Resilience among primary care professionals in a time of pandemic: a qualitative study in the Spanish context.

OBJECTIVES: This study explores the impact of the COVID-19 pandemic on the Spanish primary care structure and services and the mechanisms implemented by the primary care workforce to restore and reinforce their reference care model. DESIGN: An exploratory, qualitative study with semistructured interviews and a focus group discussion conducted during the fall semester of 2020. SETTING: Primary health centres in Madrid (Spain), chosen based on factors such as infection rates during the earliest stages of the pandemic and demographic and socioeconomic aspects. PARTICIPANTS: A total of 19 primary health and social care professionals were purposively selected. Criteria for inclusion were gender (male/female), at least 5 years of experience in their current position, category (health/social/administrative worker), and whether they worked in a rural or urban healthcare setting. RESULTS: Two main themes were identified: (1) reflecting on a model in crisis-particularly the reopening of centres to users and the proactive, participative strategies implemented by primary care professionals to reach their community; and (2) regaining a sense of purpose-how healthcare professionals implemented strategies to sustain their vision of their reference model. The COVID-19 pandemic exposed leadership deficiencies that, together with the initial unavailability of resources and difficulties maintaining face-to-face contact with users, triggered a sense of loss of professional identity. On the other hand, the analysis revealed potential strategies to restore and reinforce the traditional model, such as the adoption of digital technologies and reliance on community networks. CONCLUSION: This study highlights the importance of a solid reference framework and enhances the strengths and skills of the workforce to reinforce the community-based service provision model.

Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study.

BACKGROUND: The COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals' organisational and management strategies in primary care settings during the COVID-19 pandemic. DESIGN: Qualitative, exploratory study based on the analysis of participants' accounts within a hermeneutic phenomenologicaly approach. METHODS: Research was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years' experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews. RESULTS: A total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: "liquid" healthcare and "the best healthcare system in the world". During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers' perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement. CONCLUSION: Primary care workers' professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance. TRIAL REGISTRATION: The study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).

Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS: Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS: A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS: Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.

Emotions in the Time of COVID-19: Affections and Impacts among the Spanish Primary Care Workforce.

BACKGROUND: The literature review shows that most studies on the psychological impact of COVID-19 on healthcare professionals have focused on hospital staff, with few specifically addressing the primary care workforce. This study aims to explore primary care workers' verbal accounts of the emotions they experienced. METHODS: This is a qualitative study carried out between July and December 2020 in Spain. Semi-structured interviews and focus groups were conducted with primary care workers. Data were analysed through thematic content analysis. Participants were selected using purposive sampling. RESULTS: A total of 53 primary care workers participated in the study, of whom 38 were individually interviewed, and 15 participated in three focus groups. Our analysis revealed themes in two categories: (1) from infection to affection; and (2) affected, but not patients-a discourse based on the acceptance of their experience as part of their work in primary care, creating an ideological construct or "shield" based on emotional self-management. CONCLUSIONS: Self-reflection on the emotional impact of COVID-19 is scarce. Examples of emotional affections include an obsessive focus on hygiene, the inability to establish clear boundaries between the personal and the professional spheres, and experiencing-and having to self-manage-emotional strain.

Management of burnout among the staff of primary care centres in Spain during the pandemic caused by the SARS-CoV-2.

BACKGROUND: The provision of healthcare during the pandemic caused by the SARS-CoV-2 virus represented a challenge for the management of the resources in the primary care centres. We proposed assessing burnout among the staff of those centres and identifying factors that contributed to its appearance and those that limited it. METHODS: An observational study which, by means of anonymous questionnaires, collected information about: (i) demographic variables; (ii) the characteristics of each position; (iii) the measures implemented by the medical decision-makers in order to provide care during the pandemic; and (iv) the Burnout Clinical Subtype Questionnaire (BCSQ-36). We performed a descriptive analysis of the burnout mentioned by the staff, and, by means of a multivariate analysis, we identified the factors which influenced it. Using logit models, we analysed whether receiving specific training in COVID-19, feeling involved in decision-making processes, and/or working within different healthcare systems had effects on the development of burnout. RESULTS: We analysed the replies of 252 employees of primary care centres in Spain with an average age of 45 (SD = 15.7) and 22 (SD = 11.4) years of experience. 68% of the participants (n = 173) indicated burnout of the frenetic subtype. 79% (n = 200) of the employees had high scores in at least one burnout subtype, and 62% (n = 156) in at least two. Women older than 45 had a lower probability of suffering burnout. Receiving specific training (OR = 0.28; CI95%: 0.11-0.73) and feeling involved in decision-making (OR = 0.32; CI95%:0.15-0.70) each reduced the probability of developing burnout. Working in a different department increased the likelihood of developing burnout of at least one clinical subtype (OR = 2.85; CI95%: 1.38-5.86). CONCLUSIONS: The staff in primary care centres have developed high levels of burnout. Participation in decision-making and receiving specific training are revealed as factors that protect against the development of burnout. The measures taken to contain the adverse effects of a heavy workload appear to be insufficient. Certain factors that were not observed, but which are related to decisions taken by the healthcare management, appear to have had an effect on the development of some burnout subtypes.

Qualitative evaluation of a complex intervention to implement health promotion activities according to healthcare attendees and health professionals: EIRA study (phase II).

OBJECTIVE: To evaluate the implementation and development of a complex intervention on health promotion and changes in health-promoting behaviours in primary healthcare according to healthcare attendees and health professionals. DESIGN: Descriptive qualitative evaluation research conducted with 94 informants. Data collection techniques consisted of 14 semistructured individual interviews, 9 discussion groups, 1 triangular group and 6 documents. Three analysts carried out a thematic content analysis with the support of Atlas.ti software. This evaluation was modelled on Proctor and colleagues' concept of outcomes for implementation research. SETTING: 7 primary care centres from seven Spanish regions: Andalusia, Aragon, Balearic Islands, Basque Country, Castilla-La Mancha, Castilla-Leon and Catalonia. PARTICIPANTS: The study population were healthcare attendees (theoretical sampling) and health professionals (opportunistic sampling) who had participated in the exploratory trial of the EIRA intervention (2015). RESULTS: Healthcare attendees and professionals had a positive perception of the study. Healthcare attendees even reported that they would recommend participation to family and friends. Health professionals became aware of the significance of the motivational interview, especially for health promotion, and emphasised social prescribing of physical activity. They also put forward recommendations to improve recruitment, screening and retention of participants. Healthcare attendees modified behaviours and health professionals modified working practices. To achieve sustainability, health professionals believe that it is crucial to adapt agendas and involve all the staff. CONCLUSIONS: The discourses of all stakeholders on the intervention must be taken into consideration for the successful, setting-specific implementation of adequate, acceptable, equitable and sustainable strategies aimed at health promotion and well-being.

Percepción de familia entre mujeres embarazadas del norte de Portugal / Perception of family among pregnant women in the north of Portugal / Perceção da familia nas mulheres grávidas no norte de Portugal / Perception de famille chez les femmes enceintes dans le nord du Portugal

Resumen Objetivo: Analizarlas diferentes formas de construir la referencia de "ser una familia" en distintos ámbitos rurales y urbanos, a partir de las razones que hay detrás de la decisión de tener hijos. Materiales y métodos: Estudio cualitativo diseñado y analizado a partir del estudio de casos de diferentes áreas de salud del norte de Portugal. La metodología implicó la realización de entrevistas semi-estructuradas a 50 mujeres embarazadas en busca de sus significados recurriendo para ello al análisis de contenido. Resultados: Se identificó la categoría que denominamos "Modelo de referencia familiar", en la cual se señalan dos subcategorías: el sueño sobre la construcción de una nueva familia y el sueño hecho realidad. Estos resultados hacen coincidir la idea de las aspiraciones (ideal inicial, antes de quedar embarazada) y la de las representaciones (ideal abstracto). Los resultados apuntan a unos ideales orientados a la familia y pero muestran una disminución en el número de hijos por mujer consecuencia también de un cálculo en el cual son ponderados los costos asociados con esta decisión. Conclusiónes: Del universo de las aspiraciones, se impone la evocación del deseo de tener hijos, pues fueron realmente pocas las encuestadas que diseñaron un proyecto de vida sin hijos. Sin embargo, vemos una disonancia entre las aspiraciones iniciales y la nueva realidad. Se concluye que existe un proceso de elección entre tener o no hijos, así como la transición a la parentalidad como proyecto conyugal.

Abstract Objective: To analyze the different ways of 'being a family' and that predomínate in different social contexts ranging from rural to urban spaces based on the reasons that support the decision to have children. Materials and methods: A qualitative study was designed and analyzed using case studies of different health areas of northern Portugal. The methodology used was based on semi-structured interviews with 50 pregnant women. It was done a content analysis of interviews. Results: Based on the stories obtained through interviews, we identified the category "reference model of family ", in which two subcategories listed was identified: "the dream of building a new family" and "the dream come true". These results match the idea of aspirations (initial ideal) and representations (abstract ideal). The results suggest a family oriented by ideals and show a decrease in the number of children per woman. This is the result of a perception of the associated costs of this decision. Conclusions: From the universe of aspirations centered in the desire for children, only a few women prefer a life without children. However, we identified a dissonance between the initial aspirations and the practices. It is concluded that there is a process of choice between having children, as well as the transition to parenthood as a conjugal project.

Resumo Objectivo: Analisar os diferentes modos de «ser familia¼ e que predominam em contextos sociais que vão desde a ruralidade até a urbanidade tendo por base as razões que sustentam a decisão de ter descendência. Materiais e métodos: Estudo qualitativo com base em estudo de casos em diferentes centros de saúde no norte de Portugal. A metodologia envolveu a realização de entrevistas semiestruturadas a 50 mulheres grávidas. Para analisar os dados recorreu-se a análise de conteúdo. Resultados: Com base nos relatos obtidos identificou-se a categoria "Modelo de referencia familiar", que identifica duas subcategorias: A construção da nova familia: o sonho e o sonho tornado realidade. Estes resultados correspondem as aspirações de ideia (ideal inicial, antes de engravidar) e as representações (ideal abstracto). Conclusões: Os resultados apontam para um ideal de familia orientado para os dois filhos e demonstram uma diminução do número de filhos por mulher. A diminução do número de filhos é também o resultado de um cálculo onde são ponderados os custos associados a esta decisão. Do universo das aspirações impõe-se a evocação da vontade de ter filhos. Foram realmente poucas as inquiridas que traçaram um projeto de vida sem filhos. Todavia verificamos uma dissonancia entre as aspirações iniciais e por conseguinte com as práticas.

Résumé Objectif: Analyser les différentes formes de «etre famille¼ qui prédominent dans des contextes sociaux allant du rural a la vie urbaine ayant pour motifs la décision d'avoir des enfants. Matériaux et méthodes: Étude qualitative basée sur des études de cas dans des centres de santé primaires dans le nord du Portugal. La méthodologie se base sur des entrevues semi-structurées a 50 femmes enceintes. Pour analyser les données, on a utilisé l'analyse des contenus.. Résultats: Basé sur les données, on a identifié la catégorie «Modele de famille¼, qui identifie deux sous-catégories: la construction de la nouvelle famille : le reve et le reve devenu réalité. Ces résultats correspondent aux aspirations de l'idée (idéal, avant la grossesse) et représentations (idéal abstrait). Les résultats pointent vers un idéal de famille orienté vers les enfants et montrent une diminution du nombre d'enfants par femme qui est également la conséquence de facteurs socioéconomiques qui influencent cette décision. L'univers des aspirations permet l'évocation du désir d'avoir des enfants. Conclusions: On a eu tres peu de femmes qui désirent une vie sans enfant. Cependant, nous voyons une dissonance entre les aspirations initiales (idéal) et les représentations (idéal abstrait). On conclut qu'il existe un choix entre avoir enfants, bien comme la transition vers la parentalité en tant que projet conjugal.

Los dilemas propios de una investigación cualitativa en el ámbito de la cooperación al desarrollo: una cuestión delicada / Dilemmas appropriate for qualitative research in the field of development cooperation: a delicate question / Os dilemas próprios de uma pesquisa qualitativa na área da cooperação para o desenvolvimento: uma questão delicada

Este artículo analiza los dilemas éticos a los que tuvo que enfrentarse la autora durante la realización de la investigación antropológica para lo que sería su tesis doctoral, en el marco de un proyecto de cooperación al desarrollo en el ámbito de la salud. Se apunta un proceso de integración, de comprensión y de entendimiento en la propia investigadora, asumiendo, a veces resolviendo, e incluso entendiéndolos como parte del mismo proceso de investigación, por tanto, se apropia de ellos y los interioriza. Las disyuntivas que se presentan en el trabajo de campo se valoran como parte de este tipo de trabajos iniciáticos, contrastando con investigaciones e investigadores consolidados y observando que estas dificultades se presentan en diferentes ámbitos y de múltiples formas. Se considera necesario el abordaje de este tipo de cuestiones con rigurosidad metodológica, así como el consiguiente análisis, estimándolas como algo intrínseco a las investigaciones realizadas con otros y que sustentan intervenciones en salud. Se pretende poner el énfasis en este aspecto, a pesar de ser la ética un tema central cuando hablamos de investigaciones con sujetos y grupos sociales, pues se le dedica poco tiempo en la formación y práctica investigadora.

This article analyzes the ethical dilemmas which the authoress had to face during the accomplishment of the anthropologic investigation for what it would be his doctoral thesis, in the frame of a project of cooperation the development in the area of the health. There signs a process of integration, of comprehension and of understanding in the own investigator, taking up office, sometimes resolving, and even understanding them as part of the same process of investigation, therefore it appropriates of them, internalizes them. The dilemmas that they present in the fieldwork are valued as part of this type of initiation works, contrasting with investigations and consolidated investigators and, observing that these difficulties appear in different areas and of multiple forms, is considered to be necessary the boarding of this type of questions by methodological rigor, as well as the consequent analysis, estimating them as something intrinsically to the investigations realized with others and that sustain interventions in health. The emphasis is tried to put in this aspect, in spite of being a central topic the ethics, when we speak about investigations with subjects and social groups, since one dedicates him a little time in the formation and investigative practice.

Este artigo analisa os dilemas éticos enfrentados pela autora durante a realização da pesquisa antropológica para o que seria sua tese de doutorado, no âmbito de um projeto de cooperação para o desenvolvimento na área da saúde. Observa-se um processo de integração, compreensão e entendimento na própria pesquisadora, assumindo, às vezes resolvendo e até mesmo os entendendo como parte do processo de investigação, portanto se apropria deles e os interioriza. Os dilemas que surgem no trabalho de campo se valoram como parte deste tipo de trabalho inicial, contrastando com pesquisas e pesquisadores consolidados e constatando que estas dificuldades surgem em diferentes áreas e em diferentes aspectos, considera-se necessário abordar esses tipos de questões com rigor metodológico, bem como a análise subsequente, apreciando-as como algo intrínseco às investigações realizadas com outros e que sustentam as intervenções em saúde. Pretende enfatizar este aspecto, apesar da ética ser um tema central, quando falamos de pesquisa com sujeitos e grupos sociais, uma vez que pouco tempo é dedicado à formação e prática de investigação.

¿Una medicina efectiva entre culturas? La experiencia de un programa de salud de atención primaria en comunidades indígenas de la selva amazónica ecuatoriana / An effective medicine between cultures? The experience of a health program of primary care in indigenous communities from the Amazonian Ecuatorean Jungle

Se hace necesario un análisis de los programas de cooperación, en los cuales se reproducen pautas biomédicas foráneas y se descuidan las locales. En este trabajo se presenta el resultado de varios estudios de caso, en los cuales se aprecia cómo la forma de llevar a cabo programas de salud en zonas aisladas no examina con detalle la realidad indígena y su medicina tradicional. Es producto de una inmersión sociocultural y observación participante, realizando trabajo de campo intensivo con técnicas cualitativas (entrevistas en profundidad, análisis institucional, estudios de casos), tanto en la comunidad achuar como en las estructuras occidentales del escenario intervenido. He encontrado que la forma de llevar a cabo programas de salud en estas comunidades indígenas tan inaccesibles, genera como consecuencia desconfianza hacia el nuevo sistema que se impone y que no recoge verdaderos resultados. He constatado que la competencia cultural, es algo muy exigible a las ongs y agencias de salud que trabajan en la zona estudiada (AU)

There becomes necessary to analyze cooperation programs which reproduced our biomedical guidelines but neglect the local ones. In this Work, it show the result of several case studies, which show how the way of carrying out health programs in isolated areas does not examine closely the indigenous reality and its traditional medicine. I have done a sociocultural immersion and an observation participant, I have applied a qualitative methodology and techniques, both in the Achuar community and in the western structures of the scene researched.I have found out that the way of carrying out health programs in such inaccessible indegenous communities, provokes distrust towards the new system imposed. As a consequence, it does not gather real results.I have concluded that a greates knowledge of cultural competence, is something that should be required from ngos and health agencies that are employed in the studied area (AU)