Análisis con perspectiva de género de la Encuesta de Fecundidad 2018 en España / Gender analysis of the Spanish Fertility Survey 2018

Objetivo: Analizar el lenguaje y el contenido del cuestionario utilizado en la Encuesta de Fecundidad 2018 en España, desde una perspectiva de género. Método: Diseño cualitativo basado en el análisis de contenido del cuestionario empleado en la Encuesta de Fecundidad 2018, utilizando recomendaciones y guías metodológicas para estadísticas con perspectiva de género y la comparación con el cuestionarioGenerations and Gender Survey.Las categorías de análisis fueron: lenguaje, división sexual del trabajo y fecundidad. El procedimiento de análisis se basó en comprobar las variables incluidas en las guías a modo de lista de comprobación(checklist)e incorporando variables emergentes específicamente relacionadas con desigualdades y sesgos de género. Resultados: El cuestionario emplea algunos términos inclusivos, pero mantiene el uso del masculino como genérico, reproduce estereotipos de género y engloba binomios masculino-femenino en un concepto único. Identifica de manera limitada la división sexual del trabajo doméstico y de cuidados, la segregación horizontal y vertical en el ámbito laboral, y las diferencias por sexo entre acceso y control de los recursos. En relación con la fecundidad, reproduce desigualdades y sesgos de género que construyen una visión normalizada e idealizada sobre el hecho de tener descendencia, invisibilizan el impacto diferencial del embarazo y la crianza para la salud de las mujeres y priorizan la dimensión biológica de la maternidad y la paternidad. Conclusiones: La Encuesta de Fecundidad requiere mejorar su sensibilidad de género, recoger la diversidad de factores biológicos, socioeconómicos y estructurales condicionantes de la fecundidad, y profundizar en los elementos diferenciales generadores de desigualdades y sesgos de género. (AU)

Objective: To analyze the language and content of the questionnaire used in the Fertility Survey 2018, from a gender perspective. Method: Qualitative design based on a content analysis of the questionnaire used in the Fertility Survey 2018. Methodological recommendations and guides for gender-sensitive statistics were used, together with the comparison established with the Generations and Gender Survey. The categories of analysis were: language, sexual division of labor and fertility. The analysis procedure included the checklist and the incorporation of emerging variables specifically related to gender inequalities and biases. Results: The questionnaire uses with some inclusive language, but maintains the generic use of masculine gender, reproduces gender stereotypes and uses male-female binomials as a single concept. It offers a limited perspective on sexual division of domestic and care labor, horizontal and vertical segregation in the workplace, gender differences between the access and control of resources. In relation to fertility, it reproduces gender inequalities and biases that build a normalized and idealized vision on having children, do not reflect the differential impact of pregnancy and parenting on women's health and prioritize the biological dimension of motherhood and fatherhood. Conclusions: The Spanish Fertility Survey needs to improve its gender sensitivity, reflect the heterogeneous biological, socio-economic and structural dimensions of fertility and explore deeper into the differential elements that generate inequalities and gender biases. (AU)

[Gender analysis of the Spanish Fertility Survey 2018]. / Análisis con perspectiva de género de la Encuesta de Fecundidad 2018 en España.

OBJECTIVE: To analyze the language and content of the questionnaire used in the Fertility Survey 2018, from a gender perspective. METHOD: Qualitative design based on a content analysis of the questionnaire used in the Fertility Survey 2018. Methodological recommendations and guides for gender-sensitive statistics were used, together with the comparison established with the Generations and Gender Survey. The categories of analysis were: language, sexual division of labor and fertility. The analysis procedure included the checklist and the incorporation of emerging variables specifically related to gender inequalities and biases. RESULTS: The questionnaire uses with some inclusive language, but maintains the generic use of masculine gender, reproduces gender stereotypes and uses male-female binomials as a single concept. It offers a limited perspective on sexual division of domestic and care labor, horizontal and vertical segregation in the workplace, gender differences between the access and control of resources. In relation to fertility, it reproduces gender inequalities and biases that build a normalized and idealized vision on having children, do not reflect the differential impact of pregnancy and parenting on women's health and prioritize the biological dimension of motherhood and fatherhood. CONCLUSIONS: The Spanish Fertility Survey needs to improve its gender sensitivity, reflect the heterogeneous biological, socio-economic and structural dimensions of fertility and explore deeper into the differential elements that generate inequalities and gender biases.

Análisis de las buenas prácticas de participación ciudadana en las unidades de gestión clínica del Servicio Andaluz de Salud / Analysis of good practices for inhabitant participation in the clinical management units of the Andalusian Health Service (Spain)

Objetivo: Conocer buenas prácticas de participación ciudadana en las unidades de gestión clínica (UGC) del Servicio Andaluz de Salud (SAS) y explorar factores percibidos por profesionales de UGC del SAS que pueden influir en la existencia y la distribución de buenas prácticas de participación ciudadana. Método: Estudio con metodología mixta realizado en Andalucía en dos fases (2013-2015). En la fase 1 (estudio cuantitativo) se realizó un cuestionario online a directores/as de UGC con una comisión de participación ciudadana constituida. En la fase 2 (estudio cualitativo) se realizaron entrevistas semiestructuradas a profesionales del SAS con experiencia en participación ciudadana. Se realizó un análisis descriptivo de la información cuantitativa y un análisis de contenido semántico de la cualitativa. Resultados: En la fase 1 participaron 530 UGC. Las prácticas de participación ciudadana implementadas con mayor frecuencia en las UGC están circunscritas a los niveles de información y consulta. Otras prácticas que suponen una mayor implicación y delegación ciudadana son secundarias. En la fase 2 se entrevistó a 12 profesionales. Los obstáculos identificados por los/las profesionales que pueden afectar a la distribución de buenas prácticas están relacionados con las creencias y las actitudes de la ciudadanía, los/las profesionales, el sistema sanitario y el contexto. Conclusiones: Las principales prácticas de participación ciudadana en las UGC están relacionadas con los niveles más básicos de participación. No se reconocen claramente la manera y los mecanismos que facilitarían el empoderamiento ciudadano en el sistema sanitario (AU)

Objective: To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. Methods: Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013-2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. Results: 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. Conclusion: The main practices for inhabitant participation in the CMUs are related to the most basic levels of participation. The method and dynamics which facilitate inhabitant empowerment within the health system are not clearly recognized (AU)

[Analysis of good practices for inhabitant participation in the clinical management units of the Andalusian Health Service (Spain)]. / Análisis de las buenas prácticas de participación ciudadana en las unidades de gestión clínica del Servicio Andaluz de Salud.

OBJECTIVE: To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. METHODS: Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013-2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. RESULTS: 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. CONCLUSION: The main practices for inhabitant participation in the CMUs are related to the most basic levels of participation. The method and dynamics which facilitate inhabitant empowerment within the health system are not clearly recognised.

Opiniones de menores residentes en Andalucía (España) sobre temas de salud: Aplicación de un cuestionario por Internet / Opinions of minor children residing in Andalusia (Spain) on health-related topics: An online questionnaire

Objetivo: Analizar opiniones de menores sobre el concepto de salud, centros y profesionales sanitarios así como recomendaciones en forma de consejos sobre promoción de salud. Métodos: Estudio transversal con cuestionario online dirigido a menores de 14 años de edad. Se utilizó una versión adaptada del cuestionario Kid's Hospital, el cual contiene preguntas abiertas y cerradas. Resultados: Contestaron al cuestionario 358 menores, de los cuales 225 fueron niñas (61,3%). La edad media global fue de 9,2(DE 2,61). Asocian buena salud con la ausencia de enfermedad (n=165, 46,1%) y estar en forma (n=151, 42,2%) ; sobre experiencias de la última visita al médico, reconocen el papel de ayuda y mediación de estos profesionales (n=233, 65,1%); destacan la ayuda y la recuperación como lo mejor de la atención, y como lo peor los pinchazos y el dolor padecido. De los consejos emitidos para promoción de salud destacan aquellos sobre alimentación (n=233, 62,3%). Conclusiones: Los cuestionarios online a menores, constituyen una forma útil de recolección de información. Así, estas consultas directas permiten la participación de los niños y niñas o de los menores y proporcionan información útil para adecuar las intervenciones de cara a fomentar la promoción entre iguales, así como sobre sus preferencias en el diseño de intervenciones.

Objective: To analyze opinions of minors regarding the concept of health, health centers, and professionals, as well as providing them with recommendations on health promotion in the form of health promotion advice. Methods: A cross-sectional survey with an online questionnaire aimed to kids below 14. An adapted version of Kid's Hospital questionnaire was utilized, which has both open and closed questions. Results: 358 minors answered the questionnaire, 225 of which were girls (61.3%). The mean global age was 9.2 years (SD 2.61). They associated good health with the absence of illnesses (n=165, 46.1%) and being in shape (n=151, 42.2%). Regarding their experiences about their last doctor's appointment, they acknowledged the aiding and mediation role of these professionals as the best features of the assistance (n=233, 65.1%) and the pain suffered and syringe jabs as the worst ones. They also highlighted healthy eating advice from the health promotion advice given (n=233, 62.3%). Discussion: Online questionnaires for minors are a useful data collection tool. These direct queries allow them to participate and provide useful information to adequate medical interventions in order to develop actions for health promotion, as well as taking their opinions into account when designing interventions.

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

Objetivo Identificar los atributos con los cuales los/las pacientes crónicos/as atendidos/as en el Sistema Sanitario Público de Andalucía (SSPA) describen la competencia profesional del personal facultativo que les atiende a lo largo de su proceso asistencial. Métodos 147 pacientes crónicos de diferentes procesos asistenciales y sus familiares. Investigación cualitativa con grupos focales y entrevistas en profundidad, realizadas en centros de salud y consultas externas de Granada, Málaga, Sevilla, Cádiz y Córdoba, entre 2007 y 2008. Análisis de contenido con Nudist Vivo. Resultados Las personas participantes definen la competencia médica enlazando elementos de habilidad y conocimientos técnicos (tener conocimientos e interés por la enfermedad, mantener una continuidad en la atención mediante seguimientos correctos o solicitar las pruebas precisas) con otros relacionales, tanto sobre comunicación e información (informar, escuchar, confiar, estimular las preguntas) como sobre trato (humanidad, amabilidad, respeto, interés, cercanía). En la valoración de la asistencia en atención primaria, las expectativas incluyen relación cercana, trato personalizado, información, gestión de recetas y baja laboral, y derivación al/a la especialista. Sobre las consultas de especialidad destaca acertar diagnóstico y tratamiento, informar y hacer un seguimiento del/de la paciente. En el servicio de urgencias se valoran especialmente el alivio de los síntomas, acertar el diagnóstico, ser derivado al/a la especialista y recibir un trato humano. Conclusiones Las necesidades y las expectativas de los/as pacientes crónicos/as hacia la competencia médica se organizan en torno a habilidades técnicas y relacionales (AU)

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 (AU)

[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.

Quality of internal communication in health care and the professional-patient relationship.

A study was undertaken for the purpose of describing internal communication and the professional-patient relationship and to establish a descriptive model of the interaction between these 2 variables. A nationwide survey was carried out in primary care and specialist care centers in Spain. A simple random sampling method was used with 1183 health care professionals. The data collection instrument was a Likert questionnaire that recorded information on the perceived quality of internal communication (0-100 scale), professional-patient relationships (0-100 scale), and sociodemographic variables. The results were analyzed using SPSS 15.0, performing mean comparisons and a suitable linear regression model.The total average of the quality of internal communication was 53.79 points, and that of the professional-patient relationships was 74.17 points. Sex made no statistically significant difference. Age shows that the older the participant, the better his/her opinion of internal communication and professional-patient relationships. Nursing staff had the highest opinion of internal communication and professional-patient relationships. The association between internal communication and professional-patient relationship was positive (R = 0.45).It was concluded that continuous exchange of information among health care professionals, together with learning and shared decision making or a positive emotional climate, is an element that will consolidate good professional-patient relationships and ensure patient satisfaction.

Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa / Fibromyalgia: Patient perception on their disease and health system. Qualitative research study

Objetivo Conocer la experiencia y vivencia de personas con fibromialgia y sus expectativas sobre el sistema sanitario y sus profesionales. Métodos Diseño cualitativo a través de grupos focales. Se realizaron tres grupos, uno con pacientes que pertenecían a asociaciones de fibromialgia. Participaron 20 mujeres y 1 varón. Se incluyeron personas que recibían atención en el sistema sanitario público, con distintas trayectorias asistenciales y evolución. Se pidió consentimiento informado. Análisis de contenido. Resultados Describen una vivencia difícil con una sintomatología que puede ser incapacitante para las actividades cotidianas. Hasta que reciben el diagnóstico, perciben incomprensión y soledad. Desarrollan distintas estrategias de afrontamiento, como buscar información o asociarse. Esperan del sistema sanitario: atención y diagnósticos ágiles, acceso a consultas, pruebas que necesiten y terapias beneficiosas o impulso a la investigación. Quieren profesionales con formación para abordar la fibromialgia, una actitud proactiva, interés, empatía e información. Discusión La metodología cualitativa fue idónea para profundizar en la experiencia de pacientes. La atención sanitaria debe dirigirse a mejorar su calidad de vida facilitando su proceso asistencial y ofreciendo acompañamiento, interés, comprensión y apoyo(AU)

Objective To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. Methods Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. Results Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. Discussion Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients’ quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support(AU)

[Fibromyalgia: Patient perception on their disease and health system. Qualitative research study]. / Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa.

OBJECTIVE: To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. METHODS: Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. RESULTS: Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. DISCUSSION: Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients' quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support.