Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal / Perceived needs of women regarding maternity. Qualitative study to redesign maternal education

OBJETIVO: Explorar las necesidades expresadas por las mujeres a lo largo del proceso de convertirse en madre y sus demandas relacionadas con la educación maternal. DISEÑO: Estudio cualitativo con grupos focales. EMPLAZAMIENTO: Área de salud de Bizkaia, Servicio Vasco de Salud/Osakidetza. PARTICIPANTES: Treinta mujeres seleccionadas de forma consecutiva por matronas de atención primaria de 6 centros de salud diferentes. MÉTODOS: Entre septiembre y noviembre de 2010 se formaron 4 grupos focales estratificados por situación socioeconómica y etapa del proceso (embarazo/puerperio). Para recoger las preocupaciones de las embarazadas, de las puérperas y su opinión sobre la educación maternal se siguió el método de análisis del contenido temático con el apoyo del software ATLAS. ti. RESULTADOS: El foco de preocupación de las mujeres va cambiando con el tiempo. Pasaba de la necesidad de confirmar que 'todo va bien' a necesitar más apoyo emocional y confianza para enfrentarse a sus miedos al parto y al cuidado de los hijos. Necesitaban mayor acompañamiento en el puerperio y menos presión con la lactancia materna. En cuanto a la educación maternal, demandaban un programa de educación perinatal en lugar de solo prenatal, más actualizado, con mayor participación de su pareja, más interactivo y flexible. CONCLUSIÓN: Las mujeres de nuestro entorno perciben necesidades similares a las de los países anglosajones, independientemente de las diferencias culturales. Parece claro la necesidad de rediseñar un programa de educación perinatal extenso, personalizado, dinámico, que empodere a las mujeres para gestionar su propia salud y la de su familia

OBJECTIVES. To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education. DESIGN: Qualitative study with focus groups. SETTING: Bizkaia health region, Basque Health Service (Osakidetza), Spain. PARTICIPANTS: Thirty one women were recruited consecutively by midwives at six Osakidetza health centres. METHODS: Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS. ti software. RESULTS: The focus of the women worries changes over time. In early pregnancy, women's main concern was for 'everything to go well'. As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner. CONCLUSION: Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women

[Perceived needs of women regarding maternity. Qualitative study to redesign maternal education]. / Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal.

OBJECTIVES: To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education. DESIGN: Qualitative study with focus groups. SETTING: Bizkaia health region, Basque Health Service (Osakidetza), Spain. PARTICIPANTS: Thirty one women were recruited consecutively by midwives at six Osakidetza health centres. METHODS: Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS.ti software. RESULTS: The focus of the women worries changes over time. In early pregnancy, women's main concern was for "everything to go well". As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner. CONCLUSION: Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women.

Patients' opinions about knowing their risk for depression and what to do about it. The predictD-qualitative study.

BACKGROUND: The predictD study developed and validated a risk algorithm for predicting the onset of major depression in primary care. We aimed to explore the opinion of patients about knowing their risk for depression and the values and criteria upon which these opinions are based. METHODS: A maximum variation sample of patients was taken, stratified by city, age, gender, immigrant status, socio-economic status and lifetime depression. The study participants were 52 patients belonging to 13 urban health centres in seven different cities around Spain. Seven Focus Groups (FGs) were given held with primary care patients, one for each of the seven participating cities. RESULTS: The results showed that patients generally welcomed knowing their risk for depression. Furthermore, in light of available evidence several patients proposed potential changes in their lifestyles to prevent depression. Patients generally preferred to ask their General Practitioners (GPs) for advice, though mental health specialists were also mentioned. They suggested that GPs undertake interventions tailored to each patient, from a "patient-centred" approach, with certain communication skills, and giving advice to help patients cope with the knowledge that they are at risk of becoming depressed. CONCLUSIONS: Patients are pleased to be informed about their risk for depression. We detected certain beliefs, attitudes, values, expectations and behaviour among the patients that were potentially useful for future primary prevention programmes on depression.

Los "otros profesionales" en la atención a personas con depresión: psicólogos, trabajadores sociales y enfermeras / The "other professionals" in the care of people with depression: Psychologists, social workers and nurses

Objetivos: Conocer las vivencias y perspectivas de psicólogos (P), trabajadores sociales (TS) y personal de enfermería (DUE) acerca de su papel en la atención al paciente con depresión. Método: Investigación cualitativa con diseño exploratorio y generación de información mediante dos grupos de discusión. Análisis temático y comparación de los hallazgos con un estudio previo con médicos de familia y psiquiatras. Triangulación entre investigadores. Resultados: El desconocimiento recíproco, la falta de coordinación, la borrosidad del diagnóstico y el riesgo de psiquiatrización aparecen como vivencias compartidas. Se subraya la importancia de lo biopsicosocial y se reivindican los roles propios. Se plantea la confusión existente en cuanto al papel de la psicoterapia y su llamativa carencia en los servicios de salud. Conclusiones: Los distintos profesionales que intervienen en el tratamiento de las personas con depresión presentan visiones particulares que es importante identificar y discutir para conseguir una atención integrada y orientada al paciente (AU)

Objectives: To know experiences and perspectives of psychologists, social workers and nurses about their role in the care of depressed patients. Method: Qualitative research with exploratory design and generation of information by means of two discussion groups. Recordings obtained after confidentiality agreement. Thematic analyses and comparison with the findings obtained in a previous study with family physicians and psychiatrists. Triangulation among researchers. Results: The main shared experiences are reciprocal lack of awareness, lack of coordination, fuzziness of the diagnosis, and risk of pathologizing problems of daily living. The non-medical professionals highlight the importance of biopsychosocial factors, while at the same time stressing the need for their own role. There is evidence of confusion regarding the role of psychotherapy and its remarkable absence in health centers. Conclusions: The different professionals that participate in the treatment of people with depression have specific visions that need to be identified and discussed in order to reach an integrated level of care. The collaboration must focus on the patient and engage the different professionals throughout the long care process (AU)

Perspectivas de los pacientes diagnosticados de depresión y atendidos por médicos de familia y psiquiatras / Views of patients diagnosed with depression and cared for by general practitioners and psychiatrists

Objetivo: Conocer las vivencias de los pacientes en tratamiento por depresión según sean atendidos por médicos de familia (MF) o por psiquiatras (PSQ), para identificar vías de mejora. Diseño: Metodología cualitativa orientada a la investigación de servicios de salud. Diseño exploratorio. Participantes y contextos: 31 pacientes diagnosticados de depresión y en tratamiento farmacológico durante al menos un año, procedentes de 20 centros de salud y 8 de salud mental del Servicio Vasco de Salud-Osakidetza en Bizkaia, agrupados según profesional (MF/PSQ) y nivel socioeconómico. Método: Generación de información mediante 5 grupos de discusión y 2 entrevistas en profundidad realizadas en 2009 y 2010. Grabación y transcripción, previo compromiso de confidencialidad y consentimiento informado. Análisis sociológico de los discursos. Triangulación de técnicas y contraste entre los investigadores. Resultados: Los pacientes presentan vivencias de la depresión vinculadas a los contextos sociales de procedencia y a los recorridos previos fuera y dentro de los servicios de salud. Dichos componentes están asimismo presentes en las percepciones sobre la calidad de la atención, con expectativas diferenciadas respecto de MF y PSQ. En general, se constatan carencias de tiempo y de psicoterapia. La colaboración entre ambos profesionales no surge espontáneamente como prioridad de los pacientes. Conclusiones: Las valoraciones de los pacientes aportan dimensiones propias sobre los componentes individual y contextual en el diagnóstico y tratamiento de la depresión. Dichas dimensiones deberían ser tenidas en cuenta en la identificación de necesidades y en el diseño de estrategias compartidas por MF y PSQ para la mejora de su asistencia(AU)

Objectives: To explore the experiences of patients treated for depression either by general practitioners (GPs) or psychiatrists (Ps) with the aim of identifying improvement strategies. Design: Health services research-oriented qualitative methodology. Exploratory design. Participants and contexts: A total of 31 patients diagnosed with depression receiving pharmacological treatment for at least one year, belonging to 20 Health Centres and 8 Mental Health Centres of the Basque Health Service-Osakidetza in Bizkaia, and grouped according to the type of professional (GPs/Ps) and socioeconomic level. Method: Information generation by means of 5 discussion groups and 2 in-depth interviews carried out in 2009 and 2010. Recording and transcription with previous confidentiality agreement and informed consent. Sociological discourse analysis. Technique triangulation and agreement among researchers. Results: Patients’ experiences of depression are associated with their social contexts and their previous experience outside and inside the health services. These components also appear in perceptions on quality of care, with different expectations related to GPs and Ps. Deficiencies in time and psychotherapy are mentioned in general. Collaboration between both professionals does not spontaneously emerge as a patient priority. Conclusions: Patient assessments provide dimensions of individual and contextual components in the diagnosis and treatment of depression. These dimensions should be taken into account in the identification of needs and the design of strategies shared by GPs and Psychiatrists to improve care(AU)

[Views of patients diagnosed with depression and cared for by general practitioners and psychiatrists]. / Perspectivas de los pacientes diagnosticados de depresión y atendidos por médicos de familia y psiquiatras.

OBJECTIVES: To explore the experiences of patients treated for depression either by general practitioners (GPs) or psychiatrists (Ps) with the aim of identifying improvement strategies. DESIGN: Health services research-oriented qualitative methodology. Exploratory design. PARTICIPANTS AND CONTEXTS: A total of 31 patients diagnosed with depression receiving pharmacological treatment for at least one year, belonging to 20 Health Centres and 8 Mental Health Centres of the Basque Health Service-Osakidetza in Bizkaia, and grouped according to the type of professional (GPs/Ps) and socioeconomic level. METHOD: Information generation by means of 5 discussion groups and 2 in-depth interviews carried out in 2009 and 2010. Recording and transcription with previous confidentiality agreement and informed consent. Sociological discourse analysis. Technique triangulation and agreement among researchers. RESULTS: Patients' experiences of depression are associated with their social contexts and their previous experience outside and inside the health services. These components also appear in perceptions on quality of care, with different expectations related to GPs and Ps. Deficiencies in time and psychotherapy are mentioned in general. Collaboration between both professionals does not spontaneously emerge as a patient priority. CONCLUSIONS: Patient assessments provide dimensions of individual and contextual components in the diagnosis and treatment of depression. These dimensions should be taken into account in the identification of needs and the design of strategies shared by GPs and Psychiatrists to improve care.

[Family doctors and psychiatrists and the patient with depression: the need to re-adjust health care approaches and organisational dynamics]. / Médicos de familia y psiquiatras ante el paciente con depresión: la necesidad de readecuar enfoques asistenciales y dinámicas organizativas.

OBJECTIVES: To find out the perceptions of family doctors (FD) and psychiatrists (PS) on their inter-relationships in the health care of patients with depression. DESIGN: Qualitative methodology. Exploratory design based on FD and PS discussion groups (DG). SETTING: Primary health care centres (PHCC) and mental health centres (MHC) of the Basque Country Health Service in Vizcaya. PARTICIPANTS AND CONTEXT: A total of 29 FD from 20 PHCC, and 13 PS from 11 MHC, distributed according to the socioeconomic level of the reference population. The meetings were arranged and held in the PC research unit. METHODS: An intentional sample to configure 4 DG of FD and 2 of PS, homogenous as regards socioeconomic level, and heterogeneous as regards the centres they came from, work experience and gender. The meetings were recorded and transcribed and a sociological discourse analysis was made. Triangulation between researchers and results comparison with the participants was carried out. RESULTS: The perceptions and attitudes of the FD and PS differed, in their connections with the patient, expectations and health care context. In both cases they perceived the unsuitability of the real patient as regards the prefixed perceptions of the professional. The increase of the problem and its management seemed to be conditioned by a social medium which was uncontrolled, and due to increasing deficiencies in the collaboration between health care levels. CONCLUSIONS: Care of the patient with depression requires diagnostic and treatment approaches centred on the patient and shared by FD and PS.

Médicos de familia y psiquiatras ante el paciente con depresión: la necesidad de readecuar enfoques asistenciales y dinámicas organizativas / Family Doctors and Psychiatrists and the Patient With Depression: the Need to Re-adjust Health Care Approaches and Organisational Dynamics

Objetivos: conocer las percepciones de los médicos de familia (MF) y psiquiatras (PS) acerca de su interrelación en la asistencia a los pacientes con depresión. Diseño: metodología cualitativa. Diseño exploratorio basado en grupos de discusión (GD) de MF y PS. Emplazamiento: centros de salud (CS) de atención primaria (AP) y centros de salud mental (CSM) del Servicio Vasco de Salud-Osakidetza en Bizkaia. Participantes y contextos: un total de 29 MF de 20 CS y 13 PS procedentes de 11 CSM, distribuidos según el nivel socioeconómico de las poblaciones de referencia. La convocatoria y las reuniones se realizaron en la unidad de investigación de AP. Método: muestreo intencional para configurar 4 GD de MF y 2 de PS, homogéneos respecto al nivel socioeconómico, y heterogéneos en cuanto a centros de procedencia, experiencia laboral y sexo. Grabación y transcripción de las reuniones. Análisis sociológico del discurso. Triangulación entre investigadores y contraste de resultados con los participantes. Resultados: las percepciones y actitudes de MF y PS difieren en su vinculación con el paciente, expectativas y contexto asistencial. En ambos casos se percibe inadecuación del paciente real respecto de los esquemas prefijados por el profesional. El aumento del problema y su manejo aparecen condicionados por un medio social que no se controla, y por deficiencias crecientes en la colaboración entre niveles asistenciales. Conclusiones: la atención al paciente con depresión requiere de enfoques diagnósticos y tratamientos centrados en el paciente y compartidos por MF y PS(AU)

Objectives: To find out the perceptions of family doctors (FD) and psychiatrists (PS) on their inter-relationships in the health care of patients with depression. Design: Qualitative methodology. Exploratory design based on FD and PS discussion groups (DG). Setting: Primary health care centres (PHCC) and mental health centres (MHC) of the Basque Country Health Service in Vizcaya. Participants and context: A total of 29 FD from 20 PHCC, and 13 PS from 11 MHC, distributed according to the socioeconomic level of the reference population. The meetings were arranged and held in the PC research unit. Methods: An intentional sample to configure 4 DG of FD and 2 of PS, homogenous as regards socioeconomic level, and heterogeneous as regards the centres they came from, work experience and gender. The meetings were recorded and transcribed and a sociological discourse analysis was made. Triangulation between researchers and results comparison with the participants was carried out. Results: The perceptions and attitudes of the FD and PS differed, in their connections with the patient, expectations and health care context. In both cases they perceived the unsuitability of the real patient as regards the prefixed perceptions of the professional. The increase of the problem and its management seemed to be conditioned by a social medium which was uncontrolled, and due to increasing deficiencies in the collaboration between health care levels. Conclusions: Care of the patient with depression requires diagnostic and treatment approaches centred on the patient and shared by FD and PS(AU)