Experiences of a group of indigenous women from the Colombian Amazon with cervical cancer prevention screening. Qualitative study in the context of participatory research to reduce inequalities.

OBJECTIVES: Despite cervical cancer (CC) being a preventable disease, its incidence remains high in marginalized communities due to inequalities that restrict access to health services. This article investigates the experiences, perceptions, and attitudes regarding the screening of indigenous women in a region of the Colombian Amazon during a cervical cancer prevention initiative facilitated by community participation. DESIGN: Qualitative study based on interviews conducted with women and indigenous leaders from Paujil reserve. They participated in research focused on cervical cancer prevention, which employed a methodology of collaboration between academia and communities aimed at enhancing women's health and reducing inequalities in access to healthcare services. The analysis utilized a deductive and inductive approach. RESULTS: Five main themes were addressed: 'Barriers within health services'; 'Individual and cultural constraints'; 'Motivations and facilitators'; 'Positive experiences within the research framework'; and 'Suggestions for encouraging women's participation.' Challenges related to appointment scheduling and result delivery were frequently cited as obstacles to access. Misinformation, feelings of shame, fear, and distrust towards health services played significant roles in the reluctance to undergo screening. Factors such as support from family and community networks, respectful treatment, ease of scheduling appointments, the presence of female healthcare professionals, and involvement of leaders fluent in indigenous languages were identified as positive facilitators of screening acceptance. CONCLUSION: Understanding the factors that influence access to screening is crucial for reducing inequalities in service delivery for indigenous women. The involvement of trained leaders who can identify these factors and motivate women can have a positive impact on the acceptance and guidance of cervical cancer prevention programs.

What Should Personalised Mental Health Support Involve? Views of Young People with Lived Experience and Professionals from Eight Countries.

Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.

Clima laboral: percepción del personal de Enfermería y las oportunidades de mejora / Work environment: perception of nursing staffand opportunities for improvement

La presente investigación pretende analizar la percepción del personal de enfermería sobre el clima laboral que vivencia; se identificarán las oportunidades de mejoras por medio de su autogestión de capacidades y se pondrán en práctica las acciones que serán evaluadas para determinar el impacto que produjeron. Material y método: se llevó a cabo un estudio aplicando el modelo de investigación acción participativa con el personal de enfermería del internado general del Sanatorio Allende en el año 2022; para la recolección inicial de datos se suministró una encuesta digital que valoraba la opinión personal sobre el clima laboral que percibe. Se realizó con el equipo completo de enfermeras del internado general del turno de la mañana el cual esta compuesto por 15 enfermeras; debido al número de integrantes no se realizará una muestra, sino que todas estarán contempladas. El proceso constó de cinco etapas: acercamiento y sensibilización, inducción, interacción, implementación, y sistematización. Resultados: se presenta una síntesis de los resultados más destacados en cada etapa: el origen de la situación planteada, revisión de la bibliografía, las acciones para lograr el acercamiento, los argumentos usados en la sensibilización, las herramientas para la inducción, el logro de la interacción y como se aplicaron las oportunidades de mejoras por medio de una sistematización. Conclusiones: la investigación acción participativa permitió a los profesionales determinar cual es su percepción actual de su ambiente laboral, individualmente construyeron probables soluciones a obstáculos en el trabajo en equipo que se podrán poner en práctica colectivamente y de este modo poder reevaluar en el futuro si es necesario conservar o modificar acciones ya que son autoras y partícipes de las acciones de mejora[AU]

This research aims to analyze the perception of nursing staff about the work environment they experience, opportunities for improvement will be identified through self-management of capacities and actions will be put into practice that will be evaluated to determine the impact they produced. Material and method: a study was carried out applying the participatory action research model with the nursing staff of the general boarding school of Sanatorio Allende in the year 2022. For the initial data collection, a digital survey was provided that assessed the personal opinion on the perceived work environment. It is carried out with the complete team of nurses from the general internship, which is made up of 15 nurses. Due to the number of members, a sample will not be made, but all will be contemplated. The process consisted of five stages: approach and awareness, induction, interaction, implementation, and systematization. Results: a synthesis of the most outstanding results in each stage is presented: the origin of the situation raised, review of the biblio-graphy, the actions to achieve rapprochement, the arguments used in raising awareness, the tools for induction, the achievement of the interaction and how the improvement opportunities were applied through a systematization. Conclusions: participatory action research allowed professionals to determine what their current perception of their work environment is, individually they built possible solutions to obstacles in teamwork that could be put into practice collectively and thus be able to reassess in the future if it is It is necessary to pre-serve or modify actions since they are authors and participate in the improvement actions.Palabra chave: ambiente de trabalho, enfermagem, percepção, pesqui-sa-ação participativa, pesquisa participativa baseada na comunidade[AU]

A presente pesquisa tem como objetivos analisar a percepção dos trabalhadores de enfermagem sobre o ambiente de trabalho que vivenciam. Serão identificadas oportunidades de melhorias através da autogestão de capacidades e serão colocadas em prática ações que serão avaliadas para determinar o impacto que produziram. Material e método: foi realizado um estudo aplicando o mode-lo de pesquisa-ação participativa com a equipe de enfermagem do internato geral do Sanatório Allende em 2022. Para a coleta ini-cial de dados, foi disponibilizada uma pesquisa digital que avaliou a opinião pessoal sobre o ambiente de trabalho que percebem. Foi realizado com toda a equipe de enfermeiros do internato geral do turno matutino, que é composta por 15 enfermeiros. Devido ao número de associados, não será realizada amostra, mas todas serão incluídas. O processo consistiu em cinco etapas: abordagem e sensibilização, indução, interação, implementação e sistemati-zação. Resultados: é apresentada uma síntese dos resultados mais notáveis em cada etapa: a origem da situação levantada, revisão da literatura, ações para alcançar a reaproximação, argumentos utili-zados na sensibilização, ferramentas para indução, concretização da interação e como as oportunidades para melhorias foram apli-cadas por meio de sistematização. Conclusões: a pesquisa-ação participativa permitiu aos profissionais determinar sua percepção atual sobre seu ambiente de trabalho, individualmente construí-ram prováveis soluções para os obstáculos no trabalho em equipe que poderiam ser colocadas em prática coletivamente e assim po-der reavaliar no futuro se é necessário preservar ou modificar ações já que são autores e participantes das ações de melhoria.is presented: the origin of the situation raised, review of the biblio-graphy, the actions to achieve rapprochement, the arguments used in raising awareness, the tools for induction, the achievement of the interaction and how the improvement opportunities were applied through a systematization. Conclusions: participatory action research allowed professionals to determine what their current perception of their work environment is, individually they built possible solutions to obstacles in teamwork that could be put into practice collectively and thus be able to reassess in the future if it is It is necessary to pre-serve or modify actions since they are authors and participate in the improvement actions[AU]

Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries.

BACKGROUND: The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals' platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage. METHODS: A descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants' roles, methods) and associated difficulties, coordination problems and interventions selected. RESULTS: LSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200-479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals' time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected. CONCLUSIONS: As expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.

Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005-2022: A Systematic Review.

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.

Concerted Model of Healthcare for Awá Indigenous of Nariño, Colombia.

Indigenous communities in Colombia are facing a critical health situation; alternative health care models based on the vision of the communities themselves are needed. The objective of this research was to create a health care model that decreases health inequities for the Indigenous Awá population of Nariño, Colombia. This study was guided by the paradigm of community-based participatory action research; the process was carried out in 2015 and 2016. The proposed Intercultural Health Care Model is essentially based on health promotion, disease prevention, community empowerment, social participation in health, decentralized health care and coordination between the two medicines (traditional and allopathic). Strategies such as those reported herein, with concerted efforts rather than imposition, maintain human rights and respect for the sovereignty and autonomy of Indigenous people.

Ser joven andino quechua cerca y lejos de sus comunidades de origen / Being young, Andean and Quechua and both near and far from communities of origin / Ser jovem andino quechua perto e longe de suas comunidades de origen

Resumen (analítico) La investigación se pregunta cómo las y los «jóvenes¼ procedentes de comunidades quechuas surandinas del Perú construyen su «ser joven¼ en contextos de imposición neocolonial/neoliberal y, a la vez, de resistencias cerca y lejos de sus lugares de origen. Se realizó desde la postura decolonial con la metodología investigación-acción participativa adaptada al mundo de jóvenes de comunidades de Apurímac, Huancavelica y Ayacucho. Se constata que son afectados por imposiciones de la sociedad nacional, que a través de servicios y políticas públicas les proyectan una manera homogénea y hegemónica de ser joven que tiende a distanciarlos de sus familias y comunidades. La crianza en su cosmovisión será fuente de sus resistencias y les permitirá recuperar sus raíces por la vía de la lengua originaria y de la espiritualidad andina.

Abstract (analytical) This study asks how "young people" from the Quechua communities in Southern Peru construct "being young" in contexts involving neocolonial / neoliberal imposition and, at the same time, of acts of resistance both near and far from their places of origin. It was carried out using a decolonial position through the Participatory Action Research methodology adapted to the worlds of "young people" in the communities of Apurímac, Huancavelica and Ayacucho. The research identified that these young people are affected by impositions from Peruvian society, as government services and public policies project a homogeneous and hegemonic way of being young that tends to distance them from their families and communities. An upbringing based on their worldview will be the source of their resistance and will allow them to recover their roots through native language and Andean spirituality.

Resumo (analítico) A pesquisa questiona como os "jovens" das comunidades quíchuas do sul do Peru constroem seu "ser jovem" em contextos de imposição neocolonial / neoliberal e, ao mesmo tempo, de resistência perto e longe de seus lugares de origem. Foi realizado a partir da posição descolonial com a metodologia da Pesquisa-Ação Participativa adaptada ao mundo dos jovens das comunidades de Apurímac, Huancavelica e Ayacucho. Constata-se que são afetados por imposições da sociedade nacional, que por meio de serviços e políticas públicas os projetam de uma forma homogênea e hegemônica de ser jovem que tende a distanciarse de suas famílias e comunidades. A formação em sua visão de mundo será a fonte de sua resistência e permitirá que recuperem suas raízes por meio da língua nativa e da espiritualidade andina.

Andean Women's Persistence Amidst Racialized Gendered Impoverishment, Capitalist Incursions, and Post-conflict Hauntings.

Throughout the last four decades, Andean women from the highland communities of Peru have been significantly affected by ongoing neoliberal capitalist development and patriarchal structures. These intersecting violence(s) took on more horrific dimensions during the Peruvian armed conflict (1980-2000) and have contributed to multiple psychosocial sequelae that linger in the daily lives on these communities as "ghostly matters." Seeking to face these experiences in a context of ongoing material impoverishment, Andean women from highland communities have initiated multiple associations or economic collective projects. The authors accompanied a group of women who formed a knitting association and facilitated a feminist participatory action research (FPAR), creating opportunities through which these women could engage in action-reflection processes toward enhancing their association. Twelve women from this FPAR process agreed to be interviewed by the first author who sought to explore their understandings about the processes of forming their association in this post-conflict context and the challenges they were facing. Interview transcripts were analyzed using Charmaz's constructivist grounded theory coding strategy. The findings reveal multiple challenges for women's collaborative work created by ongoing racialized gendered violence and its intra- and interpersonal effects. Moreover, the findings confirmed that capitalist development dynamics, and, more particularly, resources introduced by agents from outside the community, bring both gains and losses for Andean women. The latter reported having learned skills that allowed them to better insert themselves in a market economy, but that these new activities were displacing more community-based Indigenous practices and traditions. Finally, this study reveals that the wounds created by the armed conflict generated multiple forms of silence that prevent Andean peasants from openly expressing their desires. Despite this, the women in this FPAR process and participants in these interviews are engaging in action-based responses through which they are overcoming some of these challenges and sustaining their association. The article concludes with a discussion of the implications for mental health professionals and activist-scholars working with Indigenous communities affected by armed conflict by underscoring the limitations of interventions based exclusively on the spoken word and arguing for action-based approaches that draw on bottom-up knowledge and practices.

Implementing joint training sessions of general practitioners and specialists aimed at improving clinical coordination in Colombia: Contributions from participatory action research.

OBJECTIVE: To analyse the contribution of participatory action research (PAR) in designing and implementing joint training sessions as a means to improve clinical coordination in a public health care network in Bogotá, Colombia. METHODS: A qualitative, descriptive-interpretative study using semi-structured individual interviews and focus groups with 40 professionals (GPs, specialists, members of the local steering committee (LSC) and network middle managers) involved in designing and implementing joint training sessions to improve cross-level clinical coordination. The intervention consisted of two forms of joint training sessions for GPs and specialists, implemented through two PAR cycles. RESULTS: The PAR approach in designing and implementing joint training sessions led to greater awareness of clinical coordination problems and helped adapting sessions to the local health care context. Study participants highlighted the role of LSC leadership during the PAR process and the importance of ensuring the necessary resources for adopting the intervention. Limited institutional support and differences between joint training sessions affected doctors' participation and reduced the time available to conduct the sessions. The use of a reflexive method was essential in enhancing doctors' participation, along with session duration, the facilitator's role and session content. CONCLUSIONS: The study provides evidence regarding the contribution of a PAR process to designing and implementing joint training sessions for improving clinical coordination. The findings can inform similar approaches in other health systems.

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries.

Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

Interventions to Improve Clinical Coordination between Levels: Participatory Experience in a Public Healthcare Network in Xalapa, Mexico.

INTRODUCTION: Coordination of care can be improved through an intervention or a combination of several ones. In addition, it is recommended to encourage the active involvement of professionals in the design, implementation and assessment of coordination mechanisms. OBJECTIVE: To analyse the factors that influence the implementation of participatively designed interventions and their effects on clinical coordination between levels of care in a public healthcare network of health services in Xalapa, Veracruz, Mexico. METHODS: A qualitative, descriptive-interpretative study, for which individual interviews and discussion groups with a criterion sample of participants: Local Steering Committee and the Professional Platform. A content analysis, with mixed category generation and segmentation by intervention and topics, was carried out. According to the problem analysis, participants designed two sequential interventions: offline virtual consultation, and joint training meetings on maternal health and chronic diseases. RESULTS: Respondents perceived a differentiated impact on clinical coordination according to intervention: greater in the case of joint maternal health trainings and limited for the chronic diseases meetings, as they were the offline virtual consultation was rarely used. CONCLUSION: The involvement of professionals in designing the interventions, as well as institutional support and reflexive methods for training, all decisively improved clinical coordination between levels.

Somos Dign@s and Trayecto Dignidad: a National Campaign for Advocating Human Rights in Puerto Rico.

Somos Dign@s, a collective, composed by students, professors, and human rights activists, concerned about the crisis of human rights and civil liberties in Puerto Rico designed a successful national campaign for human rights known as: "Trayecto Dignidad" or "The Journey toward Dignity." This educational campaign emulated the Freedom Riders initiative of the 1960s. Throughout this article, we discuss the participatory action research (PAR) methodology designed by Somos Dign@s which frames the work of our Trayecto Dignidad campaign. Our methodology is based on the theoretical approaches of De Sousa-Santos (2002) and his conceptualization of human rights as having to rise through a process of "Globalization from below"; that is, a process of globalization that allows oppressed classes to advocate for their human rights. Five campaigns have been implemented since 2011. Some results have shown the need: (1) to continue educating about human and civil rights; (2) to educate and reinforce public policies to address discrimination based on race, social class, and gender particularly in the work setting; (3) to universalize health services; (4) to conduct a debt audit and advocate for the right of people of Puerto Rico to self-determination (UN Resolution 1514 XV); and (5) to integrate a public policy education based on gender perspective on schools and declare the State of Emergency for the femicides.

Afrocolombian Struggles for Food, Land, and Culture: The Case of El Tiple.

El Tiple is one of many marginalized Afrodescendant communities confined within a green desert located in the southwest region of Colombia. This green desert is most widely known as the second-largest sugarcane monoculture field in the Americas. Herein, we describe a transdisciplinary and participatory effort to understand agroindustrial expansion in the region through the lens of the El Tiple community. Using qualitative and quantitative methodologies, we characterized the socioenvironmental context of El Tiple in terms of ethnography, autoethnography, social cartography, and ethnobotany. We implemented a participatory approach to codevelop a technology-assisted strategy for strengthening the community's small-scale farming activities. Our contextual analysis results show systemic food dispossession, which arises from several factors, including dramatic land transformation, rapid depletion and contamination of natural assets, and biodiversity loss. All these factors are associated with the presence of bordering sugarcane plantations. In collaboration with community members, we designed, constructed, and analyzed a greenhouse hydroponic cultivation system as an actionable means to gradually restore local production of food and medicinal plants for the community. Our transdisciplinary and participatory approach demonstrates how academics can partner with vulnerable communities in the coproduction of knowledge and solutions to pressing social needs.

La educación alimentaria y nutricional como parte de la atención de jóvenes con síndrome de Down en una fundación especializada de la ciudad de Medellín, Colombia / Diet and nutrition education as part of programs for young people with Down's syndrome living in a specialized foundation in the city of Medellin, Colombia

Resumen Antecedentes: la población con síndrome de Down presenta alta prevalencia de sobrepeso por factores genéticos y ambientales, por lo que requiere educación alimentaria y nutricional para promover su salud. Objetivo: diseñar y evaluar estrategias educativas pertinentes para promover el adecuado estado nutricional en población escolar con síndrome de Down. Materiales y métodos: investigación-acción con una muestra de 13 niños y sus cuidadores. Se realizó observación, tamizaje nutricional, grupo focal, entrevistas en profundidad y actividades lúdicas para el diagnóstico educativo; además, se priorizaron problemas y se diseñaron, implementaron y evaluaron estrategias educativas con los cuidadores. Resultados: se encontraron aspectos favorecedores y dificultades en la alimentación, como rechazo por "alimentos saludables", gusto por los denominados "alimentos malos", ansiedad alimentaria y poco conocimiento sobre alimentación. Se realizaron actividades con los cuidadores, centradas en las dificultades; las más aceptadas y efectivas fueron las experienciales y dialógicas; al finalizar, los participantes expresaron aprendizajes significativos que llevaron a cabo en su vida diaria y la de sus familias. Se evidenciaron modificaciones en cuanto a preparaciones más saludables, variedad en la alimentación y cambios hacia hábitos más saludables. Conclusión: los participantes obtuvieron aprendizajes para mejorar la alimentación de los niños y familiares, a partir de sus necesidades y condiciones, con estrategias basadas en metodologías dialogantes.

Abstract Background: Those living with Down's syndrome present high prevalence of overweight due to genetic and environmental factors, which requires nutrition and dietary education to promote adequate health in this population. Objective: Design and evaluate education strategies pertinent to the promotion of an adequate nutritional status in school-aged children with Down's syndrome. Materials and Methods: Action research with a sample of 13 children and their caregivers. Observations, nutritional screening, focus groups, in-depth interviews, and recreational activities were carried out for educational diagnosis. Furthermore, problems were prioritized, and educational strategies were designed, implemented, and evaluated with the caregivers. Results: Favorable and difficult aspects to eating were found, such as rejection of "healthy foods", taste for "bad foods", food anxiety, and little food knowledge. Activities were carried out with caregivers focused on difficulties, of which the most accepted and effective were the experiential and talk based. At the end, the participants expressed significant learning that they implemented in their daily lives and with their families. Modifications such as healthier food preparations, variety in diet, and changes towards healthier habits were evidenced. Conclusions: Participants gained knowledge on improving the diets of their children and families based on their needs and conditions, with strategies based on dialogue, practical and contextualized methodologies, and taking into consideration their viewpoints and concerns.

Competencias genéricas de/la profesional psicopedagogo/a*: Análisis transmetodológico para la actualización del perfil profesional por medio de una experiencia de investigación acción participativa / Generic competences of the professional psychopedagogue: Transmethodological analysis to update the professional profile through an experience of Participatory Action Research

El presente artículo da cuenta de los principales hallazgos generados a partir del proyecto de investigación denominado "Perfil del profesional psicopedagogo/a: Aportes desde una revisión epistemológica a la praxis en Chile. Concepto, ámbitos de acción y roles actuales" realizado por la Agrupación de profesionales Psicopedagogos/as de Chile en el período 2019-2020. En esta primera etapa, por medio de una transmetodología de la investigación con enfoque de Investigación Acción Participativa (IAP), se establece un constructo teórico fundamentado en la empiria, que categoriza las competencias genéricas de los/as profesionales psicopedagogos/as en cuatro áreas principales: investigación, evaluación, acompañamiento y orientación y/o asesoramiento psicopedagógico. Las categorías elaboradas se fundamentan en la triangulación hermenéutica entre datos, teoría y experiencias de diversos actores/as de la Psicopedagogía chilena (académicos/as, trabajadores/as y estudiantes) e invitan a la reflexión en torno a la ruptura paradigmática emergente, la identidad disciplinar, la transmetodología de la investigación y las aportaciones desde la complejidad en la práctica profesional.

This reports the main findings generated from the research project called "Profile of the Psychopedagogue Professional: Contributions from an epistemological review of praxis in Chile. Concept, fields of action and current roles" carried out by the Psychopedagogue Professional Association in Chile in the period 2019-2020. In this first stage, through a transmethodology of research with a Participatory Action Research (IAP) focus, an empirical-based theoretical construct is established, which categorizes the generic competences of professional psychopedagogue in four main areas: research, evaluation, accompaniment and counseling and / or psycho-pedagogical advice. The elaborated categories are based on the hermeneutic triangulation between data, theory and experiences of various actors of the Chilean Psychopedagogy (academics, workers and students) and invite reflection on the emerging paradigmatic rupture, identity discipline, the transmethodology of research and contributions from complexity in professional practice.

A successful community-base pilot programme to control insect vectors of Chagas disease in rural Guatemala

The adoption of novel integrated vector management (IVM) strategies requires proof-of-concept demonstrations. To implement a community-based intervention, for the control of vectors of Chagas disease in Guatemala, we engaged all relevant stakeholder groups. Based on this and previous experiences of the authors on engaged research and community-based interventions, several key factors can help facilitate effective integration of stakeholders in support of area-wide integrated vector management (AW - IVM) programmes. First and foremost, the diversity of stakeholders needs to be engaged early-on in the participatory action research and implementation processes, to provide ownership and contribute ideas on how to design and implement an intervention. Another important component, situational analysis regarding current pest control policies, practices and relevant stakeholders, is generated through interviews with key informants, at both national and local levels (governmental and non-governmental organizations); it can facilitate the joint identification of strengths, weaknesses, opportunities and threats regarding current pest control strategies and proposing solutions through an AW-IVM approach. In addition, successful AW - IVM can result from identifying locally relevant strategies to implement the proof-of-concept demonstrative project. Further, it is critical to maintain constant communication with the local and national leaders, involving them throughout the implementation and evaluation processes. Flexibility should also be built into the project to allow for community-driven changes in the strategy, through a cyclical joint reflective process. Periodic feedback of project development needs to be scheduled with key stakeholders to maintain rapport. Finally, the results of the evaluation should be shared and discussed with stakeholders to ensure long-term sustainability of the programme, intervention, or project. Here we present the citizen engagement procedures used to integrate community members, health officials, and non-governmental organization staff for Chagas disease control in a region of Guatemala. We demonstrate how these methods can be applied to support AW-IVM programmes, so that communities and authorities are actively involved in the development and implementation of a jointly agreed intervention. In 2012, we developed the IVM intervention in an area of Guatemala with persistentTriatoma dimidiata (Latreille) infestation that is associated with the presence of infected rodents (rats and mice), that act as reservoirs of the Trypanosoma cruzi Chagas parasites inside the households. Nine control communities received only the Ministry of Health insecticide application against the vector and nine intervention communities participated in the AW-IVM intervention. The intervention included a programme for rodent control by the community members, together with education about the risk factors for vector infestation, and insecticide application by the Ministry of Health. Entomological evaluations in 2014 and 2015 showed that vector infestation remained significantly lower in both intervention and control communities. In 2015, we found that there was a higher acceptance of vector surveillance activities in the intervention communities compared to control communities, suggesting that participatory activities increase programme sustainability. Finally, we found that there was a significant increase over time in the number of households with infected vectors in the control group, whereas there was no significant increase in the communities that participated in the programme. Thus, an AW-IVM programme including simultaneous rodent and vector control could reduce the risk of Chagas infection in communities with persistent vector infestation.

Systematic review of qualitative studies about malaria in Colombia.

INTRODUCTION: The research about malaria in Colombia has centered mainly on the biomedical (clinical, parasitological, epidemiological and entomological) field, with little focus on qualitative research. PURPOSE: Analyzing social categories related to malaria in Colombia, based on qualitative studies published among scientific literature. METHODS: Systematic review following Cochrane and PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) recommendations. An ex-ante protocol was applied, comprehensive and reproducible for the search, screening, and extraction of information. Methodological quality was evaluated through SRQR (Standards for Reporting Qualitative Research). RESULTS: 10 studies complied with the protocol; these studies interviewed 500 infected or exposed subjects, program administrators, health professionals, and indigenous people. 40 categories were identified, which account for social-economical, cultural and ecological determiners of malaria; insights and ways to understand the disease at an individual level; malaria consequences, and medical attention, disease control and elimination actions. CONCLUSION: A wide variety of populations and subjects was considered. They show similar qualitative evidence on structural determiners, family-individual effects, and ways to understand malaria. Motivations to participate in disease interventions are less known, and they constitute the central axis for subsequent studies aimed to improve community engagement in disease control and elimination initiatives.

Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America.

Healthcare coordination is considered key to improving care quality. Although participatory action research (PAR) has been used effectively to bridge the gap between evidence and practice in other areas, little is known about the key success factors of its use in healthcare organizations. This article analyses the factors influencing the implementation of PAR interventions to improve clinical coordination from the perspective of actors in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. A qualitative, descriptive-interpretative study was conducted in each country's healthcare network. Focus groups and semi-structured individual interviews were conducted to a criterion sample of: local steering committee (LSC) (29), professional platform (PP) (28), health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and themes. The PAR process led by the LSC covered the return of baseline results, selection of problems and interventions and design, implementation and adjustment of the intervention, with PP. Interventions were implemented to improve communication and clinical agreement between primary and secondary care. Results reveal that contextual factors, the PAR process and the intervention's content influenced their implementation, interacting across time. First, institutional support providing necessary resources, and professionals' and managers' willingness to participate, emerge as contextual pivotal factors, influenced by other factors related to: the system (alignment with policy and political cycle), networks (lack of time due to work overload and inadequate working conditions) and individuals (not knowing each other and mutual mistrust). Second, different characteristics of the PAR process have a bearing, in turn, on institutional support and professionals' motivation: participation, flexibility, consensual decision-making, the LSC's leadership and the facilitating role of researchers. Evidence is provided that implementation through an adequate PAR process can become a factor of motivation and cohesion that is crucial to the adoption of care coordination interventions, leading to better results when certain contextual factors converge.

Participatory Action Research Approach to improve Adolescent Girls' Reproductive Health.

OBJECTIVE: School-based reproductive health education programs (RHEP) motivate adolescent girls to maintain and improve their health, and prevent diseases. The purpose of this PAR was to design, implement and evaluate RHEP to strengthen adolescent girl's reproductive health. METHODS: The PAR process was selected as an RHEP strategy, and it has four main phases, including: 1) assessment to explore the reproductive health education needs (RHEN) of adolescent girls. We collected data through in-depth individual interviews with 11 adolescent girls (12-18 years) in high school, 2 focus group discussions (FGD), and 4 interviews with the key informants. 2) Intervention design involved a Delphi approach to design an intervention that would address each need using 7 expert participants with a background in primary health, health promotion and other youth-focused professions. 3) In the action plan phase, the workshops, lecture meetings, counseling, and FGD were organized by the research team. 4) The impact of the intervention was evaluated through a mixed evaluation methodology, a semi-structured interviews with stakeholders and key informant, quasi-experimental assessment and FGD. RESULTS: There were three themes we extracted from the data: (a) the need for RHP for adolescent girls, (b) sources of information about RH, and (c) the need to empower teachers to provide RHEP to their students. a) Workshops, (b Counseling, c) Lecture Meetings, d) Focus Group. The study showed that the level of knowledge about RH in more than half of the participants was poor and only in nearly half of them it was moderate. CONCLUSION: Results suggest that Iranian adolescents do not have adequate education regarding RH, and RHEP by PAR can be effective in improving the knowledge and behavior of female students.

Community-based approaches for malaria case management in remote communities in the Brazilian Amazon

Abstract INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.