Community and health staff perceptions on non-communicable disease management in El Salvador's health system: a qualitative study.
Identifieur interne : 000268 ( Main/Exploration ); précédent : 000267; suivant : 000269Community and health staff perceptions on non-communicable disease management in El Salvador's health system: a qualitative study.
Auteurs : Nicole Vidal [Royaume-Uni] ; Montserrat Le N-García [Royaume-Uni, Espagne] ; Marta Jiménez [Royaume-Uni] ; Keven Bermúdez [Royaume-Uni] ; Pol De Vos [Royaume-Uni, Belgique]Source :
- BMC health services research [ 1472-6963 ] ; 2020.
Descripteurs français
- KwdFr :
- Aide médicale (MeSH), Connaissances, attitudes et pratiques en santé (MeSH), Corps médical (psychologie), Entretiens comme sujet (MeSH), Femelle (MeSH), Humains (MeSH), Maladies non transmissibles (thérapie), Mâle (MeSH), Prestations des soins de santé (MeSH), Prise en charge de la maladie (MeSH), Recherche qualitative (MeSH), Salvador (MeSH), Soins de santé primaires (MeSH).
- MESH :
- psychologie : Corps médical.
- thérapie : Maladies non transmissibles.
- Aide médicale, Connaissances, attitudes et pratiques en santé, Entretiens comme sujet, Femelle, Humains, Mâle, Prestations des soins de santé, Prise en charge de la maladie, Recherche qualitative, Salvador, Soins de santé primaires.
- Wicri :
- geographic : Salvador.
English descriptors
- KwdEn :
- Delivery of Health Care (MeSH), Disease Management (MeSH), El Salvador (MeSH), Female (MeSH), Health Knowledge, Attitudes, Practice (MeSH), Humans (MeSH), Interviews as Topic (MeSH), Male (MeSH), Medical Assistance (MeSH), Medical Staff (psychology), Noncommunicable Diseases (therapy), Primary Health Care (MeSH), Qualitative Research (MeSH).
- MESH :
- geographic : El Salvador.
- psychology : Medical Staff.
- therapy : Noncommunicable Diseases.
- Delivery of Health Care, Disease Management, Female, Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, Male, Medical Assistance, Primary Health Care, Qualitative Research.
Abstract
BACKGROUND
Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders' perceptions about the management of NCDs along the pathways of care in this health system.
METHODS
During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data.
RESULTS
This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management.
CONCLUSIONS
The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach - including long-term follow-up - with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.
DOI: 10.1186/s12913-020-05249-8
PubMed: 32460769
PubMed Central: PMC7251854
Affiliations:
- Belgique, Espagne, Royaume-Uni
- Catalogne, Écosse
- Barcelone, Édimbourg
- Université autonome de Barcelone
Links toward previous steps (curation, corpus...)
Le document en format XML
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last="Vidal">Nicole Vidal</name><affiliation wicri:level="3"><nlm:affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute for Global Health and Development, Queen Margaret University, Edinburgh</wicri:regionArea><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation></author><author><name sortKey="Le N Garcia, Montserrat" sort="Le N Garcia, Montserrat" uniqKey="Le N Garcia M" first="Montserrat" last="Le N-García">Montserrat Le N-García</name><affiliation wicri:level="3"><nlm:affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK. monselg8@gmail.com.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute for Global Health and Development, Queen Margaret University, Edinburgh</wicri:regionArea><placeName><settlement 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scheme="KwdEn" xml:lang="en"><term>Delivery of Health Care (MeSH)</term><term>Disease Management (MeSH)</term><term>El Salvador (MeSH)</term><term>Female (MeSH)</term><term>Health Knowledge, Attitudes, Practice (MeSH)</term><term>Humans (MeSH)</term><term>Interviews as Topic (MeSH)</term><term>Male (MeSH)</term><term>Medical Assistance (MeSH)</term><term>Medical Staff (psychology)</term><term>Noncommunicable Diseases (therapy)</term><term>Primary Health Care (MeSH)</term><term>Qualitative Research (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Aide médicale (MeSH)</term><term>Connaissances, attitudes et pratiques en santé (MeSH)</term><term>Corps médical (psychologie)</term><term>Entretiens comme sujet (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Maladies non transmissibles (thérapie)</term><term>Mâle (MeSH)</term><term>Prestations des soins de santé (MeSH)</term><term>Prise en charge de la maladie (MeSH)</term><term>Recherche qualitative (MeSH)</term><term>Salvador (MeSH)</term><term>Soins de santé primaires (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>El Salvador</term></keywords><keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Corps médical</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Medical Staff</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Noncommunicable Diseases</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Maladies non transmissibles</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Delivery of Health Care</term><term>Disease Management</term><term>Female</term><term>Health Knowledge, Attitudes, Practice</term><term>Humans</term><term>Interviews as Topic</term><term>Male</term><term>Medical Assistance</term><term>Primary Health Care</term><term>Qualitative Research</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Aide médicale</term><term>Connaissances, attitudes et pratiques en santé</term><term>Entretiens comme sujet</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Prestations des soins de santé</term><term>Prise en charge de la maladie</term><term>Recherche qualitative</term><term>Salvador</term><term>Soins de santé primaires</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Salvador</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders' perceptions about the management of NCDs along the pathways of care in this health system.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach - including long-term follow-up - with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">32460769</PMID><DateCompleted><Year>2020</Year><Month>11</Month><Day>20</Day></DateCompleted><DateRevised><Year>2020</Year><Month>11</Month><Day>20</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1472-6963</ISSN><JournalIssue CitedMedium="Internet"><Volume>20</Volume><Issue>1</Issue><PubDate><Year>2020</Year><Month>May</Month><Day>27</Day></PubDate></JournalIssue><Title>BMC health services research</Title><ISOAbbreviation>BMC Health Serv Res</ISOAbbreviation></Journal><ArticleTitle>Community and health staff perceptions on non-communicable disease management in El Salvador's health system: a qualitative study.</ArticleTitle><Pagination><MedlinePgn>474</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/s12913-020-05249-8</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders' perceptions about the management of NCDs along the pathways of care in this health system.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach - including long-term follow-up - with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Vidal</LastName><ForeName>Nicole</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>León-García</LastName><ForeName>Montserrat</ForeName><Initials>M</Initials><Identifier Source="ORCID">http://orcid.org/0000-0001-8567-4685</Identifier><AffiliationInfo><Affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK. monselg8@gmail.com.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Biomedical Research Institute Sant Pau (IIBSant Pau), Iberoamerican Cochrane Centre, Universidad Autónoma de Barcelona, Barcelona, Spain. monselg8@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jiménez</LastName><ForeName>Marta</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bermúdez</LastName><ForeName>Keven</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>De Vos</LastName><ForeName>Pol</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Institute of Tropical Medicine, Antwerp, Belgium.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>Programme 16/136/100</GrantID><Agency>Public Health Research Programme</Agency><Country></Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>05</Month><Day>27</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>BMC Health Serv Res</MedlineTA><NlmUniqueID>101088677</NlmUniqueID><ISSNLinking>1472-6963</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D003695" MajorTopicYN="Y">Delivery of Health Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019468" MajorTopicYN="Y">Disease Management</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004544" MajorTopicYN="N" Type="Geographic">El Salvador</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007722" MajorTopicYN="N">Health Knowledge, Attitudes, Practice</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007407" MajorTopicYN="N">Interviews as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008483" MajorTopicYN="N">Medical Assistance</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008503" MajorTopicYN="N">Medical Staff</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073296" MajorTopicYN="N">Noncommunicable Diseases</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011320" 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last="Vidal">Nicole Vidal</name></region><name sortKey="Bermudez, Keven" sort="Bermudez, Keven" uniqKey="Bermudez K" first="Keven" last="Bermúdez">Keven Bermúdez</name><name sortKey="De Vos, Pol" sort="De Vos, Pol" uniqKey="De Vos P" first="Pol" last="De Vos">Pol De Vos</name><name sortKey="Jimenez, Marta" sort="Jimenez, Marta" uniqKey="Jimenez M" first="Marta" last="Jiménez">Marta Jiménez</name><name sortKey="Le N Garcia, Montserrat" sort="Le N Garcia, Montserrat" uniqKey="Le N Garcia M" first="Montserrat" last="Le N-García">Montserrat Le N-García</name></country><country name="Espagne"><region name="Catalogne"><name sortKey="Le N Garcia, Montserrat" sort="Le N Garcia, Montserrat" uniqKey="Le N Garcia M" first="Montserrat" last="Le N-García">Montserrat Le N-García</name></region></country><country name="Belgique"><noRegion><name sortKey="De Vos, Pol" sort="De Vos, Pol" uniqKey="De Vos P" first="Pol" last="De Vos">Pol De 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