Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study.

BACKGROUND: Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. METHODS: Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. RESULTS: Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. CONCLUSIONS: Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.

Community strategies for health promotion and prevention of chronic non-communicable diseases with a focus on physical activity and nutrition: the URO/FOCOS study protocol.

Non-communicable diseases (NCDs) account for 71% of all annual deaths, totaling 41 million people worldwide. The development and progression of these diseases are highly related to the environment and lifestyle choices, among which physical inactivity and excess malnutrition stand out. Currently, in Chile, there is no evidence at the regional and local level on the impact of physical activity and healthy nutrition plans and interventions on health promotion, prevention, and timely treatment of NCDs. The following protocol delineates the URO/FOCOS (Universidad Regional de O'Higgins/FOrtaleciendo COmunidades Saludables- Regional University of O'Higgins/Strengthening Healthy Communities) study, which will assess pilot community intervention strategies using a participatory action research approach by identifying barriers and facilitators on the practice of physical activity and healthy eating habits. In this project, the community from the O'Higgins region will be involved throughout the entire research process to develop strategies that promote regular physical activity and healthy eating practices. We propose three interrelated strategies: (1) Participatory Action Research, (2) Community interventions for promoting physical activity and healthy nutrition practices, and (3) health education. The URO/FOCOS study offers a unique opportunity in the O'Higgins region to develop participatory strategies and interventions based on the community's needs and motivations with regard to physical activity and healthy eating habits. We believe these strategies will help to improve the community's overall health through effective changes in their decision and preferences toward a more active lifestyle and healthier nutrition practices.

Stigma towards people with mental disorders: perceptions of devaluation and discrimination in a sample of Chilean workers / Estigma hacia personas con trastornos mentales: percepciones de devaluación y discriminación en una muestra de trabajadores chilenos

Abstract Introduction Mental disorders represent one of the main causes of disease burden in the adult population. Negative public attitudes and behaviors toward people with mental disorders negatively affect the treatment, recovery, and social inclusion of those affected. Chile laks surveys on workers that address this issue. Objective To describe the perceptions of devaluation and discrimination towards people with mental disorders in a sample of Chilean workers. Method A cross-sectional study was carried out with 1 516 workers in the formal sector of four regions of Chile (Metropolitan Region [RM], Bío Bio [VIII], Valparaíso [V] and Coquimbo [IV]). The perception of discrimination and devaluation was explored through a modified version of the The perceived Devaluation-Discrimination Scale (PDD) comprising 15 questions. The relationship of each question with sociodemographic variables (age, sex, years of study, and region) and type of economic activity was assessed. Results The study found a high percentage of perceptions of devaluation and discrimination in most aspects considered, particularly those related to hiring a person who has been hospitalized due to a mental illness (85%), feeling sorry for people with severe mental illnesses (80%), and the unwillingness to marry a person with a mental illness (78%). Significant differences were observed in the opinions by sociodemographic variables and region of residence. Discussion and conclusion The perception of Chilean workers has high levels of stigma towards people living with mental disorders. It is necessary and urgent to develop effective anti-stigma public policies to promote a more inclusive, tolerant society.

Resumen Introducción Los trastornos mentales representan una de las principales causas de carga de morbilidad en la población adulta. Las actitudes y conductas públicas negativas hacia las personas con trastornos mentales inciden negativamente en el tratamiento, la recuperación e inclusión social de las personas afectadas. Chile no cuenta con encuestas en trabajadores que aborden este tema. Objetivo Describir las percepciones de devaluación y discriminación hacia personas con trastornos mentales en una muestra de trabajadores chilenos. Método Se realizó un estudio transversal con 1 516 trabajadores del sector formal de cuatro regiones de Chile (Región Metropolitana [RM], de Bío Bio [VIII], de Valparaíso [V] y de Coquimbo [IV]). Se exploró la percepción de discriminación y devaluación por medio de una versión modificada de la Perceived Devaluation-Discrimination Scale (PDD) con 15 preguntas. Se analizó la relación de cada pregunta con variables sociodemográficas (edad, sexo, años de estudio y región) y tipo de actividad económica. Resultados Se detectó un alto porcentaje de percepción de devaluación y discriminación en la mayoría de los aspectos considerados, destacándose los relacionados con la contratación de una persona que ha sido hospitalizada por una enfermedad mental (85%), sentir pena por las personas con enfermedades mentales graves (80%) y el rechazo a casarse con una persona que tenga una enfermedad mental (78%). Se observaron diferencias significativas en las percepciones, según las variables sociodemográficas y las relativas a la región de residencia. Discusión y conclusión La percepción de los trabajadores en Chile muestra altos niveles de estigma social hacia personas con trastornos mentales. Es necesario y urgente desarrollar políticas públicas antiestigma efectivas, promoviendo al mismo tiempo una sociedad más inclusiva y tolerante.

Relación de trabajo y autopercepción de salud en estudiantes de Enfermería en Sucre, Bolivia / Relationship between work and self-perceived health among nursing students from Sucre, Bolivia

Introducción: Diversos estudios han reportado el alto estrés percibido por los estudiantes universitarios, tanto debido a las demandas académicas como a los aspectos financieros o familiares. En ese sentido, existe muy poca información sobre el efecto que el trabajo podría tener en la salud de los estudiantes de Enfermería en Latinoamérica. Objetivo: Caracterizar la relación entre trabajo y autopercepción de salud en estudiantes de Enfermería de la Universidad "San Francisco Xavier" de Chuquisaca, Bolivia. Método: Se realizó un estudio transversal en 126 estudiantes de tercer año (respuesta 83,4 por ciento). Se aplicó un cuestionario autoadministrado, que exploró características sociodemográficas, económicas, estilos de vida, apoyo social, trabajo actual y autopercepción de salud. Se calcularon los Odds Ratios crudos y ajustados con su intervalo de confianza del 95 por ciento, a través de los modelos de regresión logística. Resultados: El grupo de estudiantes que participó estuvo conformado, en su mayoría, por mujeres, menores de 24 años, solteros, los que vivían con familia o amigos, y los que presentaban estrés financiero bajo o medio. En el modelo ajustado, los estudiantes que trabajaban (Odds Ratio ajustado 5,6; 95 por ciento Intervalo de confianza 2-17,9) y aquellos que reportaron haber sufrido de estrés financiero los últimos doce meses (3,6; 1,4-8,9) resultaron más propensos a percibir su salud de forma negativa. Conclusiones: La condición adicional de trabajador, así como la presencia de estrés financiero durante la formación profesional, constituyen factores importantes que influyen en la autopercepción de salud de estudiantes de Enfermería. Es necesario considerar estrategias institucionales que apoyen a los estudiantes trabajadores para mejorar su autopercepción de salud, así como la calidad educativa y su desempeño profesional(AU)

Introduction: Various studies have reported the high stress levels perceived by university students, which are caused by academic demands as well as financial or family problems. Very little information is available about the potential effect of work on the health of Latin American nursing students. Objective: Characterize the relationship between work and self-perceived health among nursing students from San Francisco Xavier University in Chuquisaca, Bolivia. Method: A cross-sectional study was conducted of 126 third year students (response 83.4 percent) based on a self-applied questionnaire exploring sociodemographic and economic characteristics, lifestyle, social support, current job and self-perceived health. Crude and adjusted odds ratios were estimated with a 95 percent confidence interval using logistic regression models. Results: Most of the students participating in the study were female, aged under 24 years, single, living with their family or friends, and under low or medium financial stress. In the adjusted model, students who worked (adjusted odds ratio 5.6; 95 percent confidence interval; 2-17.9) and those reporting having been under financial stress in the last twelve months (3.6; 1.4-8.9) were the most prone to have a negative perception of their own health. Conclusions: The additional condition of worker and the presence of financial stress during professional training, are important factors affecting health self-perception among nursing students. Institutional strategies should be considered in support of working students to improve their health self-perception, the quality of instruction and their professional performance(AU)

Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province--Bolivia: a cross-sectional study.

BACKGROUND: In recent years, the prevalence of asthma, rhinoconjunctivitis and eczema symptoms in childhood has considerably increased in developing countries including Bolivia, possibly due to changes in lifestyle, environmental and domestic factors. This study aimed to assess the association between environmental factors and asthma, rhinoconjuctivitis and eczema symptoms in school-aged children from Oropeza Province in Chuquisaca, Bolivia. METHODS: A cross-sectional study was performed in 2340 children attending the fifth grade in 36 randomly selected elementary schools in Oropeza province. The prevalence of symptoms was determined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Environmental factors were assessed by the ISAAC environmental questionnaire including questions related to exposure to pets, farm animals, indoor and outdoor pollution, presence of disease vectors at home and precarious household conditions. Generalized linear mixed-effects models were adjusted for age, sex and place of living. RESULTS: Thirty seven percent of children reported that at least one of their parents smoked at home. Wood or coal was used as cooking fuel in 19% of the homes and 29% reported intense truck traffic on the street where they lived. With respect to hygiene conditions, 86% reported exposure to dogs, 59% exposure to cats and 36% regular contact to farm animals. More than one precarious household condition was reported by 8% of children. In the adjusted model exposure to dog (adjusted OR 1.4; CI 95% 1.0-1.9), cat (1.2; 1.0-1.5), farm animals (1.5; 1.2-1.8); intense truck traffic (1.3; 1.0-1.6), parents smoking at home (1.2; 1.0-1.5), presence of disease vectors at home (fourth quartile vs. first quartile: 1.6; 1.2-2.3) and two or more precarious household conditions (1.5; 1.0-2.2) were significantly associated with rhinoconjunctivitis symptoms. The associations were similar for asthma and eczema symptoms; however it did not reach the level of statistical significance for all items. CONCLUSION: Our results support previous findings reported for poor communities especially in Latin America, showing that lower hygiene conditions did not have protective effect against asthma and rhinoconjunctivitis and eczema symptoms.