The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context.

BACKGROUND: The recent introduction of adjustment measures in the Spanish context by means of the Royal Decree-law 16/2012 (RDL 16/2012), which limits access to health care for undocumented migrants, raises the question about the state of the matter in different European Union member states. METHODS: Narrative review of comparative studies published between 2009 and 2012 that analyzes the right to health care for undocumented migrants in the European context. RESULTS: The review shows a high degree of variability regarding health care entitlements of undocumented migrants in different European countries, a frequent legal restriction of access to health care, as well as barriers in the effective access to health care. The studies coincide in recommending access at all health care levels, regardless of the administrative status of the person seeking treatment. The analysis of the impact of the current economic crisis on access and quality of the health care directed to undocumented migrants, as well as the knowledge of the migrants' perspective are identified as future research areas. CONCLUSIONS: Compared with other European countries, the introduction of the measures established in the RDL 16/2012 modifies the place of the Spanish Public Health Care System from being situated in the group of countries that permit undocumented migrants access to all health care levels, towards the category of highest restriction.

[Climate change and vector-borne diseases. From knowledge to action]. / Cambio climático y enfermedades transmitidas por vectores. Convertir el conocimiento en acción.

Andalusia is particularly sensitive to climate change, not only because of extreme weather events, but also because of the impact on the population dynamics of vectors, pathogens, reservoirs and hosts, which has led to a change in the epidemiological patterns of vector-borne diseases. In order to achieve an integrated vector management for disease control, public action is necessary. This study describes the design of the initial phase of a strategy for knowledge translation about climate change and vector-borne diseases to the public, using transdisciplinary co-creation and the World Café participatory method with three discussion rounds to address strategies for three age groups (adults, adolescents and schoolchildren). The aim is to drive knowledge into action and for this purpose the underlying messages for action (strategic and instrumental) have been identified, as well as the formats of the knowledge products and the potential implementers of the strategies.

[Once upon a time there was a place where we learned to listen. The Other Front line_voices for social justice]. / Había una vez un lugar donde aprendimos a escuchar. The Other Front line_voces por la justicia social.

Government responses to the COVID-19 pandemic generated a new wave of social inequalities for communities around the world living in unjust circumstances . Lockdowns and health measures overlooked housing conditions, transitions to virtual schooling, ignoring homes and families without the technological infrastructure and skills to access education, as well as overlooking the availability of an economic remainder. informal employment. The experiences of various communities around the world, from racialized/ethnic communities, homeless, migrants, elderly to young populations, were not reflected in the knowledge that guided the Government's responses; in fact, their experiences were involuntarily silenced . As a result of all this, it was necessary to create alliances with communities that lived in vulnerable conditions and that bore the great burden of the pandemic, to ensure that their voices were included in Public Health policies and practices.

Las respuestas de los gobiernos a la pandemia de la COVID-19 generaron una nueva ola de desigualdades sociales para las comunidades de todo el mundo que vivían en circunstancias injustas . Los confinamientos y las medidas sanitarias pasaron por alto las condiciones de vivienda, las transiciones a la escolarización virtual, ignorando los hogares y las familias sin las infraestructuras tecnológicas y habilidades para acceder a la educación, así como la disponibilidad de un remanente económico pasó por alto el empleo informal. Las experiencias de varias comunidades en todo el mundo, desde comunidades racializadas/étnicas, personas sin hogar, migrantes, ancianos hasta poblaciones jóvenes, no se reflejaron en el conocimiento que orientó las respuestas del Gobierno; de hecho, sus experiencias fueron silenciadas involuntariamente . A consecuencia de todo ello, fue necesario generar alianzas con las comunidades que vivían en condiciones de vulnerabilidad y que soportaban la gran carga de la pandemia, para garantizar así que sus voces se incluyeran en las políticas y prácticas de Salud Pública.

[How to adapt qualitative research to confinement contexts]. / Cómo adaptar una investigación cualitativa a contextos de confinamiento.

The confinement of the population, researchers, shows the need to adapt the qualitative methodology, techniques and tools, to the current context generated by COVID-19. The Internet and the social media allow the collection of textual data, sequences, images or narratives about a limited reality for access to it in person. We enter the era of e-research, nuancing and reorienting the observation, conversation, collection and analysis of information. Currently, we are working on techniques and models of good practice in this area. This note includes data collection tools used in qualitative research in health sciences, a selection of techniques for qualitative online research is made, and 10 rules for the design of an e-research of this type are provided.

[COVID-19 on migrants and ethnic minorities]. / COVID-19 en migrantes y minorías étnicas.

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

[Not Available]. / Perspectivas de la ciudadanía sobre necesidades y expectativas de información sanitaria.

BACKGROUND: Patients' need for health information is widely recognized. The aim of this study was to determine how patients currently receive and rate this information. Additionally, we aimed to identify the needs and expectations of citizens of the autonomous region of Andalusia in this regard. MATERIAL AND METHOD: We performed a qualitative research study involving semi-structured telephone interviews with participants. A total of 48 interviews were performed in people with different social and health profiles from a structural sample. The final selection of persons to be interviewed was made using the snow-ball sampling method. Interview material was analyzed by means of NUDIST vivo 1.1 software-aided content analysis. RESULTS: The interviewees reported receiving health information mainly from healthcare personnel. Supplementary information sources were the internet, associations and publications. The interviewees expressed different degrees of satisfaction with the health information received, depending on its understandability and the amount of detail provided. The persons interviewed reported that they would like to receive all the information possible on their health-illness-care process and would prefer this information to come mainly from physicians. CONCLUSIONS: Information about the health-illness-care process should center on practical issues. Physicians are the first and principal source of medical information and consequently communication skills should be promoted in this collective through training courses. Additionally, alternative sources of information used by citizens should be strengthened to provide high-quality health information.

[Participatory tools and methods for community action. SESPAS Report 2018]. / Herramientas y métodos participativos para la acción comunitaria. Informe SESPAS 2018.

Participation is a process that requires the involvement of the policy makers, managers, technicians and staff of the institutions, and of citizens, as well as intersectoral and interdisciplinary action. To generate transformative changes, an infrastructure that encourages participation and planned action is required, and that recognises all the actors in the process. It takes time and commitment to ensure continuity through the joint production of actions, hence the importance of consolidating participatory projects that continue beyond political changes making public services sustainable. Training, the appropriate use of participation tools and a horizontal policy of delegated power are essential to ensure participation. Surveys, sociograms, flowcharts, health assets mapping, participatory budgets and participatory evaluation matrices are some of the tools that can be chosen, depending on the type of subjects addressed, the time and resources available, the characteristics of the participating population and territory, as well as determining the use that will be made of the information generated for the next phase. Participation tools are useful for citizens and professionals to analyze, understand, debate and decide collectively how to improve living conditions and environments. Over the past decade, social networks in the virtual environment have generated new trends in mass participation, which are self-managed by citizens.

[Right of access to healthcare in the context of the Royal Decree-Law 16/2012: the perspective of civil society organizations and professional associations]. / El derecho de acceso sanitario en el contexto del Real Decreto-ley 16/2012: la perspectiva de organizaciones de la sociedad civil y asociaciones profesionales.

OBJECTIVE: The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens' perspectives on the modifications introduced by the RDL 16/2012. METHODS: Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context. RESULTS: A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs. CONCLUSIONS: The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis.

[Citizens' participation in health: education and shared decision-making. SESPAS Report 2012]. / Participación ciudadana en salud: formación y toma de decisiones compartida. Informe SESPAS 2012.

In recent decades, citizen's participation has become increasingly important in the field of public health, with the new role of the patient as an active agent, manager and producer of his or her own health, and the paradigm of patient-centered care. These changes have represented some of the most important milestones in the continuous improvement of healthcare. The involvement of patients is a new way of understanding the relationship between patients, health professionals and health systems, not only in terms of knowledge management and patients' control of their own health, individually or collectively, but also in terms of the influence that patients may have in health policy planning. Increased life expectancy and the consequent rise in the prevalence of chronic diseases, which already account for 80% of primary care consultations, is one of the key factors changing the role of patients. The place traditionally occupied by professional consultations given any symptoms or signs of alarm is beginning to be occupied by self-care and information and health education resources within the reach of patients and citizens. Internet access is an inexhaustible source of health information resources aimed at patients and provides participation tools. Social networks are places to exchange information and practical advice among patients, families and health professionals. Patients may be experts in their own illnesses and may thus take a more active role in decisions about their health, such as in shared decision making, as part of initiatives, and as part of evaluation of public health activities and health services.

[Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)]. / Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía.

OBJECTIVE: To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. METHODS: A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. RESULTS: The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. CONCLUSIONS: Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills.

[Parental stance towards alcohol consumption in 12- to 17-year-old adolescents from six urban areas in Spain]. / Posicionamiento de padres y madres ante el consumo de alcohol en población de 12 a 17 años en el ámbito urbano de seis Comunidades Autónomas.

OBJECTIVES: To determine the opinions of urban parents on alcohol drinking in teenagers and their positioning regarding the legal restrictive measures. MATERIAL AND METHODS: We performed a qualitative study of six focal groups including 42 mothers and fathers of adolescents from six different Spanish regions and from diverse social strata. The quantitative part of the study consisted of a 1-10 scale questionnaire, measuring parents' acceptance and opinion about legal measures restricting underage drinking. Means and standard deviation were calculated. RESULTS: Parents did not consider adolescent alcohol drinking to be a problem so long as it was moderate and leisure time-related. The social and cultural context was permissive with the alcohol consumption. Alcohol intake depended on both external (social pressure) and internal (family) factors. Fathers' preferred to exercise authority, while mothers preferred communication and education skills. Parents approved of teachers' interventions, especially when based on the student's overall education and not restricted to knowledge transmission. Public institutions and authorities were held responsible for adolescents' lack of information, the scarcity of leisure-time alternatives and for not ensuring compliance with current regulations. Parents approved restrictions regarding the sale and advertising of alcohol. CONCLUSIONS: Parents recognize adolescent alcohol drinking as a problem and tend to deal with it. Parents use distinct intervention strategies and generally approve legal measures.

[Quality improvement of health information included in drug information leaflets. Patient and health professional expectations]. / Mejora de la información sanitaria contenida en los prospectos de los medicamentos: expectativas de pacientes y de profesionales sanitarios.

OBJECTIVE: To report on patient and professional opinions and expectations concerning the information included in drug package leaflets and to determine their readability. DESIGN: Qualitative and quantitative study. PLACEMENT: Primary Care and Specialized Centres from Andalusia, Catalonia, Basque Country, Navarra, Aragon and Extremadura. PARTICIPANTS: Patients from Primary Care Health Centers, physicians, pharmacists and citizen associations, using intentional sampling. METHOD: Qualitative interviews. Flesch Readability Test is used to determine the leaflet readability. RESULTS: There are different degrees of satisfaction between professionals and patients, concerning both quality and quantity of information leaflets. The use of technical language and a small lettering size was observed. The leaflet is considered an important source of information among professionals, but not among patients who prefer information from their physicians. The greatest comprehension difficulties appear in paragraphs on posology, secondary and adverse effects. CONCLUSIONS: Health information must centre on practical aspects of the health-illness-care process. Leaflets must be adapted to the needs of the patients and professionals. Physicians are commonly consulted by patients, so it is important to ensure they have high communication skills. Patients have the need for constant information; therefore new information channels must be created.