«Consultas sagradas» en atención primaria: ¿qué suponen para el personal médico? / "Sacred encounters" in primary care: What do they mean for family physicians?

OBJETIVO: Conocer las percepciones y actitudes de profesionales médicos de familia (MF) ante consultas con gran componente emocional, denominadas inicialmente «consultas sagradas», e identificar ámbitos de mejora en su atención. DISEÑO: Metodología cualitativa con enfoque sociosubjetivo orientado a los servicios de salud. Estudio descriptivo-interpretativo. Emplazamiento: Centros de salud de Araba y Bizkaia. Participantes y/o contextos: Selección de 23 MF de 23 centros de salud urbanos y rurales. MÉTODO: Muestreo intencional buscando la diversidad discursiva. Datos generados en 2016 mediante 3 grupos de discusión y 3 entrevistas individuales grabadas y transcritas tras consentimiento informado. Presentación al Comité de Ética de Euskadi. Análisis temático con ayuda de mapas conceptuales y programa MaxQDA. Triangulación de los resultados entre investigadores y verificación por los participantes. Resultados y discusión: Los hallazgos se agruparon en áreas temáticas solapadas entre sí y relacionadas con el significado de dichas consultas, actitudes profesionales, contexto sanitario y pacientes. Se subraya la importancia de lo emocional en las consultas de atención primaria y su invisibilización, pero se cuestiona la idoneidad del término «sagradas». Su expresión se construye en la interrelación MF-paciente si el personal médico lo favorece y el paciente lo permite, discutiéndose las principales circunstancias que intervienen en una dimensión considerada clave de la integralidad de la atención. CONCLUSIONES: La atención a la dimensión emocional en la consulta presenta deficiencias que es necesario subsanar. Además de su reconocimiento y evaluación, sería preciso modificar los factores organizativos, formativos y profesionales que condicionan la implicación del personal MF en su buena asistencia

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. Participants Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. Results and discusión: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care

[]"Sacred encounters" in primary care: What do they mean for family physicians?] / «Consultas sagradas¼ en atención primaria: ¿qué suponen para el personal médico?

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. PARTICIPANTS: Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. RESULTS AND DISCUSSION: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care.

Percepción del riesgo de contraer una enfermedad de transmisión sexual en población joven / Perception of the risk of adquire a sexually transmitted disease in a young population

Objetivo: Conocer la percepción del riesgo de contraer una enfermedad de transmisión sexual (ETS) en jóvenes de 15–21 años y sus actitudes y sus conductas para adoptar medidas protectoras en las relaciones sexuales. Diseño: Estudio cualitativo de tipo socio constructivista realizado entre 2006–2008.EmplazamientoDos centros de atención primaria de la ciudad de Girona. Participantes: Treinta y cuatro jóvenes seleccionados de listados proporcionados por médicos e informantes clave. Métodos: Muestreo teórico a partir de diferentes perfiles diseñados. Los datos se obtuvieron y se saturaron con la realización de 5 entrevistas grupales. Se realizó un análisis de contenido categorial temático del corpus narrativo. Resultados: Tienen conocimientos parciales sobre sida y escasos sobre otras ETS. El riesgo de embarazo es lo que más influye en la adopción de conductas protectoras. A pesar del buen acceso y el conocimiento del preservativo, en algunos casos no lo usan ni en parejas estables, ni en parejas esporádicas con diferentes justificaciones para realizar estas conductas de riesgo. Tienen muy poco contacto con los servicios sanitarios, la mayoría de las veces para pedir la anticoncepción de emergencia. Conclusiones_ Las estrategias sanitarias deberían encaminarse al acercamiento a los adolescentes de acuerdo con lo que necesitan de los servicios sanitarios en relación con la salud sexual en un contexto diferente del centro de salud. La información debería centrarse en combatir creencias erróneas, como que el sida es una enfermedad de “otros” y no “nuestra”, y focalizar estas actuaciones no sólo en mejorar conocimientos y actitudes, sino en cambios de conducta (AU)

Objective: To find out the perception of the risk of adquire a sexually transmitted disease (STD) in young people (15–21 years), and their attitudes and behaviour to adopt protective measures in sexual relationships. Design: Socio-constructive qualitative study performed between the years 2006 and 2008SettingTwo Primary Care Centres in the city of Girona. Participants: A total of 34 young people selected from lists provided by doctors and key informers. Methods: Theoretical sample from different designed profiles. The data was obtained and saturated by performing 5 group interviews. A thematic content analysis of the narrative data was made of the categorical subject. Results: They had partial knowledge on AIDS and very little on other STD. The risk of pregnancy has the most influence on adopting protective measures. Despite easy access and knowledge of condoms, in some cases they are not used either in stable relationships or in sporadic ones, with different reasons for having this risk behaviour. They have limited contact with the health services, and when they do it is mainly to ask for emergency contraception. Conclusions: Health strategies should be directed towards adolescents, taking into account what they need from the health services as regards sexual health, in a different context from the health centre. Information should be focused on combating erroneous beliefs, such as AIDS is a disease of “others” and not “ours”, and address these actions, not only to improve knowledge and attitudes but also changes in behavior (AU)

[Comprension of a document informing citizens as to the benefits and risks of prostate cancer screening. A semistructured interview-based study]. / Comprensión de un documento que informa a los ciudadanos sobre los beneficios y los riesgos del cribado para el cáncer de próstata. Estudio mediante entrevistas semiestructuradas.

BACKGROUND: The development of tools to aid in prostate cancer screening-related decision-making is a challenge for healthcare professionals and institutions. This study is aimed at evaluating citizen comprehension of a document prepared by experts informing as to prostate cancer screening benefits and risks. METHODS: Phenomenological qualitative study conducted in Barcelona (November 2004-January 2005). The data was gathered by means of seven interviews with males within the 50-70 age range of different educational levels attended in primary care. A descriptive-narrative theme-based categorical content analysis was made of the narrative discourse. RESULTS: This document provides knowledge regarding the aforementioned aspects, although the males possessing a lower level of education point out words and concepts found difficult to understand. In all of the educational strata, the screening-related doubts entertained are due to the prostate-specific antigen not having been precisely stated, the concept most difficult to understand being that of early cancer detection possibly not being beneficial. They are of the opinion that this document is useful for what they consider as being a decision which must be made by the patient with the collaboration of the professionals. Those interviewed are satisfied with the decision made following the information furnished. CONCLUSIONS: The educational level, the locus of control and health beliefs-attitudes condition the comprehension-assimilation of the information. Citizen participation in the preparation of tools to aid in decision-making processes concerning prostate cancer screening affords the possibility of attaining more useful documents. Further research is necessary on the effects this type of information has on citizens.