Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain.

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.

Segmentation and fragmentation of health systems and the quest for universal health coverage: conceptual clarifications from the Mexican case.

Health systems are complex entities. The Mexican health system includes the private and public sectors, and subsystems that target different populations based on corporatist criteria. Lack of unity and its consequences can be better understood using two concepts, segmentation and fragmentation. These reveal mechanisms and strategies that impede progress toward universality and equity in Mexico and other low- and middle-income countries. Segmentation refers to separation of the population by position in the labour market. Fragmentation refers to institutions, and to financial aspects, health care levels, states' systems of care, and organizational models. These elements explain inequitable allocation of resources and packages of health services offered by each institution to its population. Overcoming segmentation will require a shift from employment to citizenship as the basis for eligibility for public health care. Shortcomings of fragmentation can be avoided by establishing a common package of guaranteed benefits. Mexico illustrates how these two concepts characterize a common reality in low- and middle-income countries.

Psychometric Properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale.

This study evaluates the psychometric properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale (AOAOPHSS), in research conducted among 707 Mexican older adults selected by convenience from 14 rural and one urban locations. The AOAOPHSS explores 10 dimensions of two integrated subscales: Accessibility and Personal Abilities. Data analysis was performed in five phases. First, potentially biased responses were identified. Second, the response efficiency of the items and their association with external variables were evaluated. Third, the basic properties of the scores for the subscales' dimensions of the AOAOPHSS were identified using non-parametric Mokken Scaling Analysis (MSA). Fourth, the Structural Equation Modeling methodology was used to identify the properties of the internal structure of the latent construct. Finally, reliability and internal consistency were evaluated at both score and item levels. The following findings emerged. 13 items with inefficient response options were removed, and 24 were retained using the MSA. The latent structure of the latter was defined based on 21 items of five Accessibility Subscale dimensions. Its internal consistency reliability ranged between 0.67 and 0.81 (omega coefficients) and between 0.61 and 0.78 (alpha coefficients). Accordingly, this paper discusses the overall implications of using the Accessibility Subscale.

Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity.

The aim of this study was to estimate the prevalence of health needs and use of outpatient services for indigenous (IP) and non-indigenous (NIP) populations aged ≥15 years, and to explore the associated factors and types of need. A cross-sectional study was conducted based on the 2018-19 National Health and Nutrition Survey. The population aged ≥15 years who had health needs and used outpatient services was identified. Logistic models were developed to explore the factors underlying the use of outpatient services. For both populations, being a woman increased the likelihood of using health services, and having health insurance was the most important variable in explaining the use of public health services. Compared to the NIP, a lower proportion of IP reported health needs during the month prior to the survey (12.8% vs. 14.7%); a higher proportion refrained from using outpatient services (19.6% vs. 12.6%); and a slightly higher proportion used public health services (56% vs. 55.4%). For the NIP, older age and belonging to a household that had received cash transfers from a social program, had few members, a high socioeconomic level, and a head with no educational lag, all increased the likelihood of using public health services. It is crucial to implement strategies that both increase the use of public health services by the IP and incorporate health-insurance coverage as a universal right.

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.

Content Validity of a Scale Designed to Measure the Access of Older Adults to Outpatient Health Services.

The objective of this work was to validate the content of a scale formulated in Spanish for older adults in Mexico, with the aim of comprehensively measuring the access of this population group to outpatient primary-care services. To this end, we carried out a methodological content-validity study in four stages: (1) construction of the scale; (2) evaluation of item legibility; (3) quantitative content evaluation by two groups of judges selected by convenience: participant-judges including older adults with adequate reading comprehension, surveyed in person (n = 23), and expert-judges comprised of researchers specialized in the fields of health services, psychometrics and aging, surveyed online (n = 7); and (4) collection of qualitative feedback from several of the participant-judges (older adults, n = 4). The content was validated both by sequentially examining the level of consensus in the responses of both groups of judges, using the Tastle and Wierman method, and by calculating Aiken's Validity Coefficient with a 90% confidence interval. The scale contained 65 items pertaining to 10 dimensions of two major constructs: accessibility (n = 39) and personal abilities (n = 26). Five items were eliminated in accordance with the minimum-consensus criterion (0.5). This is the first psychometric scale to be developed in Mexico with the view of integrating the characteristics of health-care services and the abilities of the older adults in a single questionnaire designed to measure the access of this population group to outpatient primary-care services.

Overcoming the health systems' segmentation to achieve universal health coverage in Mexico.

Health is a human right that everyone should be able to exercise. Yet health systems segmentation and fragmentation are a major challenge to advancing universal health coverage (UHC) and achieving health equity. Between 2019 and 2020, Mexico launched a profound restructuration of its health system claiming its aim was to attain UHC, free healthcare services and drugs and to combat corruption. We analyse the implications of the modifications of the Mexican Constitution and the dismantling of the Seguro Popular de Salud (Popular Health Insurance) in relation to segmentation. We argue that, instead of advancing towards UHC and equality, these changes reinforce inequalities and that transforming health systems must respect human rights.

Influenza vaccination hesitancy in large urban centers in South America. Qualitative analysis of confidence, complacency and convenience across risk groups.

Influenza vaccination coverage in countries of Latin America is low among priority risk groups, ranging from 5 to 75% among older people. This paper aims to describe and analyze the determinants of influenza vaccination hesitancy through the lens of the 3C model of confidence, complacency and convenience among middle-class, urban risk group populations in Brazil, Chile, Paraguay, Peru, Uruguay, countries in South America with contrasting vaccination coverage. Focus groups were conducted among four risk groups: pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥60 years in samples of urban residents. Adults with risk factors expressed the most detailed perceptions about confidence in the vaccine. A wide range of perceptions regarding complacency were expressed across risk groups and countries, with pregnant women and mothers showing greater concerns while convenience had a narrower and generally more positive range of perceptions. Participants from Chile and Paraguay expressed the most contrasts regarding confidence and complacency. Information and communication strategies need to be tailored for risk groups while confidence and complacency should be addressed in synergy.

Los Grupos de Ayuda Mutua como posible estrategia de apoyo emocional para personas indígenas que padecen diabetes / Mutual Aid Groups as a possible emotional support strategy for indigenous people with diabetes

Resumen: Objetivo: Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos: Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados: Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones: Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

Abstract: Objective: To think about the emotional support that Mutual Aid Groups (MAG) offer up to indigenous people with diabetes and their importance in adherence to treatment. Materials and methods: Qualitative study: 25 semi-structured interviews; 3 focus groups (17 participants); and non-participant observation. Content analysis was carried out with the support of the Atlas-ti program. Results: We identified emotional expressions related to the disease. The opinion about MAGs and group work was positive. The MAG is a catharsis space, but it does not work as a support to face the restrictions of the treatment and the emotional impact in case of major complications. Conclusions: With proper training of the health personnel in charge of the groups, MAGs can become emotional support spaces for indigenous people and contribute to their well-being.

Innovación pedagógica para mejorar la calidad del trato en la atención de la salud de mujeres indígenas / Pedagogical innovation to improve the quality-responsiveness in the health care of indigenous women

Resumen: Objetivo: Presentar los resultados de una intervención pedagógica para mejorar la calidad en el trato que brindan los prestadores de servicios de salud en regiones indígenas. Material y métodos: Se diseñó una metodología didáctica con enfoque crítico-constructivista dirigida a personal de salud que atiende a población indígena en cinco entidades de México. Resultados: Entre 09/2016 a 01/2020 se capacitó a 1 825 trabajadores de la salud que deconstruyeron las creencias que determinan prácticas de discriminación y maltrato durante la atención a la salud de los usuarios indígenas. La intervención logró un aprendizaje significativo transformador de las valoraciones y prácticas sociales, con propuestas para evitar cualquier forma de maltrato y garantizar el trato digno. Conclusiones: Para la construcción de un sistema de salud universal y equitativo, es necesario incluir intervenciones que actúen sobre las creencias determinantes de las prácticas de discriminación y maltrato en los servicios de salud hacia grupos sociales vulnerables.

Abstract: Objective: Present the results of a pedagogical intervention to improve the quality-responsiveness in healthcare provided by health service providers in indigenous regions. Materials and methods: A didactic methodology with a critical-constructivist approach was designed aimed to health personnel who attend to the indigenous population in five entities of Mexico. Results: Between 09/2016 and 01/2020, 1 825 health workers were trained, who deconstructed the beliefs that determine practices of discrimination and abuse during the health care of indigenous users. The intervention achieved significant transformative learning of social beliefs and practices, with proposals to avoid any form of abuse and guarantee dignified treatment. Conclusions: For the construction of a universal and equitable health system, it is necessary to include interventions that act on the beliefs that determine discrimination and mistreatment practices in health services towards vulnerable social groups.

The importance of confidence, complacency, and convenience for influenza vaccination among key risk groups in large urban areas of Peru.

Influenza vaccination has been available under Peru's national immunization program since 2008, but vaccination coverage has decreased lately. Surveys and focus groups were conducted among four risk groups (pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥65 years) to identify factors affecting influenza vaccine hesitancy in Peru. The 3Cs model (Confidence, Complacency, and Convenience) was used as a conceptual framework for the study. Most pregnant women and mothers of young children (70.0%), but less than half (46.3%) of older adults and adults with risk factors were vaccinated against influenza. Vaccine confidence and complacency were positively associated with educational level. Complacency was the most deficient of the 3Cs. Pregnant women and mothers were the most informed and least complacent among risk groups. Focus groups revealed the misconceptions behind the high level of complacency observed, including the perception of influenza risk and the role assigned to vaccination in preventing the disease. Interviews with officials identified that most strategies are directed to vaccination availability and hence to convenience, with opportunities for strategies to improve vaccination uptake and community engagement. The results highlight the importance of implementing in Peru communication strategies to increase perceptions of vaccine safety and effectiveness thus improving confidence and reducing complacency. The establishment of explicit incentives should also be considered to increase vaccination uptake, particularly to health personnel.

La judicialización del derecho a la protección de la salud desde la óptica de los actores clave / The judicialization of the right to health in México from the stakeholders' perspective

Resumen: Objetivo: Conocer la opinión de actores clave respecto del proceso de judicialización del derecho a la protección de la salud en México. Material y métodos: Se realizaron 30 entrevistas semiestructuradas a representantes de los poderes Judicial (PJ), Legislativo (PL), Sector Salud (SS), industria farmacéutica, academia y organizaciones de la sociedad civil (OSC) durante mayo de 2017 a agosto de 2018, en distintos lugares de la Ciudad de México. Se transcribieron las grabaciones y se analizó el contenido con base en categorías de interés. Resultados: Las posturas respecto al fenómeno de la judicialización del derecho a la salud son disímiles. Hay tensiones entre quienes ven su potencial efecto como agente de cambio del sector y quienes la perciben como una interferencia ilegítima del PJ. No existe una estrategia coordinada entre los sectores para promover un cambio en el SS. Conclusiones: Las posturas respecto al fenómeno de la judicialización en México son disímiles. Hay tensiones entre quienes ven su potencial efecto como agente de cambio del sector y quienes la perciben como una interferencia ilegítima del PJ en el SS. Otros argumentan que no existe una estrategia coordinada entre los sectores para promover un cambio en el SS. Todos coinciden en que la judicialización en México es una realidad.

Abstract: Objective: Understand what Mexican key stakeholders think about the judicialization of the right to health in Mexico. Materials and methods: 30 semi-structured interviews were conducted at different settings in Mexico City with representatives of the judiciary, legislative power, Health Sector (HS), pharmaceutical industry, academia and non-governmental organizations from May 2017 to August 2018. Interviews were transcribed and analyzed based on different categories of interest. Results: There are different opinions regarding judicialization of the right to health. Tensions exist between those who see its potential effect as a game changer for the HS and those who perceive it as an illegitimate interference of the judiciary. There is no coordinated strategy between sectors to promote change in the HS. Conclusions: There are different opinions regarding judicialization of the right to health in Mexico. There are tensions between those who see its potential effect as a game changer for the HS and those who perceive it as an illegitimate interference of the judiciary. Others argue that there is no coordinated strategy between sectors to promote change in the HS. All agree that judicialization in Mexico is a reality.

Influenza vaccination hesitancy in five countries of South America. Confidence, complacency and convenience as determinants of immunization rates.

INTRODUCTION: Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status. METHODS: An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken. RESULTS: Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries. CONCLUSIONS: Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine.

[Collateral effect of transnational migration: the transformation of medical habitus]. / Efecto colateral de la migración transnacional:la transformación del habitus médico.

OBJECTIVE: To analyze health practice transformations in health providers in Mexico. MATERIALS AND METHODS: . We used qualitative data to explore transnational health practices of men with migration experience to the US, healthcare professionals in Mexico from eight rural communities, and Mexican providers in US. Data used came from a study that explored transnational health practices in the context of migration. RESULTS: Healthcare professionals provided care to migrants through remote consultations or via a family member, and in-person during migrants' visits or by health-care professionals relocating to migrants' destination com-munities in the US. The remote consultations mainly caused three changes in the field of medical practice: providing care without a patient review or clinical examination, long-distance prescription of medications, and provision of care mediated by a family member. CONCLUSIONS: Changes in their medical practice shifted roles of healthcare professionals and of migrants as patients, transforming the hegemonic biomedical model in Mexico.

OBJETIVO: Analizar las transformaciones de la práctica médica en proveedores de salud en México. MATERIAL Y MÉTODOS: Se utilizaron datos cualitativos para explorar las prácticas de salud transnacionales de hombres con ex-periencia en migración a los Estados Unidos y profesionales de la salud en México de ocho comunidades rurales y pro-veedores mexicanos en Estados Unidos. RESULTADOS: Los profesionales de la salud brindan atención a los migrantes a través de consultas remotas o a través de un miembro de la familia, y en persona, durante las visitas de los migrantes o por profesionales de la salud que se trasladan a las comunidades de destino de los migrantes en los EU. Las consultas a distan-cia causaron principalmente tres cambios en el campo de la práctica médica: proporcionar atención sin una revisión del paciente o un examen clínico, la prescripción a larga distancia de medicamentos y la prestación de atención mediada por un miembro de la familia. CONCLUSIONES: Los cambios en la práctica médica modificaron el rol de los profesionales de la salud y los migrantes como pacientes, lo que ha transformado el modelo biomédico hegemónico en México.

Collateral effect of transnational migration: the transformation of medical habitus / Efecto colateral de la migración transnacional: la transformación del habitus médico

Abstract Objective: To analyze health practice transformations in health providers in Mexico. Materials and methods: We used qualitative data to explore transnational health practices of men with migration experience to the US, healthcare professionals in Mexico from eight rural communities, and Mexican providers in US. Data used came from a study that explored transnational health practices in the context of migration. Results: Healthcare professionals provided care to migrants through remote consultations or via a family member, and in-person during migrants' visits or by healthcare professionals relocating to migrants' destination communities in the US. The remote consultations mainly caused three changes in the field of medical practice: providing care without a patient review or clinical examination, long-distance prescription of medications, and provision of care mediated by a family member. Conclusions: Changes in their medical practice shifted roles of healthcare professionals and of migrants as patients, transforming the hegemonic biomedical model in Mexico.

Resumen Objetivo: Analizar las transformaciones de la práctica médica en proveedores de salud en México. Material y métodos. Se utilizaron datos cualitativos para explorar las prácticas de salud transnacionales de hombres con experiencia en migración a los Estados Unidos y profesionales de la salud en México de ocho comunidades rurales y proveedores mexicanos en Estados Unidos. Resultados: Los profesionales de la salud brindan atención a los migrantes a través de consultas remotas o a través de un miembro de la familia, y en persona, durante las visitas de los migrantes o por profesionales de la salud que se trasladan a las comunidades de destino de los migrantes en los EU. Las consultas a distancia causaron principalmente tres cambios en el campo de la práctica médica: proporcionar atención sin una revisión del paciente o un examen clínico, la prescripción a larga distancia de medicamentos y la prestación de atención mediada por un miembro de la familia. Conclusiones: Los cambios en la práctica médica modificaron el rol de los profesionales de la salud y los migrantes como pacientes, lo que ha transformado el modelo biomédico hegemónico en México.

Factores psicosociales del trabajo y efectos psicológicos en comerciantes informales en Morelos, México: una exploración mixta preliminar / Psychosocial factors at work and psychological effects in informal vendors in Morelos, México: A preliminary mixed exploration

Resumen Introducción: La mayor parte de la fuerza laboral en Latinoamérica está compuesta por personas que trabajan en la economía informal, a pesar de eso, son pocos los estudios que abordan los factores psicosociales laborales a los que se encuentran expuestas estas personas y su relación con consecuencias psicológicas. Objetivo: Mostrar resultados preliminares de la exploración de los factores psicosociales del trabajo y su relación con efectos psicológicos negativos y positivos, en una muestra de comerciantes informales. Metodología: Mediante una exploración cuanti-cualitativa, se identificaron factores psicosociales negativos y positivos, y su relación con la salud mental, el estrés, la satisfacción, el burnout y el engagement laboral en una muestra de comerciantes informales en la ciudad de Cuernavaca, Morelos, México (N=116). Resultados: Los resultados mostraron una mayor presencia de factores psicosociales positivos sobre los negativos (v.gr tareas gratificantes, compartir con gente, etc., versus riesgos ambientales, batallar con clientes, etc.), y aunque mostraron pocas relaciones bivariadas con los efectos psicológicos, los análisis de escalamiento multidimensional confirmaron un componente de motivación intrínseca en la naturaleza del trabajo que es más cercano a los efectos positivos (v.gr satisfacción, engagement) y una dimensión de interacción negativa con las personas, que se vinculó más a los efectos negativos (v.gr burnout y síntomas negativos de salud mental) (S-Stress=.07731, RSQ=.97006). Conclusión: Este estudio preliminar permitió identificar factores psicosociales muy específicos en el contexto de estos comerciantes informales que son inexistentes en escalas estandarizadas, así como una estructura de dimensiones y relaciones trascendentes entre variables, lo que puede contribuir a la comprensión futura de estos fenómenos y su consideración estratégica en la solución de problemas y condiciones de trabajo de este sector en América Latina.

Abstract Introduction: Most of the workforce in Latin-America is integrated by workers in the informal economy, however, few studies have been carried out to explore those job psychosocial factors and psychological consequences occurring in these workers. Objective. To show preliminary results of exploring the psychosocial factors of work and their relationship to negative and positive psychological effects, in a sample of informal workers. Methodology: Through a quanti-qualitative approach, positive and negative psychosocial job factors were explored as well as their relationship with mental health, job stress, job satisfaction, burnout and engagement in a sample of informal street vendors in the City of Cuernavaca Morelos, México (N=116). Results: The results showed a higher frequency of positive psychosocial factors over the negatives ones (e.g gratifying tasks, sharing with others, etc., versus environmental risks, struggle with clients, etc.), and even there were few bivariate associations with the psychological effects, the multidimensional scaling analyses confirm an intrinsically motivating work component that is linked to positive effects (e.g satisfaction, engagement), and a negative interaction-people dimension which was more closely linked to negative effects (e.g mental health symptoms, burnout) (S-Stress=.07731, RSQ=.97006). Discussion: This preliminary study allowed the identification of very specific-context psychosocial factors in these informal vendors that are non-existent in traditional standardized questionnaires, also we could identify structural dimensions and relationships among variables which may contribute to the future understanding of these phenomena and its strategic consideration in solving problems and improving work conditions in this sector in Latin America.

The challenges facing indigenous communities in Latin America as they confront the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-2019) pandemic struck Latin America in late February and is now beginning to spread across the rural indigenous communities in the region, home to 42 million people. Eighty percent of this highly marginalized population is concentrated in Bolivia, Guatemala, Mexico and Peru. Health care services for these ethnic groups face distinct challenges in view of their high levels of marginalization and cultural differences from the majority. Drawing on 30 years of work on the responses of health systems in the indigenous communities of Latin America, our group of researchers believes that countries in the region must be prepared to combat the epidemic in indigenous settings marked by deprivation and social disparity. We discuss four main challenges that need to be addressed by governments to guarantee the health and lives of those at the bottom of the social structure: the indigenous peoples in the region. More than an analysis, our work provides a practical guide for designing and implementing a response to COVID-19 in indigenous communities.

Health needs of indigenous Mayan older adults in Mexico and health services available.

Current data indicate that inequitable health service access is one of the major problems faced by indigenous people in Mexico and around the world. The aim of this study was to analyse the perceived health needs of indigenous older adults in a Mayan region of Mexico and the health services provided to address these needs. It used a qualitative design which explored health needs, perceptions of well-being, experiences with public health services and obstacles in accessing services through semi-structured interviews with 20 older adults, nine traditional healers and seven public healthcare providers from Mayan municipalities in southeastern Mexico during 2013-2014. We identified that cultural differences related to the language, values, beliefs and worldview of indigenous populations are ignored or incorporated only minimally by health services. The provision of services does not correspond to the health needs of indigenous Mayan older adults, and wide gaps still undermine their human rights and health status; despite the establishment of favourable regulations, healthcare services are organised for the non-indigenous population. The conditions of social vulnerability affecting indigenous older adults require that healthcare institutions incorporate an intercultural approach in order to improve the quality of care according to the necessities of the population.