Desarrollo de un instrumento para medir competencia cultural en trabajadores de Salud

OBJECTIVE: To validate an instrument measuring the cultural competence in health care workers from Chile. METHODS: Using Sue & Sue’s theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study. RESULTS: The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated. CONCLUSION: The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.OBJETIVO: Validar un instrumento de medición de competencia cultural en trabajadores de salud de Chile. MÉTODOS: Utilizando el modelo teórico de Sue y Sue, se diseñó un instrumento de medición el cual fue evaluado por trabajadores de salud y expertos. Este instrumento se aplicó a una muestra diversa de 483 proveedores de salud, durante 2018 en Santiago de Chile. Se realizó análisis factorial exploratorio, confirmatorio, estimación de confiabilidad y análisis de sesgo de medición. Se estimó el nivel de competencia cultural alcanzado por los profesionales. RESULTADOS: El instrumento final contó con 14 ítems los cuales se agruparon en tres dimensiones: sensibilidad a los propios prejuicios, conocimiento cultural y habilidades para trabajar en entornos culturalmente diversos. Esta herramienta mostró buen ajuste en los modelos factoriales, adecuada confiabilidad y ausencia de evidencias de sesgo de medición. Los trabajadores de salud evaluados exhibieron un bajo nivel de sensibilidad a los propios prejuicios en comparación con las otras dimensiones evaluadas. CONCLUSIONES: La Escala de Medición de Competencia Cultural en trabajadores de salud (EMCC-14) es una herramienta confiable, con soporte inicial para su validez, que puede usarse en el contexto Chileno. Además, los resultados de este estudio podrían guiar algunas posibles intervenciones en el sector de la salud para fortalecer el nivel de competencia cultural

Desafíos en la atención sanitaria de migrantes internacionales en Chile

Objectives. To investigate the perceptions of primary health workers (PHW) about the challenges of health care for migrants. Materials and methods. A qualitative multicase study was conducted in eight communes of Chile, using the snowball technique, where 101 PHW and local authorities were recruited. Semi-structured interviews and focal groups were conducted, achieving information saturation. Results. The findings were grouped into two major thematic axes: 1. Technical and administrative difficulties, and 2. Perception of cultural barriers. According to the PHW, although regulations have been established and health care strategies have been generated for the migrant population, these are mostly not stable or known to all PHW. They are also not easy to implement in the various realities investigated. The absence of records on the number of migrants accessing the health system makes it difficult to design specific interventions. Additionally, health care has complications, and the PHW do not necessarily have tools that allow them to provide a care that is culturally sensitive to the needs of the migrant community. Conclusions. The findings put into question the new  challenges in health that Chile is facing in the face of the growing migrant population. The needs perceived by PHW are: stability and clarity in the regulations in force in relation to access and provision of services, training in regulations and the concrete way in which they should operate, and sensitization in cultural competence.Objetivos. Indagar en las percepciones de los trabajadores de salud primaria (TSP) sobre los desafíos de atención de salud para población migrante. Materiales y métodos. Se realizó un estudio cualitativo de caso múltiple en ocho comunas de Chile, mediante la técnica de bola de nieve se reclutó a 101 TSP y autoridades locales. Se realizaron entrevistas semiestructuradas y grupos focales, logrando saturación de información. Resultados. Los hallazgos fueron agrupados en dos grandes ejes temáticos: 1. Dificultades técnicas y administrativas, y 2. Percepción de barreras culturales. De acuerdo a los TSP, pese a que se han establecido normativas y se han generado estrategias de atención en salud para población migrante, estas, en su mayoría, no son estables ni conocidas por todos los TSP. Tampoco son fáciles de implementar en las diversas realidades investigadas. La ausencia de registros sobre el número de migrantes que accederán al sistema sanitario, dificulta el diseño de intervenciones específicas. Adicionalmente, la atención en salud presenta  complicaciones, y los TSP no necesariamente poseen herramientas que les permitan brindar una atención que sea culturalmente sensible a las necesidades de la comunidad migrante. Conclusiones. Los hallazgos ponen en discusión los nuevos desafíos en salud que enfrenta Chile frente a la creciente población migrante. Las necesidades percibidas por TSP son: estabilidad y claridad en las normativas vigentes en relación a acceso y prestación de servicios, capacitación en normativas y la manera concreta en la que estas deben operar, y sensibilización en competencia cultural

Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary

In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. Methods: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. Results: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. Conclusions: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions

To scope or not to scope? The benefits and challenges of integrating scoping studies in rapid qualitative research and evaluation

Creating lasting and sustainable change and developing collaborative relationships between researchers, stakeholders, and healthcare teams is a recognised challenge. Healthcare leaders and organisations struggle with how to make research informed decisions, because of the need for immediate and timely research data. Scoping studies, or the integration of a rapid study at the pre-design stage is a methodological approach within the framework of rapid qualitative research and evaluation. In this paper, we discuss how to implement a targeted, evidence based scoping study which has been developed iteratively based on stakeholder engagement. In our experience, a scoping study can be carried out in as little as 5 days or as long as six weeks. A scoping study can be used to make collaborative decisions on research priorities, and function as an evaluability assessment that can be delivered in time sensitive contexts. This paper provides a step-by-step guide for the design and implementation of scoping studies as well as a case example of how we have applied this approach

Lesiones por presión de origen hospitalario y factores que afectan su desarrollo: estudio multicéntrico

Introduction: Hospital-acquired pressure ulcers (HAPU) represent a significant public health challenge. Understanding their main characteristics and related factors is essential for effective prevention. This article aims to analyse the main characteristics of HAPUs in four high-complexity hospital centres in Chile.Methods: Secondary, analytical observational study. The sample (n=1000) included paediatric and adult patients. The study variables were the presence of HAPU, age, sex, dermatitis, risk of HAPU, change of position, pressure relief surface, immobilisation and speed of onset. Measurement of variables included physical examination and chart review. Descriptive statistics and multivariate logistic regression models were performed, accepting 95%CI, p<0.05.Results: A crude prevalence of 18.7% was estimated. Most patients with HAPU were male (56.1%), aged 18-59 years (39.6%) and 60-80 years (39.0%). On average, ten days elapsed from patient admission to the development of HAPU The most common stage was stage I (50%), and the sacral region was the most frequent site of occurrence (30.1%). The factor with the strongest association with having HAPU was having a high ulceration risk classification (OR 2.6, 95%CI1.5-4.4).Conclusions: This is the first study in Chile that showed the characterization of HAPU in a relevant sample of hospitalized patients. The relevant representative aspects for monitoring and preventing HAPU as its prevalence, location and factors associated with its appearance.Introducción: Las Lesiones por presión de origen hospitalario (LPPH) representan un desafío significativo en salud pública. Comprender sus principales características y factores relacionados es esencial para contribuir a su prevención efectiva. El objetivo de esta investigación es analizar las características principales de LPPH en cuatro centros hospitalarios de alta complejidad en Chile. Metodología: Estudio secundario, observacional analítico. La muestra (n=1000) incluyó pacientes pediátricos y adultos. Las variables de estudio fueron: presencia de LPPH, estadio, edad, sexo, dermatitis, riesgo de LPPH, cambio de posición, superficie de alivio de presión, inmovilización y velocidad de aparición. La medición de variables incluyó examen físico y revisión de ficha clínica. Se realizó estadística descriptiva y modelos de regresión logística multivariada, aceptando IC95%, p<0,05.Resultados: Se estimó una prevalencia cruda de 18,7%. La mayoría de los pacientes con LPPH eran hombres (56,1%), con edades entre 18 a 59 años (39,6%) y 60 a 80 años (39,0%). En promedio, transcurrieron 10 días desde el ingreso del paciente hasta el desarrollo de las LPPH. El estadio I fue el más frecuente (50%), predominantemente en la región sacra (30,1%). El factor con mayor fuerza de asociación a la aparición de LPPH fue contar con clasificación de riesgo alto de ulceración (OR 2,6, IC95%1,5-4,4). Conclusiones: Este es el primer estudio en Chile que permitió caracterizar las LPPH en una muestra relevante de pacientes hospitalizados. Los hallazgos reflejan aspectos relevantes para el monitoreo y prevención de LPHH, como su prevalencia, ubicación y factores asociados a su aparición

Twitter Analysis of Health Care Workers’ Sentiment and Discourse Regarding Post–COVID-19 Condition in Children and Young People: Mixed Methods Study

BackgroundThe COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post–COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post–COVID-19 condition on this demographic. ObjectiveWith a social media analysis of the discourse surrounding the prevalence of post–COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post–COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post–COVID-19 condition and identify critical areas and future directions for researchers and policy makers. MethodsFrom a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post–COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. ResultsWe obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post–COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. ConclusionsThe perceptions described on Twitter by HCWs concerning the presence of the post–COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post–COVID-19 condition

Social determinants of the health of international migrant children in Chile: qualitative evidence

Objective. To explore the social determinants of health (SDH) of international migrant children, from the perceptions of caregivers, health workers and local authorities in eight municipalities in Chile. Materials and methods. A secondary analysis of data was conducted from a qualitative study that took place between 2014 and 2017. The original study involved semi-structured interviews and focus groups. The secondary thematic analysis of data included all emerging issues related to international migrant children and their living conditions, including use of health services. Results. Findings were grouped according to the model of social determinants of health, which allow a reflection on living conditions of international migrant children and their health situation. Conclusion. This research shows the impact of SDH on international migrant children in Chile, highlighting relevant issues around this group