[Motivations for alcohol consumption in schooled adolescents: analysis of discussion groups]. / Motivaciones para el consumo de alcohol en adolescentes escolarizados: análisis de grupos de discusión.

OBJECTIVE: To find out the motivations of adolescents for alcohol consumption. DESIGN: Qualitative methodology with discussion groups. PARTICIPANTS AND CONTEXT: 131 adolescents (15-17 years old) enrolled in nine schools in Tarragona (Spain). METHOD: Systematic coding strategy, adapted to focus groups. Educational centers were selected through a stratified purposive sampling by educational levels (segmentation criterion) and ownership of the center (public or private). Participants within the educational levels were randomly selected for the groups. Content analysis was conducted using an open and flexible coding strategy. RESULTS: Motivations for alcohol consumption were identified, revolving around six fundamental dimensions: a) seeking fun and new sensations, b) alleviating discomfort, c) consumption due to social contagion and group pressure, d) consumption as a rite of passage into adulthood, e) environmental availability of alcohol, and f) low perception of risk. This motivation varied according to the adolescent's gender. In girls, drinking behavior appeared related to overcoming negative emotional states, while for boys, belonging to the peer group took precedence: drinking reinforces hegemonic masculinity and ensures complicity among peers. Adolescents considered that the information they receive from educational centers is sufficient, but it does not motivate change. CONCLUSIONS: Public health strategies focused on preventing alcohol consumption in adolescents should incorporate their motivations to achieve greater efficiency, paying due attention to sex/gender variables.

Validación transcultural de cuestionario sobre literacidad en salud en el contexto chileno

Objetivos: Validar transculturalmente para contexto chileno, cuestionario en inglés que evalúa competencias comunicacionales empleadas por el odontólogo con sus pacientes. Métodos: Se realizaron seis etapas: traducción, panel de expertos, entrevistas cognitivas, adaptación en línea, método test y re-test, evaluando la consistencia interna y estabilidad, y retrotraducción al inglés. Se realizó un análisis descriptivo de las variables sociodemográficas y un análisis descriptivo de los ítems del cuestionario considerando la media de las puntuaciones, desviación estándar y proporción de respuestas positivas, neutras y negativas. Resultados: 70 participantes contestaron el cuestionario (42 mujeres y 28 hombres, edad promedio 38 años). Las entrevistas cognitivas y comité de expertos permitieron hacer adaptaciones a la cultura chilena. Con respecto a la consistencia interna y estabilidad del cuestionario, el valor obtenido para α-Cronbach fue mayor a 72% y λ-Guttman mayor a 81%. Para la estabilidad del cuestionario el coeficiente de correlación Spearman fue de 72% y los coeficientes de concordancia fueron mayores a 76% (valor-p<0,05). Conclusiones: El cuestionario sobre la literacidad de salud oral en el contexto chileno es válido desde la perspectiva de la adaptación transcultural y confiable desde la perspectiva de la consistencia interna y estabilidad.

Objectives: Transcultural validation of a survey in the Chilean context that assesses communication skills of dentists with patients, from English to Spanish. Methods: The process considered six stages: translation, a panel of experts, cognitive interviews, online adaptation, test and re-test practice to assess internal consistency and stability, and finally, back-translation into English. The method included the analysis of the sociodemographic variables and a descriptive analysis of the questionnaire items, considering the mean of the scores, standard deviation, and proportion of positive, neutral, and negative responses. Results: 70 participants answered the questionnaire (42 women and 28 men, average age 38 years). The cognitive interviews and the suggestions of the panel of experts allowed for some changes to better adapt to the Chilean culture. Regarding the internal consistency and stability of the questionnaire, the value obtained for α-Cronbach was greater than 72% and for λ-Guttman greater than 81%. Furthermore, the Spearman correlation coefficient was 72%, and the concordance coefficients were higher than 76% (p-value <0.05). Conclusions: The questionnaire on health literacy in the Chilean context is valid from the perspective of cross-cultural adaptation and reliable from the internal consistency and stability standpoint.

Creatividad, identidad y subjetividad de personas con enfermedades crónicas: Estado del arte / Creativity, Identity, and Subjectivity of People with Chronic Diseases: State of the Art

Resumen Este artículo es parte de una investigación que pretende identificar el impacto que tienen las enfermedades crónicas en el desarrollo de la creatividad, la identidad y la subjetividad de los sujetos que las padecen. El documento presenta la revisión de 50 artículos con resultados de estudios que, en la última década, investigaron sobre la creatividad en relación con la identidad y la subjetividad de niños, niñas, adolescentes y jóvenes que viven con enfermedades crónicas. Desde lo metodológico, se trata de un estudio no probabilístico de tipo intencional, en el cual se abordaron datos bibliométricos construidos a partir de bases de datos especializadas y, posteriormente, se efectuó un análisis interpretativo crítico de estas investigaciones desde una perspectiva cualitativa, para el que se recurrió a la categorización de la información. Los resultados evidencian que el uso del arte como estrategia terapéutica facilita el afrontamiento de la enfermedad; sin embargo, también se evidencian afectaciones relevantes en el sistema familiar y relacional de quienes viven con estas enfermedades. Se concluye que la investigación en este campo se ha dado principalmente desde la medicina y la psicología, pero dejó un campo abierto que puede ser explorado por la investigación social.

Abstract This article presents a state of the art that integrates the review of fifty articles of the results of studies that, in the last decade, investigated creativity in relation to the identity and subjectivity of children, adolescents and young people living with chronic diseases .The document is part of a doctoral research that aims to identify the transformations that creativity undergoes in relation to the development of identity and subjectivity of children living with chronic diseases, such as HIV/AIDS, cancer and diabetes, given that these are the diseases that Sontag (2008) relates as the diseases that cause the greatest social and economic impacts and that modify the life project of people in the long term. From the methodological point of view, bibliometric data constructed from specialized databases such as PubMed, APA, Science Direct, Proquest, Redalyc, Scielo and Scopus were approached; subsequently a critical interpretive analysis of these investigations was carried out from a qualitative perspective. The results show that the use of art as a therapeutic strategy facilitates coping with the disease; however, relevant effects are also evident in the family and relational system of those who live with these diseases. It is also found that a large part of the research, as suggested by Sontag (2008), assumes diseases as an enemy, making use of the language of war, in addition to locating whoever experiences the disease as a battle hero or as a survivor when it is possible to go through the disease in a satisfactory way, however, it is also evident that this position implies a struggle of the subject with himself. Also, some of the authors state that the disease facilitates the recognition of abilities, tastes and skills of which one was not aware before experiencing it. Through these investigations, the understanding of the importance of relationships with peers as a key aspect for the development of self-regulation is broadened, which facilitates self-care practices far from victimization and family overprotection. Creativity has been understood mainly from artistic exercises, art-therapy and the use of some resources such as painting, drawing, music and dance for the approach to the subject who lives with chronic diseases, from the research exercises themselves, but also from an attempt to allow the subject to establish diverse communications with his context and to establish communication bridges with himself and with his new life circumstances. However, this perspective leaves aside the proposal of Lavie, Narayan and Rosaldo (1993), who argue that creativity is the human capacity to respond to daily circumstances in different ways, which allows expanding the field of action of what creative, facilitating that it is linked to the daily lives of the subjects and other ways of displaying creativity are explored, from relationships, from the practices of self-recognition and self-care regarding the same disease.It is also found that chronic diseases are related to metaphors that force the subject who experiences them to assume the role of warrior, war hero or war victim; these postures assume burdens for the subject and, although in some cases they help to assume the disease with a spirit of improvement, they also increase responsibility, guilt and difficulties in cases in which the disease is not overcome.

Conceptualización teórica y metodológica del análisis situacional: un enfoque de la teoría fundamentada / Theoretical and methodological con-ceptualization of situational analysis: A grounded theory approach

La Teoría Fundamentada ha sido un método de investigación de gran importancia para los estudios cualitativos. La corriente posmoderna, posestructuralista e interpretativa del análisis situacional propuesto por Adele Clarke ofrece una nueva visión amplia, compleja y heterogénea de los fenómenos sociales de la naturaleza, representados en tres enfoques cartográficos de análisis: (a) mapa de situación, (b) mapa de mundos/arenas sociales y (c) mapa de posiciones. En este escrito se esbozan las conceptualizaciones teóricas del análisis situacional, sus nuevas bases epistemológicas y la ruta de construcción de cada uno de los mapas situacionales. Dicho método ofrece una herramienta innovadora para estudiar fenómenos desde una visión crítico-social que fomenta el cuidado de enfermería con posturas diferenciadoras en el quehacer.(AU)

Grounded Theory has been a research method of great importance for qualitative studies. The postmodern, poststructuralist and interpretive current of situational analysis (SA) proposed by Adele Clarke offers a new broad, complex and heterogeneous vision of the social phenomena of nature, represented in three cartographic approaches of analysis: (a) situation map, (b) map of worlds/social arenas and (c) map of positions. In this paper, the theoretical conceptualizations of situational analysis, its new epistemological bases and the construction route of each of the situational maps are briefly outlined. This method offers an innovative tool to study phenomena from a critical-social vision that promotes nursing care with differentiating positions in the work.(AU)

Apropiación de los elementos de innovación social en organizaciones comunitarias agropecuarias del departamento de Boyacá, Colombia / Appropriation of the elements of social innovation in community agricultural organizations of the department of Boyaca, Colombia

RESUMEN Con el objetivo de establecer criterios mínimos relativos a la innovación social en organizaciones comunitarias agropecuarias, se hizo uso de herramientas propias de la investigación cualitativa que incluyeron búsquedas especializadas y uso de programas para análisis de datos bibliográficos (por ejemplo VOSviewer™) para determinar los elementos relativos a la gestión, gobernanza, capacidades, modelo de negocio sostenibilidad para ocho (8) organizaciones comunitarias de productores agropecuarios de la provincia del Sugamuxi, en el departamento de Boyacá, Colombia. Se pudo establecer que algunas organizaciones de productores agropecuarios que ejercen actividades en el departamento de Boyacá no están apropiando de forma integral los elementos de innovación social (en niveles operativos y gerenciales) y, consecuentemente, existe toda una ruta de mejoramiento por desarrollar con estas para optimizar los índices de eficiencia organizacional; además, se evidencia la complejidad de la temática, dado que la sostenibilidad de las innovaciones sociales dependerá en gran medida de la gestión de las organizaciones, donde se establezcan agendas institucionales compartidas contextualizadas y ajustadas a los territorios. Es necesario optimizar los canales de participación de manera mancomunada entre el Estado, las organizaciones y los mismos productores para poder dinamizar procesos, metas y alcances reales de la innovación social a la luz de los acelerados cambios a los que se enfrenta el productor agropecuario agremiado en Colombia, relativos estos a la dinámica del mercado, el acceso a recursos y otros.

ABSTRACT In order to establish minimum criteria related to social innovation in agricultural community organizations, qualitative research tools were used, including specialized searches and the use of programs for the analysis of bibliographic data (for example VOSviewer™), with the purpose of defining the elements related to management, governance, capacities, business model and sustainability for eight (8) community organizations of agricultural producers in the province of Sugamuxi, in the department of Boyacá, Colombia. It was possible to establish that some organizations of agricultural producers that carry out activities in the department of Boyacá are not integrally appropriating the elements of social innovation (at operational and managerial levels) and, consequently, there is a whole route of improvement to be developed with them to optimize the organizational efficiency indexes; in addition, the complexity of the subject is evident, given that the sustainability of social innovations will depend largely on the management of the organizations, where shared institutional agendas contextualized and adjusted to the territories are established. It is necessary to optimize the channels of participation in a joint manner between the State, the organizations, and the producers themselves to be able to dynamize processes, goals and the real scope of social innovation in light of the accelerated changes faced by the agribusiness producer in Colombia, related to market dynamics, access to resources and others.

Representaciones sociales sobre el Programa Mais Médicos entre consejeros municipales de salud de Brasil / Social representations on Mais Médicos Program among municipal health councelors of Brazil

Introducción: La atención primaria de salud en Brasil se considera una prioridad. En el año 2013 se creó el Programa Mais Médicos, de formación en servicio y de ampliación de la cantidad de médicos en el país. La cooperación cubana, gestionada por la Organización Panamericana de la Salud fue quien envió la mayor cantidad de profesionales. Objetivo: Analizar las representaciones sociales de los consejeros de salud sobre el Programa Mais Médicos, en municipios en los que prestaron atención a su población médicos provenientes de Cuba. Métodos: Estudio de caso descriptivo de corte transversal abordado con metodología cualitativa. La muestra fue intencional. Se trabajó con 58 entrevistas semiestructuradas y el análisis fue realizado mediante el software gratuito Iramuteq con la técnica de análisis lexical. Resultados: Se pudo distinguir cuatro grupos de representaciones, sobre el funcionamiento de los consejos municipales de salud, sobre las representaciones del Programa Mais Médicos, sobre las redes de atención y sobre los médicos brasileños y cubanos. El estudio aporta evidencias de la aplicación de un nuevo modelo de atención para los consejeros que objetivaron y anclaron en el concepto de nacionalidad. El modelo cubano incorpora características de humanismo, atributos que no estaban contenidos en las representaciones sobre los médicos locales. Conclusiones: Las representaciones sociales sobre el Programa Mais Médicos aluden a una acción que mejora la calidad de los servicios, no obstante, la literatura sobre atención básica aún deja ver algunos problemas de acceso y tránsito por la red del sistema único de salud(AU)

Introduction: Primary health care in Brazil is considered a priority. In 2013, Mais Médicos Program was created, providing in-service training and expanding the number of doctors in the country. Cuban cooperation, managed by the Pan American Health Organization, sent the largest number of professionals. Objective: Analyze the social representations of health counselors on Mais Médicos Program, in municipalities in which doctors from Cuba cared to their population. Methods: Descriptive cross-sectional case study approached with qualitative methodology. The sample was intentional. It was conducted a work with 58 semi-structured interviews and the analysis was carried out using the free software Iramuteq with the lexical analysis technique. Results: Four groups of representations could be distinguished: on the functioning of the municipal health councils, on the representations of Mais Médicos Program, on the care networks and on Brazilian and Cuban doctors. The study brings evidence of the application of a new model of care for counselors who objectified and anchored in the concept of nationality. The Cuban model incorporates characteristics of humanism, attributes that were not contained in the representations about local doctors. Conclusions: The social representations on Mais Médicos Program allude to an action that improves the quality of services, however, the literature on basic care still shows some problems of access and transit through the network of the health system(AU)

Avances en Psicología Social Libertaria para autogestión activa: QCA mejorada y reflexiones desde República Dominicana / Advances in Libertarian Socialist Social Psychology’s Self-management: enhanced QCA and reflections from the Dominican Republic

Profundizo en una observación participante en una comunidad libertaria que emerge como mi-noría activa en las metrópolis de República Dominicana, mediante veinte entrevistas en pro-fundidad a diez personas a principios y a finales del 2013. Reconstruyo un modelo teórico dis-tinguiendo entre el compromiso de autogestión activo del pasivo. En este adelanto, presento una explicación mejorada del resultado de interés (laautogestión activa), gracias a un diálogo entre teorías y evidencias, junto a una revisión metodológica mejorada. Para la explicación de la autogestión activa, opto por la conjugación de dos condiciones principales: 1) las multiplici-dades discursivas, el solapamiento de herramientas comunitarias del discurso autogestionario como optimizadores de la autogestión; y 2) las actitudes personales que facilitan asumir un rol protagónico en el compromiso autogestionario como sujeto. Distingo esta explicación cuando hay un compromiso autogestionario libertario más general en comparación con el compromiso específicamente anarquista. (AU)

Drawing from exploratory participant observation with libertarian socialist groups and indi-viduals emerging as active minorities in the metropolitan areas of the Dominican Republic, twenty in-depth interviews were conducted with ten participants in the beginning and the end of 2013. An advanced theoretical model was reconstructed, which distinguished itself between the persons as the commitment of active self-management, and the passive self-management commitment. This improvement is done thanks to a more profound dialogue between theories and evidence and an enhanced methodological framework. From the explanation of the active self-management we can see the combination of: 1) discursive multiplicities, the overlap of communitarian tools of discourse self-management of the cases studied as optimizers; and 2) personal attitudes that facilitate one taking a protagonist role in self-management commit-ment as a subject. These conditions are differentiated when explaining the most general lib-ertarian socialist self-management commitment separated from the specifically anarchist commitment. (AU)

Evaluation of mobile emergency service with the use of mixed method / Avaliação do serviço móvel de urgência com o uso de método misto / Evaluación de la atención móvil de urgencias con el uso del método mixto

This is an evaluative study, with sequential explanatory mixed methods, aimed at evaluating the performance of the Brazilian Mobile Emergency Medical Service (SAMU) in the Grande ABC region, located in the state of São Paulo, Brazil. In the quantitative approach, an analysis of interrupted time series was performed to evaluate the immediate and gradual effects of the SAMU on hospital mortality due to acute myocardial infarction. The qualitative approach was conducted via semi-structured interviews and a thematic analysis was applied for the interpretation of the results, exploring the attitudes and values of the interviewees regarding the performance of SAMU in the Grande ABC region. Interrupted time series analysis showed a -0.04% reduction in the underlying mortality rate since SAMU implementation (95%CI: -0.0816; -0.0162; p-value = 0.0040) and a reduction in the mortality level, -2.89 (95%CI: -4.3293; -1.4623; p-value = 0.0001), both with statistical significance. To improve the robustness of the results, a control region was used, showing a statistically significant difference in the post-intervention result of -0.0639 (95%CI: -0.1060; -0.0219; p-value = 0.0001). The interviews revealed that the SAMU has the potential to intervene in the prognosis of transported cases, however, challenges related to the availability of beds, expansion of telemedicine, and continuous training of professionals for qualified emergency care in the event of a heart attack must be overcome. The results indicate that the studied intervention is part of a set of factors that, together, generate more conditions to achieve a better result.

Estudo avaliativo com uso de métodos mistos na tipologia explanatória sequencial cujo objetivo foi avaliar o desempenho do Serviço de Atendimento Móvel de Urgência (SAMU) na região do Grande ABC, Estado de São Paulo, Brasil. Na abordagem quantitativa, foi realizada análise de séries temporais interrompidas para testar os efeitos imediatos e graduais da intervenção sobre a mortalidade hospitalar por infarto agudo do miocárdio. A abordagem qualitativa foi realizada através de entrevistas semi-estruturadas, e a análise temática foi aplicada para a interpretação dos resultados, explorando as atitudes e valores dos entrevistados em relação ao desempenho do SAMU no Grande ABC. A análise de série temporal interrompida mostrou uma redução de -0,04% na taxa de mortalidade subjacente desde a implementação do SAMU (IC95%: -0,0816; -0,0162; p = 0,0040) e uma redução no nível de mortalidade, de -2,89 (IC95%: -4,3293; -1,4623; p = 0,0001), ambas estatisticamente significativas. Para melhorar a robustez dos resultados, foi utilizada uma região de controle, o que mostrou uma diferença estatisticamente significativa na tendência pós-intervenção de -0,0639 (IC95%: -0,1060; -0,0219; p = 0,0001). De acordo com as entrevistas, o SAMU tem o potencial de intervir no prognóstico dos pacientes transportados; entretanto, em casos de infarto agudo do miocárdio, diversos desafios precisam ser superados, relacionados à disponibilidade de leitos, expansão da telemedicina e capacitação permanente das equipes de atendimento qualificado em emergências. Os resultados indicam que a intervenção faz parte de um conjunto de fatores que, conjuntamente, geram mais condições para alcançar melhores resultados.

Investigación evaluativa, utilizando métodos mixtos explicativos secuenciales, cuyo objetivo fue evaluar el desempeño del Servicio de Atención Móvil de Urgencia (SAMU) en una región de Brasil, denominada Grande ABC, estado de São Paulo, Brasil. En el enfoque cuantitativo, se realizó un análisis de series temporales interrumpidas para comprobar los efectos inmediatos y graduales de la intervención sobre la mortalidad intrahospitalaria por infarto agudo de miocardio. El enfoque cualitativo se llevó a cabo a través de entrevistas semiestructuradas y para la interpretación de los resultados se aplicó un análisis temático, investigando las actitudes y valores de los entrevistados sobre el desempeño del SAMU en la región Grande ABC. Los análisis de series de tiempo interrumpido mostraron una reducción -0,04% en la tasa de mortalidad subyacente desde la implementación del SAMU (IC95%: -0,0816; -0,0162; p = 0,0040) y una reducción en el nivel de mortalidad, -2,89 (IC95%: -4,3293; -1,4623; p = 0,0001), ambos con significación estadística. Con el fin de mejorar la solidez de los resultados, se utilizó un control de región, que mostró una diferencia estadísticamente significativa en la tendencia del resultado post intervención de -0,0639 (IC95%: -0,1060; -0,0219; p = 0,0001). Las entrevistas revelaron que el SAMU tiene el potencial de intervenir en la prognosis de los casos trasportados, sin embargo, deben superarse los desafíos relacionados con la disponibilidad de camas, expansión de la telemedicina y el entrenamiento continuo de profesionales para la asistencia cualificada en emergencias, en caso de un ataque al corazón. Los resultados indican que la intervención estudiada es parte de un conjunto de condiciones que, juntas, generan más condiciones para alcanzar un mejor resultado.

Transiciones migratorias de profesionales de enfermería mexicanos en alemania

RESUMEN Objetivo: Examinar las transiciones migratorias de profesionales de enfermería mexicanos que residen en Alemania. Material y Método: Estudio cualitativo de tipo etnográfico focalizado, guiado por la Teoría de Transiciones; se realizó entre los meses de noviembre de 2020 y mayo de 2021; se utilizó un muestreo por bola de nieve, donde los participantes de la red social Facebook, que aceptaron participar, hicieron referencia a otras personas. Se reclutaron a 11 profesionales de enfermería mexicanos; se realizaron entrevistas por Zoom, audiograbadas con previo consentimiento. La información obtenida fue transcrita en su totalidad y examinada mediante el análisis temático con el apoyo del software QUIRKOS. Resultados: El 63,6% fueron mujeres con una edad promedio de 30,8 años y un tiempo promedio de 1,26 años en Alemania. Las transiciones migratorias se clasificaron en 10 categorías: 1) Condiciones económicas y laborales, 2) Idioma, 3) Proceso de homologación de estudios, 4) Costos, 5) Discriminación, 6) Costumbres y tradiciones, 7) Gastronomía, 8) Clima, 9) Recreación y 10) Seguridad. Conclusiones. Conocer las transiciones migratorias de profesionales de enfermería mexicanos en Alemania permite realizar una serie de recomendaciones a la práctica, las políticas públicas y futuros proyectos de investigación e intervención.

ABSTRACT Objective: To examine the migration transitions of Mexican nursing professionals residing in Germany. Materials and Methods: A focused ethnography guided by the Theory of Transitions was conducted between the months of November 2020 and May 2021; snowball sampling was used, where the participants of the social network Facebook, who agreed to participate, referred to other people. Eleven Mexican nurses living in Germany were recruited; interviews were conducted using the Zoom platform and audio-recorded with prior consent. The information obtained was transcribed verbatim and examined through thematic analysis using the QUIRKOS software. Results: 63.6% of the nurses were women, with an average age of 30.8 years; and an average time of 1.26 years living in Germany. Migration transitions were classified into 10 categories: 1) Economic and labor conditions, 2) Language, 3) Study accreditation process, 4) Costs, 5) Discrimination, 6) Customs and traditions, 7) Gastronomy, 8) Climate, 9) Recreation, and 10) Safety. Conclusions: Understanding the migration transitions of Mexican nurses in Germany allows us to make a series of recommendations for practice, public policies, and future research and intervention projects.

RESUMO Objetivo: Examinar as transições migratórias de profissionais de enfermagem mexicanos que residem na Alemanha. Material e Método: Estudo qualitativo de tipo etnográfico focado, guiado pela Teoria das Transições e realizado entre os meses de novembro de 2020 e maio de 2021. Utilizou-se uma amostragem de bola de neve, na qual os participantes da rede social Facebook, que concordaram em participar, contactaram outras pessoas. Onze profissionais mexicanos residentes na Alemanha foram recrutados; foram realizadas entrevistas usando a plataforma Zoom e gravadas em áudio com consentimento prévio. As informações obtidas foram transcritas textualmente e examinadas por meio de análise temática utilizando o software QUIRKOS. Resultados: 63,6% dos profissionais de enfermagem eram mulheres, com idade média de 30,8 anos; e tempo médio de 1,26 anos vivendo na Alemanha. As transições migratórias foram classificadas em 10 categorias: 1) Condições econômicas e trabalhistas, 2) Idioma, 3) Processo de acreditação de estudos, 4) Custos, 5) Discriminação, 6) Costumes e tradições, 7) Gastronomia, 8) Clima, 9) Lazer, e 10) Segurança. Conclusões: Conhecer as transições migratórias dos profissionais de enfermagem mexicanos na Alemanha permite fazer uma série de recomendações para a prática, as políticas públicas e os futuros projetos de pesquisa e intervenção.

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

INTRODUCTION: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.

Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in primary care in Colombia. A qualitative analysis.

BACKGROUND: Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma. OBJECTIVES: Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice. MATERIALS AND METHODS: Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique. RESULTS: The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact. CONCLUSIONS: The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.

Análisis cualitativo de los procesos regulatorios de la calidad en los programas de Nutrición y Dietética en Chile

RESUMEN Introducción. El objetivo de este estudio es establecer patrones positivos y negativos de los resultados de los procesos de acreditación de las carreras. Asimismo, identificar desde una perspectiva cualitativa, variables relevantes y relaciones entre los criterios usados en su evaluación. Materiales y métodos. El estudio es transversal, descriptivo y cualitativo. Se analizaron veinte resoluciones de acreditación de las carreras de Nutrición y Dietética en Chile, emitidas entre los años 2004 y 2016 por la Comisión Nacional de Acreditación mediante el software ATLAS ti. Se consideraron las tres dimensiones; Propósitos e Institucionalidad; Condiciones de Operación y Resultados; y Capacidad de Autorregulación para establecer una matriz de relaciones con la identificación de patrones positivos y negativos entre criterios. Resultados. Se evidencian fuertes diferencias entre las carreras. Las relaciones positivas y negativas entre los códigos de los criterios perfil de egreso y plan de estudio indican que solo algunas de ellas proveen una formación adecuada. Del mismo modo, las relaciones entre la calificación del cuerpo docente y la investigación revelan casos de docentes sin niveles suficientes. Otros aspectos deficitarios son el nivel con que ingresan los estudiantes y el uso efectivo de diagnósticos y autoevaluaciones. Conclusiones. El estudio provee información relevante para la toma de decisiones y procesos de retroalimentación orientados al urgente mejoramiento y aseguramiento de la calidad de carreras, en particular de sus planes de estudio, calificación de docentes y efectividad de los procesos de aseguramiento de la calidad, dada la creciente importancia de estos profesionales en la salud pública.

ABSTRACT Introduction. The objective of this study is to establish positive and negative patterns based on the results of accreditation processes of degree programs. Similarly, its aim is to identify, from a qualitative perspective, relevant variables and relationships among the criteria used in their evaluation. Materials and methods. This is a cross-sectional, descriptive and qualitative study. Twenty accreditation resolutions of Chilean Nutrition and Dietetics degree programs were analyzed using the software ATLAS ti. Resolutions were issued between 2004 and 2016 by the National Accreditation Commission. Three dimensions were considered in order to establish a matrix of relationships associated with the identification of positive and negative patterns among criteria: Purpose and Institutionalism; Operating Conditions and Results; and Self-Regulatory Ability. Results. Major differences were found among the degree programs. Positive and negative relationships between criteria codes, graduate profile and curriculum, indicate that only some degree programs provide an appropriate training. In the same way, the relationship between the teaching staff qualification and research work revealed cases of teachers who were not sufficiently qualified. Other weak aspects were the level of knowledge that students have when they enter university and the effective use of diagnostics and self-assessment tests. Conclusions. This study provides relevant information for decision making and feedback processes oriented at the urgent improvement and quality assurance of degree programs, particularly of curricula, teaching staff qualifications, and effectiveness of the quality assurance processes, given the increasing importance of nutrition professionals in the public health area.

Dimensión ambiental en la formación de profesionales de la salud: concepciones de los docentes de una universidad pública

Objetivo. Analizar las concepciones de docentes sobre la integración de la dimensión ambiental en la formación de profesionales de salud en una universidad pública. Métodos. Estudio cualitativo, donde participaron 13 docentes seleccionados por un muestreo socioestructural. Se aplicó una entrevista semiestructurada y la técnica de análisis de contenido utilizando ATLAS.ti. Resultados. Los docentes reconocieron limitaciones para incorporar la dimensión ambiental en profesionales de la salud, pero se concentran en los cambios que se necesitarían para su integración a nivel macro y microcurricular. El análisis evidencia la vinculación entre los cambios necesarios con acciones de sensibilización y socialización, gestión política y administrativa, y propuestas de mejora de infraestructura. Conclusión. Los docentes, a pesar de las limitaciones, tienen concepciones proactivas hacia el cambio, lo que favorecería su participación en procesos de reforma curricular hacia una formación orientada al desarrollo sostenible.

Objective. Analyze the conceptions of teachers about the integration of the environmental dimension in the training of health professionals in a public university. Methods. Qualitative study, where 13 teachers selected by a socio-structural sampling participated. A semi-structured interview and the content analysis technique were applied using ATLAS.ti. Results. The teachers recognized limitations to incorporate the environmental dimension in health professionals, but they focus on the changes that would be needed for its integration at the macro and micro-curricular level. The analysis shows the link between the necessary changes with awareness and socialization actions, political and administrative management, and proposals for infrastructure improvement. Conclusion. Teachers, despite the limitations, have proactive conceptions towards change, which would favor their participation in curricular reform processes towards training oriented towards sustainable development.

The combined used of quantitative and qualitative longitudinal methods in the study of obesity.

OBJECTIVE: To explore the combined use of quantitative and qualitative methods with a longitudinal perspective in the field of obesity diet and physical activity. METHOD: A systematic scoping review following PRISMA guidelines. The databases searched were Web of Science, PubMed, and ASSIA. RESULTS: 1592 records were returned from the searches. In total, nine studies met the inclusion criteria and were included in the review. Authors of included studies mixed quantitative and qualitative methods to obtain a deeper understanding of their study subjects, but few documents use longitudinal data. Authors value the combination of methods and try to integrate the results in their conclusions. CONCLUSIONS: Total integration is rarely achieved in the analysis. The origin of this divergence can be found in the lack of theoretical guidance in these articles, but also in the difficulty of working in multidisciplinary teams in the field of obesity.

Understanding the provision of a clinical service in mental health and the role of the pharmacist: a qualitative analysis / Compreendendo a provisão de um serviço clínico na saúde mental e o papel do farmacêutico: uma análise qualitativa / Comprender la prestación de un servicio clínico en salud mental y el papel del farmacéutico: un análisis cualitativo

Pharmacists have important roles in mental health disease; however, their performance in Brazilian Psychosocial Care Centers (CAPS) is unknown. This qualitative study was conducted in a CAPS, Brazil; using interviews and analyzes from the perspective of Bardin, in which categories arising from the perceptions of patients and the health team emerged in relation to the provision of the medication review with follow up (MR) service and the role of the pharmacist in mental health. According to the participants, the MR service is essential and important because it allows professional recognition, beyond the identification of professional attributes of the pharmacists. Moreover, there was a duality in the pharmacist's role between the logistic and clinical attributes of mental health. Thus, this perception helps to elucidate the pharmacist's process of work in mental health and supports future strategies of action in this area. (AU)

Farmacêuticos têm papéis importantes na área da saúde mental; entretanto, sua atuação nos Centros de Atenção Psicossociais (CAPS) brasileiros é desconhecida. Este estudo qualitativo foi realizado em um CAPS, Brasil; utilizando-se de entrevistas e análises sob a perspectiva de Bardin, no qual categorias em relação à prestação do serviço de acompanhamento farmacoterapêutico (AFT) e ao papel do farmacêutico na saúde mental emergiram através das percepções dos pacientes e equipe de saúde. Segundo os participantes, o serviço de AFT é essencial e importante porque permite o reconhecimento profissional, além da identificação dos atributos profissionais dos farmacêuticos. Além disso, houve uma dualidade no papel do farmacêutico em relação aos atributos logísticos e clínicos na saúde mental. Assim, essas percepções ajudam a elucidar o processo de trabalho do farmacêutico em saúde mental, subsidiando futuras estratégias de ação nesta área. (AU)

Los farmacéuticos tienen un papel importante en el área de la salud mental; sin embargo, se desconoce su desempeño en los Centros de Atención Psicosocial de Brasil (CAPS). Este estudio cualitativo se llevó a cabo en un CAPS, Brasil; utilizando entrevistas y análisis desde la perspectiva de Bardin, en las que de las percepciones de los pacientes y del equipo de salud surgieron categorías en relación a la prestación del servicio de seguimento farmacoterapéutico (SFT) y el papel del farmacéutico en la salud mental. Según los participantes, el servicio de SFT es fundamental e importante. Además, existía una dualidad en el rol del farmacéutico en relación a los atributos logísticos y clínicos en salud mental. Así, estas percepciones ayudan a dilucidar el proceso de trabajo del farmacéutico en salud mental, apoyando futuras estrategias de actuación. (AU)

Motivaciones hacia la actividad física de adolescentes, adultos mayores y exdeportistas de élite: Un análisis cualitativo / Motivations toward Physical Activity of Adolescents, Older Adults and Former Elite Athletes: A Qualitative Analysis / Motivações para a atividade física em adolescentes, idosos e ex-atletas de elite: Uma análise qualitativa

Resumen Objetivo. Explorar las similitudes y diferencias de los tipos de motivación hacia la práctica de actividad física (AF) de adolescentes, adultos mayores y exdeportistas de élite, desde la Teoría de la Autodeterminación, para la creación de programas de AF. Método. La recolección de los datos se llevó a cabo mediante grupos focales: tres con adolescentes, dos con adultos mayores y uno con exdeportistas. En total, participaron 17 adolescentes, 14 adultos mayores y cuatro exdeportistas. Se realizó un análisis temático. Resultados. Para cada grupo se encontró un conjunto de factores de motivación autónoma, controlada y amotivacionales hacia la práctica de AF. En común, en los tres grupos estudiados, se identificaron la diversión, la socialización y la salud como factores de motivación hacia la práctica de AF. Conclusión. Las orientaciones para la creación de programas de AF para adolescentes se centraron en la individualización de sus objetivos y la percepción en la libertad de elección relacionada con cada AF. En adultos mayores, el enfoque fue hacia nuevas experiencias, considerando de forma significativa el perfil del monitor. Para el grupo de exdeportistas se propone que el punto de partida sea la reconceptualización de la práctica de AF después de la carrera deportiva.

Abstract Objective. To explore the similarities and differences between the types of motivation towards the practice of physical activity (PA) in different populations (adolescents, older adults and former elite athletes) for the creation of PA programs that reflect the particularities of those populations. Method. The qualitative data collection was carried out through focus groups; three groups with adolescents, two with older adults and one with former elite athletes. In total, 17 adolescents, 14 older adults and four former elite athletes participated in this study. A thematic analysis was conducted. Results. The results are shown based on autonomous, controlled motivation and amotivation towards the practice of physical activity for each group. Fun, socialization and health have been identified as motivating factors towards the PA practice common in the three groups studied. Conclusion. Orientations are proposed for the creation of PA programs. For adolescents, the proposal would include the individualization of their objectives and the perception of the freedom of choice in relation to the PA. For the group of older adults, it is important to offer new experiences, taking into account the profile of the monitor. For the group of former elite athletes, the proposed starting point would be the reconceptualization of the PA practice after the athletic career.

Resumo Escopo. Explorar as similitudes e as diferencias dos tipos de motivação para a prática física (AF) de adolescentes, idosos, e ex-atletas de elite, desde a Teoria da Autodeterminação, para a criação de programas de AF. Metodologia. A recolecção de dados foi feita em grupos focais: três com adolescentes, dois com idosos e um com ex-atletas. Foi realizada uma análise temática. Resultados. Para cada grupo foi encontrado um conjunto de fatores de motivação autónoma, controlada e amotivacionais para a prática de AF. Em comum, nos três grupos estudados, foram identificadas a diversão, a socialização e a saúde como fatores de motivação para a prática de AF. Conclusão. As orientações para a criação de programas de AF para adolescentes estiveram centradas na individualização dos seus escopos e a percepção na liberdade de eleição relacionada com cada AF. Nos idosos, o enfoque foi para as novas experiências, considerando de forma significativa o perfil do monitor. Para o grupo de ex-atletas se propõe que o ponto de partida seja a reconceptualização da prática de AF depois da carreira esportiva.

Barreras para diagnóstico y tratamiento de cáncer de cuello uterino en un hospital público de Lima, Perú: un estudio cualitativo / Barriers for diagnosis and therapy of cervical cancer in a public hospital in Lima, Peru: a qualitative study

RESUMEN Objetivos: analizar y discutir las barreras para diagnóstico y tratamiento de cáncer de cuello uterino (CCU) en un hospital público de Lima, Perú. Materiales y métodos: se llevó a cabo un estudio cualitativo entre los meses de diciembre 2019 y marzo 2020. Observación y entrevistas a profundidad fueron las herramientas de recojo de información empleadas. En total, 15 entrevistas a profundidad con pacientes y distintos miembros del personal de salud fueron realizadas. Resultados: para los diferentes miembros del personal de salud, las barreras se centran en la falta de personal y mejora de las infraestructuras hospitalarias. Esto ocasiona un debilitamiento en campañas de educación sobre la importancia del tamizaje para la prevención del CCU. Para las pacientes, los tiempos, el desconocimiento y el miedo a exponerse ante un personal de salud varón, son las principales barreras para la toma de decisiones en salud respecto a la prevención y cuidado de CCU. Conclusiones: la débil infraestructura hospitalaria repercute en actividades de educación y promoción sobre CCU. También impacta el tiempo de entrega de resultados de pruebas de tamizaje y el acceso a citas ginecológicas. Estas demoras generan ausencias y discontinuidad en el autocuidado de las mujeres. Esta realidad, sumada al desconocimiento sobre la gravedad del CCU por parte de las pacientes y a la priorización de responsabilidades laborales y domésticas, invitan a reflexionar sobre el insuficiente trabajo del sistema de salud en relación al manejo de esta enfermedad.

ABSTRACT Objectives: To analyze and discuss barriers for diagnosis and therapy of cervical cancer (CC) in a public hospital in Lima, Peru. Materials and methods: A qualitative study was performed between December 2019 and March 2020. Observation and detailed interviews were the data collection tools used. In total, 15 detailed interviews with patients and healthcare personnel were carried out. Results: For healthcare personnel interviewed, barriers (for good care) are basically lack of personnel and poor hospital infrastructure. This leads to weakening educational campaigns with respect to the importance of adequate screening for CC prevention. For patients, time limitations, lack of knowledge and fear of being exposed to a male healthcare worker are the main barriers for healthcare proper decision making with respect to CC prevention and management. Conclusions: The weak Peruvian hospital infrastructure influences educational and promotional activities dedicated to CC. There is also an impact of the time for obtaining results of screening tests and access to gynecological consultation. These delays lead to absence and discontinuation in women self care. All this, additionally to lack of knowledge about CC severity by patients, and also because of prioritization of their working and household tasks, may lead us to reflect on an insufficient performance of our healthcare system with respect to management of this disease.

Barreras y facilitadores relacionados con el diagnóstico de la lepra en Costa Rica / Barriers and facilitators related to leprosy detection in Costa Rica

Resumen Objetivo: Analizar barreras y facilitadores relacionados con el diagnóstico de la lepra en Costa Rica, desde la perspectiva de la persona con la enfermedad y en el contexto de la vida cotidiana. Métodos: Se llevó a cabo un estudio cualitativo de carácter exploratorio a partir de 25 entrevistas semiestructuradas, a personas con lepra o con antecedente de haberla padecido, de entre 23 y 88 años, atendidos en el sistema de salud público costarricense. A partir del análisis de los datos cualitativos, las barreras y facilitadores se agruparon en factores personales, culturales y la oferta de los servicios de salud. Resultados: En relación con los factores personales, la mayoría de los participantes reportó no poseer conocimiento ni conciencia previa a la enfermedad. El temor a ser estigmatizado, la sintomatología intermitente, sentirse bien, compromisos laborales y familiares, fueron percibidos como barreras. Entre los factores culturales, algunas creencias religiosas fueron percibidas como barreras, y la historia familiar de lepra como facilitador en términos de la búsqueda de atención y diagnóstico. Con respecto a los servicios de salud, el acceso oportuno a citas con personal de salud informado, la telemedicina y médicos de la familia, fueron citados como facilitadores. Conclusiones: Las principales barreras y facilitadores descritos en los resultados del estudio deben ser tomados en cuenta a fin de contribuir a la detección y tratamiento oportuno de la lepra, para curar la enfermedad, evitar la discapacidad y eliminar la transmisión.

Abstract Objective: To analyze barriers and facilitators related to the diagnosis of leprosy in Costa Rica from the perspective of the person with the disease and in the context of everyday life. Methods: A qualitative exploratory study was carried out from 25 semi-structured interviews, with people with leprosy or with a history of having it, aged between 23 - 88 years, treated in the Costa Rican public health system. From the analysis of the qualitative data, the barriers and facilitators were classified into personal, cultural factors and the offer of health services. Results: In relation to personal factors, most of the participants reported having no knowledge or awareness prior to the disease. Fear of being stigmatized, intermittent symptoms, feeling good, work and family commitments were perceived as barriers. Among the cultural factors, some religious beliefs were perceived as barriers and the family history of leprosy as a facilitator in terms of seeking care and diagnosis. With respect to health services, timely access to appointments with informed health personnel, telemedicine and family doctors were cited as facilitators. Conclusions: The main barriers and facilitators described in the results of the study should be considered in order to contribute to the detection and timely treatment of leprosy to cure the disease avoid disability and eliminate transmission.

Caracterización del proceso de implementación de la Política Nacional para el Control de la Tuberculosis en Costa Rica, 2012-2015 / Characterization of the implementation process of the National Policy to the Tuberculosis Control in Costa Rica, 2012-2015

Resumen Objetivo: caracterizar el proceso de implementación de la Política Nacional para el Control de la Tuberculosis, en Costa Rica, 2012-2015. Métodos: se utilizó la estrategia política de Monitoreo y Evaluación (M&E) con la finalidad de analizar los objetivos del programa según su contexto y los indicadores obtenidos durante el período 2012-2015. Se planteó un estudio instrumental de caso para saber cuáles componentes de la política se han utilizado y así comprender el proceso de implementación. Se recolectó la información por medio de entrevistas semiestructuradas a las personas tomadoras de decisiones y al personal encargado de la implementación de la política. Resultados: Costa Rica para el año 2015 tuvo 8.13 casos reportados de tuberculosis (TB) por 100 000 habitantes. Además, cumplió con la meta del 85 % del tratamiento exitoso; no obstante, el porcentaje de curación fue del 60 % y el porcentaje de fallecimiento del 6.55 %. Conclusiones: se concluye que el país no realiza las estrategias de colaboración establecidas por la Organización Panamericana de la Salud, no existe coordinación intersectorial ni trabajo interinstitucional con las demás entidades que forman parte del Sistema de Salud y no se ha logrado involucrar a la comunidad ni a instituciones sociales.

Summary Aim: To characterize the implementation process of the National Policy of Tuberculosis Control in Costa Rica 2012-2015. Methods: The Monitoring and Evaluation Strategy (M&E) was used in order to analyze the objectives of the program according to the context and to obtained indicators for 2012-2015. A case study was proposed to know which components of the policy had been used and to comprehend the implementation process. The information was collected through semi-structured interviews to policy makers and implementers of the policy. Results: In 2015, Costa Rica had 8.13 reported cases of tuberculosis per 100 000 people. The country achieved the 85 % of successful treatment; however, the cure rate was 60 % and the death rate was 6.55 %. Conclusions: The country did not perform the recommended collaborative strategies by Pan American Health Organization, did not have inter-sectorial coordination or inter-institutional work with other institutions from the Health System, and did not achieve the participation of the community or the social institutions in the program.

Aspectos éticos relacionados con la atención de enfermería en personas en situación de discapacidad: un análisis cualitativo / Ethical aspects related to nursing care for persons with disabilities: a qualitative analysis / Aspectos éticos relacionados com a atenção de enfermagem em pessoas com deficiência: uma análise qualitativa

Resumen Este estudio tiene como propósito describir aspectos éticos relacionados con la atención de enfermería en personas con discapacidad, población considerada socialmente vulnerable y reconocida en condiciones de desigualdad. Corresponde a una primera fase de estudio primario realizado en la región de Atacama, Chile, que utilizó metodología cualitativa y análisis de contenido. Se realizan entrevistas a profesionales de enfermería respetando los criterios éticos de Ezekiel Emanuel. Los principales hallazgos dan cuenta de las categorías ontológicas: razonamiento moral, sistema de valores, modelo de relación enfermera-paciente, consecuencias de la acción ética de enfermería, estrategias para superar conflictos morales y barreras en el cuidado. Se concluye que cuidar personas con discapacidad es fuente de dilema y angustia moral para los profesionales de enfermería, especialmente cuando se trata de sujetos con discapacidad sensitiva o cognitiva. El modelo médico paternalista predomina en el contexto clínico, lo que limita el derecho a la autonomía de las personas con discapacidad. A los valores morales tradicionales promovidos por los profesionales de enfermería se suman valores instrumentales como la eficiencia. No se mencionan valores cívicos considerados fundamentales ante el desafío de la diversidad humana y la vida en democracia.

Abstract The purpose of the study is to describe ethical aspects related to nursing care for persons with disabilities; a population considered socially vulnerable and in conditions of inequality. It corresponds to the first phase of a primary study conducted in Atacama, Chile using a qualitative methodology and content analysis. Nursing graduates are interviewed respecting Ezekiel Emanuel's ethical criteria. The main findings account for ontological categories such as moral reasoning, value system, nurse-patient relationship model, consequences of the ethical nursing action, strategies to overcome moral conflicts, and barriers in care. It is concluded that caring for people with disabilities is a source of dilemma and moral anguish for nurses, especially when it comes to individuals with sensitive or cognitive disabilities. The paternalistic medical model predominates in the clinical context, limiting the right to autonomy of persons with disabilities. Instrumental values such as efficiency are added to traditional moral values promoted by nurses. Civic values considered fundamental to the challenge of human diversity and life in democracy are not mentioned.

Resumo Este estudo tem como objetivo descrever aspectos éticos relacionados com a atenção de enfermagem em pessoas com deficiência, população considerada socialmente vulnerável e reconhecida em condições de desigualdade. Corresponde a uma primeira fase de estudo realizado na região de Atacama, Chile, que utilizou metodologia qualitativa e análise de conteúdo. Foram realizadas entrevistas com profissionais de enfermagem, respeitando os critérios éticos de Ezekiel Emanuel. Os principais achados evidenciam as categorias ontológicas: raciocínio moral, sistema de valores, modelo de relação enfermeiro-paciente, consequências da ação ética de enfermagem, estratégias para superar conflitos morais e barreiras no cuidado. Conclui-se que cuidar de pessoas com deficiência é fonte de dilema e angústia moral para os profissionais de enfermagem, especialmente quando se trata de pessoas com deficiência sensitiva ou cognitiva. O modelo médico paternalista predomina no contexto clínico, o que limita o direito à autonomia das pessoas com deficiência. Aos valores morais tradicionais promovidos pelos profissionais de enfermagem, somam-se valores instrumentais como a eficiência. Não são mencionados valores cívicos considerados fundamentais ante o desafio da diversidade humana e a vida na democracia.