Evaluación del modelo de calidad de Donabedian en base a los criterios de Chinn y Kramer / Evaluation of the Donabedian quality model based on the Chinn and Kramer criteria

INTRODUCCIÓN: La evaluación de teorías es un proceso crucial para el desarrollo del conocimiento enfermero, permite seleccionar y utilizar la teoría en función de los problemas y fenómenos del cuidado, sin embargo, es escasamente realizada, especialmente en teorías de otras disciplinas. OBJETIVO: Analizar críticamente el modelo de calidad de la atención de salud de Donabedian, a través de la propuesta metodológica de Chinn y Kramer. DESARROLLO: Se realizó un estudio descriptivo-reflexivo del componente teórico y conceptual del modelo de Donabedian, se explica el propósito, conceptos, relaciones, estructura y supuestos. Se continua con la evaluación crítica del modelo, analizada bajo los criterios de claridad, sencillez, generalidad, accesibilidad e importancia, a través de una revisión narrativa de la literatura. CONCLUSIÓN: el modelo es útil para la gestión, los procesos de mejora, evaluación de estrategias y programas. Con valor para enfermería, puesto que coinciden en el significado e importancia otorgada a la calidad de la atención, reconociendo su contribución en la implementación, desarrollo de intervenciones y mejoramiento de la salud.

NTRODUCTION: The evaluation of theories is a crucial process for the development of nursing knowledge, as it allows the selection and use of such theories to address the problems of patient care. However, it is scarcely performed, especially with theoriesfrom disciplines other than nursing. OBJECTIVE: To critically analyze the Donabedian model of health care quality, through the methodological approach of Chinn and Kramer (1999). METHODOLOGY: A descriptive-reflexive study of the theoretical and conceptualcomponent of the Donabedian model was carried out, explaining its purpose, concepts, relationships, structure, and assumptions. A critical evaluation of the model was then conducted, using the criteria of clarity, simplicity, generality, accessibility, and importance, through a narrative review of the literature. CONCLUSIONS: The model is useful for management, improvement processes, and the evaluation of strategies and programs. It is especially valuable for nursing, since it coincides with the meaning and importance given to the quality of nursing care, recognizing its contribution in the development and implementation of interventions and improvement of health.

Barriers to physical activity among adults in primary healthcare units in the National Health System: a cross-sectional study in Brazil

ABSTRACT BACKGROUND: Many factors may negatively impact physical activity (PA), but studies lack evidence of individual predictors of perceived barriers to PA among adults in primary healthcare units. OBJECTIVE: To analyze associations between sociodemographic characteristics, health conditions, leisure-time physical activity (LTPA), PA counseling and perceived barriers to LTPA among adult patients in primary healthcare units of the National Health System in Brazil. DESIGN AND SETTING: Cross-sectional study on a representative sample of adults in primary healthcare units in São José dos Pinhais, Paraná, Brazil. METHODS: This study was conducted in 2019, among 779 adults (70% women). Barriers to LTPA, sociodemographic characteristics (sex, age, marital status, skin color, education and income), health conditions (body mass index, hypertension, diabetes, dyslipidemia, coronary disease and medications), LTPA level and PA counseling received were measured using validated, standardized procedures. The data were analyzed using chi-square and Mann-Whitney U tests. RESULTS: The most prevalent barriers were "feeling too tired" (53%) and "lack of time" (52%). PA counseling was inversely associated with "lack of time" (45% versus 57%; P < 0.001) but positively associated with "injury or disease" (38% versus 29%; P = 0.008). There was an inverse linear trend between the number of barriers and LTPA (walking and total) (P < 0.001). Most barriers differed in comparisons of sociodemographic characteristics, health conditions, LTPA and counseling (P < 0.05). CONCLUSIONS: The barriers vary according to the individual predictors. Counseling strategies need to be specific for each barrier and may be promising for promoting LTPA within primary healthcare.

Impact of COVID-19 public health responses on income, food security and health services among key and vulnerable women in South Africa

Globally, COVID-19 has impacted lives and livelihoods. Women living with HIV and/or at high risk of acquiring HIV are socially and economically vulnerable. Less is known of the impact of COVID-19 public health responses on women from key and vulnerable populations. The purpose of this cross-sectional survey conducted in four South African provinces with a high burden of HIV and COVID-19 from September to November 2021 was to advance understanding of the socio-economic and health care access impact of COVID-19 on women living with HIV or at high risk of acquiring HIV. A total of 2 812 women >15 years old completed the survey. Approximately 31% reported a decrease in income since the start of the pandemic, and 43% an increase in food insecurity. Among those accessing health services, 37% and 36% reported that COVID-19 had impacted their access to HIV and family planning services respectively. Economic and service disruptions were enhanced by living in informal housing, urbanisation and being in the Western Cape. Food insecurity was increased by being a migrant, having fewer people contributing to the household, having children and experience of gender-based violence. Family planning service disruptions were greater for sex workers and having fewer people contributing to the household. These differentiated impacts on income, food security, access to HIV and family planning services were mediated by age, housing, social cohesion, employment and household income, highlighting the need for improved structural and systemic interventions to reduce the vulnerability of women living with HIV or at high risk of acquiring HIV.

Implementación de un modelo de comunicación en Chagas basado en la estrategia de educación por pares / Implementation of a communication model in Chagas based on the peer education strategy

OBJETIVOS: el presente estudio evalúa el cambio en las perspectivas, conocimientos, actitudes y prácticas de los familiares de un grupo de pacientes capacitados con la estrategia de educación por pares que fueron tratados en la Plataforma de atención integral de Chagas, y si ese cambio se traduce en un aumento de la demanda de atención integral de Chagas en los servicios de salud del Valle Alto de Cochabamba. MÉTODOS: se comparó los resultados de la encuesta realizada en 32 familiares de 8 pacientes capacitados en 2018 (grupo A) con una encuesta similar realizada en 64 familiares de 16 pacientes tratados en 2017 (grupo B) que no fueron capacitados, pero en cambio recibieron la consejería que provee el personal de salud de forma rutinaria. RESULTADOS: los resultados obtenidos muestran que los familiares de pacientes educadores pares han modificado sus conocimientos, actitudes, prácticas y percepciones sobre la enfermedad de Chagas y este cambio ha influido positivamente la demanda de atención de servicios integrales para dicha enfermedad. CONCLUSIÓN: la estrategia de educación por pares ha demostrado ser eficaz, fácil de aplicar por un personal de enfermería en los 1º y 2º niveles de atención, y que permite llegar a las familias afectadas a un costo relativamente bajo.(AU)

OBJECTIVES: this study aims to identify changes in the perspectives, knowledges, attitudes and practices of the relatives of a group of patients treated in the Platform of integral care of Chagas, and trained as peer educators, and if that changes led to an increase of the Chagas demand in the health services of Valle Alto, in Cochabamba department. METHODS: we compared the results of the survey conducted on 32 relatives of 8 patients trained in 2018 (group A) with a similar survey conducted on 64 family members of 16 patients treated in 2017 (group B) who were not specifically trained, but received the counseling routinely provided by the health staff. RESULTS: the results show that relatives of peer educators have modified their knowledge, attitudes, practices and perceptions about Chagas disease and this change has influenced the demand for diagnosis of this disease. CONCLUSIONS: the strategy of peer education has proven to be effective, easy to apply by a nursing staff in the 1ª and 2ª levels of care, and allows reaching affected families at an affordable cost.(AU)

Avaliação da acessibilidade na atenção primária à saúde na perspectiva dos gerentes / Evolution of accessibility in primary health care from the perspective of managers

Introdução: O sistema público brasileiro está alicerçado pela atenção primária à saúde, que se caracteriza como o primeiro contato preferencial dos usuários com o serviço de saúde. Nesse contexto, destaca-se a avaliação do serviço como uma ferramenta de gestão que busca detectar possíveis fragilidades e potencialidades do serviço. Objetivo: Avaliar a presença e extensão do atributo acessibilidade na perspectiva dos gerentes da atenção primária à saúde. Material e Métodos: Estudo transversal de caráter avaliativo. Os dados foram coletados entre 42 gerentes das unidades de atenção primária à saúde, por meio do questionário auto aplicável Primary Care Asssessment Tool ­ Brasil, versão para profissionais. A análise estatística foi realizada através do software Statiscal Package for the Social Sciences (versão 22). O teste U de Mann Whitney foi utilizado para comparação dos escores entre os modelos de atenção (eSF e eAB), áreas (rural e urbana), formação e qualificação profissional, com nível de significância de 5%. Resultados: A acessibilidade mostrou-se insatisfatória em todas as análises, com melhor avaliação das equipes de Saúde da Família (p=0,375), na área rural (p=0,528), entre os profissionais que possuem especialização em saúde da família (p=0,685) e residência em saúde da família (p=0,196). Conclusão: O estudo apontou fragilidades estruturais do serviço no que diz respeito à acessibilidade e identificou a importância de investimentos na qualificação dos profissionais como fator que promove melhor acesso ao serviço.

Introdution: The Brazilian public system is enabled by Primary Health Care, wich presents as the first preferential contact of users with the health service. Given this importance, select a service evaluation as a search management tool that can detect potential service weaknesses and potentials. Objective: To assess the presence and extension of the accessibility attribute from the perspective of primary health care managers. Material and Methods: Evaluative cross-sectional study. Data were collected from 42 managers of primary health care units, through the self-administered questionnaire Primary Care Assessment Tool-Brazil, version for professionals. Statistical analysis was performed using the Statiscal Package for Social Sciences software (version 22). The Mann Whitney U test was used to compare the scores the attention models (eSF na eAB), areas (rural and urban), training and professional qualification, with a significance level of 5%. Results: Accessibility was unsatisfactory in all analyzes, with better evaluation of Family Health teams (p=0,375) in the rural areas (p=0,528) among professionals who havespecialization in Family health (p=0,685) and Family health residency (p=0,196). Conclusion: The study pointed out structural weaknesses of the service regarding accessibility, and identified the importance of investments in the qualification of professionals as a factor that promotes better access to the service.

Medical Experiences and Unmet Health Care Perception among Elderly People with Chronic Disease / 보건행정학회지

BACKGROUND: The purpose of this study is to elucidate the context of medical experience and the perception of unmet healthcare of elderly people with chronic diseases based on in-depth interview data. METHODS: We carried out in-depth interviews with 10 elderly people with chronic diseases using semi-structured questionnaires based on literature review. The in-depth interview data were analyzed using thematic analysis; one qualitative research methodology, three core meaning categories, and four attributes associated with unmet healthcare were ultimately derived. RESULTS: The context of the medical experience were based on the following three categories: (1) discomfort due to diseases and high medical needs, (2) the poor community medical environment and difficulties in accessing to metropolitan medical institutions, and (3) inconvenience caused by long waiting time and side effects of medicine. In addition, the elderly with chronic disease realized the unmet healthcare as (1) the availability related to the desired medical institutions at the right time, (2) the affordability related to their economic capacity, (3) the effectiveness of the medical services they experienced, and (4) the appropriateness related to receiving medical services in a pleasant environment. CONCLUSION: The perception of unmet healthcare among the elderly with chronic disease is the result of interaction of multi-level and multi-dimensional factors related with their medical experience.

Avaliação dos Atributos em Atenção Primária à Saúde no Estágio em Saúde da Família / Evaluation of the Attributes of Primary Healthcare during an Internship in Family Health

RESUMO O objetivo deste estudo foi avaliar os atributos da APS desenvolvidos durante o estágio de internato em Saúde da Família do curso médico da Universidade Federal de Alagoas (Ufal). Trata-se de um estudo transversalp, em que os dados foram coletados por meio do questionário PCATool-Brasil aplicado aos preceptores médicos das Unidades Básicas de Saúde da Família (UBSF) e discentes que já haviam cursado o estágio em Saúde da Família. As médias dos escores para ambos, preceptores e discentes, foram consideradas boas: o escore essencial foi 6,71 e 6,78; o escore derivado, 7,35 e 7,67; e o escore geral, 6,88 e 6,91, para preceptores e discentes, respectivamente. No entanto, evidenciaram-se fragilidades nos atributos de acesso (5,94 e 5,91), coordenação do cuidado (5,33 e 5,00) e integralidade e serviços complementares disponíveis (6,36 e 5,99). Foi evidenciado que as UBSF de ensino da Ufal apresentam, em sua maioria, escores satisfatórios dos atributos da APS de maneira a contribuir para uma formação adequada às necessidades de saúde da população, e o seu aprimoramento pode fortalecer sua integração ensino-serviço.

ABSTRACT The aim of this study was to evaluate the attributes of PHC developed during an internship in Family Health. Cross-sectional in nature, data for the study was collected via the PCATool-Brazil questionnaire applied to both medical preceptors in Basic Unit Family Health (UBSF) and students to have attended Family Health training at the Federal University of Alagoas (Ufal). The average scores for both preceptors and students were considered good: essential scores were 6.71 and 6.78, derivative scores were 7.35 and 7.67 and overall scores were 6.88 and 6.91 for the preceptors and the students respectively. Several weaknesses were however highlighted on access attributes (5.94 and 5.91), care coordination (5.33 and 5.00), integrality and complementary services (6.36 and 5.99). This showed that scores for Ufal’s teaching UBSFs are mostly up to the APS standards, therefore helping ensure it provides training adapted to the population’s healthcare needs, although adjustments may be made where necessary in order to strengthen teaching and service integration.

Access to public dental care facilities in Chandigarh.

Objectives: The objective of the study was to determine the level of dental health care access and associated factors, at various public health facilities in the Union Territory (UT) of Chandigarh. Materials and Methods: A study was done using a multistage random sampling technique, to interview adult respondents at their homes and to interview the dentists in the public dental clinics and hospitals. Results: The mean composite access score was 59.2 (SD 18.9) in urban areas and 60.5 (SD 20.9) in rural areas (P=0.64) on a scale of 100. The mean score for the self-perceived condition of their oral health was 6.47 (95% CI 6.17 - 6.76). Thirty-four percent of the respondents did not contact a dentist despite having a problem in the last year, primarily because dental problems were not important for them (45%), they lacked time (22%), and took self-medication (16%). Overall 58% of the respondents suggested government clinics and 44% liked private dentists for treatment of dental cavities. The government setup was preferred because the facilities were cheaper and affordable. Conclusions: Dental health care access and only limited dental facilities were available in most of the dental clinics in Chandigarh. Self-reported dental problem was low, and people ignored their dental problems.

A Survey on Health Behavior of Chinese Foreign Students in Japan / 国際保健医療

<B>Objective</B><BR>The number of foreign students coming to Japan continues to increase year by year. The majority of those students are from China. Besides social problems and insurance difficulties, cultural differences are an underlying cause of their health problem. The aim of our research is to evaluate the health behavior and health status of students from China who are living in Japan with the objective of providing recommendations for improvement of health care.<BR><B>Method</B><BR>A survey of students was conducted using questionnaires. The target for this study is Chinese students compared with domestic students at the same university in Japan. The contents of the questionnaire are related to; attribute attitude toward health and sickness, belief in health, mental and physical health status, social support, health behavior, and fitness activity.<BR><B>Results</B><BR>The rate of collected questionnaires was 35.7% (107/300) from Chinese students and 47.7% (143/300) from Japanese students. The average age of Chinese students was 24.5 years old and average duration of their stay was three years. Chinese students had high consciousness about maintaining good health. They obtained social support from friends, parents, acquaintances, family members other than parents and not much was obtained from school related people. As for health habit, female students were more likely to practice good health habits than males.<BR><B>Conclusions</B><BR>1.Chinese students had high consciousness about maintaining good health.<BR>2.Chinese students living in a foreign culture are highly aware and concerned about their health status but they are not in a position to obtain sufficient social support from university. It is vital for them to secure imminent social supports from now on.<BR>3.Differences in responses by gender were evident in the group related to health habits.

Equidad en el acceso al tratamiento para el cáncer de mama en Colombia / Equity in access to treatment for breast cancer in Colombia

OBJETIVOS: Evaluar la equidad en el acceso al tratamiento para cáncer de mama y comparar las barreras geográficas, económicas y organizacionales y las autorizaciones que enfrentan las mujeres, de acuerdo con su afiliación a la seguridad social en salud. MATERIAL Y MÉTODOS: Seguimiento retrospectivo a través de encuestas a mujeres bajo tratamiento para establecer la equidad y contrastar los obstáculos para acceder al tratamiento con objeto de determinar las diferencias relacionadas con su condición de afiliación a la seguridad social en salud. RESULTADOS: Es más probable que las afiliadas al régimen subsidiado y las mujeres de estratos pobres sin seguro deban desplazarse a otra ciudad para recibir tratamiento (RM= 2.40; IC95 por ciento: 1.64-3.43, y RM= 1.80; IC95 por ciento: 1.04-3.06, respectivamente). La probabilidad de que las mujeres pobres sin seguro deban pagar por los medicamentos es mayor (RM= 3.7; IC95 por ciento: 2.15-6.44). CONCLUSIONES: El acceso real al tratamiento para cáncer de mama en Colombia es inequitativo, dado que las mujeres más vulnerables enfrentan mayores barreras.

OBJECTIVES: To evaluate equity in access by comparing geographic, economic, and organizational barriers as well as authorization obstacles that women encounter depending on their affiliation with the social security health system. MATERIAL AND METHODS: A retrospective survey was conducted among women undergoing breast cancer treatment to determine differences and the degree of fairness in access to care according to their affiliation with the social security health system. RESULTS: Women affiliated with the subsidized social security health system as well as women living in rural areas have a greater probability to travel to another city (OR 2.40 IC95 percent;1.64-3.43 and OR 1.80 IC95 percent;1.04-3.06, respectively). Poor women without insurance have greater probability of having to pay for medications (OR 3.7 IC95 percent;2.15-6.44). CONCLUSIONS: Access to breast cancer treatment is inequitable and particularly detrimental to vulnerable populations.

Equidad en la detección del cáncer de seno en Colombia / Equity regarding early breast cancer screening according to health insurance status in Colombia

Objetivos Evaluar la equidad en la detección temprana del cáncer de seno, comparando el acceso real y la oportunidad de la mamografía según la condición de afiliación a la seguridad social en salud de la mujer. Métodos Se adelantó un seguimiento retrospectivo a mujeres en tratamiento por esta patología en Bogotá, Cali, Medellín, Bucaramanga y Barranquilla entre enero de 2005 y junio de 2006 a quienes se les aplicó una encuesta personal para recoger información sobre el acceso real y la oportunidad de la mamografía como prueba de detección temprana. Para establecer diferencias según la condición de afiliación a la seguridad social en salud se calcularon OR con intervalos de confianza del 95 por ciento, ajustados a través de modelos de regresión logística múltiple y se evaluaron posibles interacciones a través del test de verosimilitudes. Resultados Comparadas con las afiliadas al régimen contributivo, tienen menor probabilidad de acceso real a una mamografía para detección temprana las afiliadas al régimen subsidiado (OR=0,46; IC95 por ciento=0,26-0,72) y las pobres sin seguro de salud (OR=0,36; IC95 por ciento=0,13-0,65). Además, el nivel educativo se asocia con el acceso real a esta prueba ya que, comparadas con las alfabetas, las analfabetas tienen menor probabilidad de usar una mamografía de detección (OR=0,13; IC95 por ciento=0,02-0,30). Finalmente, comparadas con las afiliadas al régimen contributivo, las afiliadas al régimen subsidiado tienen menor probabilidad de acceder oportunamente a la mamografía de detección temprana (OR=0,10; IC95 por ciento=0,04-0,41). Conclusiones El uso de una mamografía para detección temprana del cáncer de seno es inequitativo pues tienen menores probabilidades de hacerlo las mujeres más vulnerables de la escala social.

Objectives Evaluating equity regarding early breast cancer detection by comparing real access to and opportunity for mammography screening according to women's social health insurance status. Methods A retrospective follow-up study was conducted on women receiving breast cancer treatment in Bogotá, Cali, Medellin, Bucaramanga and Barranquilla between January 2005 and June 2006. A survey was carried out for collecting data about real access to and the opportunity of having mammography screening. OR and 95 percent confidence intervals were calculated (adjusted by multivariate logistical regression models) for establishing differences according to health insurance status. Possible interactions were investigated through verisimilarity log-like test. Results Women belonging to the contributory regime had a lower probability of real access to mammography screening for early detection of breast cancer than those affiliated to the subsidised regimen (OR=0,46; 0,26-0,72 95 percentCI) and poor uninsured women (OR=0,36; 0,13-0,65 95 percentCI). Educational level was also associated with real access to mammography, illiterate women having a lower probability of receiving mammography screening than literate women (OR=0,13; 0,02-0,30 95 percentCI). Women having government-subsidised health insurance had a lower probability of accessing timely mammography screening (OR=0,10; 0,04-0,41 95 percentCI). Conclusions : Mammography screening for the early detection of breast cancer is not equitable and such inequality particularly affects the most vulnerable women.

A utilização de serviços de saúde por acidentados de trabalho / Health services utilization by occupational injured workers

Neste estudo descrevem-se as características da utilização de serviços de saúde por trabalhadores que sofreram acidentes de trabalho. Os dados provêm das três primeiras fases de um estudo de coorte de base comunitária sobre saúde e trabalho, iniciado no ano 2000, e conduzido com todos os trabalhadores de 2.512 famílias selecionadas por amostragem aleatória de conglomerado, de estágio único, residentes na cidade de Salvador, Bahia. Entrevistas individuais foram empregadas para a coleta de dados. Nesta pesquisa analisaram-se os trabalhadores (n = 628) que referiram ter sofrido acidente de trabalho nos 12 meses antes da entrevista. Observou-se que cerca de metade dos casos de acidentes recebeu primeiros socorros e tratamento médico. A maioria (71%) foi atendida em unidades do SUS. Cerca de 15% tiveram o atendimento pago por planos de saúde privados. Observou-se também que a maioria referiu alta satisfação com o atendimento, tanto em serviços públicos como privados. Entre os usuários do SUS, predominaram os trabalhadores sem carteira assinada, mas trabalhadores segurados também utilizaram os serviços públicos em sua maioria. Concluiu-se que o SUS tem expressiva participação no atendimento de acidentados do trabalho, independentemente da condição de cobertura por planos de saúde.

This study describes the characteristics of health services utilization by workers reporting work-related injuries. Data comes from the three first phases of a community-based cohort study about health and work that started in the year 2000, carried out with all workers from 2,512 families living in the city of Salvador, Bahia, that were selected by one-stage cluster area random sampling. Individual interviews were used for data collection. In this study, cases of work injuries reported during the 12 months before the interview (n=628) are analyzed. The majority (71.0%) of injured workers received medical treatment in facilities from the Unified Health System, SUS, a public health care system of universal coverage. Around 15% received treatment from private health insurance plans. Among SUS customers most workers have no formal job contracts, although insured workers also utilized public health care services. In sum, the SUS has expressive participation in the health care of injured workers independently of their entitlement for private health care.