[Analysis of the epidemiological profile of the indigenous community of Hueyapan, Morelos]. / Análisis del perfil epidemiológico de la comunidad indígena de Hueyapan, Morelos.

BACKGROUND: The epidemiological transition is a phenomenon that has had a different impact between urban and rural settings. The WHO points out that the population with the lowest socioeconomic status is the most adversely affected for the unequal distribution of resources, indigenous people are a part of this population. OBJECTIVE: To analyze the epidemiological profile of the indigenous people of Hueyapan, Morelos during the months of March to June 2017. METHODS: A cross-sectional epidemiological study was carried out in the indigenous community of Hueyapan, belonging to the municipality of Morelos, in 2017. A sample of 338 households was calculated; as inclusion criteria, those dwellings where the age of residence in Hueyapan was equal to or greater than four years were taken; a systematic sampling was carried out every three households, in addition, Mexico's INEGI and Health Department databases were analyzed from 2011 to 2015. RESULTS: In relation to morbidity, an upward trend was found in the crude rate, from 119.7 per 1,000 in 2011 to 270.7 per 1000 in 2015, among the most prevalent diseases in those years, infectious diseases were identified as major and the appearance of noncommunicable diseases began to be observed. In relation to mortality, a linear trend was observed in the crude rate of 5.7 per 1000 in 2011 to 6.6 per 1000 in 2015. CONCLUSIONS: The epidemiological profile of Hueyapan coincides with a process of epidemiological transition where there is a double burden of disease. This suggests a challenge for the public health area that should be addressed from the creation of health strategies, programs and policies aimed at this population from an intercultural approach.

INTRODUCCIÓN: la transición epidemiológica es un fenómeno que se ha presentado de forma distinta entre sectores urbanizados y rurales. OBJETIVO: analizar el perfil epidemiológico de la comunidad indígena de Hueyapan, Morelos, durante el periodo de marzo a junio de 2017. MÉTODOS: se realizó un estudio epidemiológico transversal en la comunidad indígena de Hueyapan, perteneciente al municipio de Morelos, en 2017. Se calculó un tamaño de muestra de 338 viviendas; como criterios de inclusión se tomaron aquellas viviendas dónde la edad de residencia en Hueyapan fuera igual o mayor a cuatro años; se realizó un muestreo sistemático cada tres viviendas, además se analizaron bases de datos de INEGI y Secretaría de Salud de 2011 a 2015. RESULTADOS: en relación con la morbilidad, se encontró una tendencia ascendente en la tasa bruta. Dentro de las enfermedades más prevalentes se identificaron las enfermedades infecciosas como principales y se empezó a observar la aparición de enfermedades no transmisibles. En relación con la mortalidad, se observó una tendencia lineal en su tasa bruta. CONCLUSIONES: el perfil epidemiológico de Hueyapan coincide con un proceso de transición epidemiológica, donde existe una doble carga de enfermedad. Esto sugiere un reto para el área de la salud pública que debiera enfrentarse desde la creación de estrategias, programas y políticas de salud dirigidas a esta población desde un enfoque intercultural.

Using codesign to develop a culturally tailored, behavior change mHealth intervention for indigenous and other priority communities: A case study in New Zealand.

The obesity rate in New Zealand is one of the highest worldwide (31%), with highest rates among Maori (47%) and Pasifika (67%). Codesign was used to develop a culturally tailored, behavior change mHealth intervention for Maori and Pasifika in New Zealand. The purpose of this article is to provide an overview of the codesign methods and processes and describe how these were used to inform and build a theory-driven approach to the selection of behavioral determinants and change techniques. The codesign approach in this study was based on a partnership between Maori and Pasifika partners and an academic research team. This involved working with communities on opportunity identification, elucidation of needs and desires, knowledge generation, envisaging the mHealth tool, and prototype testing. Models of Maori and Pasifika holistic well-being and health promotion were the basis for identifying key content modules and were applied to relevant determinants of behavior change and theoretically based behavior change techniques from the Theoretical Domains Framework and Behavior Change Taxonomy, respectively. Three key content modules were identified: physical activity, family/whanau [extended family], and healthy eating. Other important themes included mental well-being/stress, connecting, motivation/support, and health literacy. Relevant behavioral determinants were selected, and 17 change techniques were mapped to these determinants. Community partners established that a smartphone app was the optimal vehicle for the intervention. Both Maori and Pasifika versions of the app were developed to ensure features and functionalities were culturally tailored and appealing to users. Codesign enabled and empowered users to tailor the intervention to their cultural needs. By using codesign and applying both ethnic-specific and Western theoretical frameworks of health and behavior change, the mHealth intervention is both evidence based and culturally tailored.