ABSTRACT
A growing research agenda shows the importance of local welfare systems in understanding socio-spatial inequalities in health. Welfare services provided by local governments overlap with those provided by other levels of government. Thus, differences in the provision of welfare services between municipalities could explain differences in residents' health, moderating the magnitude of health inequalities if local governments deploy actions capable of positively influencing the social determinants of health. This article attempts to analyse this idea in the Spanish case, exploring the influence of local policies according to the orientation of municipal spending on three indicators of the population's health status: self-perceived health, healthy practices and activity limitations due to health problems. A multilevel cross-sectional study was designed using information from two waves of the 2006-2007 and 2011-2012 National Health Survey for the population aged 15 years and older (N = 31,378) residing in Spanish municipalities of 20,000 inhabitants or over (N = 373). The results show that the magnitude of inequalities in self-perceived health, in the adoption of healthy practices and in daily activity limitations by social class are smaller as municipalities" spending was oriented towards policy areas considered as redistributive. Therefore, the proposed institutional overlap thesis could help understand the role of subnational governments on the magnitude of health inequalities, as well as in comparative analysis between countries with institutional systems in which local governments have a greater or lesser capacity to provide welfare services.
Subject(s)
Local Government , Social Welfare , Cross-Sectional Studies , Social Class , Health Status , Socioeconomic Factors , Health Status DisparitiesABSTRACT
Objetivo principal: Conocer cuáles son los factores predictores del incumplimiento farmacológico y explorar qué actitudes adoptan las enfermeras ante la conducta no adherente. Metodología: Estudio cualitativo mediante grupos focales y entrevistas en profundidad. Resultados principales: Destacan como condicionantes de la conducta no adherente: a) falta de conocimientos, comorbilidad y polimedicacción; b) características sociodemográficas; c) aspectos psicológicos; d) pérdida de habilidades; y e) modelo de relación profesional-paciente. Ante la conducta no adherente manifiestan diferentes actitudes que reflejan en la relación con el paciente y en el manejo de la adherencia farmacológica. Conclusión principal: Las enfermeras identifican diferentes predictores de incumplimiento farmacológico, aunque centran su atención en los relacionados con el paciente. Predomina el modelo paternalista en la relación con el paciente. Desaconsejan la disponibilidad de glucómetros y tensiómetros así como la lectura del prospecto por considerar que influyen negativamente en el cumplimiento. De la práctica de la automedicación solo destacan los aspectos negativos (AU)
Objective: To discover, according to nurses, which are the predictor factors for pharmacological non-adherence; and to explore what attitudes they adopt when dealing with non-adherence behaviors. Methods: A qualitative study including focal groups and in-depth interviews. Results: The determinant factors for non-adherence behaviors are: a) lack of knowledge, comorbility and polypharmacy; b) sociodemographic features; c) psychological aspects; d) skill loss; and e) the professional-patient relationship model. When encountered with a non-adherent behavior, nurses exhibit different attitudes which have an impact on the relationship with the patient and on the positions they adopt when dealing with pharmacological adherence. Conclusions: Nurses identify several different predictor factors which interfere with pharmacological adherence, although they focus on those related to the patients themselves. Nurses discourage the availability of glucometers, tensiometers and reading the patient information leaflet, for they consider these elements exert a negative influence on adherence. As for self-medication, nurses only highlight the negative aspects (AU)
