[Healthier decisions. Nudges.] / Decisiones más saludables. Nudges.

This paper intends to raise the potential interest that the principles and experiences of the so-called behavioral economy have in the field of public health and, more specifically, in behavioral changes, thus substituting harmful behaviors to health for salutogenic behaviors while respecting the final freedom of choice of the person. In this article, we review the foundations of behavioral economics, emphasizing the work of Tversky and Kahneman and their approach to prospective theory and the role of brain activity levels 1 (automatic) and 2 (reflective) in decision making process. On the basis of these approaches, Thaler and Sustein identify a series of biases that will be used as tools to facilitate behavioral changes through a set of actions "that modify people's behavior in a predictable way without prohibiting any option or significantly changing their economic incentives" based on the so-called libertarian paternalism. We review its interest in public health, citing some empirical studies that demonstrate its high level of effectiveness and efficiency, reflected in the creation of Nudge Units in various countries, and concluding that this can be an interesting tool to add (not to replace) the classical techniques of health promotion and disease prevention.

Se pretende plantear el potencial interés que los principios y experiencias de la denominada economía conductual tienen en el terreno de la salud pública y, más concretamente, en los cambios conductuales, substituyendo conductas nocivas para la salud por conductas salutogénicas, respetando la libertad final de elección de la persona. En el artículo revisamos las bases de la economía conductual, haciendo hincapié en los trabajos de Tversky y Kahneman, con su planteamiento de la teoría prospectiva y el rol de los niveles de actividad cerebral 1 (automático) y 2 (reflexivo) en la toma de decisiones. A partir de estos planteamientos Thaler y Sustein identifican una serie de sesgos que serán utilizados como herramientas para facilitar los cambios conductuales mediante un conjunto de actuaciones "que modifican la conducta de las personas de una manera predecible sin prohibir ninguna opción ni cambiar de forma significativa sus incentivos económicos" basándose en el denominado paternalismo libertario. Revisamos su interés en salud pública, citando algunos estudios empíricos que demuestran su alto nivel de efectividad y eficiencia, plasmado en la creación de Unidades de Nudges en diversos países, y llegando a la conclusión de que esta puede ser una herramienta interesante para añadir, no para substituir, a las técnicas clásicas de la promoción de la salud y la prevención de la enfermedad.

Percepción del sistema sanitario catalán de la población marroquí. Creencias sobre salud y enfermedad / Moroccan population perception of the catalonian health system. Beliefs on health and disease

ObjetivoDescribir la percepción que tiene la población marroquí del sistema sanitario catalán.DiseñoEstudio epidemiológico descriptivo y transversal.EmplazamientoInstituciones sociales y población general marroquí de la ciudad de Reus.ParticipantesCiento cincuenta individuos (el 50,8% eran mujeres) de 33±13 años de edad, de origen marroquí. Porcentaje de participación: 82,7%.MétodoValoración de la percepción del sistema sanitario catalán mediante un cuestionario validado para el estudio, traducido al árabe.ResultadosLa población marroquí cree mayoritariamente en la efectividad de los fármacos y los programas de vacunación, pero también piensa que la enfermedad depende de la voluntad de Alá (el 93,7% de las mujeres y el 95,0% de los hombres). La desconfianza de los maridos a que los médicos varones atiendan a su mujer aumenta con los años de residencia en nuestro país (del 17,1 al 21,1%).ResultadosEl colectivo se siente satisfecho con el sistema sanitario español (el 92,2% de las mujeres y el 86,7% de los hombres), aunque tiene dificultades relacionadas con el idioma (el 51,6% de las mujeres y el 43,3% de los hombres) y, especialmente los hombres, manifiestan dificultades para acudir a las visitas programadas (50,8%).ConclusionesLa mayoría de los inmigrantes de origen marroquí están satisfechos con la asistencia sanitaria recibida en Cataluña. Indican como principales problemas las dificultades para acudir a las visitas programadas y el idioma.ConclusionesEl tiempo de residencia en España no disminuye las dificultades y las diferencias en la relación con la población marroquí con el sistema sanitario. Esto indica la necesidad de promover acciones educativas en los colectivos implicados(AU)

ObjectiveTo describe the perception that the Moroccan population have of the Catalonian Health System.DesignA cross-sectional, descriptive epidemiological study.SettingSocial Institutions and the general Moroccan population in the city of Reus, Spain.ParticipantsA total of 150 people of Moroccan origin (50.8% females) from 33±13 years of age, were selected, of which 82.7% took part.MethodEvaluation of the perception of the Catalonian Health System using a questionnaire validated for the study, translated into Arabic.ResultsThe majority of the Moroccan population believe that medications and vaccination programmes are effective, but also think that the disease depends on Allah (93.7% females and 95% males). The distrust of the husbands that their wives may be seen by male doctors increases (from 17.1% to 21.1%).ResultsAs group they felt satisfied with the Spanish Health System (92.2% females and 86.7% males), had difficulties associated with language (51.6% females and 43.3% males) and, the males, in particular, found it difficult to keep appointments (50.8%).ConclusionsThe majority of immigrants of Moroccan origin are satisfied with the health care received in Catalonia. The main difficulties they appear to have are keeping appointments and the language.ConclusionsThe length of residence in Spain as regards the Moroccan population does not decrease the difficulties and differences in the Health System. This shows that education activities need to be promoted in the groups involved(AU)

[Moroccan population perception of the Catalonian health system. Beliefs on health and disease]. / Percepción del sistema sanitario catalán de la población marroquí. Creencias sobre salud y enfermedad.

OBJECTIVE: To describe the perception that the Moroccan population have of the Catalonian Health System. DESIGN: A cross-sectional, descriptive epidemiological study. SETTING: Social Institutions and the general Moroccan population in the city of Reus, Spain. PARTICIPANTS: A total of 150 people of Moroccan origin (50.8% females) from 33+/-13 years of age, were selected, of which 82.7% took part. METHOD: Evaluation of the perception of the Catalonian Health System using a questionnaire validated for the study, translated into Arabic. RESULTS: The majority of the Moroccan population believe that medications and vaccination programmes are effective, but also think that the disease depends on Allah (93.7% females and 95% males). The distrust of the husbands that their wives may be seen by male doctors increases (from 17.1% to 21.1%). As group they felt satisfied with the Spanish Health System (92.2% females and 86.7% males), had difficulties associated with language (51.6% females and 43.3% males) and, the males, in particular, found it difficult to keep appointments (50.8%). CONCLUSIONS: The majority of immigrants of Moroccan origin are satisfied with the health care received in Catalonia. The main difficulties they appear to have are keeping appointments and the language. The length of residence in Spain as regards the Moroccan population does not decrease the difficulties and differences in the Health System. This shows that education activities need to be promoted in the groups involved.

El análisis de contenidos: ¿qué nos están diciendo? / Contents analysis. What are they telling us?

Se presenta la técnica del análisis de contenidos, su concepto, definición y metodología, ventajas y limitaciones. El análisis de contenidos es una herramienta de gran utilidad basada en el análisis y la interpretación de fuentes documentales y en identificar los códigos utilizados por el emisor del discurso, su contenido manifiesto, el contexto en el que surge y se desarrolla el mensaje, para descubrir y evidenciar sus contenidos latentes. El objetivo es conocer no sólo lo que se transmite literalmente, sino todo aquello que pueda influir o condicionar el mensaje implícitamente

This article presents the technique of content analysis, its concept, definition, methodology, advantages and limitations. Content analysis is a highly useful tool based on the analysis and interpretation of documented sources. The aim is to identify the codes used by the agents of discourse, the manifest content, the context in which the content arises and the message is developed to discover and reveal the underlying contents. The objective is not just to find out whether it is transmitted literally, but also if all this could effectively influence or determine the message

[Not Available]. / El análisis de contenidos: ¿qué nos están diciendo?

This article presents the technique of content analysis, its concept, definition, methodology, advantages and limitations. Content analysis is a highly useful tool based on the analysis and interpretation of documented sources. The aim is to identify the codes used by the agents of discourse, the manifest content, the context in which the content arises and the message is developed to discover and reveal the underlying contents. The objective is not just to find out whether it is transmitted literally, but also if all this could effectively influence or determine the message.

Pacientes, médicos y enfermeros: tres puntos de vista distintos sobre una misma realidad. Actitudes y percepciones ante los derechos de los pacientes / Patients, physicians and nurses: three different points of view on the same issue. Attitudes to and preceptions of patient rights

Objetivos: Analizar las actitudes y las percepciones de pacientes, médicos y enfermeros respecto a los derechos de los pacientes en el ámbito de los hospitales públicos del sector sanitario de Reus (Tarragona). Métodos: Análisis cualitativo, mediante grupos focales de profesionales sanitarios (médicos y enfermeros) y usuarios dados de alta, seguido de 3 encuestas dirigidas a cada uno de estos colectivos. Se realizó un análisis descriptivo de los resultados y de las diferencias entre colectivos. Se utilizó el análisis de componentes principales categóricos para reducir el número de dimensiones y revelar las relaciones existentes entre las diversas variables. Resultados: Ex pacientes y enfermeros identifican los «derechos a la información» y «autonomía del paciente» como los más importantes, mientras que para los médicos las 2 dimensiones más importantes son «derecho a la autonomía» y «derecho a la formulación de la opinión del paciente». Una minoría de pacientes es refractaria a la toma de decisiones. Las mujeres, los más jóvenes y los niveles de educación altos son más favorables al respeto a la autonomía del paciente. Hay posiciones menos favorables a las visiones «autonomistas» por parte de los pacientes, en comparación con las visiones más favorables por parte de los médicos y radicalmente partidarias por parte de los enfermeros. Conclusiones: Los derechos de los pacientes no son suficientemente conocidos y el derecho a la información es valorado como más importante que el derecho al ejercicio de la autonomía. Ex pacientes, médicos y enfermeros tienen actitudes y percepciones diferentes frente a situaciones similares

Objectives: To analyze patients', physicians' and nurses' attitudes to and perceptions of patient rights in the public hospitals of the Reus health district in Catalonia (Spain). Methods: We performed a qualitative analysis, through focus groups composed of health professionals (physicians and nurses) and discharged patients, followed by three surveys aimed at physicians, nurses, and patients. A descriptive analysis was performed of the results and of the differences among the three collectives. A principal components analysis for categorical data was used to reduce the number of dimensions and to reveal the associations among the different variables. Results: Among discharged patients and nurses, the most important patient rights were «the right to information» and «patient autonomy», whereas among physicians, the most important dimensions were the «right to autonomy» and «the patient's right to form an opinion». A minority of patients was reluctant to participate in decision-making. The groups with the most favorable attitudes to exercising patient autonomy were women, younger patients, and those with the highest educational level. Patients were less in favor of patient autonomy than physicians while nurses had the most radical attitudes in favor of patient autonomy. Conclusions: Patient's rights are not sufficiently well known, and the right to information is valued more highly than the right to exercise autonomy. Discharged patients, physicians and nurses have different attitudes to and perceptions of the same issue

[Patients, physicians and nurses: three different points of view on the same issue. Attitudes to and perceptions of patient rights]. / Pacientes, médicos y enfermeros: tres puntos de vista distintos sobre una misma realidad. Actitudes y percepciones ante los derechos de los pacientes.

OBJECTIVES: To analyze patients', physicians' and nurses' attitudes to and perceptions of patient rights in the public hospitals of the Reus health district in Catalonia (Spain). METHODS: We performed a qualitative analysis, through focus groups composed of health professionals (physicians and nurses) and discharged patients, followed by three surveys aimed at physicians, nurses, and patients. A descriptive analysis was performed of the results and of the differences among the three collectives. A principal components analysis for categorical data was used to reduce the number of dimensions and to reveal the associations among the different variables. RESULTS: Among discharged patients and nurses, the most important patient rights were "the right to information" and "patient autonomy", whereas among physicians, the most important dimensions were the "right to autonomy" and "the patient's right to form an opinion". A minority of patients was reluctant to participate in decision-making. The groups with the most favorable attitudes to exercising patient autonomy were women, younger patients, and those with the highest educational level. Patients were less in favor of patient autonomy than physicians while nurses had the most radical attitudes in favor of patient autonomy. CONCLUSIONS: Patient's rights are not sufficiently well known, and the right to information is valued more highly than the right to exercise autonomy. Discharged patients, physicians and nurses have different attitudes to and perceptions of the same issue.

[Quality in public health]. / Calidad en salud pública.

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services.

Calidad en salud pública / Quality in public health

A partir de la definición de los conceptos de calidad y de salud pública, y de la consideración de las organizaciones de salud pública como organizaciones de servicios, se plantea la conveniencia de poder llegar a establecer un modelo de referencia de calidad en salud pública basado en criterios objetivos, indicadores y estándares. Se revisan los 2 principales modelos de gestión de la calidad en el terreno de las organizaciones de servicios, ISO 9001-2000 y EFQM, y se contrastan sus ventajas y desventajas en lo referente a su aplicación en los servicios de salud pública. A partir de la definición del Institute of Medicine de las funciones en salud pública, seguimos los planteamientos del estudio Delphi de la OMS y del modelo APEX PH (Assesstment Protocol fo Excellence in Public Health). Se describe y propone el Proyecto Nacional de Medición de Estándares y Desempeño de la Salud Pública (NPHPSP) planteado por los Centers for Disease Control como modelo de referencia para la gestión y la mejora de la calidad en las organizaciones de salud pública. Por último, se concluye que la aprobación de la Ley de Cohesión y Calidad del Sistema Nacional de Salud, con el planteamiento de las 8 principales prestaciones en salud que debe prestar el Sistema Nacional de Salud, permitiría una adaptación a nuestro contexto del modelo NPHSPS como herramienta de gestión de la calidad de los servicios de salud pública españoles

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health servicesBased on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services

Calidad en salud pública / Quality in public health

A partir de la definición de los conceptos de calidad y de salud pública, y de la consideración de las organizaciones de salud pública como organizaciones de servicios, se plantea la conveniencia de poder llegar a establecer un modelo de referencia de calidad en salud pública basado en criterios objetivos, indicadores y estándares. Se revisan los 2 principales modelos de gestión de la calidad en el terreno de las organizaciones de servicios, ISO 9001-2000 y EFQM, y se contrastan sus ventajas y desventajas en lo referente a su aplicación en los servicios de salud pública. A partir de la definición del Institute of Medicine de las funciones en salud pública, seguimos los planteamientos del estudio Delphi de la OMS y del modelo APEX PH (Assesstment Protocol fo Excellence in Public Health). Se describe y propone el Proyecto Nacional de Medición de Estándares y Desempeño de la Salud Pública (NPHPSP) planteado por los Centers for Disease Control como modelo de referencia para la gestión y la mejora de la calidad en las organizaciones de salud pública. Por último, se concluye que la aprobación de la Ley de Cohesión y Calidad del Sistema Nacional de Salud, con el planteamiento de las 8 principales prestaciones en salud que debe prestar el Sistema Nacional de Salud, permitiría una adaptación a nuestro contexto del modelo NPHSPS como herramienta de gestión de la calidad de los servicios de salud pública españoles

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services