲ ﻋﻠﻮﻳﭽﻪ‪ ،2‬ﻣﺮﺿﻴﻪ ﻋﺮﺑﺎﻥ‪ ،3‬ﺁﺭﺵ ﺳﻠﺤﺸﻮﺭﻱ‪ ،4‬ﻣﺒﺎﺭﻙ ﺟﻴﺒﺎ‪ ،5‬ﺟﻮﺍﺩ ﻫﺎﺭﻭﻧﻰ‬

‫‪ 1‬ﻛﺎﺭﺷﻨﺎﺱ ﺍﺭﺷﺪ ﺁﻣﻮﺯﺵ ﺑﻬﺪﺍﺷﺖ‪ ،‬ﮔﺮﻭﻩ ﺑﻬﺪﺍﺷﺖ ﻋﻤﻮﻣﻰ ﻭ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﺑﻴﻤﺎﺭﻳﻬﺎﻯ ﻋﻔﻮﻧﻰ ﻭ ﮔﺮﻣﺴﻴﺮﻯ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺟﻨﺪﻱ ﺷﺎﭘﻮﺭ ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻳﺮﺍﻥ‬
‫‪ 2‬ﺍﺳﺘﺎﺩﻳﺎﺭ‪ ،‬ﮔﺮﻭﻩ ﺁﻣﻮﺯﺵ ﻭ ﺍﺭﺗﻘﺎ ﺳﻼﻣﺖ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﺑﻬﺪﺍﺷﺖ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺍﺻﻔﻬﺎﻥ‪ ،‬ﺍﺻﻔﻬﺎﻥ‪ ،‬ﺍﻳﺮﺍﻥ‬
‫‪ 3‬ﺍﺳﺘﺎﺩﻳﺎﺭ‪ ،‬ﮔﺮﻭﻩ ﺑﻬﺪﺍﺷﺖ ﻋﻤﻮﻣﻰ ﻭ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﺑﻴﻤﺎﺭﻳﻬﺎﻯ ﻋﻔﻮﻧﻰ ﻭ ﮔﺮﻣﺴﻴﺮﻯ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺟﻨﺪﻱ ﺷﺎﭘﻮﺭ ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻳﺮﺍﻥ‬
‫‪ 4‬ﺩﺍﻧﺸﺠﻮﻯ ﺩﻛﺘﺮﺍﻯ ﺗﺨﺼﺼﻰ ﺁﻣﻮﺯﺵ ﺑﻬﺪﺍﺷﺖ ﻭ ﺍﺭﺗﻘﺎء ﺳﻼﻣﺖ‪ ،‬ﻛﺎﺭﺷﻨﺎﺱ ﺳﺘﺎﺩ ﮔﺴﺘﺮﺵ ﺷﺒﻜﻪ‪ ،‬ﻣﺮﻛﺰ ﺑﻬﺪﺍﺷﺖ ﺍﻳﺬﻩ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺟﻨﺪﻯ ﺷﺎﭘﻮﺭ ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻳﺮﺍﻥ‬
‫‪ 5‬ﻛﺎﺭﺷﻨﺎﺱ ﺑﻬﺪﺍﺷﺖ ﺣﺮﻓﻪ ﺍﻯ‪ ،‬ﻣﺮﻛﺰ ﺑﻬﺪﺍﺷﺖ ﻟﻨﺠﺎﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺍﺻﻔﻬﺎﻥ‪ ،‬ﺍﺻﻔﻬﺎﻥ‪ ،‬ﺍﻳﺮﺍﻥ‬
‫‪ 6‬ﺩﺍﻧﺸﺠﻮﻯ ﺩﻛﺘﺮﺍﻯ ﺗﺨﺼﺼﻰ ﺁﻣﻮﺯﺵ ﺑﻬﺪﺍﺷﺖ ﻭﺍﺭﺗﻘﺎء ﺳﻼﻣﺖ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﺑﻬﺪﺍﺷﺖ‪،‬ﻛﻤﻴﺘﻪ ﺗﺤﻘﻴﻘﺎﺕ ﺩﺍﻧﺸﺠﻮﻳﻰ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻰ‪ ،‬ﺗﻬﺮﺍﻥ‪ ،‬ﺍﻳﺮﺍﻥ‬

‫ﭼﻜﻴﺪﻩ‬
‫ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ‪ :‬ﺑﻴﻤﺎﺭﺍﻥ ﺭﻳﻮﻯ ﺍﺳﻤﻴﺮ ﻣﺜﺒﺖ ﮔﺎﻫﻰ ﺑﻪ ﻋﻠﻞ ﻣﺨﺘﻠﻒ ﺩﺭﻣﺎﻥ ﺧﻮﺩ ﺭﺍ ﻗﻄﻊ ﻣﻰﻛﻨﻨﺪ ﻭ ﺑﺎﻋﺚ ﺷﻴﻮﻉ ﺳﻞ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ ﺩﺭ ﺟﺎﻣﻌﻪ‬
‫ﻣﻰﺷﻮﻧﺪ‪ .‬ﺍﻳﻦ ﭘﮋﻭﻫﺶ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﺒﻴﻴﻦ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺍﻧﺠﺎﻡ ﺷﺪ‪.‬‬
‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵﻫﺎ‪ :‬ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺨﺸﻰ ﺍﺯ ﻳﻚ ﺗﺤﻘﻴﻖ ﻛﻴﻔﻰ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺁﻥ ﺍﺯ ﻧﻤﻮﻧﻪ ﮔﻴﺮﻯ ﻣﺒﺘﻨﻰ ﺑﺮ ﻫﺪﻑ ﺑﺎ ﺣﺪﺍﻛﺜﺮ ﺗﻨﻮﻉ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺍﺳﺖ‪.‬‬
‫ﺗﻮﻟﻴﺪ ﺩﺍﺩﻩﻫﺎ ﺍﺯ ﻃﺮﻳﻖ ﻣﺼﺎﺣﺒﻪ ﻋﻤﻴﻖ ﺑﺎ ‪ 26‬ﺑﻴﻤﺎﺭ‪ 5 ،‬ﻧﻔﺮ ﺍﻋﻀﺎﻯ ﺧﺎﻧﻮﺍﺩﻩ ﺁﻧﻬﺎ ﻭ ‪ 6‬ﻧﺎﻇﺮ ﺑﺮ ﺩﺭﻣﺎﻥ ﻭ ﻫﻤﭽﻨﻴﻦ ﻣﺸﺎﻫﺪﻩ ﭘﺮﻭﻧﺪﻩ ﺑﻴﻤﺎﺭﺍﻥ‪،‬‬
‫ﺍﻃﻼﻋﺎﺕ ﺛﺒﺖ ﺷﺪﻩ ﺩﺭ ﺑﺮﻧﺎﻣﻪ ‪ Tuberculosis register‬ﻭ ﺩﻓﺘﺮ ﺛﺒﺖ ﻧﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺩﺭ ﻣﺮﺍﻛﺰ ﺑﻬﺪﺍﺷﺖ ﺷﻬﺮﺳﺘﺎﻧﻬﺎ‪ ،‬ﺣﺎﺻﻞ‬
‫ﮔﺮﺩﻳﺪ‪ .‬ﻣﺼﺎﺣﺒﻪ ﺑﻪ ﺻﻮﺭﺕ ﺳﺎﺯﻣﺎﻥ ﻧﻴﺎﻓﺘﻪ ﺗﺎ ﺭﺳﻴﺪﻥ ﺑﻪ ﺍﺷﺒﺎﻉ ﺩﺍﺩﻩﻫﺎ ﺍﺩﺍﻣﻪ ﻳﺎﻓﺖ‪ .‬ﺗﺤﻠﻴﻞ ﺩﺍﺩﻩﻫﺎ ﺑﺎ ﻣﻘﺎﻳﺴﻪ ﻣﺪﺍﻭﻡ ﻭ ﻫﻤﺰﻣﺎﻥ ﺑﺎ ﺟﻤﻊ ﺁﻭﺭﻯ‬
‫ﺁﻧﻬﺎ ﺻﻮﺭﺕ ﮔﺮﻓﺖ‪ .‬ﻫﻤﭽﻨﻴﻦ ﺍﺯ ﺷﺮﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺟﻬﺖ ﺷﺮﻛﺖ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺭﺿﺎﻳﺖ ﺁﮔﺎﻫﺎﻧﻪ ﻛﺴﺐ ﮔﺮﺩﻳﺪ‪.‬‬
‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬ﺩﺭ ﻧﺘﻴﺠﻪ ﺗﺤﻠﻴﻞ ﺩﺍﺩﻩﻫﺎ‪ ،‬ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺩﺭ ‪ 6‬ﻃﺒﻘﻪ ﻓﺮﻋﻰ ﺷﺎﻣﻞ ﺿﻌﻒ ﺣﻤﺎﻳﺖ‬
‫ﺍﺟﺘﻤﺎﻋﻰ‪ ،‬ﺍﻧﮓ ﻭ ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺳﻞ‪ ،‬ﻣﺴﺎﺋﻞ ﻣﺮﺑﻮﻁ ﺑﻪ ﻛﺎﺭ‪ ،‬ﻓﻘﻴﺮ ﺑﻮﺩﻥ‪ ،‬ﺯﻧﺪﺍﻧﻰ ﺷﺪﻥ ﻭ ﺍﺳﺘﻌﻤﺎﻝ ﻣﻮﺍﺩ ﻣﺨﺪﺭ ﺩﺭ ﻃﻮﻝ ﺩﺭﻣﺎﻥ ﺑﻮﺩﻧﺪ‪.‬‬
‫ﻧﺘﻴﺠﻪ ﮔﻴﺮﻱ‪ :‬ﺑﺮﺍﺳﺎﺱ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ‪ ،‬ﺑﺎﻳﺴﺘﻰ ﺟﻬﺖ ﻛﺎﻫﺶ ﻣﻮﺍﻧﻊ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﻭ ﺁﻣﻮﺯﺵ ﻣﺆﺛﺮ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺁﻧﻬﺎ‬
‫ﻭ ﻧﺎﻇﺮﻳﻦ ﺑﺮ ﺩﺭﻣﺎﻥ‪ ،‬ﻣﺪﺍﺧﻼﺕ ﻣﻨﺎﺳﺒﻰ ﻃﺮﺍﺣﻰ ﻭ ﺍﺟﺮﺍ ﻧﻤﻮﺩ‪.‬‬

‫ﻛﻠﻴﺪ ﻭﺍژﻩﻫﺎ‪ :‬ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ‪ ،‬ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺳﻞ‪ ،‬ﻣﻄﺎﻟﻌﻪ ﻛﻴﻔﻰ‬

‫*ﺁﺩﺭﺱ ﻧﻮﻳﺴﻨﺪﻩ ﻣﺴﺌﻮﻝ‪:‬‬

‫ﻛﺎﺭﺷﻨﺎﺱ ﺍﺭﺷﺪ ﺁﻣﻮﺯﺵ ﺑﻬﺪﺍﺷﺖ‪ ،‬ﮔﺮﻭﻩ ﺑﻬﺪﺍﺷﺖ ﻋﻤﻮﻣﻰ ﻭ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﺑﻴﻤﺎﺭﻳﻬﺎﻯ ﻋﻔﻮﻧﻰ ﻭ ﮔﺮﻣﺴﻴﺮﻯ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺟﻨﺪﻱ ﺷﺎﭘﻮﺭ ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻫﻮﺍﺯ‪ ،‬ﺍﻳﺮﺍﻥ‬

‫‪Email: mostafajiba2@gmail.com‬‬
‫ﺗﺎﺭﻳﺦ ﺩﺭﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ‪1393/11/14 :‬‬
‫ﺗﺎﺭﻳﺦ ﭘﺬﻳﺮﺵ ﻣﻘﺎﻟﻪ‪1394/07/14 :‬‬
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‫ﺿﻤﻨﺎ‪ ،‬ﺧﻴﻠﻰ ﺍﺯ ﻋﻮﺍﻣﻞ ﺧﻄﺮ ﺑﻴﻤﺎﺭﻯ ﺳﻞ ﺑﺎ ﺷﺮﺍﻳﻂ ﺍﺟﺘﻤﺎﻋﻰ‬
‫ﻭ ﺭﻓﺘﺎﺭﻯ ﺍﺭﺗﺒﺎﻁ ﺩﺍﺭﻧﺪ ﻛﻪ ﻣﻤﻜﻦ ﺍﺳﺖ ﺷﻨﺎﺧﺘﻪ ﻧﺸﺪﻩ ﺑﺎﺷﻨﺪ ﻭ‬
‫ﻣﻤﻜﻦ ﺍﺳﺖ ﺷﻨﺎﺳﺎﻳﻰ ﻭ ﻣﺪﺍﺧﻠﻪ ﺻﺤﻴﺢ ﺩﺭ ﺍﻳﻦ ﻋﻮﺍﻣﻞ ﺑﺘﻮﺍﻥ ﺑﻪ‬
‫ﻃﻮﺭ ﺳﺮﻳﻊ ﺍﻳﻨﮕﻮﻧﻪ ﺭﻓﺘﺎﺭﻫﺎ ﺭﺍ ﺗﻐﻴﻴﺮ ﺩﻫﻨﺪ]‪ .[14‬ﺑﻨﺎﺑﺮﺍﻳﻦ ﻧﻤﻰﺗﻮﺍﻥ‬
‫ﺍﺯ ﺭﻭﺷﻬﺎﻯ ﻛﻤﻰ ﺍﺳﺘﻔﺎﺩﻩ ﻧﻤﻮﺩ ﭼﺮﺍ ﻛﻪ ﻫﻨﻮﺯ ﻋﻠﺖ ﺍﻳﻦ ﻋﻮﺍﻣﻞ‬
‫ﻛﺸﻒ ﻧﺸﺪﻩ ﺍﺳﺖ‪ ،‬ﻟﺬﺍ ﺗﺤﻘﻴﻘﺎﺕ ﻛﻴﻔﻰ ﺭﻭﺷﻬﺎﻳﻰ ﺭﺍ ﺑﺮﺍﻯ ﺩﺭﻙ‬
‫ﭼﻨﻴﻦ ﻋﻮﺍﻣﻞ ﻭ ﺭﻓﺘﺎﺭﻫﺎﻳﻰ ﻓﺮﺍﻫﻢ ﻣﻰﻛﻨﻨﺪ ﻭ ﺑﻪ ﺷﻨﺎﺧﺖ ﺷﻴﻮﻩﻫﺎﻯ‬
‫ﻋﻤﻠﻰ ﻛﺎﺭﺁﻣﺪﺗﺮ ﻭ ﻣﻔﻴﺪﺗﺮ ﺩﺭ ﻣﺮﺍﻗﺒﺖﻫﺎﻯ ﺑﻬﺪﺍﺷﺘﻰ ﻛﻤﻚ‬
‫ﻣﻰﻧﻤﺎﻳﻨﺪ ﻭ ﻛﺎﺭﺷﻨﺎﺳﺎﻥ ﺑﻬﺪﺍﺷﺘﻰ ﺭﺍ ﺍﺯ ﻛﻠﻴﻪ ﻗﺴﻤﺘﻬﺎﻯ ﻣﻮﺿﻮﻉ‬
‫ﺁﮔﺎﻩ ﻣﻰﻧﻤﺎﻳﺪ ]‪ .[15‬ﺍﺯ ﻃﺮﻓﻰ ﺗﺤﻘﻴﻘﺎﺕ ﻛﻴﻔﻰ ﺑﺮﺍﻯ ﻣﻮﺍﺭﺩﻯ ﺑﻪ‬
‫ﻛﺎﺭ ﻣﻰﺭﻭﻧﺪ ﻛﻪ ﺍﻃﻼﻋﺎﺕ ﻧﺎﭼﻴﺰﻯ ﺩﺭ ﻣﻮﺭﺩ ﺁﻧﻬﺎ ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻭ‬
‫ﺣﺘﻰ ﺩﺭ ﺑﻌﻀﻰ ﻣﻮﺍﻗﻊ ﻧﺎﺷﻨﺎﺧﺘﻪ ﻣﺎﻧﺪﻩﺍﻧﺪ ﻭ ﺗﺤﻘﻴﻘﺎﺕ ﻛﻴﻔﻰ ﺑﺮﺍﻯ‬
‫ﺟﻮﺍﺏ ﺩﺍﺩﻥ ﺑﻪ ﻋﻮﺍﻣﻞ ﻭ ﺭﻓﺘﺎﺭﻫﺎﻯ ﻧﺎﺷﻨﺎﺧﺘﻪ ﺑﻪ ﻛﺎﺭ ﻣﻰﺭﻭﻧﺪ‬
‫]‪ .[16‬ﺍﺯ ﺁﻧﺠﺎ ﻛﻪ ﺩﺭ ﺑﺮﺭﺳﻰ ﻣﻨﺎﺑﻊ‪ ،‬ﺑﻪ ﻣﻄﺎﻟﻌﻪ ﻣﺸﺎﺑﻬﻰ ﻣﺮﺗﺒﻂ ﺑﺎ‬
‫ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺩﺭ ﺟﺎﻣﻌﻪ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﻭ‬
‫ﺣﺘﻰ ﻛﺸﻮﺭ ﺩﺳﺖ ﻧﻴﺎﻓﺘﻴﻢ‪ ،‬ﻟﺬﺍ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪﻑ ﺷﻨﺎﺳﺎﻳﻰ‬
‫ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﺗﺴﻬﻴﻞ ﻛﻨﻨﺪﻩ ﻭ ﻣﺎﻧﻊ ﺷﻮﻧﺪﻩ ﻣﻮﺛﺮ ﺑﺮ ﺭﻓﺘﺎﺭﻫﺎﻯ‬
‫ﻣﺮﺗﺒﻂ ﺑﺎ ﺩﺭﻣﺎﻥ ﺳﻞ‪ ،‬ﺑﺎ ﺭﻭﺵ ﺗﺤﻘﻴﻖ ﻛﻴﻔﻰ ﻃﺮﺍﺣﻰ ﻭ ﺍﺟﺮﺍ ﺷﺪ‪.‬‬
‫ﻳﻜﻰ ﺍﺯ ﻋﻠﻞ ﺍﺻﻠﻰ ﻋﻮﺩ ﻣﺠﺪﺩ ﺑﻴﻤﺎﺭﻯ ﺳﻞ‪ ،‬ﺩﺭﻣﺎﻥ ﻧﺎﻗﺺ ﺍﺳﺖ‬
‫ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻛﺎﺭ‬
‫ﺍﻳﻦ ﻣﻘﺎﻟﻪ ﺑﺨﺸﻰ ﺍﺯ ﻳﻚ ﭘﮋﻭﻫﺶ ﻛﻴﻔﻰ ﺍﺳﺖ ﻛﻪ ﺩﺭ ﺍﺳﺘﺎﻥ‬
‫ﺧﻮﺯﺳﺘﺎﻥ ﺩﺭ ﺳﺎﻟﻬﺎﻯ ‪ 91-92‬ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ‪ .‬ﻧﻤﻮﻧﻪﻫﺎ ﺑﺮ‬
‫ﺍﺳﺎﺱ ﻧﻤﻮﻧﻪ ﮔﻴﺮﻯ ﻣﺒﺘﻨﻰ ﺑﺮ ﻫﺪﻑ )‪(Purposeful Sampling‬‬
‫ﻭ ﺑﺎ ﺣﺪﺍﻛﺜﺮ ﻭﺍﺭﻳﺎﻧﺲ )‪(Maximum variation sampling‬‬
‫]‪ [17‬ﺍﺯ ﺑﻴﻦ ﺍﻃﻼﻉ ﺩﻫﻨﺪﮔﺎﻥ ﺍﺻﻠﻰ)‪ (Key informant‬ﺷﺎﻣﻞ‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﺭﻳﻮﻯ ﺍﺳﻤﻴﺮ ﻣﺜﺒﺖ ﺟﺪﻳﺪ‪ ،‬ﻋﻮﺩ ﻣﺠﺪﺩ‪ ،‬ﻏﻴﺒﺖ ﺍﺯ ﺩﺭﻣﺎﻥ‪،‬‬
‫ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ﻭ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ ﻛﻪ ﺩﺭ ﺳﺎﻟﻬﺎﻯ ‪ 91 -92‬ﺑﺎ‬
‫ﻣﻮﻓﻘﻴﺖ ﺩﺭﻣﺎﻥ ﻭ ﻳﺎ ﺑﻪ ﻫﺮ ﻋﻠﺖ ﺩﺭﻣﺎﻥ ﺧﻮﺩ ﺭﺍ ﻗﻄﻊ ﻧﻤﻮﺩﻩ ﺑﻮﺩﻧﺪ‪،‬‬
‫ﺍﺯ ﺑﻴﻦ ﮔﺮﻭﻩﻫﺎﻯ ﻣﺨﺘﻠﻒ ﻗﻮﻣﻰ‪ ،‬ﺳﻨﻰ‪ ،‬ﺟﻨﺴﻰ‪ ،‬ﻭﺿﻌﻴﺖ ﺗﺎﻫﻞ‪،‬‬
‫ﻣﻴﺰﺍﻥ ﺳﻮﺍﺩ ﻭ ﻭﺿﻌﻴﺖ ﺍﻗﺘﺼﺎﺩﻯ‪ -‬ﺍﺟﺘﻤﺎﻋﻰ ﻣﺘﻔﺎﻭﺕ ﺍﺯ ﺩﻓﺘﺮ‬
‫ﺛﺒﺖ ﻧﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﺑﺮﻧﺎﻣﻪ ‪ TB register‬ﻭ ﭘﺮﻭﻧﺪﻩ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻮﺟﻮﺩ‬
‫ﺩﺭ ﺷﻬﺮﺳﺘﺎﻧﻬﺎﻯ ﺍﺳﺘﺎﻥ ﺍﻧﺘﺨﺎﺏ ﮔﺮﺩﻳﺪﻧﺪ ﻭ ﺟﻬﺖ ﺩﺳﺘﻴﺎﺑﻰ‬
‫ﺑﻪ ﺩﺍﺩﻩﻫﺎﻯ ﻛﺎﻣﻞﺗﺮ ﻭ ﻋﻤﻴﻖﺗﺮ‪ ،‬ﺍﻃﻼﻉ ﺩﻫﻨﺪﮔﺎﻥ ﻏﻴﺮﺍﺻﻠﻰ‬
‫)‪ (General Informants‬ﺍﺯ ﻣﻴﺎﻥ ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺑﻴﻤﺎﺭﺍﻥ‬
‫ﻭ ﻧﺎﻇﺮﻳﻦ ﺑﺮ ﺩﺭﻣﺎﻥ ﻛﻪ ﻛﺎﺭﻣﻨﺪ ﺑﻬﺪﺍﺷﺘﻰ ﻭ ﺍﺯ ﻫﺮ ﺩﻭ ﺟﻨﺲ‬
‫ﺑﻮﺩﻧﺪ‪ ،‬ﺍﻧﺘﺨﺎﺏ ﺷﺪﻧﺪ‪ .‬ﻭﺍﺣﺪﻫﺎﻱ ﭘﮋﻭﻫﺶ ﺑﻪ ﻋﻨﻮﺍﻥ ﻫﻤﻜﺎﺭﺍﻥ‬
‫ﻳﺎ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺗﺤﻘﻴﻖ ﻣﺤﺴﻮﺏ ﻣﻲ ﺷﻮﻧﺪ ﻭ ﺍﺯ ﺍﺻﻄﻼﺡ‬
‫‪ Informant‬ﺑﻪ ﻣﻌﻨﻲ ﺍﻓﺮﺍﺩ ﻣﻄﻠﻊ ﻳﺎ ﻣﺨﺒﺮ ﻭ ﻳﺎ ﺍﻃﻼﻉ ﺩﻫﻨﺪﻩ ﻧﻴﺰ‬
‫ﺑﺮﺍﻱ ﺍﺷﺎﺭﻩ ﺑﻪ ﺁﻧﻬﺎ ﺍﺳﺘﻔﺎﺩﻩ ﻣﻲ ﺷﻮﺩ ]‪.[18‬‬
‫ﻣﻘﺪﻣﻪ‬
‫ﺳﻞ ﻳﻚ ﺑﻴﻤﺎﺭﻯ ﻋﻔﻮﻧﻰ ﺍﺳﺖ‪ ،‬ﻛﻪ ﺍﺑﺘﻼ ﻭ ﻣﺮگ ﻭ ﻣﻴﺮ ﺑﺎﻻﻳﻰ ﺩﺍﺭﺩ‬
‫]‪ .[1‬ﻣﻬﻤﺘﺮﻳﻦ ﻣﻨﺒﻊ ﻋﻔﻮﻧﺖ ﺳﻞ ﺩﺭ ﺟﺎﻣﻌﻪ ﺑﻴﻤﺎﺭﺍﻥ ﺭﻳﻮﻯ ﺍﺳﻤﻴﺮ‬
‫ﻣﺜﺒﺖﺍﻧﺪ ﻛﻪ ﺳﺮﻓﻪ ﺩﺍﺭﻧﺪ ﻭ ﺑﻪ ﻭﺳﻴﻠﻪ ﺳﺮﻓﻪ ﻛﺮﺩﻥ ﺫﺭﺍﺕ ﻋﻔﻮﻧﻰ ﺭﺍ‬
‫ﺩﺭ ﻫﻮﺍ ﭘﺨﺶ ﻣﻰﻧﻤﺎﻳﻨﺪ ﻭ ﺑﺎﻋﺚ ﺁﻟﻮﺩﻩ ﺷﺪﻥ ﺍﻓﺮﺍﺩ ﺩﻳﮕﺮ ﻣﻰﮔﺮﺩﻧﺪ‬
‫]‪ .[2‬ﻳﻚ ﺑﻴﻤﺎﺭ ﺭﻳﻮﻯ ﺍﺳﻤﻴﺮ ﻣﺜﺒﺖ ﺍﮔﺮ ﺩﺭﻣﺎﻥ ﻧﺸﻮﺩ ﻣﻰﺗﻮﺍﻧﺪ‬
‫ﺳﺎﻻﻧﻪ ‪ 10‬ﺗﺎ ‪ 15‬ﻧﻔﺮ ﺭﺍ ﺑﻪ ﺳﻞ ﻓﻌﺎﻝ ﻣﺒﺘﻼ ﻧﻤﺎﻳﺪ ]‪ .[3‬ﺑﺎ ﺍﻳﻦ ﻭﺟﻮﺩ‬
‫ﺑﻌﻀﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﻛﻪ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﺳﻞ ﻗﺮﺍﺭ ﻣﻰﮔﻴﺮﻧﺪ ﺑﻪ ﻋﻠﻞ‬
‫ﻣﺨﺘﻠﻔﻰ ﺍﺯ ﺟﻤﻠﻪ ﺍﺣﺴﺎﺱ ﻛﺎﺫﺏ ﺑﻬﺒﻮﺩﻯ‪ ،‬ﻣﺼﺮﻑ ﺩﺧﺎﻧﻴﺎﺕ‬
‫ﻭ ﻋﺪﻡ ﺣﻤﺎﻳﺖ ﺧﺎﻧﻮﺍﺩﻩ ﺩﺭﻣﺎﻥ ﺧﻮﺩ ﺭﺍ ﺭﻫﺎ ﻣﻰﻧﻤﺎﻳﻨﺪ ﻛﻪ ﺑﻪ ﺁﻥ‬
‫ﻗﻄﻊ ﺩﺭﻣﺎﻥ )‪ (Treatment interrupted‬ﮔﻔﺘﻪ ﻣﻰﺷﻮﺩ ]‪ [4‬ﻛﻪ‬
‫ﻣﻌﻤﻮﻻً ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﺩﺭﻣﺎﻥ ﻣﺠﺪﺩ )‪ (Retreatment‬ﻧﻴﺎﺯ ﺩﺍﺭﻧﺪ‬
‫]‪ .[2‬ﺑﻴﻤﺎﺭﺍﻧﻰ ﻛﻪ ﻏﻴﺒﺖ ﺍﺯ ﺩﺭﻣﺎﻥ ﺩﺍﺭﻧﺪ )‪(Default treatment‬‬
‫ﻳﻚ ﺭﻳﺴﻚ ﻓﺎﻛﺘﻮﺭ ﻋﻮﺩ ﻣﺠﺪﺩ )‪ (Relapse‬ﻭ ﻣﺮگ ﻭ ﻣﻴﺮ ﻣﺮﺗﺒﻂ‬
‫ﺑﺎ ﺳﻞ ﻭ ﻫﻤﭽﻨﻴﻦ ﻳﻚ ﺗﻬﺪﻳﺪ ﺑﺮﺍﻯ ﺑﻬﺪﺍﺷﺖ ﻋﻤﻮﻣﻰﺍﻧﺪ ]‪.[5‬‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭﻣﺎﻥ ﻣﺠﺪﺩ‪ ،‬ﺩﺭﻣﺎﻥ ﭘﺮﻫﺰﻳﻨﻪ ﺍﻯ ﺩﺍﺭﻧﺪ ﻭ ﺑﺮﺍﻯ ﮔﺴﺘﺮﺵ‬
‫ﺳﻞ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ )‪(Multi drug resistant tuberculosis‬‬
‫ﺑﺴﻴﺎﺭ ﺧﻄﺮﻧﺎﻙ ﻫﺴﺘﻨﺪ ]‪.[4‬‬
‫ﻛﻪ ﺩﺭﻣﺎﻥ ﻧﺎﻗﺺ ﺑﺮﻭﺯ ﺳﻞ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ ﺭﺍ ﺍﻓﺰﺍﻳﺶ ﻣﻰﺩﻫﺪ‬
‫]‪ .[6‬ﻣﻄﺎﻟﻌﻪﺍﻯ ﻛﻴﻔﻰ ﻛﻪ ﺩﺭ ﺳﺎﻝ ‪ 2008‬ﺩﺭ ﺍﺗﻴﻮﭘﻰ ﺻﻮﺭﺕ‬
‫ﮔﺮﻓﺖ ﻧﺸﺎﻥ ﺩﺍﺩ‪ ،‬ﻣﺤﺪﻭﺩﻳﺘﻬﺎﻯ ﺍﻗﺘﺼﺎﺩﻯ‪ ،‬ﻛﻤﺒﻮﺩ ﻣﻮﺍﺩ ﻏﺬﺍﻳﻰ‪،‬‬
‫ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺳﻞ ﻭ ﻋﺪﻡ ﺍﺭﺗﺒﺎﻁ ﻛﺎﻓﻰ ﺑﺎ ﻛﺎﺭﻛﻨﺎﻥ‬
‫ﺑﻬﺪﺍﺷﺘﻰ ﺍﺯ ﻣﻮﺍﻧﻊ ﻣﻬﻢ ﺩﺭﻣﺎﻥ ﺳﻞ ﻣﻰﺑﺎﺷﻨﺪ ]‪ [7‬ﻣﻄﺎﻟﻌﻪﺍﻯ ﻛﻴﻔﻰ‬
‫ﺩﺭ ﻣﺎﻟﺰﻯ‪ ،‬ﻛﻤﺒﻮﺩ ﺗﺠﻬﻴﺰﺍﺕ‪ ،‬ﻓﺎﺻﻠﻪ ﺗﺎ ﻣﺤﻞ ﺩﺭﻣﺎﻥ ﻭ ﺍﺳﺘﻔﺎﺩﻩ‬
‫ﺍﺯ ﻣﻮﺍﺩ ﻣﺨﺪﺭ ﺭﺍ ﺍﺯ ﻓﺎﻛﺘﻮﺭﻫﺎﻯ ﻣﻬﻢ ﻏﻴﺒﺖ ﺍﺯ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ‬
‫ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﮔﺰﺍﺭﺵ ﻧﻤﻮﺩ ]‪ .[8‬ﻫﻤﭽﻨﻴﻦ ﻣﻄﺎﻟﻌﻪﺍﻯ ﺩﺭ ﺍﺗﻴﻮﭘﻰ‪،‬‬
‫ﻋﺪﻡ ﺩﺳﺘﺮﺳﻰ ﺟﻐﺮﺍﻓﻴﺎﻳﻰ ﺑﻪ ﺍﻣﻜﺎﻧﺎﺕ ﺑﻬﺪﺍﺷﺘﻰ‪ ،‬ﺑﺎﺭ ﻣﺎﻟﻰ‪ ،‬ﻛﻴﻔﻴﺖ‬
‫ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻰ ﺍﺭﺍﺋﻪ ﺷﺪﻩ ﻭ ﺿﻌﻒ ﺣﻤﺎﻳﺖ ﺍﺟﺘﻤﺎﻋﻰ‪،‬‬
‫ﻓﺎﻛﺘﻮﺭﻫﺎﻯ ﺍﺻﻠﻰ ﻛﺎﻣﻞ ﻧﻜﺮﺩﻥ ﺩﺭﻣﺎﻥ ﺗﻮﺳﻂ ﻣﺒﺘﻼﻳﺎﻥ ﺑﻪ ﺳﻞ‬
‫ﮔﺰﺍﺭﺵ ﻧﻤﻮﺩ ]‪.[9‬‬
‫ﺳﻞ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ ﻳﻚ ﭘﺪﻳﺪﻩ ﺳﺎﺧﺘﻪ ﺩﺳﺖ ﺍﻧﺴﺎﻥ ﺍﺳﺖ‬
‫ﻛﻪ ﺩﺭ ﻧﺘﻴﺠﻪ ﺩﺭﻣﺎﻥ ﻧﺎﻣﻨﺎﺳﺐ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﻧﺎﺷﻰ ﺷﺪﻩ‬
‫ﺍﺳﺖ ]‪ .[10‬ﮔﺮﭼﻪ ﻣﻮﻓﻘﻴﺖ ﺩﺭﻣﺎﻥ ﺗﺤﺖ ﻧﻈﺎﺭﺕ ﺩﺍﺗﺲ ﺑﻪ ﻃﻮﺭ‬
‫ﭼﺸﻤﮕﻴﺮﻯ ﺍﻓﺰﺍﻳﺶ ﻳﺎﻓﺘﻪ ﺍﺳﺖ ]‪ [11‬ﻭﻟﻰ ﻫﻨﻮﺯ ﻣﺎﻳﻜﻮﺑﺎﻛﺘﺮﻳﻮﻡ‬
‫ﺗﻮﺑﺮﻛﻠﻮﺯﻳﺲ ﺑﻌﺪ ﺍﺯ ‪ HIV‬ﺑﻴﺸﺘﺮﻳﻦ ﺩﻟﻴﻞ ﻣﺮگ ﺑﺎﻟﻐﻴﻦ ﺩﺭ ﺳﺮﺍﺳﺮ‬
‫ﺟﻬﺎﻥ ﺍﺳﺖ ]‪.[12‬‬
‫ﻋﻤﻞ ﻛﺮﺩﻥ ﺑﻪ ﺑﺮﻧﺎﻣﻪﻫﺎﻯ ﺍﺟﺘﻤﺎﻋﻰ ﻫﻤﺎﻧﻨﺪ ﺣﻤﺎﻳﺖ ﺍﺟﺘﻤﺎﻋﻰ‬
‫ﻣﻰﺗﻮﺍﻧﻨﺪ ﺑﻪ ﻃﻮﺭ ﻣﻮﺛﺮﻯ ﺩﺭ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﻮﺛﺮ ﺑﺎﺷﻨﺪ ]‪[13‬‬

‫ﺧﻮﺍﺳﺘﻪ ﻣﻰﺷﺪ ﻛﻪ ﻋﻮﺍﻣﻞ ﺭﺍ ﺩﻭﺑﺎﺭﻩ ﺗﻜﺮﺍﺭ ﻧﻤﺎﻳﺪ‪ .‬ﻣﺼﺎﺣﺒﻪ ﺑﻮﺳﻴﻠﻪ‬
‫ﺭﻛﻮﺭﺩﺭ ﺿﺒﻂ ﻭ ﺩﺭ ﺍﻭﻟﻴﻦ ﻓﺮﺻﺖ ﻛﻠﻤﻪ ﺑﻪ ﻛﻠﻤﻪ ﺩﺳﺖ ﻧﻮﻳﺲ ﻭ‬
‫ﺗﺎﻳﭗ ﻣﻰﺷﺪ‪ .‬ﺑﻌﺪ ﺍﺯ ﺗﺎﻳﭗ ﺷﺪﻥ ﻣﻄﺎﻟﺐ‪ ،‬ﻣﺠﺪﺩﺍ ﻣﺼﺎﺣﺒﻪ ﮔﻮﺵ‬
‫ﺩﺍﺩﻩ ﺷﺪﻩ ﻭ ﺑﺎ ﻣﺘﻦ ﺗﺎﻳﭗ ﺷﺪﻩ ﭼﻚ ﻣﻰﮔﺮﺩﻳﺪ ﺗﺎ ﻣﻄﺎﻟﺐ ﺍﺯ ﻧﻈﺮ‬
‫ﻧﺎﻗﺺ ﻳﺎ ﻧﺎﻣﻔﻬﻮﻡ ﺑﻮﺩﻥ ﺍﺻﻼﺡ ﺷﻮﺩ‪ .‬ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺩﺍﺩﻩﻫﺎ ﻫﻤﺮﺍﻩ‬
‫ﺑﺎ ﻣﻘﺎﻳﺴﻪ ﺩﺍﺋﻤﻰ ﻭ ﻫﻤﺰﻣﺎﻥ ﺑﺎ ﺟﻤﻊ ﺁﻭﺭﻯ ﺩﺍﺩﻩﻫﺎ‪ ،‬ﺑﻪ ﺻﻮﺭﺕ‬
‫ﻫﺪﻓﻤﻨﺪ ﻭ ﺑﺎ ﺭﻭﺵ ﺩﺳﺘﻰ ﺻﻮﺭﺕ ﮔﺮﻓﺖ‪ ،‬ﻣﺤﻘﻖ ﺑﻼﻓﺎﺻﻠﻪ ﺑﻌﺪ ﺍﺯ‬
‫ﻣﺼﺎﺣﺒﻪ ﻭ ﻗﺒﻞ ﺍﺯ ﻣﺼﺎﺣﺒﻪ ﺑﺎ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﻩ ﺑﻌﺪﻯ ﻣﺘﻦ ﻣﺼﺎﺣﺒﻪ‬
‫ﺭﺍ ﺩﺭ ﻣﺤﻴﻂ ‪ Word‬ﺑﻪ ﻃﻮﺭ ﻛﺎﻣﻞ ﺗﺎﻳﭗ ﻧﻤﻮﺩ ﻭ ﺩﺭ ﻣﻨﻮﻯ ‪Review‬‬
‫ﻭ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺩﺳﺘﻮﺭ ‪ Comment‬ﻛﺪﻫﺎ ﺭﺍ ﺩﺭ ﺣﺎﺷﻴﻪ ﺳﻤﺖ ﭼﭗ‬
‫ﻣﺘﻦ ﺛﺒﺖ ﻭ ﺳﭙﺲ ﻣﺘﻦ ﻫﺮ ﻣﺼﺎﺣﺒﻪ ﺑﻪ ﺩﻗﺖ ﻣﻄﺎﻟﻌﻪ ﺷﺪ ﻭ ﺍﺯ‬
‫ﺷﻜﺴﺘﻦ ﻫﺮ ﻣﺘﻦ‪ ،‬ﻭﺍﺣﺪﻫﺎﻯ ﻣﻌﻨﻰ ﺍﺳﺘﺨﺮﺍﺝ‪ ،‬ﻛﺪﺑﻨﺪﻯ ﻭ ﻃﺒﻘﻪ‬
‫ﺑﻨﺪﻯ ﺷﺪﻧﺪ‪ .‬ﻛﺪﻫﺎﻯ ﺍﻭﻟﻴﻪ ﺑﺮ ﺍﺳﺎﺱ ﺗﺸﺎﺑﻬﺎﺕ ﻭ ﺗﻔﺎﻭﺗﻬﺎﻳﺸﺎﻥ‬
‫ﻃﺒﻘﻪ ﺑﻨﺪﻯ ﺷﺪﻧﺪ ﻭ ﺑﺎ ﻧﺎﻣﮕﺬﺍﺭﻯ ﻫﺮ ﻃﺒﻘﻪ ﻭ ﺗﻜﺮﺍﺭ ﻃﺒﻘﻪ ﺑﻨﺪﻯ‬
‫ﻭ ﺍﺩﻏﺎﻡ ﻛﺪﻫﺎﻯ ﻣﺸﺎﺑﻪ ﻭ ﺍﺿﺎﻓﻪ ﻛﺮﺩﻥ ﻛﺪﻫﺎﻯ ﺟﺪﻳﺪ ﺗﻮﻟﻴﺪ ﺷﺪﻩ‪،‬‬
‫ﻭﺍﺣﺪﻫﺎﻯ ﻣﻌﻨﻰ ﺩﺍﺭ ﺍﺻﻠﻰ ﺗﻮﻟﻴﺪ‪ ،‬ﻛﺪﺑﻨﺪﻯ ﻭ ﻃﺒﻘﻪ ﺑﻨﺪﻯ ﺷﺪﻧﺪ ﺗﺎ‬
‫ﻣﻀﻤﻮﻥﻫﺎ ﻳﺎ ﺩﺭﻭﻥ ﻣﺎﻳﻪﻫﺎﻯ ﺍﺻﻠﻰ )‪ (Themes‬ﺍﺳﺘﺨﺮﺍﺝ ﮔﺮﺩﻧﺪ‪.‬‬
‫ﺑﺮﺍﻯ ﺍﺭﺯﻳﺎﺑﻰ ﻭ ﺍﻓﺰﺍﻳﺶ ﺭﻭﺍﻳﻰ ﻭ ﭘﺎﻳﺎﻳﻰ ﻛﻪ ﻣﻌﺎﺩﻝ ﺑﺎ ﺍﺳﺘﺤﻜﺎﻡ‬
‫ﻋﻠﻤﻰ ﻳﺎﻓﺘﻪﻫﺎ )‪ (Trustworthiness‬ﺩﺭ ﺗﺤﻘﻴﻖ ﻛﻴﻔﻰ ﺍﺳﺖ‪ ،‬ﺍﺯ‬
‫ﺭﻭﺵﻫﺎﻯ ﭘﻴﺸﻨﻬﺎﺩﻯ ‪ Lincoln & Guba‬ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ‪ .‬ﺑﻪ ﺍﻳﻦ‬
‫ﺗﺮﺗﻴﺐ ﻛﻪ ﺑﺮﺍﻯ ﺗﺄﻣﻴﻦ ﺍﻋﺘﺒﺎﺭ ﻭ ﻣﻘﺒﻮﻟﻴﺖ ﺩﺍﺩﻩﻫﺎ )‪(Credibility‬‬
‫ﺍﺯ ﺭﻭﺵ ﺩﺭﮔﻴﺮﻯ ﺩﺍﺋﻤﻰ ﻭ ﻣﺴﺘﻤﺮ )‪(Prolong Engagement‬‬
‫ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ ]‪ [17‬ﺑﻪ ﻧﺤﻮﻯ ﻛﻪ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺩﺭ ﺑﺎﺯﻩ ﺯﻣﺎﻧﻰ ‪ 13‬ﻣﺎﻫﻪ‬
‫ﺩﺭ ﺍﺭﺗﺒﺎﻁ ﺑﺎ ﺍﻃﻼﻉ ﺩﻫﻨﺪﮔﺎﻥ ﺍﺻﻠﻰ ﻭ ﺍﻃﻼﻉ ﺩﻫﻨﺪﮔﺎﻥ ﻏﻴﺮﺍﺻﻠﻰ‬
‫ﺍﻧﺠﺎﻡ ﮔﺮﺩﻳﺪ ﺗﺎ ﺷﻨﺎﺧﺖ ﺑﻬﺘﺮﻯ ﺍﺯ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﺩﺭﻣﺎﻥ‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺑﻪ ﺩﺳﺖ ﺁﻳﺪ‪ ،‬ﻫﻤﭽﻨﻴﻦ ﺑﺮﺍﻯ ﺍﺭﺯﻳﺎﺑﻰ ﻭ‬
‫ﻣﻘﺎﻳﺴﻪ ﺑﻴﻦ ﺑﺮﺩﺍﺷﺘﻬﺎﻯ ﻣﺤﻘﻖ ﺑﺎ ﺑﺮﺩﺍﺷﺘﻬﺎﻯ ﺍﻃﻼﻉ ﺩﻫﻨﺪﮔﺎﻥ‬
‫ﺍﺻﻠﻰ ﻭ ﻏﻴﺮﺍﺻﻠﻰ ﺍﺯ ﺭﻭﺵ ﺍﺭﺯﻳﺎﺑﻰ ﻋﻀﻮ )‪(Member Check‬‬
‫ﻭ ﻛﻤﻚ ﮔﺮﻓﺘﻦ ﺍﺯ ﻧﻈﺮﻫﺎﻯ ﺍﺻﻼﺣﻰ ﺁﻧﻬﺎ ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ ﻛﻪ ﺍﻳﻦ‬
‫ﺭﻭﺵ ﺑﺎﺯﮔﺸﺖ ﻣﺤﻘﻖ ﺑﻪ ﻃﺮﻑ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ‪ ،‬ﺑﺎﻋﺚ ﺑﺎﻻ‬
‫ﺭﻓﺘﻦ ﺍﻋﺘﺒﺎﺭ ﺑﻴﺸﺘﺮ ﺩﺍﺩﻩﻫﺎ ﺷﺪ‪ .‬ﻫﻤﭽﻨﻴﻦ ﺑﺮﺍﻯ ﺗﺎﻣﻴﻦ ﻗﺎﺑﻞ ﻗﺒﻮﻝ‬
‫ﺑﻮﺩﻥ ﻭ ﺭﻭﺍﻳﻰ ﺩﺍﺩﻩﻫﺎ ﺍﺯ ﻧﻈﺮ ﺩﻭ ﻧﻔﺮ ﺍﺯ ﺍﺷﺨﺎﺹ ﻣﺘﺨﺼﺺ ﺩﺭ‬
‫ﺯﻣﻴﻨﻪ ﭘﮋﻭﻫﺸﻬﺎﻯ ﻛﻴﻔﻰ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ ﻛﻪ ﺍﻳﻦ ﻣﺘﺨﺼﺼﺎﻥ ﺯﻭﺍﻳﺎﻯ‬
‫ﻣﺨﺘﻠﻒ ﭘﮋﻭﻫﺶ ﺭﺍ ﺑﺮﺭﺳﻰ ﻭ ﻣﻮﺭﺩ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﻗﺮﺍﺭ ﺩﺍﺩﻧﺪ‪.‬‬
‫ﺭﻭﺵ ﺩﻳﮕﺮﻯ ﻛﻪ ﺑﺮﺍﻯ ﺑﺎﻻ ﺑﺮﺩﻥ ﺍﺳﺘﺤﻜﺎﻡ ﻳﺎﻓﺘﻪﻫﺎ ﺑﻪ ﻛﺎﺭ ﺭﻓﺖ‬
‫ﺭﻭﺵ ﺍﺷﺒﺎﻉ ﺩﺍﺩﻩﻫﺎ ﺑﻮﺩ‪ .‬ﻧﻤﻮﻧﻪﻫﺎ ﺑﺮﺍﻯ ﺗﺎﻣﻴﻦ ﻗﺎﺑﻠﻴﺖ ﺍﻧﺘﻘﺎﻝ‬
‫)‪ (Transferability‬ﺩﺍﺩﻩﻫﺎ ﺍﺯ ﺑﻴﻦ ﮔﺮﻭﻩﻫﺎﻯ ﻣﺨﺘﻠﻒ ﻗﻮﻣﻰ‪،‬‬
‫ﺳﻨﻰ‪ ،‬ﺟﻨﺴﻰ ﺑﺎ ﻭﺿﻌﻴﺖ ﺗﺎﻫﻞ‪ ،‬ﻣﻴﺰﺍﻥ ﺳﻮﺍﺩ ﻭ ﻭﺿﻌﻴﺖ ﺍﻗﺘﺼﺎﺩﻯ‪-‬‬
‫ﺍﺟﺘﻤﺎﻋﻰ ﻣﺘﻔﺎﻭﺕ ﻭ ﺑﺎ ﺭﻋﺎﻳﺖ ﺣﺪﺍﻛﺜﺮ ﻭﺍﺭﻳﺎﻧﺲ ﺍﻧﺘﺨﺎﺏ ﮔﺮﺩﻳﺪﻧﺪ‪.‬‬
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‫ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺩﺭ ﺯﻣﻴﻨﻪ ﻋﻮﺍﻣﻞ ﻣﻨﺠﺮ ﺑﻪ ﻣﻮﻓﻘﻴﺖ ﺩﺭﻣﺎﻥ ﻭ‬
‫ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺗﺠﺮﺑﻴﺎﺕ ﺍﺭﺯﺷﻤﻨﺪﻯ ﺩﺍﺷﺘﻨﺪ ﻭ ﻫﻤﭽﻨﻴﻦ ﻋﻼﻗﻤﻨﺪ ﺑﻪ‬
‫ﻫﻤﻜﺎﺭﻯ ﻭ ﺷﺮﻛﺖ ﺩﺭ ﺗﺤﻘﻴﻖ ﻭ ﺑﻴﺎﻥ ﺗﺠﺮﺑﻴﺎﺕ ﺧﻮﺩ ﺑﻮﺩﻧﺪ‪ .‬ﺗﻮﻟﻴﺪ‬
‫ﺩﺍﺩﻩﻫﺎ ﺍﺯ ﻃﺮﻳﻖ ﻣﺸﺎﻫﺪﻩ ﭘﺮﻭﻧﺪﻩ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﺑﺮﻧﺎﻣﻪ ‪ TB register‬ﻭ‬
‫ﺩﻓﺘﺮ ﺛﺒﺖ ﻧﺎﻡ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻣﺮﺍﻛﺰ ﺷﻬﺮﺳﺘﺎﻧﻬﺎ ﻭ‪ 37‬ﻣﺼﺎﺣﺒﻪ ﻋﻤﻴﻖ‬
‫ﺳﺎﺯﻣﺎﻥ ﻧﻴﺎﻓﺘﻪ ﺑﺎ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﺑﺮﺧﻰ ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺁﻧﻬﺎ ﻭ ﻧﺎﻇﺮﻳﻦ ﺑﺮ‬
‫ﺩﺭﻣﺎﻥ ﺣﺎﺻﻞ ﮔﺮﺩﻳﺪ‪ .‬ﻗﺒﻞ ﺍﺯ ﺷﺮﻭﻉ ﻣﺼﺎﺣﺒﻪ ﺍﺯ ﺷﺮﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ‬
‫ﺟﻬﺖ ﺷﺮﻛﺖ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻭ ﺿﺒﻂ ﺻﺪﺍﻯ ﺁﻧﻬﺎ ﺭﺿﺎﻳﺖ ﺁﮔﺎﻫﺎﻧﻪ‬
‫ﻛﺴﺐ ﮔﺮﺩﻳﺪ‪ ،‬ﻫﻤﭽﻨﻴﻦ ﺑﻪ ﺁﻧﻬﺎ ﺩﺭ ﺧﺼﻮﺹ ﺭﻋﺎﻳﺖ ﺍﺻﻞ ﺭﺍﺯﺩﺍﺭﻯ‪،‬‬
‫ﻣﺤﺮﻣﺎﻧﻪ ﻣﺎﻧﺪﻥ ﺍﻃﻼﻋﺎﺕ ﻭ ﻋﺪﻡ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻧﺎﻡ ﺁﻧﻬﺎ ﺩﺭ ﻛﻠﻴﻪ ﻣﺮﺍﺣﻞ‬
‫ﭘﮋﻭﻫﺶ ﺍﻃﻤﻴﻨﺎﻥ ﺩﺍﺩﻩ ﺷﺪ‪ .‬ﻣﺼﺎﺣﺒﻪ ﺑﻪ ﺻﻮﺭﺕ ﺳﺎﺯﻣﺎﻥ ﻧﻴﺎﻓﺘﻪ ﻭ ﺗﺎ‬
‫ﺭﺳﻴﺪﻥ ﺑﻪ ﺍﺷﺒﺎﻉ ﺩﺍﺩﻩﻫﺎ )‪ [19] (Data saturation‬ﺍﺩﺍﻣﻪ ﻳﺎﻓﺖ‪،‬‬
‫ﻣﺼﺎﺣﺒﻪ‪ ،‬ﺑﺎ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺩﺭ ﺍﺗﺎﻗﻬﺎﻯ ﻫﻤﺎﻫﻨﮓ ﻛﻨﻨﺪﮔﺎﻥ ﺳﻞ‬
‫ﺷﻬﺮﺳﺘﺎﻧﻬﺎ‪ ،‬ﺍﺗﺎﻗﻬﺎﻯ ﻧﺎﻇﺮﻳﻦ ﺑﺮ ﺩﺭﻣﺎﻥ ﺩﺭ ﻣﺮﺍﻛﺰ ﺑﻬﺪﺍﺷﺘﻰ ﺩﺭﻣﺎﻧﻰ‬
‫ﺷﻬﺮﻯ‪ /‬ﺭﻭﺳﺘﺎﻳﻰ‪ /‬ﭘﺎﻳﮕﺎﻩﻫﺎﻯ ﺑﻬﺪﺍﺷﺘﻰ‪ ،‬ﺧﺎﻧﻪﻫﺎﻯ ﺑﻬﺪﺍﺷﺖ ﻭ‬
‫ﻣﻨﺰﻝ ﺑﻴﻤﺎﺭﺍﻥ ﺻﻮﺭﺕ ﮔﺮﻓﺖ ﻭ ﻣﺪﺕ ﻫﺮ ﻣﺼﺎﺣﺒﻪ ‪ 25-50‬ﺩﻗﻴﻘﻪ‬
‫ﺍﺩﺍﻣﻪ ﻳﺎﻓﺖ ﻛﻪ ﺑﻪ ﺭﻭﻧﺪ ﻣﺼﺎﺣﺒﻪ ﻭ ﺷﺮﺍﻳﻂ ﺁﻥ ﺑﺴﺘﮕﻰ ﺩﺍﺷﺖ‪ .‬ﺩﺭ‬
‫ﺷﺮﻭﻉ ﻫﺮ ﻣﺼﺎﺣﺒﻪ ﺍﻫﺪﺍﻑ ﺗﺤﻘﻴﻖ ﺑﺮﺍﻯ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﮔﻔﺘﻪ‬
‫ﻣﻰﺷﺪ ﻭ ﺑﺮﺍﻯ ﺍﻳﻨﻜﻪ ﻣﺼﺎﺣﺒﻪﻫﺎ ﺿﺒﻂ ﮔﺮﺩﻧﺪ ﺍﺯ ﺁﻧﻬﺎ ﻛﺴﺐ ﺍﺟﺎﺯﻩ‬
‫ﻣﻰﺷﺪ‪ ،‬ﺑﻌﻀﻰ ﺍﺯ ﺍﻓﺮﺍﺩ ﺣﺎﺿﺮ ﺑﻪ ﺷﺮﻛﺖ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺪﻧﺪ ﻭ‬
‫ﺍﻟﺒﺘﻪ ‪ 2‬ﻧﻔﺮ ﺍﺯ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺯﻥ ﺍﺟﺎﺯﻩ ﻧﺪﺍﺩﻧﺪ ﻛﻪ ﺻﺪﺍﻳﺸﺎﻥ‬
‫ﺿﺒﻂ ﺷﻮﺩ‪ ،‬ﺑﻨﺎﺑﺮﺍﻳﻦ ﻣﺼﺎﺣﺒﻪ ﺁﻧﻬﺎ ﺑﻪ ﺻﻮﺭﺕ ﻛﺎﻣﻞ ﻧﻮﺷﺘﻪ ﺷﺪ‪.‬‬
‫ﻣﺼﺎﺣﺒﻪ ﺑﺎ ﺳﻮﺍﻟﻬﺎﻯ ﻓﺮﻋﻰ ﻣﺜﻞ ﭘﺮﺳﻴﺪﻥ ﺳﻦ‪ ،‬ﻭﺿﻌﻴﺖ ﺗﺎﻫﻞ‪،‬‬
‫ﺗﻌﺪﺍﺩ ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ‪ ،‬ﺷﻐﻞ‪ ،‬ﻣﻴﺰﺍﻥ ﺳﻄﺢ ﺳﻮﺍﺩ‪ ،‬ﺳﺎﺑﻘﻪ ﻣﺼﺮﻑ‬
‫ﺩﺧﺎﻧﻴﺎﺕ‪ ،‬ﻣﻮﺍﺩ ﻣﺨﺪﺭ‪ ،‬ﻣﺸﺮﻭﺑﺎﺕ ﺍﻟﻜﻠﻰ ﻭ ﺳﺎﺑﻘﻪ ﺯﻧﺪﺍﻥ ﺁﻏﺎﺯ ﺷﺪ‪،‬‬
‫ﺗﺎ ﺑﻌﺪ ﺍﺯ ﺁﺷﻨﺎﻳﻰ ﺑﻴﺸﺘﺮ ﻭ ﺍﻳﺠﺎﺩ ﻣﺤﻴﻂ ﺻﻤﻴﻤﺎﻧﻪﺗﺮ‪ ،‬ﺯﻣﻴﻨﻪ ﺑﺮﺍﻯ‬
‫ﭘﺮﺳﻴﺪﻥ ﺳﻮﺍﻝ ﺍﺻﻠﻰ ﻓﺮﺍﻫﻢ ﺷﻮﺩ‪ ،‬ﺳﭙﺲ ﺳﻮﺍﻝ ﺍﺻﻠﻰ ﺑﺎ ﻋﺒﺎﺭﺕ‬
‫”ﻟﻄﻔﺎ ﺩﺭ ﻣﻮﺭﺩ ﺯﻧﺪﮔﻴﺘﺎﻥ ﻗﺒﻞ ﺍﺯ ﺍﺑﺘﻼء ﺑﻪ ﺳﻞ ﺑﺮﺍﻡ ﺻﺤﺒﺖ ﻛﻨﻴﺪ“‬
‫ﺷﺮﻭﻉ ﻭ ﻣﺼﺎﺣﺒﻪ ﺍﺩﺍﻣﻪ ﭘﻴﺪﺍ ﻣﻰﻛﺮﺩ ﻭ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﻮﻉ ﺗﺠﺮﺑﻴﺎﺕ‬
‫ﻓﺮﺩ‪ ،‬ﺳﻮﺍﻟﻬﺎﻯ ﻓﺮﻋﻰ ﻭ ﺍﺯ ﭘﻴﺶ ﺗﻌﻴﻴﻦ ﻧﺸﺪﻩ ﻭ ﺍﺯ ﮔﻔﺘﻪﻫﺎﻯ ﺧﻮﺩ‬
‫ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﻩ ﻧﻴﺰ ﭘﺮﺳﻴﺪﻩ ﻣﻰﺷﺪ ﻛﻪ ﺗﻮﺍﻟﻰ ﺁﻧﻬﺎ ﺑﺮﺍﻯ ﻫﺮ ﺷﺮﻛﺖ‬
‫ﻛﻨﻨﺪﻩ ﻣﺘﻔﺎﻭﺕ ﺑﻮﺩ‪ .‬ﺩﺭ ﺧﻼﻝ ﻣﺼﺎﺣﺒﻪ ﺟﻬﺖ ﻛﺴﺐ ﺍﻃﻼﻋﺎﺕ‬
‫ﺑﻴﺸﺘﺮ ﻭ ﺭﻭﺷﻦ ﺷﺪﻥ ﻣﻄﻠﺐ‪ ،‬ﻫﻤﭽﻨﻴﻦ ﺗﺸﻮﻳﻖ ﺷﺮﻛﺖ ﻛﻨﻨﺪﻩ ﺑﻪ‬
‫ﺍﺩﺍﻣﻪ ﻣﺼﺎﺣﺒﻪ ﻭ ﺭﺳﻴﺪﻥ ﺑﻪ ﻣﻄﺎﻟﺐ ﻋﻤﻴﻖﺗﺮ ﺍﺯ ﺳﺆﺍﻟﻬﺎﻯ ﻓﺮﻋﻰ‬
‫ﻧﻈﻴﺮ ”ﺍﻳﻨﻜﻪ ﮔﻔﺘﻴﺪ ‪ ...‬ﺭﺍ ﻟﻄﻔ ًﺎ ﺗﻮﺿﻴﺢ ﺩﻫﻴﺪ ﻭ ﻳﺎ ﺑﻴﺸﺘﺮ ﺩﺭ ﻣﻮﺭﺩﺵ‬
‫ﺑﺮﺍﻡ ﺻﺤﺒﺖ ﻛﻨﻴﺪ ؟“ ‪ ” ،‬ﺍﻳﻦ ﻣﻮﺿﻮﻉ ﻛﻪ ﻓﺮﻣﻮﺩﻳﺪ ‪ ...‬ﺗﺠﺮﺑﻪ‬
‫ﻣﻬﻤﻰ ﺍﺳﺖ‪ ،‬ﻣﻰﺗﻮﺍﻧﻢ ﺧﻮﺍﻫﺶ ﻛﻨﻢ ﻛﻪ ﺑﻴﺸﺘﺮ ﺗﻮﺿﻴﺢ ﺑﺪﻫﻴﺪ؟“‬
‫ﺍﺳﺘﻔﺎﺩﻩ ﻣﻰﮔﺮﺩﻳﺪ‪ .‬ﺑﺮﺍﻯ ﺟﻠﻮﮔﻴﺮﻯ ﺍﺯ ﻓﺮﺍﻣﻮﺷﻰ ﺍﺣﺘﻤﺎﻟﻰ ﺩﻻﻳﻞ‬
‫ﻭ ﻋﻮﺍﻣﻞ ﻣﻮﺛﺮ ﺑﺮ ﺩﺭﻣﺎﻥ‪ ،‬ﻣﺠﺪﺩﺍ ً ﺍﻭﺍﺳﻂ ﻳﺎ ﺁﺧﺮ ﻣﺼﺎﺣﺒﻪ ﺍﺯ ﻓﺮﺩ‬
‫‪29/‬‬

‫‪ 1‬ﻧﻔﺮ( ﺑﻮﺩ‪ .‬ﺳﺎﻳﺮ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ‪11‬ﻧﻔﺮ )ﻧﺎﻇﺮ ﺑﺮ ﺩﺭﻣﺎﻥ ﻣﺮﺩ‬ ‫ﻳﺎﻓﺘﻪﻫﺎ‬
‫‪ 4‬ﻧﻔﺮ‪ ،‬ﻧﺎﻇﺮ ﺑﺮ ﺩﺭﻣﺎﻥ ﺯﻥ ‪ 2‬ﻧﻔﺮ‪ ،‬ﻭ ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺑﻴﻤﺎﺭﺍﻥ ‪5‬‬ ‫ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺍﺻﻠﻰ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺟﻤﻌ ًﺎ ‪ 37‬ﻧﻔﺮ ﺑﻮﺩ‪ .‬ﺍﺯ ﺍﻳﻦ‬
‫ﻧﻔﺮ ﺷﺎﻣﻞ ‪ 1‬ﭘﺪﺭ‪ 2 ،‬ﻣﺎﺩﺭ ﻭ ‪ 2‬ﺧﻮﺍﻫﺮ( ﺑﻮﺩﻧﺪ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﻭ ﻣﻴﺎﻧﻪ‬ ‫ﺗﻌﺪﺍﺩ ‪ 26‬ﻧﻔﺮ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺍﺻﻠﻰ ﺷﺎﻣﻞ ‪16‬ﻣﺮﺩ )ﻣﻮﻓﻘﻴﺖ‬
‫ﺳﻨﻰ ﺍﻃﻼﻉ ﺩﻫﻨﺪﮔﺎﻥ ﺍﺻﻠﻰ ﻭ ﻏﻴﺮ ﺍﺻﻠﻰ ﺑﻪ ﺗﺮﺗﻴﺐ ‪40 ،42/19‬‬ ‫ﺩﺭﻣﺎﻥ ‪ 8‬ﻧﻔﺮ‪ ،‬ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ‪ 2‬ﻧﻔﺮ‪ ،‬ﻏﻴﺒﺖ ﺍﺯ ﺩﺭﻣﺎﻥ ‪ 1‬ﻧﻔﺮ‪ ،‬ﻋﻮﺩ‬
‫ﺳﺎﻝ ﻭ ‪ 44 ،41/72‬ﺳﺎﻝ ﺑﻮﺩ‪ .‬ﻭﻳﮋﮔﻰﻫﺎﻯ ﺟﻤﻌﻴﺖ ﺷﻨﺎﺧﺘﻰ ﺍﻓﺮﺍﺩ‬ ‫‪ 3‬ﻧﻔﺮ ﻭ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ ‪ 2‬ﻧﻔﺮ( ﻭ ‪10‬ﺯﻥ )ﻣﻮﻓﻘﻴﺖ ﺩﺭﻣﺎﻥ ‪6‬‬
‫ﻣﺼﺎﺣﺒﻪ ﺷﻮﻧﺪﻩ ﻧﻴﺰ ﺩﺭ ﺟﺪﻭﻝ ‪ 1‬ﺁﻣﺪﻩ ﺍﺳﺖ‪.‬‬ ‫ﻧﻔﺮ‪ ،‬ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ‪ 1‬ﻧﻔﺮ‪ ،‬ﻋﻮﺩ ﻣﺠﺪﺩ ‪ 2‬ﻧﻔﺮ ﻭ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ‬
‫ﺟﺪﻭﻝ ‪ -1‬ﻭﻳﮋﮔﻰ ﺟﻤﻌﻴﺖ ﺷﻨﺎﺧﺘﻰ ﻣﺼﺎﺣﺒﻪ ﺷﻮﻧﺪﮔﺎﻥ‬
‫‪ž¼m‬‬ ‫‡‪€ËZ‬‬
‫]‪½YZ¼Ì‬‬
‫»‪½Z³|¿Â‹ Ä^uZ‬‬ ‫»Œ‪½Z³|ÀÀ¯ d¯Z‬‬ ‫»‪€Ì¤f‬‬
‫{|‬ ‫‪{Y| e‬‬ ‫{|‬ ‫‪{Y| e‬‬ ‫{|‬ ‫‪{Y| e‬‬
‫‪56/75‬‬ ‫‪21‬‬ ‫‪13/52‬‬ ‫‪5‬‬ ‫‪43/23‬‬ ‫‪16‬‬ ‫»€{‬
‫‪†Àm‬‬
‫‪43/25‬‬ ‫‪16‬‬ ‫‪16/22‬‬ ‫‪6‬‬ ‫‪27/03‬‬ ‫‪10‬‬ ‫½‬
‫‪5/40‬‬ ‫‪2‬‬ ‫‪0‬‬ ‫‪0‬‬ ‫‪5/40‬‬ ‫‪2‬‬ ‫‪µZ‡ 20 €Ë‬‬
‫‪54/05‬‬ ‫‪20‬‬ ‫‪21/62‬‬ ‫‪8‬‬ ‫‪32/43‬‬ ‫‪12‬‬ ‫‪40-20‬‬
‫‪ÊÀ‡ ÃÁ€³‬‬
‫‪32/44‬‬ ‫‪12‬‬ ‫‪8/20‬‬ ‫‪3‬‬ ‫‪24/32‬‬ ‫‪9‬‬ ‫‪60-41‬‬
‫‪8/20‬‬ ‫‪3‬‬ ‫‪0‬‬ ‫‪0‬‬ ‫‪8/20‬‬ ‫‪3‬‬ ‫]‪µZ‡ 60 Y €eÓZ‬‬
‫‪72/97‬‬ ‫‪27‬‬ ‫‪21/62‬‬ ‫‪8‬‬ ‫‪51/30‬‬ ‫‪19‬‬ ‫»‪¶ÅZf‬‬
‫‪¶ÅZe dÌ “Á‬‬
‫‪27/03‬‬ ‫‪10‬‬ ‫‪8/20‬‬ ‫‪3‬‬ ‫‪18/88‬‬ ‫‪7‬‬ ‫»‪{€n‬‬
‫‪43/20‬‬ ‫‪16‬‬ ‫‪10/81‬‬ ‫‪4‬‬ ‫‪32/43‬‬ ‫‪12‬‬ ‫]‪{YˆÌ‬‬
‫‪24/27‬‬ ‫‪9‬‬ ‫‪5/40‬‬ ‫‪2‬‬ ‫‪18/88‬‬ ‫‪7‬‬ ‫‪ÊËY|f]Y‬‬
‫‪13/52‬‬ ‫‪5‬‬ ‫‪5/40‬‬ ‫‪2‬‬ ‫‪8/20‬‬ ‫‪3‬‬ ‫‪ÊËZ¼ÀÅY‬‬ ‫»‪{Y‡ t˜‡ ½Y‚Ì‬‬
‫‪8/20‬‬ ‫‪3‬‬ ‫‪0‬‬ ‫‪0‬‬ ‫‪8/20‬‬ ‫‪3‬‬ ‫{]‪½Zf‡€Ì‬‬
‫‪10/81‬‬ ‫‪4‬‬ ‫‪8/20‬‬ ‫‪3‬‬ ‫‪2/70‬‬ ‫‪1‬‬ ‫{‪ÊÅZ´Œ¿Y‬‬

‫ﻳﺎﻓﺘﻪﻫﺎﻯ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩ ﻳﻚ ﺳﺮﻯ ﻋﻮﺍﻣﻠﻰ ﺑﻮﺩﻧﺪ ﻛﻪ ﻣﺎﻧﻊ‬ ‫ﺩﺭ ﻣﺠﻤﻮﻉ ﺣﺪﻭﺩ ‪ 56/75‬ﺩﺭﺻﺪ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﻣﺮﺩ ﻭ‬
‫ﺍﺯ ﭘﻴﺸﺮﻓﺖ ﺩﺭﻣﺎﻥ ﻣﻰﺷﺪﻧﺪ‪ ،‬ﻛﻪ ﺩﺭ ﺯﻳﺮ ﺑﻪ ﺷﺮﺡ ﺁﻧﻬﺎ ﭘﺮﺩﺍﺧﺘﻪ‬ ‫‪ 43/25‬ﺩﺭﺻﺪ ﺯﻥ ﺑﻮﺩﻧﺪ‪ .‬ﺑﻴﺸﺘﺮﺁﻧﻬﺎ ﺩﺭ ﮔﺮﻭﻩ ﺳﻨﻰ ‪ 20-40‬ﺳﺎﻝ‬
‫ﺷﺪﻩ ﺍﺳﺖ‪:‬‬ ‫)‪ (%54/05‬ﺑﻮﺩﻧﺪ‪ 72/97 ،‬ﺩﺭﺻﺪ ﻣﺘﺎﻫﻞ ﻭ ﺣﺪﻭﺩ ‪ 43/20‬ﺩﺭﺻﺪ‬
‫ﺑﻴﺴﻮﺍﺩ ﺑﻮﺩﻧﺪ‪ .‬ﺩﺭ ﻧﺘﻴﺠﻪ ﺁﻧﺎﻟﻴﺰ ﺩﺍﺩﻩﻫﺎ ﺑﺎ ﺭﻭﺵ ﻣﻘﺎﻳﺴﻪ ﻣﺴﺘﻤﺮ‪،‬‬
‫ﺟﺪﻭﻝ ﺷﻤﺎﺭﻩ ‪ -2‬ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ‬
‫ﻛﺪﻫﺎﻯ ﺳﻄﺢ ﺍﻭﻝ‪ ،‬ﺩﻭﻡ ﻭ ﺳﻮﻡ ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻧﺪ‪ ،‬ﺗﻌﺪﺍﺩ ﻛﺪﻫﺎﻯ‬
‫“‪ʟZ¼fmY dËZ¼u ¦ ‬‬ ‫ﺍﻭﻟﻴﻪ ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻩ ﺟﻤﻌ ًﺎ ‪ 1006‬ﻛﺪ ﺑﻮﺩﻧﺪ ﻛﻪ ﺗﻌﺪﺍﺩ ﻛﺪﻫﺎﻯ‬
‫‪¶‡ Ä] Ôf]Y Y ʋZ¿ Ê»Z¿|] Á ²¿Y‬‬ ‫ﺍﻭﻟﻴﻪ ﻣﻮﺛﺮ ﺑﺮ ﺍﺩﺍﻣﻪ ﺩﺭﻣﺎﻥ ‪ 435‬ﻛﺪ ﻭ ﺗﻌﺪﺍﺩ ﻛﺪﻫﺎﻯ ﺍﻭﻟﻴﻪ ﻣﻮﺛﺮ ﺑﺮ‬
‫ﻗﻄﻊ ﺩﺭﻣﺎﻥ ‪ 571‬ﻛﺪ ﺑﻮﺩﻧﺪ‪ .‬ﺩﺭ ﺟﺮﻳﺎﻥ ﻃﺒﻘﻪ ﺑﻨﺪﻯ ﻛﺪﻫﺎﻯ ﺳﻄﺢ‬
‫»ˆ‪Z¯ Ä] •Â]€» ¶WZ‬‬
‫Ÿ‪Ã|¿Â‹ ž¿Z» ʟZ¼fmY ¶»YÂ‬‬ ‫ﺍﻭﻝ‪ 22 ،‬ﻛﺪ ﺳﻄﺢ ﺩﻭﻡ ﺍﻳﺠﺎﺩ ﮔﺮﺩﻳﺪ‪ ،‬ﺍﺯ ﺍﻳﻦ ﺗﻌﺪﺍﺩ ﻛﺪﻫﺎﻯ ﺳﻄﺢ‬
‫§¬‪½{Â] €Ì‬‬ ‫ﺩﻭﻡ ﻣﻮﺛﺮ ﺑﺮ ﺍﺩﺍﻣﻪ ﺩﺭﻣﺎﻥ ‪10‬ﻣﻮﺭﺩ ﻭ ‪ 12‬ﻣﻮﺭﺩ ﺑﻪ ﻛﺪﻫﺎﻯ ﻣﻮﺛﺮ‬
‫{»‪¶‡ Ä] Ôf^» ½YZ¼Ì] ½Z‬‬
‫¿|‪½|‹ Ê¿Y‬‬ ‫ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﻣﺮﺑﻮﻁ ﻣﻰﺷﺪﻧﺪ ﻛﻪ ﺩﺭ ﺍﺩﺍﻣﻪ ﺑﻪ ﺗﻮﺿﻴﺢ ﺩﺭ ﻣﻮﺭﺩ‬
‫‪½Z»{ µÂ— { |z» {Y» µZ¼ f‡Y‬‬ ‫ﺑﺮﺧﻰ ﺍﺯ ﺁﻧﻬﺎ ﺧﻮﺍﻫﻴﻢ ﭘﺮﺩﺍﺧﺖ‪.‬‬

‫ﺩﺍﺭﻭﻫﺎﻯ ﺧﻮﺩ ﻣﻌﺮﻓﻰ ﻛﺮﺩﻧﺪ‪ .‬ﮔﻔﺘﻪﻫﺎﻯ ﻳﻜﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﺷﺮﺡ‬
‫ﺯﻳﺮ ﺑﻮﺩ »ﻣﻦ ﻣﺼﺮﻑ ﻗﺮﺻﻬﺎ ﺭﺍ ﭘﺸﺖ ﮔﻮﺵ ﻣﻴﻨﺪﺍﺧﺘﻢ‪ ،‬ﺑﻪ ﺧﺎﻃﺮ‬
‫ﺍﻳﻨﻜﻪ ﺩﺭﮔﻴﺮ ﻛﺎﺭ ﺑﻮﺩﻡ ﻭ ﺧﺴﺘﻪ ﻣﻰﺷﺪﻡ‪ ،‬ﻳﻚ ﺭﻭﺯ ﻣﻰﺧﻮﺭﺩﻡ ﺳﻪ‬
‫ﺭﻭﺯ ﻧﻤﻰ ﺧﻮﺭﺩﻡ« ]ﻣﺮﺩ‪ ،‬ﺑﻴﻤﺎﺭ ﻋﻮﺩﻯ‪ 33 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫ﺑﻴﻜﺎﺭﻯ ﻧﻴﺰ‪ ،‬ﺍﺯ ﻋﻮﺍﻣﻠﻰ ﺑﻮﺩ ﻛﻪ ﺑﺎﻋﺚ ﺗﺒﻌﻴﺖ ﺿﻌﻴﻒ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ‬
‫ﺩﺭﻣﺎﻥ ﻣﻰﺷﺪ‪ ،‬ﻳﻜﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺍﻇﻬﺎﺭ ﺩﺍﺷﺖ »ﺩﺍﺭﻭﻫﺎ ﺭﺍ ﺑﻪ ﻋﻠﺖ‬
‫ﺍﻳﻨﻜﻪ ﺑﻴﻜﺎﺭ ﺷﺪﻩ ﺑﻮﺩﻡ ﻭ ﺩﻳﺮ ﺍﺯ ﺧﻮﺍﺏ ﺑﻠﻨﺪ ﻣﻰﺷﺪﻡ‪ ،‬ﻧﻤﻰﺧﻮﺭﺩﻡ‪،‬‬
‫ﭼﻮﻥ ﻛﺎﺭﻯ ﻧﺪﺍﺷﺘﻢ ﻛﻪ ﺑﺨﻮﺍﻡ ﺻﺒﺢ ﺯﻭﺩ ﺑﻠﻨﺪ ﺑﺸﻢ ﻭ ﺩﺍﺭﻭﻫﺎﻡ ﺭﺍ‬
‫ﺑﺨﻮﺭﻡ »]ﻣﺮﺩ‪ ،‬ﺑﻴﻤﺎﺭ ﻋﻮﺩﻯ‪ 28 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫‪ -‬ﻓﻘﻴﺮ ﺑﻮﺩﻥ‬
‫ﺑﻌﻀﻰ ﺍﺯ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ‪ ،‬ﻓﻘﺮ ﺭﺍ ﻳﻚ ﻋﺎﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﺎﻧﻊ‬
‫ﺷﻮﻧﺪﻩ ﻣﻮﺛﺮ ﺑﺮ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﻣﻰﺩﺍﻧﺴﺘﻨﺪ‪ .‬ﭼﻮﻥ ﺑﻪ ﻋﻠﺖ ﻓﻘﺮ‪،‬‬
‫ﻏﺬﺍﻯ ﻣﻨﺎﺳﺒﻰ ﺗﻬﻴﻪ ﻧﻤﻰﻛﺮﺩﻧﺪ ﻭ ﺣﺘﻰ ﺑﻪ ﻋﻠﺖ ﻋﺪﻡ ﺗﻮﺍﻧﺎﻳﻰ ﺩﺭ‬ ‫ﻣﺎﺩﺭﻣﻮﻥ ﺳﻞ ﺩﺍﺭﻩ ﻓﺮﺍﺭ ﻛﺮﺩﻳﻢ‪ ،‬ﻧﻤﻰ ﺍﻭﻣﺪﻳﻢ ﻃﺮﻓﺶ‪ ،‬ﻧﺰﺩﻳﻜﺶ‬
‫ﭘﺮﺩﺍﺧﺖ ﻫﺰﻳﻨﻪ ﺗﺰﺭﻳﻖ‪ ،‬ﺁﻣﭙﻮﻟﻬﺎ ﺭﺍ ﺗﺰﺭﻳﻖ ﻧﻤﻰﻛﺮﺩﻧﺪ‪ .‬ﻣﺸﺎﺭﻛﺖ‬
‫ﻛﻨﻨﺪﻩﺍﻯ ﺍﻳﻨﭽﻨﻴﻦ ﺑﻴﺎﻥ ﻛﺮﺩ‪» :‬ﺗﻮﻯ ﺍﻳﻦ ﻣﻨﻄﻘﻪﺍﻯ ﻛﻪ ﻣﺎ ﻫﺴﺘﻴﻢ‬
‫‪ ،...‬ﺧﻴﻠﻰ ﻫﺎﺷﻮﻥ ﻓﻘﻴﺮ ﻫﺴﺘﻨﺪ ﻭ ﺧﻮﺩﺷﻮﻥ ﻣﻴﮕﻦ ﻛﻪ ﺩﺭﺁﻣﺪﻣﻮﻥ‬
‫ﻫﻤﻴﻦ ﻳﺎﺭﺍﻧﻪ ﺍﺳﺖ‪ ،‬ﻛﺠﺎ ﺧﺮﺟﺶ ﻛﻨﻴﻢ‪ ،‬ﺍﻛﺜﺮ ﺑﻴﻤﺎﺭﺍﻧﻰ ﻛﻪ ﺍﻳﻨﺠﺎ‬
‫ﻫﺴﺘﻨﺪ‪ ،‬ﻣﺸﻜﻞ ﺗﺎﻣﻴﻦ ﻫﺰﻳﻨﻪ ﺩﺍﺭﻧﺪ‪ ،‬ﺍﻳﻦ ﭼﻴﺰﻯ ﺍﺳﺖ ﻛﻪ ﺗﻮﻯ‬
‫ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﺗﺎﺛﻴﺮ ﻣﻨﻔﻰ ﺩﺍﺭﻩ« ]ﻣﺮﺩ‪ ،‬ﻧﺎﻇﺮ ﺑﺮ ﺩﺭﻣﺎﻥ‪ 29 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﻩﺍﻯ ﺩﻳﮕﺮ ﺑﻴﺎﻥ ﺩﺍﺷﺖ‪» :‬ﻭﺍﻗﻌ ًﺎ ﻣﺸﻜﻞ ﻣﺎﻟﻰ ﺩﺍﺷﺘﻢ‪،‬‬
‫ﻭﺳﻴﻠﻪﺍﻯ ﭼﻴﺰﻯ ﻫﻢ ﻧﺪﺍﺷﺘﻢ‪ ،‬ﺍﻭﻥ ﻣﻮﻗﻊ ﺑﺎﻳﺪ ﻣﻰﺭﻓﺘﻢ ‪ ،...‬ﭘﻨﺠﺎﻩ‬
‫ﺭﻭﺯ ﺍﻳﻦ ﻛﺎﺭﻭ ﻛﺮﺩﻡ‪ ،‬ﻣﻦ ﻫﺰﺍﺭ ﺗﻮﻣﺎﻥ ﻛﺮﺍﻳﻪ ﻣﻰﺩﺍﺩﻡ ﻭ ﻫﺰﺍﺭ ﻭ‬
‫ﭘﺎﻧﺼﺪ ﺗﻮﻣﺎﻥ ﻫﻢ ﺁﻣﭙﻮﻟﻬﺎ ﺭﺍ ﻣﻰﺯﺩﻡ‪ ،‬ﺩﻩ ﺗﺎ ﺍﺯ ﺁﻣﭙﻮﻟﻬﺎ ﺭﺍ ﺑﻪ ﺧﺎﻃﺮ‬
‫ﻣﺸﻜﻼﺕ ﻣﺎﻟﻰ ﻧﺰﺩﻡ‪ .‬ﭼﻮﻥ ﺭﻭﺯﻯ ﺩﻭ ﻫﺰﺍﺭ ﻭ ﭘﺎﻧﺼﺪ ﺑﺎﻳﺪ ﻣﻰﺩﺍﺩﻡ‪.‬‬
‫ﻭﺍﻗﻌ ًﺎ ﺑﻴﻜﺎﺭ ﺑﻮﺩﻡ‪ ،‬ﻧﺪﺍﺷﺘﻢ« ]ﻣﺮﺩ‪ ،‬ﺑﻴﻤﺎﺭ ﻋﻮﺩﻯ‪ 40 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫‪ -‬ﺯﻧﺪﺍﻧﻰ ﺷﺪﻥ‬
‫ﺗﺠﺮﺑﻴﺎﺕ ﺑﻴﺎﻥ ﺷﺪﻩ ﺗﻮﺳﻂ ﻣﺮﺩﺍﻧﻰ ﻛﻪ ﺳﺎﺑﻘﻪ ﺩﺭﻣﺎﻥ ﺩﺭ ﺯﻧﺪﺍﻥ‬ ‫ﺍﺯ ﻫﻤﺴﺎﻳﻪﻫﺎ ﺑﺎﻋﺚ ﻣﻰﺷﺪ ﻛﻪ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺟﺎﺯﻩ ﻧﺪﻫﻨﺪ ﻛﻪ ﻧﺎﻇﺮﻳﻦ‬
‫ﺩﺍﺷﺘﻨﺪ‪ ،‬ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﺯﻧﺪﺍﻧﻰ ﺷﺪﻥ ﻳﻚ ﻣﺎﻧﻊ ﻣﻮﺛﺮ ﺩﺭ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ‬
‫ﺍﺳﺖ‪ .‬ﻳﻜﻰ ﺍﺯ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻴﺎﻥ ﻧﻤﻮﺩ‪» :‬ﺗﻮﻯ ﺯﻧﺪﺍﻥ ﻣﻰﺩﻭﻧﻰ‬
‫ﺩﺍﺭﻭﻫﺎ ﺭﺍ ﭼﻄﻮﺭ ﻣﻰﺩﺍﺩﻧﺪ‪ ،‬ﻫﻤﺶ ‪ 5‬ﺩﺍﺭﻭ ﺑﺮﺍﻯ ﺩﻭ ﺭﻭﺯﺕ ﺑﻬﺖ‬
‫ﻣﻰﺩﺍﺩﻧﺪ‪ ،‬ﺩﺍﺭﻭﻫﺎ ﺭﺍ ﻧﺎﻗﺺ ﺑﻬﺖ ﻣﻰﺩﺍﺩﻧﺪ‪ ،‬ﻧﻤﻰ ﮔﻔﺘﻦ ﻛﻰ ﺑﺨﻮﺭ‪،‬‬
‫ﭼﻪ ﺟﻮﺭ ﺑﺨﻮﺭ‪ ،‬ﻓﻘﻂ ﻣﻰﮔﺬﺍﺷﺘﻨﺪ ﺗﻮﻯ ﺍﺗﺎﻕ ﻗﺮﻧﻄﻴﻨﻪ ﭘﺸﺖ ﭘﻨﺠﺮﻩ‬
‫ﻭ ﻣﻴﺮﻓﺘﻦ‪ .‬ﺑﻌﺪ ﻣﻰﮔﻔﺘﻦ ﺩﺍﺭﻭﻫﺎ ﺭﺍ ﺑﺮﺩﺍﺭ‪ ،‬ﺩﻳﮕﻪ ﻧﻤﻰ ﮔﻔﺖ ﭼﻄﻮﺭ‬
‫ﺑﺨﻮﺭ« ]ﻣﺮﺩ‪ ،‬ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ‪ 37 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫ﺑﺮﺧﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﻣﺸﻜﻼﺕ ﺭﻭﺣﻰ ﻭ ﺭﻭﺍﻧﻰ ﺩﺭ ﺯﻧﺪﺍﻥ ﺭﺍ ﻋﺎﻣﻠﻰ‬
‫ﺑﺮﺍﻯ ﻣﺼﺮﻑ ﻧﻜﺮﺩﻥ ﺩﺍﺭﻭﻫﺎﻯ ﺧﻮﺩ ﺑﻴﺎﻥ ﻛﺮﺩﻧﺪ‪ ،‬ﻳﻜﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ‬
‫ﮔﻔﺖ‪ » :‬ﺩﺍﺧﻞ ﺯﻧﺪﺍﻥ ﺁﺩﻡ ﺷﺐ ﻭ ﺭﻭﺯﺵ ﻳﻜﻰ ﺍﺳﺖ‪ ،‬ﺣﺎﻟﺖ ﺧﻔﻪ‬
‫ﺩﺍﺭﻩ‪ ،‬ﺁﺩﻡ ﺩﻟﺶ ﻣﻰﮔﻴﺮﻩ‪ ،‬ﻣﺸﻜﻼﺕ ﺭﻭﺣﻰ ﺭﻭﺍﻧﻰ ﭘﻴﺪﺍ ﻣﻰﻛﻨﻪ‪ ،‬ﺩﻝ‬
‫ﻭ ﺩﻣﺎﻍ ﺩﺍﺭﻭ ﺧﻮﺭﺩﻥ ﻧﺪﺍﺭﻩ «]ﻣﺮﺩ‪ ،‬ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ‪ 29 ،‬ﺳﺎﻟﻪ[‪.‬‬
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‫‪ -‬ﺿﻌﻒ ﺣﻤﺎﻳﺖ ﺍﺟﺘﻤﺎﻋﻰ‬
‫ﺑﺮﺧﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻌﺘﺎﺩ ﺍﺯ ﺳﻮﻯ ﺧﺎﻧﻮﺍﺩﻩ ﻃﺮﺩ ﺷﺪﻩ ﻭ ﺣﻤﺎﻳﺖ‬
‫ﺁﻧﺎﻥ ﺭﺍ ﺍﺯ ﺩﺳﺖ ﺩﺍﺩﻩﺍﻧﺪ ﻭ ﺑﻪ ﻋﻠﺖ ﺗﻨﻬﺎﻳﻰ ﺗﺒﻌﻴﺖ ﺿﻌﻴﻔﻰ ﻧﺴﺒﺖ‬
‫ﺑﻪ ﺩﺭﻣﺎﻥ ﺩﺍﺷﺘﻨﺪ‪ .‬ﻳﻜﻰ ﺍﺯ ﻧﺎﻇﺮﻳﻦ ﺑﺮ ﺩﺭﻣﺎﻥ ﺍﻇﻬﺎﺭ ﻧﻤﻮﺩ‪» :‬ﺑﻴﺸﺘﺮ‬
‫ﺑﻴﻤﺎﺭﺍﻣﻮﻥ ﺑﻪ ﺧﺎﻃﺮ ﻣﺴﺌﻠﻪ ﺍﻋﺘﻴﺎﺩ ﺷﻮﻥ ﺩﺭﮔﻴﺮﻯ ﺧﺎﻧﻮﺍﺩﮔﻰ ﺩﺍﺭﻧﺪ‪،‬‬
‫ﻛﻪ ﺗﻮﻯ ﺩﺭﻣﺎﻧﺸﻮﻥ ﺗﺎﺛﻴﺮ ﻣﻨﻔﻰ ﺩﺍﺭﻩ‪ ،‬ﺩﺭﮔﻴﺮ ﻣﻴﺸﻪ ﺑﺎ ﺧﺎﻧﻮﺍﺩﻩﺍﺵ‪،‬‬
‫ﺑﺎ ﺧﺎﻧﻤﺶ ﻭ ﭼﻮﻥ ﺧﺎﻧﻮﺍﺩﻩ ﻃﺮﺩﺵ ﻣﻴﻜﻨﻪ‪ ،‬ﻣﻴﮕﻪ ﻣﻦ ﺩﺍﺭﻭ‬
‫ﻧﻤﻰﺧﻮﺭﻡ« ]ﻣﺮﺩ‪ ،‬ﻧﺎﻇﺮ ﺑﺮ ﺩﺭﻣﺎﻥ‪ 29 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫ﻋﺎﻣﻞ ﺩﻳﮕﺮﻯ ﻛﻪ ﺑﻴﺎﻧﮕﺮ ﺿﻌﻒ ﺣﻤﺎﻳﺖ ﺍﻓﺮﺍﺩﻩ ﺧﺎﻧﻮﺍﺩﻩ ﻣﻰﺷﺪ‪،‬‬
‫ﺗﺮﺱ ﺁﻧﻬﺎ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺑﻴﻤﺎﺭﻯ ﺳﻞ ﺑﻮﺩ ﻛﻪ ﺑﺎﻋﺚ ﺩﻭﺭﻯ ﺍﺯ ﺑﻴﻤﺎﺭ‬
‫ﻭ ﺑﻪ ﻭﺟﻮﺩ ﺁﻣﺪﻥ ﻣﺸﻜﻼﺗﻰ ﺩﺭ ﺍﺩﺍﻣﻪ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻰﮔﺮﺩﻳﺪ‪.‬‬
‫ﻳﻜﻰ ﺍﺯ ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺑﻴﻤﺎﺭ ﺑﻴﺎﻥ ﺩﺍﺷﺖ‪» :‬ﺍﻭﺍﻳﻞ ﻭﻗﺘﻰ ﻓﻬﻤﻴﺪﻳﻢ‬
‫ﻧﻤﻰﺷﺪﻳﻢ‪ ،‬ﺧﺎﻧﻮﺍﺩﻩ ﺩﺍﺩﺍﺷﻢ ﻃﺒﻘﻪ ﺑﺎﻻ ﺯﻧﺪﮔﻰ ﻣﻰﻛﺮﺩ‪ ،‬ﻧﻤﻰ ﺍﻭﻣﺪﻥ‬
‫ﭘﺎﻳﻴﻦ‪ ،‬ﻓﺮﺍﺭ ﻣﻰﻛﺮﺩﻧﺪ‪ ،‬ﻳﻚ ﻣﺎﻩ ﺍﻭﻝ ﻣﺎﺩﺭﻡ ﺗﻨﻬﺎﻯ ﺗﻨﻬﺎ ﺑﻮﺩ‪ ،‬ﻃﺮﺩﺵ‬
‫ﻛﺮﺩﻩ ﺑﻮﺩﻳﻢ ﺑﻪ ﺧﺎﻃﺮ ﺑﻴﻤﺎﺭﻳﺶ ﻭ ﭼﻨﺪ ﺭﻭﺯ ﺑﻪ ﻫﻤﻴﻦ ﺧﺎﻃﺮ ﺩﺍﺭﻭ‬
‫ﻧﺨﻮﺭﺩ« ]ﻧﺎﻇﺮ ﺧﺎﻧﻮﺍﺩﮔﻰ ‪،‬ﺩﺧﺘﺮ ﺑﻴﻤﺎﺭ ‪ 27 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫‪ -‬ﺍﻧﮓ ﻭ ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺳﻞ‬
‫ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺳﻞ ﺩﺭ ﺑﻴﺸﺘﺮ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎﻋﺚ ﻣﻰﺷﺪ ﻛﻪ‬
‫ﺁﻧﻬﺎ ﺗﺎ ﺟﺎﻳﻰ ﻛﻪ ﺍﻣﻜﺎﻥ ﺩﺍﺷﺖ‪ ،‬ﺑﻴﻤﺎﺭﻯ ﺧﻮﺩ ﺭﺍ ﺍﺯ ﺩﻳﮕﺮﺍﻥ ﻣﺨﻔﻰ‬
‫ﻧﻤﺎﻳﻨﺪ‪ ،‬ﺣﺘﻰ ﺑﻌﻀﻰ ﻣﻮﺍﻗﻊ ﺑﻪ ﺧﺎﻃﺮ ﻣﺨﻔﻰ ﻣﺎﻧﺪﻥ ﺑﻴﻤﺎﺭﻯ‪ ،‬ﺍﺯ‬
‫ﺧﻮﺭﺩﻥ ﺩﺍﺭﻭﻫﺎ ﺍﺟﺘﻨﺎﺏ ﻣﻰﻛﺮﺩﻧﺪ‪ :‬ﮔﻔﺘﻪﻫﺎﻯ ﻳﻜﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻪ ﺍﻳﻦ‬
‫ﺗﺮﺗﻴﺐ ﺑﻮﺩ »ﺑﻌﻀﻰ ﻭﻗﺘﻬﺎ ﺧﺠﺎﻟﺖ ﻣﻰﻛﺸﻴﺪﻡ ﺩﺍﺭﻭﻫﺎ ﺭﺍ ﺑﺨﻮﺭﻡ‪،‬‬
‫ﭼﻮﻥ ﻣﻰﮔﻔﺘﻦ ﻛﻪ ﺍﻳﻦ ﺧﺎﻧﻢ ﺑﺮﺍﻯ ﭼﻰ ﺍﻳﻦ ﺩﺍﺭﻭﻫﺎ ﺭﺍ ﻣﻰﺧﻮﺭﻩ ﻣﺜﻞ‬
‫ﺍﻳﻨﻜﻪ ﻣﺮﻳﻀﻰ ﺑﺪﻯ ﺩﺍﺭﻩ« ]ﺯﻥ‪ ،‬ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ‪ 40 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺳﻞ ﻭ ﺿﺮﻭﺭﺕ ﻣﺨﻔﻰ ﻣﺎﻧﺪﻥ ﺑﻴﻤﺎﺭﻯ‬
‫ﺑﺮ ﺩﺭﻣﺎﻥ ﺑﺮﺍﻯ ﺍﺟﺮﺍﻯ ﺩﺍﺗﺲ ﺑﻪ ﺩﺭﺏ ﻣﻨﺰﻝ ﺁﻧﻬﺎ ﻣﺮﺍﺟﻌﻪ ﻧﻤﺎﻳﻨﺪ‪.‬‬
‫ﻳﻜﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﮔﻔﺖ‪ »:‬ﺗﻨﻬﺎ ﻣﺸﻜﻞ ﺩﺭ ﻃﻮﻝ ﺩﺭﻣﺎﻧﻢ‪ ،‬ﻣﺮﺍﺟﻌﻪ‬
‫ﻛﺎﺭﻣﻨﺪﺍﻥ ﺑﻬﺪﺍﺷﺖ ﺑﻪ ﺩﺭﺏ ﻣﻨﺰﻟﻤﺎﻥ ﺑﻮﺩ‪ ،‬ﺍﮔﻪ ﻫﻤﺴﺎﻳﻪﻫﺎ ﻣﺘﻮﺟﻪ‬
‫ﻣﻰﺷﺪﻧﺪ‪ ،‬ﺧﻴﻠﻰ ﺑﺮﺍﻡ ﺑﺪ ﻣﻰﺷﺪ‪ .‬ﺑﻪ ﻫﻤﻴﻦ ﺧﺎﻃﺮ ﺑﻬﺸﻮﻥ ﮔﻔﺘﻢ‬
‫ﺩﺭﺏ ﺧﺎﻧﻤﻮﻥ ﻧﻴﺎﻳﻨﺪ ﻭ ﺍﮔﻪ ﺑﻴﺎﻳﻨﺪ ﺑﺎﻫﺎﺷﻮﻥ ﺩﺭﮔﻴﺮ ﻣﻴﺸﻢ» ]ﻣﺮﺩ‪،‬‬
‫ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ‪ 37 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫‪ -‬ﻣﺴﺎﺋﻞ ﻣﺮﺑﻮﻁ ﺑﻪ ﻛﺎﺭ‬
‫ﺗﺠﺮﺑﻴﺎﺕ ﺑﻴﺎﻥ ﺷﺪﻩ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪ ﮔﺎﻥ ﻧﺸﺎﻧﮕﺮ ﺍﻳﻦ ﺑﻮﺩ ﻛﻪ ﻣﺴﺎﺋﻞ‬
‫ﻣﺮﺑﻮﻁ ﺑﻪ ﻛﺎﺭ ﻳﻜﻰ ﺍﺯ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﺍﺻﻠﻰ ﻣﺎﻧﻊ ﺷﻮﻧﺪﻩ ﺩﺭ‬
‫ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻰﺑﺎﺷﺪ ﻛﻪ ﺧﻮﺩ ﺷﺎﻣﻞ ﺩﻭ ﺯﻳﺮ ﻃﺒﻘﻪ ﻓﺮﻋﻰ‬
‫ﻣﺸﻐﻠﻪ ﻛﺎﺭﻯ ﺯﻳﺎﺩ ﻭ ﻳﺎ ﺑﻴﻜﺎﺭﻯ ﺍﺳﺖ‪ .‬ﺩﺭ ﻣﻮﺍﺭﺩﻯ ﻛﻪ ﺑﻴﻤﺎﺭﺍﻥ‬
‫ﻣﺸﻐﻮﻝ ﻛﺎﺭ ﺑﻮﺩﻧﺪ‪ ،‬ﺧﺴﺘﮕﻰ ﻧﺎﺷﻰ ﺍﺯ ﻛﺎﺭ ﺭﺍ ﺩﻟﻴﻞ ﺍﺻﻠﻰ ﻧﺨﻮﺭﺩﻥ‬
‫‪31/‬‬
‫ﺍﺯ ﺩﺭﻣﺎﻥ ﺫﻛﺮ ﮔﺮﺩﻳﺪﻩ ﺍﺳﺖ‪ ،‬ﺑﻪ ﻧﻈﺮ ﻣﻰﺭﺳﺪ ﺩﺭ ﺍﺳﺘﺎﻥ ﺧﻮﺯﺳﺘﺎﻥ‪،‬‬
‫ﻋﺪﻡ ﻭﺟﻮﺩ ﺣﻤﺎﻳﺖ ﺧﺎﻧﻮﺍﺩﻩ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﺎﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻬﻤﻰ ﺩﺭ‬
‫ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ‪ ،‬ﺑﺴﻴﺎﺭ ﻣﺆﺛﺮ ﺍﺳﺖ‪ .‬ﺩﺭﺻﻮﺭﺗﻰ ﻛﻪ ﺑﻪ ﻫﺮ ﺩﻟﻴﻠﻰ‪،‬‬
‫ﻓﺮﺩ ﺑﻴﻤﺎﺭ ﺑﺎ ﺍﻋﻀﺎﻯ ﺧﺎﻧﻮﺍﺩﻩ ﺧﻮﺩ ﺩﭼﺎﺭ ﻣﺸﻜﻞ ﺷﻮﺩ‪ ،‬ﻣﻤﻜﻦ‬
‫ﺍﺳﺖ ﺣﻤﺎﻳﺖ ﺁﻧﻬﺎ ﺭﺍ ﺩﺭ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﻯ ﺳﻞ ﺍﺯ ﺩﺳﺖ‬
‫ﺑﺪﻫﺪ‪ .‬ﻣﻄﺎﻟﻌﻪﺍﻯ ﻛﻪ ﺗﻮﺳﻂ ﻣﺤﻤﻮﺩ ﻛﺎﺷﻴﻒ )‪ (2012‬ﺩﺭ ﭘﺎﻛﺴﺘﺎﻥ‬
‫ﺻﻮﺭﺕ ﮔﺮﻓﺖ‪ ،‬ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺭﻳﻮﻯ ﺍﺳﻤﻴﺮ ﻣﺜﺒﺖ‪،‬‬
‫ﻣﺸﻜﻼﺕ ﺧﺎﻧﻮﺍﺩﮔﻰ ‪ %44‬ﺍﺯ ﻋﻮﺍﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺭﺍ‬
‫ﺗﺸﻜﻴﻞ ﻣﻰﺩﻫﻨﺪ ]‪ .[21‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻳﺎﻓﺘﻪﻫﺎﻯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ‪،‬‬
‫ﺑﻴﻤﺎﺭﺍﻧﻰ ﻛﻪ ﺳﺎﺑﻘﻪ ﺍﻋﺘﻴﺎﺩ ﺩﺍﺷﺘﻨﺪ‪ ،‬ﺍﺯ ﺿﻌﻒ ﺣﻤﺎﻳﺖ ﺧﺎﻧﻮﺍﺩﻩ‬
‫ﻭ ﺑﻮﻳﮋﻩ ﻫﻤﺴﺮ ﺷﻜﺎﻳﺖ ﺩﺍﺷﺘﻨﺪ‪ ،‬ﺁﻧﻬﺎ ﺩﺭ ﻃﻮﻝ ﺩﺭﻣﺎﻥ‪ ،‬ﺣﻤﺎﻳﺖ‬
‫ﺧﺎﻧﻮﺍﺩﻩ ﺭﺍ ﺍﺯ ﺩﺳﺖ ﺩﺍﺩﻩﺍﻧﺪ ﻭ ﺑﻪ ﻋﻨﻮﺍﻥ ﺍﻓﺮﺍﺩﻯ ﺗﻨﻬﺎ ﻭ ﻃﺮﺩ ﺷﺪﻩ‪،‬‬
‫ﭘﺎﻳﺒﻨﺪﻯ ﺿﻌﻴﻔﻰ ﺑﻪ ﺩﺭﻣﺎﻥ ﺩﺍﺷﺘﻪ ﻭ ﺑﻪ ﻫﻤﻴﻦ ﺩﻟﻴﻞ ﺑﺎ ﺷﻜﺴﺖ‬
‫ﺩﺭﻣﺎﻥ ﺭﻭﺑﺮﻭ ﺷﺪﻩﺍﻧﺪ‪ .‬ﺍﻳﻦ ﻣﻮﺿﻮﻉ ﺑﺎ ﻳﺎﻓﺘﻪﻫﺎﻯ ﻣﻄﺎﻟﻌﻪﺍﻯ ﻛﻪ‬
‫ﺗﻮﺳﻂ ﻓﺮﺍﻧﻚ ﺍﻧﺠﺎﻡ ﺷﺪ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻣﻮﺍﺩ ﻣﺨﺪﺭ ﺭﺍ ﻳﻜﻰ ﺍﺯ‬
‫ﻋﻮﺍﻣﻞ ﻏﻴﺒﺖ ﺍﺯ ﺩﺭﻣﺎﻥ ﺩﺭ ﻣﻴﺎﻥ ﻣﺮﺩﺍﻥ ﻧﺸﺎﻥ ﺩﺍﺩ ]‪ ،[5‬ﻫﻤﺨﻮﺍﻧﻰ‬
‫ﺩﺍﺭﺩ‪ .‬ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﮔﺎﻫﻰ ﺗﺮﺱ ﺍﻃﺮﺍﻓﻴﺎﻥ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ‬
‫ﺑﻴﻤﺎﺭﻯ ﺳﻞ‪ ،‬ﺑﺎﻋﺚ ﺩﻭﺭﻯ ﺍﺯ ﺑﻴﻤﺎﺭ ﻭ ﺑﻪ ﻭﺟﻮﺩ ﺁﻣﺪﻥ ﻣﺸﻜﻼﺗﻰ‬
‫ﺩﺭ ﺍﺩﺍﻣﻪ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﮔﺮﺩﻳﺪﻩ ﺍﺳﺖ‪ .‬ﻣﻄﺎﻟﻌﺎﺕ ﻧﺸﺎﻥ ﻣﻰﺩﻫﻨﺪ‬
‫ﻛﻪ ﺗﺮﺱ ﺍﺯ ﮔﺮﻓﺘﻦ ﺳﻞ ﺩﺭ ﻣﻴﺎﻥ ﺍﻋﻀﺎﻯ ﺧﺎﻧﻮﺍﺩﻩ‪ ،‬ﻳﻚ ﻋﺎﻣﻞ ﻣﻨﻔﻰ‬
‫ﺍﺳﺖ‪ .‬ﺑﺮﺍﻯ ﻣﺮﺍﻗﺒﺖ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﺧﺎﻧﻮﺍﺩﻩﻫﺎ ﻭ ﺍﮔﺮ ﺩﺭ ﺧﺎﻧﻪﻫﺎﻳﻰ‬
‫ﻛﻪ ﺑﻪ ﺑﻴﻤﺎﺭ ﺧﺪﻣﺎﺕ ﺩﺍﺩﻩ ﻣﻰﺷﻮﺩ ﺑﻴﻤﺎﺭ ﻃﺮﺩ ﺷﻮﺩ‪ ،‬ﻣﻤﻜﻦ ﺍﺳﺖ‬
‫ﺍﺣﺴﺎﺱ ﺗﻨﻬﺎﻳﻰ ﺷﺪﻳﺪ ﻛﻨﺪ ﻭ ﺍﺯ ﺍﺩﺍﻣﻪ ﺩﺭﻣﺎﻥ ﺧﻮﺩﺩﺍﺭﻯ ﻧﻤﺎﻳﺪ‬
‫]‪.[22‬‬
‫ﺩﺭ ﺑﻌﻀﻰ ﻣﻮﺍﻗﻊ ﺗﺮﺱ ﺍﺯ ﺍﻧﮓ ﻭ ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ‬
‫ﺳﻞ ﺑﻪ ﻋﻨﻮﺍﻥ ﻣﺎﻧﻌﻰ ﺑﺮﺍﻯ ﺗﺒﻌﻴﺖ ﺍﺯ ﺩﺭﻣﺎﻥ‪ ،‬ﻣﻮﺟﺐ ﻣﻰﺷﻮﺩ‬
‫ﻛﻪ ﺍﻓﺮﺍﺩ ﻣﺒﺘﻼ ﺑﺮﺍﻯ ﭘﺮﻫﻴﺰ ﺍﺯ ﺑﺪﻧﺎﻣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺍﺑﺘﻼ ﺑﻪ ﺳﻞ ﺗﺎ‬
‫ﺣﺪ ﺍﻣﻜﺎﻥ ﺑﻴﻤﺎﺭﻯ ﺧﻮﺩ ﺭﺍ ﻣﺨﻔﻰ ﻧﻤﺎﻳﻨﺪ ﻭ ﺣﺘﻰ ﺍﺯ ﺧﻮﺭﺩﻥ‬
‫ﺩﺍﺭﻭﻫﺎ ﻳﺎ ﻣﺮﺍﺟﻌﻪ ﺑﺮﺍﻯ ﺩﺭﻳﺎﻓﺖ ﺩﺳﺘﻮﺭﺍﺕ ﺩﺍﺭﻭﻳﻰ ﺷﺮﻡ ﺩﺍﺷﺘﻪ‬
‫ﺑﺎﺷﻨﺪ ﻭ ﺍﺯ ﺷﺮﻭﻉ ﻳﺎ ﺍﺩﺍﻣﻪ ﺩﺭﻣﺎﻥ ﺍﺟﺘﻨﺎﺏ ﻭﺭﺯﻧﺪ‪ .‬ﺩﺭ ﻣﻄﺎﻟﻌﻪﺍﻯ‬
‫ﻛﻪ ﺗﻮﺳﻂ ﺁﻟﻴﺴﺎ ﻓﻴﻨﻼﻯ ﺩﺭ ﺁﻓﺮﻳﻘﺎﻯ ﺟﻨﻮﺑﻰ ﺍﻧﺠﺎﻡ ﮔﺮﻓﺖ‪ ،‬ﺍﻳﻦ‬
‫ﻋﺎﻣﻞ‪ ،‬ﻳﻌﻨﻰ ﺍﺣﺴﺎﺱ ﺷﺮﻡ ﺍﺯ ﺑﻴﻤﺎﺭﻯ ﺳﻞ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﻚ ﻣﺎﻧﻊ‬
‫ﺩﺭ ﺩﺭﻣﺎﻥ ﻣﺴﻠﻮﻟﻴﻦ ﮔﺰﺍﺭﺵ ﮔﺮﺩﻳﺪ ]‪ .[23‬ﻣﻄﺎﻟﻌﺎﺕ ﻗﺒﻠﻰ ﻣﺎﻧﻨﺪ‬
‫ﻣﻄﺎﻟﻌﻪ ﺍﺷﺎﺭﻩ ﺷﺪﻩ ﻓﻮﻕ‪ ،‬ﻋﻤﺪﺗ ًﺎ ﻣﻮﺿﻮﻉ ﺗﺮﺱ ﺍﺯ ﺭﺳﻮﺍﻳﻰ ﻭ ﺍﻧﮓ‬
‫ﻭ ﺑﺪﻧﺎﻣﻰ ﺭﺍ ﻣﺎﻧﻌﻰ ﺑﺮﺍﻯ ﻣﺮﺍﺟﻌﻪ ﻭ ﺗﺒﻌﻴﺖ ﺍﺯ ﺩﺳﺘﻮﺭﺍﺕ ﺩﺍﺭﻭﻳﻰ‬
‫ﻭ ﺩﺭ ﻧﺘﻴﺠﻪ ﻋﺎﻣﻠﻰ ﻣﺆﺛﺮ ﺩﺭ ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ﮔﺰﺍﺭﺵ ﻧﻤﻮﺩﻩﺍﻧﺪ‪.‬‬
‫ﺍﺯ ﺟﻤﻠﻪ ﻋﻮﺍﻣﻞ ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻩ ﺩﺭ ﺍﻳﻦ ﭘﮋﻭﻫﺶ‪ ،‬ﻣﺴﺎﺋﻞ ﺷﻐﻠﻰ‬
‫ﻫﻢ ﺍﺯ ﻧﻈﺮ ﻣﺸﻐﻮﻟﻴﺖ ﺯﻳﺎﺩ ﻭ ﻫﻢ ﺍﺯ ﻧﻈﺮ ﺑﻴﻜﺎﺭﻯ ﺑﻮﺩ ﻛﻪ ﺑﻪ ﻧﻮﻋﻰ‬
‫ﻣﺎﻧﻊ ﺍﺯ ﻣﻮﻓﻘﻴﺖ ﺩﺭﻣﺎﻥ ﻣﻰﺷﺪ‪ .‬ﺩﺭ ﻣﻄﺎﻟﻌﻪﺍﻯ ﻛﻪ ﺩﺭ ﭘﺎﻛﺴﺘﺎﻥ ﺑﺮ‬
‫‪ -‬ﺍﺳﺘﻌﻤﺎﻝ ﻣﻮﺍﺩ ﻣﺨﺪﺭ ﺩﺭ ﻃﻮﻝ ﺩﺭﻣﺎﻥ‬
‫ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻧﻰ ﻛﻪ ﺍﻛﺜﺮﺍ ً ﻣﺮﺩ ﺑﻮﺩﻧﺪ ﻭ ﺳﺎﺑﻘﻪ ﺍﻋﺘﻴﺎﺩ ﺩﺭ ﻃﻮﻝ‬
‫ﺩﺭﻣﺎﻥ ﺩﺍﺷﺘﻨﺪ‪ ،‬ﻭﺍﺑﺴﺘﮕﻰ ﺑﻪ ﻣﻮﺍﺩ ﻣﺨﺪﺭ ﺭﺍ ﻳﻚ ﻣﺎﻧﻊ ﻣﻬﻢ ﻭ ﻣﻮﺛﺮ‬
‫ﺑﺮ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﻣﻰﺩﺍﻧﺴﺘﻨﺪ‪ .‬ﻳﻜﻰ ﺍﺯ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﮔﻔﺖ‪:‬‬
‫»ﻣﻦ ‪ 6‬ﻣﺎﻩ ﺍﻭﻝ ﻛﻪ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﺑﻮﺩﻡ‪ ،‬ﺧﻴﻠﻰ ﻋﺎﺟﺰ ﺑﻮﺩﻡ ﺍﺯ ﺩﺍﺭﻭ‬
‫ﺧﻮﺭﺩﻥ‪ ،‬ﺗﺮﻳﺎﻙ ﺍﺳﺘﻔﺎﺩﻩ ﻣﻰﻛﺮﺩﻡ ﻭ ﺑﻪ ﺧﺎﻃﺮ ﻫﻤﻴﻦ ﻣﻦ ﺩﺍﺭﻭﻫﺎﻡ‬
‫ﺭﻭ ﺗﺮﻙ ﻛﺮﺩﻡ‪ .‬ﭼﻮﻥ ﺑﺎ ﻫﻢ ﺟﻮﺭ ﺩﺭ ﻧﻤﻰ ﺍﻭﻣﺪﻥ ﻭ ﺑﻪ ﺧﺎﻃﺮ‬
‫ﺍﻋﺘﻴﺎﺩ ﻛﻪ ﺩﺍﺷﺘﻢ ﺩﺍﺭﻭ ﺧﻮﺭﺩﻥ ﺭﺍ ﻭﻝ ﻛﺮﺩﻡ‪ ،‬ﺣﻘﻴﻘﺘ ًﺎ« ]ﻣﺮﺩ‪ ،‬ﺑﻴﻤﺎﺭ‬
‫ﻋﻮﺩﻯ‪ 40 ،‬ﺳﺎﻟﻪ[‪.‬‬
‫ﻳﻜﻰ ﺍﺯ ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺩﺭ ﻣﻮﺭﺩ ﺗﺎﺛﻴﺮ ﺍﻋﺘﻴﺎﺩ ﺑﺮ ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ‬
‫ﭘﺪﺭ ﭼﻨﻴﻦ ﮔﻔﺖ‪ »:‬ﭘﺪﺭﻡ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻛﻪ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﺳﻞ ﺑﻮﺩ‪،‬‬
‫ﻣﻮﺍﺩ ﻣﺨﺪﺭ ﻣﺼﺮﻑ ﻧﻤﻰ ﻛﺮﺩ‪ .‬ﺗﺎ ﺍﻳﻨﻜﻪ ﺩﺍﻣﺎﺩﻣﻮﻥ ‪ 3-2‬ﺑﺎﺭ ﻣﻮﺍﺩ‬
‫ﺑﻬﺶ ﺩﺍﺩ‪ ،‬ﭼﻮﻥ ﭼﻨﺪ ﺳﺎﻝ ﻣﻮﺍﺩ ﻣﻰﻛﺸﻴﺪ ﻧﻤﻰ ﺷﺪ ﻳﻚ ﺩﻓﻌﻪ‬
‫ﻛﻨﺎﺭ ﺑﺬﺍﺭﻩ‪ ،‬ﺩﺭ ﻃﻮﻝ ﺩﺭﻣﺎﻥ‪ ،‬ﺗﺮﻳﺎﻙ ﻣﻰﺧﻮﺭﺩ‪ ،‬ﻧﻤﻰ ﻛﺸﻴﺪ ﻭ ﺑﻪ‬
‫ﺧﺎﻃﺮ ﻫﻤﻴﻦ ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ﺷﺪ«]ﻧﺎﻇﺮ ﺧﺎﻧﻮﺍﺩﮔﻰ‪ ،‬ﺩﺧﺘﺮ ﺑﻴﻤﺎﺭ‪،‬‬
‫‪ 25‬ﺳﺎﻟﻪ[‪.‬‬
‫ﺑﺤﺚ‬
‫ﭘﺎﻳﺒﻨﺪﻯ ﺿﻌﻴﻒ ﺑﻪ ﺩﺭﻣﺎﻥ‪ ،‬ﻳﻜﻰ ﺍﺯ ﻣﻮﺍﻧﻊ ﺍﺻﻠﻰ ﻣﻮﻓﻘﻴﺖ ﺩﺭﻣﺎﻥ‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺍﺳﺖ ﻛﻪ ﻣﻰﺗﻮﺍﻧﺪ ﺑﺎﻋﺚ ﺍﻧﺘﻘﺎﻝ ﻣﻮﺍﺭﺩ‬
‫ﺳﻞ‪ ،‬ﮔﺴﺘﺮﺵ ﺳﻞ ﻣﻘﺎﻭﻡ ﺑﻪ ﺩﺭﻣﺎﻥ ﻭ ﻋﻮﺩ ﻣﺠﺪﺩ ﻣﻮﺍﺭﺩ ﺷﻮﺩ‬
‫]‪ .[20‬ﻳﺎﻓﺘﻪﻫﺎﻯ ﺣﺎﺻﻞ ﺍﺯ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ‬
‫ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺷﺎﻣﻞ ‪ 6‬ﻃﺒﻘﻪ ﻓﺮﻋﻰ ﺑﻮﺩ‪ .‬ﺑﺮﺍﻯ ﻣﻘﺎﻳﺴﻪ ﺍﻳﻦ‬
‫ﻳﺎﻓﺘﻪﻫﺎ ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﺎﺕ ﻗﺒﻠﻰ‪ ،‬ﻧﻮﻳﺴﻨﺪﮔﺎﻥ ﻣﻘﺎﻟﻪ ﺟﺴﺘﺠﻮﻱ‬
‫ﮔﺴﺘﺮﺩﻩﺍﻯ ﺩﺍﺷﺘﻨﺪ ﻭ ﺑﻪ ﻣﻄﺎﻟﻌﻪ ﻣﺘﻮﻥ ﻭ ﻣﻘﺎﻻﺕ ﻣﺮﺗﺒﻂ ﭘﺮﺩﺍﺧﺘﻨﺪ‪،‬‬
‫ﺍﻣﺎ ﻣﻄﺎﻟﻌﻪﺍﻱ ﺑﺎ ﻭﻳﮋﮔﻲﻫﺎﻱ ﻣﺸﺎﺑﻪ ﺩﺭ ﺟﺎﻣﻌﻪ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ‬
‫ﺳﻞ ﻭ ﺳﺎﻳﺮ ﺍﻓﺮﺍﺩ ﻣﺮﺗﺒﻂ ﺑﺎ ﺁﻧﻬﺎ ﻧﻴﺎﻓﺘﻨﺪ‪ .‬ﻫﺮﭼﻨﺪ ﺑﺮﺧﻰ ﺍﺯ ﻣﻔﺎﻫﻴﻢ‬
‫ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻩ ﺩﺭ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎﺕ ﻣﺮﺗﺒﻂ ﺑﺎ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﻯ‬
‫ﺳﻞ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻰ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪﺍﻧﺪ ﻭﻟﻰ ﺗﺮﻛﻴﺐ ﻳﺎﻓﺘﻪﻫﺎ ﻭ ﻣﻔﺎﻫﻴﻢ‬
‫ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻩ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ‪ ،‬ﺗﺮﻛﻴﺒﻲ ﺟﺪﻳﺪ ﺍﺳﺖ‪ .‬ﺑﺎ ﺗﻮﺟﻪ‬
‫ﺑﻪ ﻛﻴﻔﻰ ﺑﻮﺩﻥ ﺗﺤﻘﻴﻖ‪ ،‬ﺍﺳﺘﺨﺮﺍﺝ ﻧﺘﺎﻳﺞ ﻓﻮﻕ ﺗﺤﺖ ﺗﺄﺛﻴﺮ ﻓﺮﻫﻨﮓ ﻭ‬
‫ﻭﻳﮋﮔﻲﻫﺎﻱ ﺧﺎﺹ ﺟﺎﻣﻌﻪ ﻭ ﻣﺤﻴﻂ ﻣﻄﺎﻟﻌﻪ ﻳﻌﻨﻲ ﺍﺳﺘﺎﻥ ﺧﻮﺯﺳﺘﺎﻥ‬
‫ﺍﺳﺖ‪ .‬ﺑﻨﺎﺑﺮﺍﻳﻦ ﺩﺭ ﺍﻳﻨﺠﺎ ﺑﻪ ﻣﻘﺎﻳﺴﻪ ﻣﻔﺎﻫﻴﻢ ﻭ ﺳﺎﺯﻩﻫﺎﻱ ﺍﺳﺘﺨﺮﺍﺝ‬
‫ﺷﺪﻩ ﺑﺎ ﻳﺎﻓﺘﻪﻫﺎﻱ ﺳﺎﻳﺮ ﻣﻄﺎﻟﻌﺎﺗﻰ ﻛﻪ ﺑﺨﺸﻲ ﺍﺯ ﺁﻧﻬﺎ ﻣﺸﺎﺑﻪ ﺑﻮﺩ‪،‬‬
‫ﭘﺮﺩﺍﺧﺘﻪ ﺷﺪﻩﺍﺳﺖ‪.‬‬
‫ﻳﻜﻰ ﺍﺯ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ‬
‫ﻛﻪ ﺍﻛﺜﺮ ﻫﻤﻜﺎﺭﺍﻥ ﺷﺮﻛﺖ ﻛﻨﻨﺪﻩ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺁﻥ ﺍﺷﺎﺭﻩ ﻧﻤﻮﺩﻧﺪ‪،‬‬
‫ﺿﻌﻒ ﺣﻤﺎﻳﺖ ﺍﺟﺘﻤﺎﻋﻰ ﺑﻮﺩ‪ .‬ﺍﺯ ﺁﻧﺠﺎﺋﻰ ﻛﻪ ﺿﻌﻒ ﺣﻤﺎﻳﺖ‬
‫ﺍﺟﺘﻤﺎﻋﻰ ﺗﻮﺳﻂ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺑﻪ ﻋﻨﻮﺍﻥ ﻣﺎﻧﻌﻰ ﺑﺮﺍﻯ ﺗﺒﻌﻴﺖ‬
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‫ﻣﻄﺎﻟﻌﻪﺍﻯ ﺩﺭ ﺭﻭﺳﻴﻪ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﺧﺴﺘﻪ ﺷﺪﻥ ﭘﺰﺷﻜﺎﻥ ﺯﻧﺪﺍﻥ‪،‬‬
‫ﻓﻘﺪﺍﻥ ﺗﺠﻬﻴﺰﺍﺕ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻰ ﻭ ﺗﺸﺨﻴﺼﻰ ﻣﻨﺎﺳﺐ ﺩﺭ ﺯﻧﺪﺍﻥ ﻭ‬
‫ﻧﺒﻮﺩ ﺳﻴﺴﺘﻤﻬﺎﻯ ﺟﺪﺍ ﺳﺎﺯﻯ ﻣﻨﺎﺳﺐ‪ ،‬ﺑﻪ ﻃﻮﺭ ﺑﺎﻟﻘﻮﻩ ﻫﻢ ﻛﺎﺭﻛﻨﺎﻥ‬
‫ﺑﻬﺪﺍﺷﺘﻰ ﺯﻧﺪﺍﻥ ﻭ ﻫﻢ ﺯﻧﺪﺍﻧﻴﺎﻥ ﺭﺍ ﺩﺭ ﻣﻌﺮﺽ ﺳﻞ ﻭ ﺳﻞ ﻣﻘﺎﻭﻡ‬
‫ﺑﻪ ﺩﺭﻣﺎﻥ ﻗﺮﺍﺭ ﻣﻰﺩﻫﺪ ]‪ .[26‬ﺯﻧﺪﺍﻧﻴﺎﻥ ﻳﻚ ﮔﺮﻭﻩ ﺑﺎ ﺭﻳﺴﻚ ﺧﻄﺮ‬
‫ﺑﺎﻻ ﺑﺮﺍﻯ ﺍﻧﺘﻘﺎﻝ ﺳﻞ ﻫﺴﺘﻨﺪ ]‪ .[27‬ﻛﻪ ﺑﺎ ﻳﺎﻓﺘﻪﻫﺎﻯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ‬
‫ﻫﻤﺨﻮﺍﻧﻰ ﺩﺍﺭﺩ‪.‬‬
‫ﻛﻪ ﺑﺎ ﻣﻄﺎﻟﻌﻪﺍﻯ ﻛﻪ ﺩﺭ ﻧﭙﺎﻝ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺑﻮﺩ ﻭ ﺑﻴﻜﺎﺭﻯ ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ‬
‫ﻧﺘﻴﺠﻪ ﮔﻴﺮﻯ‬
‫ﻧﺘﺎﻳﺞ ﺍﻳﻦ ﭘﮋﻭﻫﺶ ﻋﻮﺍﻣﻞ ﺍﺟﺘﻤﺎﻋﻰ ﻣﻮﺛﺮ ﺑﺮ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ‬
‫ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺭﺍ ﺍﺭﺍﺋﻪ ﻧﻤﻮﺩ ﻛﻪ ﻣﻰﺗﻮﺍﻥ ﺑﺮﺍﺳﺎﺱ ﺁﻥ ﺟﻬﺖ ﻛﺎﻫﺶ‬
‫ﻣﻮﺍﻧﻊ ﻭ ﺁﻣﻮﺯﺵ ﻣﺆﺛﺮ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﺍﻓﺮﺍﺩ ﺧﺎﻧﻮﺍﺩﻩ ﺁﻧﻬﺎ ﻭ ﻧﺎﻇﺮﻳﻦ ﺑﺮ‬
‫ﺩﺭﻣﺎﻥ‪ ،‬ﻣﺪﺍﺧﻼﺕ ﻣﻨﺎﺳﺒﻰ ﺭﺍ ﻃﺮﺍﺣﻰ ﻭ ﺍﺟﺮﺍ ﻧﻤﻮﺩ‪ .‬ﺩﺭ ﺿﻤﻦ‬
‫ﺍﺯ ﺁﻧﺠﺎﺋﻰ ﻛﻪ ﻳﺎﻓﺘﻪﻫﺎﻯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﺗﻌﺪﺍﺩﻯ‬
‫ﺍﺯ ﻣﺸﺎﺭﻛﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻳﺎ ﺧﻮﺩ ﺳﺎﺑﻘﻪ ﺯﻧﺪﺍﻥ ﺩﺍﺷﺘﻪﺍﻧﺪ‬
‫ﻭ ﻳﺎ ﺩﺭ ﺗﻤﺎﺱ ﺑﺎ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺑﻮﺩﻩﺍﻧﺪ ﻛﻪ ﺳﺎﺑﻘﻪ ﺯﻧﺪﺍﻥ‬
‫ﺩﺍﺷﺘﻪﺍﻧﺪ‪ ،‬ﺑﻨﺎﺑﺮﺍﻳﻦ ﺑﻪ ﻧﻈﺮ ﻣﻰﺭﺳﺪ‪ ،‬ﻛﻪ ﻳﻜﻰ ﺍﺯ ﻋﻮﺍﻣﻞ ﺍﻧﺘﺸﺎﺭ‬
‫ﺑﻴﻤﺎﺭﻯ ﺳﻞ ﺩﺭ ﺍﺳﺘﺎﻥ ﺧﻮﺯﺳﺘﺎﻥ ﺍﻓﺮﺍﺩ ﺯﻧﺪﺍﻧﻰ ﻭ ﻳﺎ ﻛﺴﺎﻧﻰ ﻛﻪ‬
‫ﺳﺎﺑﻘﻪ ﺯﻧﺪﺍﻥ ﺩﺍﺭﻧﺪ‪ ،‬ﻣﻰﺑﺎﺷﻨﺪ‪ .‬ﻟﺬﺍ ﭘﻴﺸﻨﻬﺎﺩ ﻣﻰﺷﻮﺩ ﻛﻪ ﺑﺮﺍﻯ‬
‫ﺟﻠﻮﮔﻴﺮﻯ ﺍﺯ ﺍﻧﺘﺸﺎﺭ ﺑﻴﻤﺎﺭﻯ ﺳﻞ ﻭ ﻫﻤﭽﻨﻴﻦ ﺳﻞ ﻣﻘﺎﻭﻡ ﺑﻪ‬
‫ﺩﺭﻣﺎﻥ ﺩﺭ ﺯﻧﺪﺍﻧﻬﺎ‪ ،‬ﺟﺪﺍﺳﺎﺯﻯ ﺍﻓﺮﺍﺩ ﻣﺸﻜﻮﻙ ﺑﻪ ﺳﻞ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ‬
‫ﺳﻴﺴﺘﻤﻬﺎﻯ ﺟﺪﺍﺳﺎﺯﻯ ﻣﻨﺎﺳﺐ ﺗﺎ ﻣﺸﺨﺺ ﺷﺪﻥ ﻭﺿﻌﻴﺖ ﻧﻬﺎﻳﻰ‬
‫ﺁﻧﻬﺎ ﻛﺎﻣﻼ ﺻﻮﺭﺕ ﮔﻴﺮﺩ ﻭ ﺗﺠﻬﻴﺰﺍﺕ ﺗﺸﺨﻴﺼﻰ ﻣﻨﺎﺳﺐ ﺩﺭ ﺯﻧﺪﺍﻧﻬﺎ‬
‫ﺑﺮﺍﻯ ﺗﺸﺨﻴﺺ ﺳﺮﻳﻊ ﻓﺮﺍﻫﻢ ﮔﺮﺩﺩ ﻭ ﺍﺯ ﺗﻬﻮﻳﻪﻫﺎﻯ ﻣﻨﺎﺳﺐ ﺑﺮﺍﻯ‬
‫ﺯﻧﺪﺍﻧﻬﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺷﻮﺩ‪ ،‬ﻫﻤﭽﻨﻴﻦ ﺑﺎﻳﺪ ﭘﺬﻳﺮﺵ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﺯﻧﺪﺍﻧﻬﺎ ﺑﺎ‬
‫ﺗﻮﺟﻪ ﺑﻪ ﻇﺮﻓﻴﺖ ﺯﻧﺪﺍﻧﻬﺎ ﺻﻮﺭﺕ ﮔﻴﺮﺩ ﺗﺎ ﺍﺯ ﺍﺯﺩﺣﺎﻡ ﺟﻤﻌﻴﺖ ﺩﺭ‬
‫ﺯﻧﺪﺍﻧﻬﺎ ﺟﻠﻮﮔﻴﺮﻯ ﺷﻮﺩ‪.‬‬
‫ﻣﺤﺪﻭﺩﻳﺘﻬﺎ‪ :‬ﺧﻮﺩﺩﺍﺭﻯ ﺍﺯ ﻫﻤﻜﺎﺭﻯ ﺑﺮﺧﻰ ﻧﺎﻇﺮﻳﻦ ﺑﺮ ﺩﺭﻣﺎﻥ‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﺩﺭ ﻣﺮﺍﻛﺰ ﺑﻬﺪﺍﺷﺘﻰ ﺩﺭﻣﺎﻧﻰ ﺑﺎ ﭘﮋﻭﻫﺸﮕﺮﺍﻥ‬
‫ﻭ ﻋﺪﻡ ﺗﻤﺎﻳﻞ ﺑﺮﺧﻰ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺮﺍﻯ ﺷﺮﻛﺖ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺍﺯ‬
‫ﻣﺤﺪﻭﺩﻳﺘﻬﺎﻯ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻮﺩ‪.‬‬
‫ﺭﻭﻯ ﻋﻮﺍﻣﻞ ﻭ ﻋﻠﻞ ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ﺑﻌﺪ ﺍﺯ ﺷﺮﻭﻉ ﺩﺭﻣﺎﻥ ﺳﻞ ﺩﺭ‬
‫ﻣﻴﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﺭﻳﻮﻯ ﺍﺳﻤﻴﺮ ﻣﺜﺒﺖ ﺻﻮﺭﺕ ﮔﺮﻓﺖ‪ ،‬ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ‬
‫ﻣﺸﻜﻼﺕ ﻣﺮﺑﻮﻁ ﺑﻪ ﻛﺎﺭ )‪ (%14‬ﺍﺯ ﻋﻮﺍﻣﻞ ﻣﺮﺑﻮﻁ ﺑﻪ ﻗﻄﻊ ﺩﺭﻣﺎﻥ‬
‫ﻣﻰﺑﺎﺷﻨﺪ ]‪.[21‬‬
‫ﻫﻤﭽﻨﻴﻦ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻴﻤﺎﺭﺍﻧﻰ ﺑﻮﺩﻧﺪ ﻛﻪ ﺍﺯ ﻣﺸﻜﻼﺕ ﻣﺎﻟﻰ‬
‫ﻭ ﻧﺪﺍﺷﺘﻦ ﺩﺭﺁﻣﺪ ﺑﻪ ﺧﺎﻃﺮ ﻣﺒﺘﻼ ﺷﺪﻥ ﺑﻪ ﺳﻞ ﻭ ﺍﺯ ﺩﺳﺖ ﺩﺍﺩﻥ ﻛﺎﺭ‬
‫ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﺎﻣﻠﻰ ﺑﺮﺍﻯ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﻭ ﻧﺨﻮﺭﺩﻥ ﺩﺍﺭﻭﻫﺎ‪ ،‬ﻳﺎﺩ ﻛﺮﺩﻧﺪ‬
‫ﻳﻜﻰ ﺍﺯ ﻋﻮﺍﻣﻞ ﻗﻄﻊ ﺩﺭﻣﺎﻥ ﺍﻋﻼﻡ ﻧﻤﻮﺩﻩ ﺑﻮﺩ ]‪ ،[24‬ﻫﻤﺨﻮﺍﻧﻰ‬
‫ﺩﺍﺷﺖ‪ .‬ﺍﻣﺎ ﺩﺭ ﻣﻄﺎﻟﻌﺎﺕ ﺍﺷﺎﺭﻩ ﺷﺪﻩ‪ ،‬ﻣﺴﺎﺋﻞ ﺷﻐﻠﻰ ﺑﻴﺸﺘﺮ ﺍﺯ ﻧﻈﺮ‬
‫ﻣﺎﻟﻰ ﻭ ﺍﻗﺘﺼﺎﺩﻯ ﻣﻮﺭﺩ ﺗﻮﺟﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ ﺍﻣﺎ ﻫﻤﺎﻧﮕﻮﻧﻪ ﻛﻪ‬
‫ﮔﻔﺘﻪ ﺷﺪ‪ ،‬ﻣﺸﻐﻠﻪ ﺯﻳﺎﺩ ﻧﻴﺰ ﻣﻰﺗﻮﺍﻧﺪ ﺩﺭ ﺍﻓﺮﺍﺩ ﺷﺎﻏﻞ ﻛﻪ ﺍﺣﺘﻤﺎﻻً‬
‫ﻣﺸﻜﻞ ﺍﻗﺘﺼﺎﺩﻯ ﻧﺪﺍﺭﻧﺪ ﻣﺎﻧﻌﻰ ﺑﺮﺍﻯ ﺗﺒﻌﻴﺖ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺩﺭﻧﺘﻴﺠﻪ‬
‫ﺷﻜﺴﺖ ﺩﺭﻣﺎﻥ ﺷﻮﺩ ﻭ ﻻﺯﻡ ﺍﺳﺖ ﺩﺭ ﺁﻳﻨﺪﻩ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻰ ﻭ‬
‫ﺗﺤﻘﻴﻖ ﻗﺮﺍﺭ ﮔﻴﺮﺩ ﺗﺎ ﺭﺍﻫﻜﺎﺭﻯ ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﺍﻓﺰﺍﻳﺶ ﺗﺒﻌﻴﺖ ﺍﻳﻦ‬
‫ﮔﺮﻭﻩ ﺑﻜﺎﺭ ﮔﺮﻓﺘﻪ ﺷﻮﺩ‪.‬‬
‫ﻳﺎﻓﺘﻪﻫﺎﻯ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﺩﺍﺩ‪ ،‬ﺑﻴﻤﺎﺭﺍﻧﻰ ﻛﻪ ﻓﻘﻴﺮ ﻫﺴﺘﻨﺪ ﺗﻮﺍﻧﺎﻳﻰ‬
‫ﭘﺮﺩﺍﺧﺖ ﻫﺰﻳﻨﻪ ﺗﺰﺭﻳﻖ ﺩﺍﺭﻭ‪ ،‬ﻫﺰﻳﻨﻪ ﺍﻳﺎﺏ ﻭ ﺫﻫﺎﺏ ﺑﻪ ﻣﺮﺍﻛﺰ‬
‫ﺩﺭﻣﺎﻧﻰ ﺑﺮﺍﻯ ﮔﺮﻓﺘﻦ ﺩﺍﺭﻭﻫﺎ ﻭ ﺣﺘﻰ ﺗﻮﺍﻧﺎﻳﻰ ﺗﻬﻴﻪ ﻣﻮﺍﺩ ﻏﺬﺍﻳﻰ‬
‫ﻣﻐﺬﻯ ﺑﻪ ﻋﻠﺖ ﻣﺸﻜﻼﺕ ﺍﻗﺘﺼﺎﺩﻯ ﺭﺍ ﻧﺪﺍﺭﻧﺪ‪ .‬ﻫﻤﻴﻦ ﻣﺴﺌﻠﻪ ﺑﺮ‬
‫ﺗﺒﻌﻴﺖ ﺍﺯ ﺩﺭﻣﺎﻥ ﺁﻧﻬﺎ ﺗﺎﺛﻴﺮ ﻣﻨﻔﻰ ﺩﺍﺭﺩ ﻛﻪ ﺩﺭ ﻣﻄﺎﻟﻌﻪﺍﻯ ﺗﻮﺳﻂ ﺳﺎﻻ‬
‫ﻣﻮﻧﺮﻭ ﻛﻪ ﺩﺭ ﺳﺎﻝ ‪ 2007‬ﺩﺭﺑﺎﺭﻩ ﺗﺒﻌﻴﺖ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﺩﺭﻣﺎﻥ ﺳﻞ‬
‫ﺍﻧﺠﺎﻡ ﺷﺪ‪ ،‬ﻓﻘﺮ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﻜﻰ ﺍﺯ ﻣﻮﺍﻧﻊ ﻭ ﻓﺎﻛﺘﻮﺭﻫﺎﻯ ﺳﺎﺧﺘﺎﺭﻯ‬
‫ﺩﺭ ﺗﺒﻌﻴﺖ ﺍﺯ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ‪ ،‬ﮔﺰﺍﺭﺵ ﺷﺪ ]‪.[25‬‬
‫ﺍﺯ ﻣﻮﺍﻧﻊ ﺍﺳﺘﺨﺮﺍﺝ ﺷﺪﻩ ﺩﺭ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﻯ ﺳﻞ‪ ،‬ﺯﻧﺪﺍﻧﻰ‬
‫ﺷﺪﻥ ﺑﻴﻤﺎﺭﺍﻥ ﺑﻮﺩ ﻛﻪ ﺑﻪ ﻋﻠﺖ ﻣﺸﻜﻼﺕ ﺭﻭﺣﻰ ﻧﺎﺷﻰ ﺍﺯ ﺣﺒﺲ‬
‫ﻭ ﻧﺒﻮﺩ ﻧﺎﻇﺮ ﺑﺮ ﺩﺭﻣﺎﻥ ﺩﺭ ﺭﻭﺯﻫﺎﻯ ﺗﻌﻄﻴﻞ ﻭ ﺑﻰﺗﻮﺟﻬﻰ ﺑﻪ ﺁﻧﺎﻥ‪،‬‬
‫ﺑﻴﻤﺎﺭﺍﻥ ﺗﺒﻌﻴﺖ ﺿﻌﻴﻔﻰ ﻧﺴﺒﺖ ﺑﻪ ﺩﺭﻣﺎﻥ ﺩﺍﺷﺘﻨﺪ ﻛﻪ ﺍﻳﻦ ﻳﺎﻓﺘﻪﻫﺎ ﺑﺎ‬
‫ﺗﺤﻘﻴﻘﺎﺕ ﺍﺳﺘﻮﺭﻯ ﻭ ﻫﻤﻜﺎﺭﺍﻥ ﻛﻪ ﺩﺭ ﻟﻨﺪﻥ ﺍﻧﺠﺎﻡ ﮔﺮﻓﺖ ﻭ ﻳﻜﻰ‬
‫ﺍﺯ ﻓﺎﻛﺘﻮﺭﻫﺎﻯ ﻣﻮﺛﺮ ﺩﺭ ﺗﺒﻌﻴﺖ ﺿﻌﻴﻒ ﺍﺯ ﺩﺭﻣﺎﻥ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ‬
‫ﺑﻪ ﺳﻞ ﺭﺍ ﺯﻧﺪﺍﻧﻰ ﺷﺪﻥ ﺁﻧﺎﻥ ﮔﺰﺍﺭﺵ ﻧﻤﻮﺩ ﻫﻤﺨﻮﺍﻧﻰ ﺩﺍﺷﺖ]‪.[20‬‬

‫ﺗﺸﻜﺮ ﻭ ﻗﺪﺭﺩﺍﻧﻰ‬
‫ﺍﻳﻦ ﻣﻘﺎﻟﻪ ﺑﺮﮔﺮﻓﺘﻪ ﺍﺯ ﭘﺎﻳﺎﻥ ﻧﺎﻣﻪ ﺁﻗﺎﻯ ﻣﺼﻄﻔﻰ ﺟﻴﺒﺎ ﺩﺍﻧﺸﺠﻮﻯ ﻛﺎﺭﺷﻨﺎﺳﻰ ﺍﺭﺷﺪ ﺁﻣﻮﺯﺵ ﺑﻬﺪﺍﺷﺖ ﺍﺳﺖ ﻛﻪ ﺑﻪ ﻋﻨﻮﺍﻥ ﻃﺮﺡ ﺗﺤﻘﻴﻘﺎﺗﻰ‬
‫ﻣﺼﻮﺏ ﻭ ﺑﺎ ﺣﻤﺎﻳﺖ ﻣﻌﺎﻭﻧﺖ ﺗﺤﻘﻴﻘﺎﺕ ﻭ ﻓﻨﺎﻭﺭﻯ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ ﺟﻨﺪﻯ ﺷﺎﭘﻮﺭ ﺍﻫﻮﺍﺯ ﻭ ﺩﺭ ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﺑﻴﻤﺎﺭﻳﻬﺎﻯ ﻋﻔﻮﻧﻰ‬
‫ﻭ ﮔﺮﻣﺴﻴﺮﻯ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ )ﺷﻤﺎﺭﻩ ﻃﺮﺡ ‪ .(TB-04‬ﻧﻮﻳﺴﻨﺪﮔﺎﻥ ﻻﺯﻡ ﻣﻰﺩﺍﻧﻨﺪ ﻛﻪ ﺍﺯ ﻫﻤﻜﺎﺭﻯ ﺑﻴﻤﺎﺭﺍﻥ‪ ،‬ﺍﻋﻀﺎﻯ ﺧﺎﻧﻮﺍﺩﻩ ﺁﻧﻬﺎ‪ ،‬ﻧﺎﻇﺮﻳﻦ‬
‫ﺑﺮ ﺩﺭﻣﺎﻥ‪ ،‬ﭘﺮﺳﻨﻞ ﻭﺍﺣﺪ ﺳﻞ ﻣﺮﻛﺰ ﺑﻬﺪﺍﺷﺖ‪ ،‬ﻣﺮﺍﻛﺰ ﺑﻬﺪﺍﺷﺘﻰ ﺩﺭﻣﺎﻧﻰ ﺷﻬﺮﻯ‪ /‬ﺭﻭﺳﺘﺎﻳﻰ‪ ،‬ﭘﺎﻳﮕﺎﻩﻫﺎﻯ ﺑﻬﺪﺍﺷﺘﻰ‪ ،‬ﻭ ﺧﺎﻧﻪﻫﺎﻯ ﺑﻬﺪﺍﺷﺖ ﺍﺳﺘﺎﻥ‬
‫ﺧﻮﺯﺳﺘﺎﻥ ﻭ ﺗﻤﺎﻣﻰ ﻋﺰﻳﺰﺍﻧﻰ ﻛﻪ ﺑﻪ ﺍﺟﺮﺍﻯ ﺍﻳﻦ ﭘﮋﻭﻫﺶ ﻛﻤﻚ ﻧﻤﻮﺩﻩﺍﻧﺪ ﻭ ﻫﻤﭽﻨﻴﻦ ﺍﺯ ﺣﻤﺎﻳﺖ ﺩﺍﻧﺸﻜﺪﻩ ﺑﻬﺪﺍﺷﺖ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻰ‬
‫ﺍﻫﻮﺍﺯ ﺗﺸﻜﺮ ﻭ ﻗﺪﺭﺩﺍﻧﻰ ﻧﻤﺎﻳﻨﺪ‪.‬‬
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