En la serie Cuadernos de Investigación del Instituto de Investigaciones Interdisciplinarias de la Universidad de Puerto Rico en Cayey se presentarán resultados parciales y preliminares de algunas de las investigaciones auspiciadas por el Instituto, versiones preliminares de artículos, informes técnicos emitidos por nuestras(os) investigadoras(es) así como versiones finales de publicaciones que, por su naturaleza, sean de difícil publicación por otros medios. Los(as) autores(as) son responsables por el contenido y retienen los derechos de publicación sobre el material contenido en estos Cuadernos. Copias de los Cuadernos se pueden obtener solicitándolos por teléfono, por correo regular o por correo electrónico al Instituto. También se pueden descargar de nuestra página electrónica en formato pdf. Instituto de Investigaciones Interdisciplinarias Universidad de Puerto Rico en Cayey 205 Ave. Antonio R. Barceló Cayey, PR 00736 Tel. 787-738-2161, exts. 2615, 2616 Fax 787-263-1625 Correo electrónico: instituto.investigacion@upr.edu Página web: http://webs.oss.cayey.upr.edu/iii/ Diseño de Portada: Prof. Harry Hernández Encargado de la serie de cuadernos: Dr. Errol L. Montes Pizarro Directora del Instituto: Dra. Isar P. Godreau Directora Auxiliar: Sra. Vionex M. Marti © Instituto de Investigaciones Interdisciplinarias Universidad de Puerto Rico en Cayey

Perspectives Concerning Prevention of Health Problems

Shirley Bejarano1, Glaymar Domínguez2, Sarah Lince3, David Nachi4, Abbey Wells5

1 Department of Anthropology and Pre-Medicine Program, University of South Florida 2 Department of Biology, University of Puerto Rico-Cayey

3 Department of Anthropology, Frances Perkins Scholar at Mount Holyoke College 4 Department of Biology, University of Puerto Rico-Cayey

5 Department of Anthropology, Mount Holyoke College

Submitted as partial fulfillment of the Research Methodologies in Community Health Fieldschool (INTD 4996) requisites, June 2007.

©2007 Institute of Interdisciplinary Research, University of Puerto Rico-Cayey. ________________________________________________________________________

ABSTRACT

Our research was conducted in collaboration with the Hospital de Area in Cayey. Building on research conducted by field school students in 2006, we focused on documenting perspectives about “prevention of health issues”. We documented perspectives of clients (people attending the hospital-field school sponsored health fair as well as the hospital’s public sector waiting rooms), as well as personnel of the hospital (including doctors, nurses, and the administrators). We asked each group what “prevention” meant to them and about their ideas about current and future strategies and specific health conditions for prevention efforts. We have also incorporated results from an internationally verified food security survey conducted at the health fair. This report includes an analysis of participants responses in terms of “individual”, “socio-economic” and “environmental” factors associated with maintaining health. It also specifically describes participants’ ideas about strategies for implementing prevention efforts, and preventable conditions commonly mentioned as needing attention in prevention efforts. This information is provided to our collaborators at the Hospital de Area en Cayey to allow the hospital to interpret it and use it for developing current and future “prevention” efforts. ________________________________________________________________________ INTRODUCTION Our research was conducted in the second year of a five year field school project named Health in Community “Salud en Comunidad”. It builds on research conducted by students of the first year of this field school (2006). Results from the previous year’s work with the Hospital de Area en Cayey

identified prevention of health issues as a topic for future research. The hospital then took up this topic as a focus of their collaborative work with us in this year’s community-based research (2007). This research project was designed to provide the hospital with information for developing prevention efforts. This project includes the collected opinions of the clients of the hospital personnel regarding the existing

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and possibilities for future prevention efforts. We gathered information about participants’ ideas about current and future strategies and specific health conditions for prevention efforts strategies for implementing prevention efforts. During our research we noticed different ways that participants were talking about prevention as well as factors related to maintaining health. We saw several prevention discourses emerge based on individual, socio-economic, and environmental factors effecting understandings of health and prevention. Our analysis of these discourses has been informed by contrasting tendencies in health promotion and prevention discourse to concentrate on individual factors related to maintaining health, and emerging assertions that health issues are also related to factors such as social, economic, and environmental contexts. Our theoretical approach to analyzing our participants’ discourses in individual, socio-economic, and environmental terms is similar to those of Nancy P. Chin with Alicia Monroe and Kevn Fiscella (2000), and Lisbeth Sachs (1996). Chin et al (200) differentiate between a “rational choice model” for health promotion and prevention efforts and a “biopsychosocial model” (Chin et al 2000: 318). Chin et al describe the rational choice model as based on individualistic “Western” (2000:319) values. It focuses health promotion and prevention on the individual actions of a single person/patient. It “assumes people are rational, aware, self-creating agents of their own health…” (ibid: 319). The biopsychosocial model is based on the idea that the social, economic, community, environmental context are relevant to assessing health problems

and determining the efficacy of health promotion/prevention efforts. It suggests changing the “rational choice model’ to one based on “integrating socio-cultural factors into a patient-centered approach to health care…” (ibid:325). Sachs (1996) describes the impacts of similar differentiations of health promotion/prevention discourses. The “responsability and blame” (Sachs 1996:632) discourse describes health based in individual factors. Sachs identifies another discourse based on acknowledging socio-economic, cultural context of health issues, what she calls “causal relationships” (ibid:632). She identifies that differences in care and responses to health issues are rooted in different levels of “[locating] the cause of sickness” (ibid:635) as individual “responsibility” or within a “causal relationship” with socio-economic, economic pr environmental factors. We have also used similar structures as Chin et al and Sachs in developing instruments and interview guides, as well as for identifying health conditions and strategies for prevention efforts from our data. Results from the food security questionnaire were also analyzed in a way that highlighted the intertwined relationships between the micro, individual factors, and the macro, socio-economic and environmental factors, effecting health. METHODS The methods we used include: preliminary interviews, fieldwork, survey development, data collection, and data analysis. Through preliminary interviews and lectures, we developed an understanding of our research topic and community based research. Therefore,

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this initial work allowed us to develop our ultimate objectives. We did fieldwork that included; observations and mapping exercises. This initial introduction to the setting and the hospital community assisted us to familiarize ourselves and understand the hospital area. After gaining more understanding of the hospital, we developed surveys to conduct with the hospital personnel and the clients of the hospital. We created two surveys for the clients of the hospital. One for the clients in waiting in the emergency room and one for the residents of the community of Las Vegas that attended the health clinic held in el Barrio Las Vegas. We also created survey/interviews for the hospital personnel to understand their points of view on the subject. Also, we used the USAID and The Food and Nutrition Technical Assistance Projects’, Food Security Survey. This survey has been constructed to be used in the United States and validated for use internationally. This survey provides the level of food security for a person by grouping these participants in four categories: Food Secure, Mildly Food Insecure, Moderately Food Insecure, and Severely Food Insecure. We collected the data from a range of participants during three hospital visits and the health clinic. At the hospital we collected twenty-six questionnaires and five interviews. At the health clinic, we collected thirty-nine of our own questionnaires, and thirty-nine food security questionnaires, from the residents of Las Vegas. Finally, after collecting the data using these instruments, we used data analysis to draw conclusions from our research. We used the SPSS program to

analyze the quantitative data through finding frequencies, means, modes, medians, and created graphs. We also did qualitative analysis practices such as code, categorizing common topics, and created theories from the qualitative data. RESULTS After collecting our data, we organized it and received a plethora of results. First we organized the sample into two groups: the Health Clinic and the Hospital. This division helped to determine what kind of sample we were looking at, allowing us to evaluate the questionnaire responses according to group. This data included information about gender- fifty-one females and twenty males in total of the clients’ questionnaires; age, medical insurance, education level (for complete demographic information used: see appendix 1). After organizing that data we entered the quantitative data into a date base using SPSS Statistical Package for Social Sciences. By doing this, we were then able to compare the demographic information to the quantitative information given to us through our questionnaires. When looking at our data, we realized that the information could be broken down into three categories of results: health conditions that were mentioned, the manner in which they receive or would like to receive information, and finally the individual, socio-economic, and environmental factors that affected these people to practice preventive health. Some of the questions on the hospital client questionnaire and in the hospital personnel interview inquired about: a) what kind of health issues do the participants see most often, b) what kind of health issues do the participants

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have, and c) what kind of health topics issues do the participants see material about prevention programming. We received a wide range of answers from both the hospital personnel and the hospital clients. The top answers for the hospital personnel were gastroenteritis, asthma, and cardiovascular issues- mainly hypertension. One of the hospital personnel emphasized the fact that gastroenteritis is one of the main health issues that they see at the hospital. Also, the day of the interview the hospital personnel had mentioned that three patients had already been treated for gastroenteritis that same day. The hospital personnel also mentioned several current prevention efforts that there are already prevention efforts for diabetes, depression, osteoporosis, and cardiovascular health issues. One of the hospital personnel emphasized the need for prevention efforts surrounding “sexual education”. They explained that the hospital offers services such as a free testing clinic on Tuesday afternoons, where the hospital will test for sexually transmitted diseases including HIV, for free. The hospital personnel also specified different topics of health in which they provided information to their patients about. These topics included practicing good hygiene, regular exercise, good diet and nutrition, using dental services, and using optometry services. The clients from the emergency waiting room and the health clinic replied to these questions with similar answers to those of the hospital personnel. The top three responses that we received from the clients at the health fair consisted of asthma, cardiovascular issues- mainly hypertension, and diabetes. The other responses ranged from typical trauma type issues (cuts and

animals bites) to obesity, back pain, and HIV/AIDs. They identified that they are either experiencing these issues, believe that they are common, or have seen or would like to see prevention efforts for them. We also asked both sets of participant the strategies in which they have seen prevention efforts and if they had any ideas for future strategies. The hospital personnel answered this question indicating that the efforts that the hospital has now are good, but they want more. After a question regarding their feelings on the current hospital health prevention efforts, one hospital personnel answered “Excelente… muy bien” (Excellent…very good), they then specified that they believe that strategies for example, “Charlas” or talks, were good already, receiving between sixty and seventy participants, but that they would like to see them more often. Other current and suggested strategies mentioned were more health clinics, more Mobile visits, family planning services, suggestions by the hospital personnel to the patients, prevention classes in schools, free blood pressure tests, the STD testing clinic, recreation and sports that promote health, free health insurance, better access to the laboratory for testing, and more resources for the hospital. When the clients were asked about the current and future prevention strategies they answered timidly. The responses that we received can be summarized in the following: “Oh, I guess more talks”, this quote suggests that not many of the responses were suggestive of future different strategies. They indicated that they attended the health clinics, talks, and read health literature. The clients emphasized that they enjoyed more interactive activities

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when considering health prevention strategies. Some also made a point that they did not find the pamphlets regarding different health conditions were helpful or effective. The main ideas for how to get more people to participate in prevention efforts were television, health promotion or television programs, active participation, more talks, one-on-one with doctors, health clinics with games and food, and education in the schools and community, (outside of the hospital). Socio-economic factors One of the main problems noticed on different interviews and questionnaires with personnel from the hospital, was that they identified various socio-economics factors as why they didn’t practice health problems prevention. Socio-economics factors are considered to be factors involving both social and economic factors which can affect your whole life in general. The most important socio-economic factors they identified were lack of orientation or education, cultural problems such as sexual taboo, no funds and access to resources and health services. Lack of orientation and education, is one of the major problems because when people are not familiar with prevention and different health problems they just loose interest in the matter and then don’t get motivated to take care of themselves. Sexual taboo, presents an important cultural problem because it affects the education which people receive concerning pregnancies and sexually transmitted diseases. It is the problem behind unwanted pregnancies in adolescents and people getting sexually transmitted diseases. According to hospital personnel, there should be more

sexually transmitted diseases orientation and more sexual education in schools. Access to resources and health services, present an obstacle to many people who are interested in taking care of themselves because a person may have the best interest in practicing prevention but needs to have at his disposition health services or the resources to be able to afford or receive those services. Lack of funds, present a problem to the hospital and to the personnel because they have a lot of motivation and initiatives but are not able to realize them because there are no resources. If there are no funds from the government or from other agencies to develop and put to work prevention programs, then all efforts are worthless. An interesting quote from personnel from the hospital is: “If the government does not invest on health problem prevention services or programs, eventually it will finish expending more money on health problem”. One of the main problems also is that Puerto Rico’s public health plan, called La Reforma, presents a problem to people’s health because they make it very difficult for people to get their routine tests. Another quote concerning this problem is “They have to change La Reforma, there are too much obstacles”. The Cayey Hospital has health problems prevention initiatives, but not implemented programs. They do STD (Sexually transmitted diseases) free clinics on Tuesdays, where they make free tests to clients. They offer chats on different health topics and they have a nurse which specializes on family planning. One of the aspects that were indicated was that the hospital is in need of a prevention activities infrastructure, which includes prepared personnel in different health topics, facilities, and

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good advertisement, to interest people and at the same time diminishes health problems which can be prevented. Other socio-economic factors were identified by clients of the hospital. When clients were asked why they thought that other people did not practice prevention measures, they answered that it was because of individual factors like lack of interest, ignorance and behavior. But, when we asked people why they didn’t practice prevention it turned out that it was because of socioeconomic factors like transportation, lack of money for medicines and food, and lack of health insurance. Transportation presented a problem because for example, a person who has to go to the hospital for a certain treatment at a certain day or time will not have the transportation to get there so the person will not receive the treatment. Lack of food and medicines presents a problem for example for people with diabetes because they need to eat well and get insulin daily to keep it from turning worst. Lack of health insurance is also a big obstacle for people because a person who does not have health insurance has to pay for all the services and the medicines and sometimes people cannot afford it so they don’t get their medical services like they should. All this problems are individual factors, all result of socio-economic factors. Environmental Factors In interviews and surveys done to the hospital personnel we noticed that environmental conditions were crucial to the most common health problems in the Hospital. In the hospital there are a great number of cases in chronic asthma and respiratory problems which are associated with the cigar factory and the quality of the air. There have been seen

numerous cases of young workers of the factory with respiratory problems. Also, the quality of the air because of volcanoes and deserts dusts which arrive to Puerto Rico and the fluctuations in Cayey’s climate affect people’s health. One of the most common problems in the emergency room is one that concerns the quality of water and foods. The emergency room receives numerous cases of gastrointestinal problems like, gastritis and gastroenteritis. These cases are commonly seen in people of all ages but very rare in infants, because of the type of water they consume which is distilled. Security or quality of food and water are determinant factors for gastrointestinal problems because most cases are because of food intoxication, poisoning or for drinking contaminated water. These factors were identified as serious factors guilty for so many cases of diarrhea and vomiting in the emergency room. CONCLUSION During the analyzing process of the data we found a very interesting pattern that was seen through out the responses of the questionnaires and the interviews. This trend was based on how the people were being affected by various factors that impeded them to practice prevention for health. We then categorized some of the quantitative data and quantified the qualitative responses into three factors: individual, socio-economic and environmental. We gave two presentations on our research, one to the municipality of Cayey and to the administration of the Hospital de Area, and another to the residence of Las Vegas. First, we were able give an insight on the perspectives of prevention and what it meant to the residence that participated in the health

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fair, clients and personnel of the hospital, on the their definition of prevention. We were then able to bring to the attention of the hospital and the municipality personnel the main health conditions that were most frequently mentioned which the residence and clients of the hospital suffer from. During our presentation we were able to the municipality and the Hospital de Area personnel about our investigation. FUTURE INVESTIGATIONS The results of our inquiry have led us to identify various aspects that could be further studied. Our research provided to the Hospital de Área with preliminary baseline information that could possibly assist the personnel of the hospital to take the first step in constructing an efficient program that will teach their patients and other people of the community about health prevention. Our results suggested that a possible next step to discover the missing existing pieces to this investigation is to further study the effectiveness of the current health prevention strategies and programs efforts. Another recommendation that can suggest a better understanding is to do follow up studies to understand the relationships between three factors identified: individual, socio-economical, and environmental. These studies can possibly improve the effectiveness of the current and future health prevention efforts. In addition, we factors that further investigations can possibly facilitate the community of Las Vegas can determine an answer to why the people of this area were demonstrating food insecurity. Some of the pressing questions that can be drawn are: Were these people referring to foods that they simply

enjoyed to eat but did not have the luxury to afford these extra types of foods? Or were they referring to not being able to have access to essential nutritional foods? These are the questions that should be asked in a future investigation of Las Vegas where the focus would be on nutrition. This would help to explain the accumulative number of the 50 + % of the sample of people that expressed food insecurity. In addition, to the food insecurity questionnaire, another factor from our results that stood out from our research was the fact that several of the hospital clientele and residence that participated in the health fair mentioned that a main problem that impeded them to practice health prevention was transportation. This could also be another possible explanation to why people showed food insecurity. ACKNOWLEDGEMENTS We would like to thank the University of Puerto Rico at Cayey and the University of South Florida at Tampa for hosting the summer program Escuela de Verano: Salud En Comunidad. We would also like to thank the Institute of Interdisciplinary Research at UPR Cayey; especially our program director Dr. Jannette Gavillán-Suárez. Also, to the staff at the Hospital de Area en Cayey, the clients of the hospital, and residents of Las Vegas; Thank you so much for your cooperation and participation, without you our research would not have been possible. In addition, we would like to recognize the National Institutes of Health (NIH-RIMI Grant #1-P2MD001112-0), and the American Folklife Center from the Library of Congress for their support of our project.

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Thank you to our mentors, Federico Cintrón-Moscoso and Orquídea Frias; the faculty, Dr. David Himmelgreen, Dr. Nancy Romero-Daza, Dr. Mariolga Reyes, and Dr. Guha Shankar; and everyone else who made this possible, Aixa Alemán, José Alvarado, Dr. Jessica Gaspar, Dr. Isar P. Godreau, and all the presenters that took time to meet with us. RESEARCH TEAM We are students from three different universities studying at the Institute of Interdisciplinary Research, University of Puerto Rico at Cayey. This is a one month internship program part of a five year project sponsored by the National Institutes of Health, in which students and faculty participate in research concerning community health within the municipality of Cayey, Puerto Rico. • Shirley Bejarano is entering her senior year at University South Florida-Tampa; she is Pre-Med and Anthropology. Spanish proficiency: native speaker. • Glaymar Dominguez is entering her senior year at the University of Puerto Rico-Cayey and is studying Biology. Spanish proficiency: native speaker. • Sarah Lince is a Frances Perkins Scholar at Mount Holyoke College, also studying Anthropology. Spanish proficiency: intermediate. • David Nachi is entering his fifth year at the University of Puerto Rico-Cayey, majoring in biology. Spanish proficiency: native speaker. • Abbey Wells is entering her third year at Mount Holyoke College. She is studying Anthropology and Film Studies, and this is her first research

experience. Spanish proficiency: intermediate. REFERENCES Chin, Nancy, P., Monroe, Alicia; Fiscella, Kevin. 2000. 2000 Implications for Institutions/Policy Issues: Social Determinants of (Un) Healthy Behaviors. Education for Health Vol. 13, No. 3:317-328. Sachs, Lisbeth, 1996 Causality, Responsibility and Blame – Core Issues in the Cultural Construction and Subtext of Prevention. Sociology of Health and Illness Vol. 18, No. 5:632-652. Porter, Dorothy 2006 How Did Social Medicine Evolve, and Where Is It Heading? PLOS Medicine Vol. 3, No. 10, October: 1667-1672. WORKS CONSIDERED Center for Disease Control website: 2007 [2005] Chronic Disease Prevention Electronic Document, http://www.cdc.gov/nccdphp/overview.htm, accessed June 20, 2007. Castro, Arachu; Farmer, Paul 2005 Understanding and Addressing AIDS-related Stigma: From Anthropological Theory to Clinical Practice in Haiti. American Journal of the Public Health Vol. 95, No. 1: 53-58. Messonier, Mark; Corso, Phaedra; Teutch, Steven M.; Haddix, Anne C.; Harris, J.R. 1999 An Ounce of Prevention…What Are the Returns? American Journal of Preventive Medicine Vol. 16, No. 3: 248-262.

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Nizeye, Bruce; Stulac, Sara; Kashavjee, Salmaan 2006 Structural Violence and Clinical Medicine. PLOS Medicine Vol. 3, No. 10, October: 1686-1691. Rylko-Bauer, Barbara; Farmer, Paul

2002 Managed Care or Managed Inequility? A Call for Critiques of Market-Based Medicine. Medical Anthropology Quarterly Vol. 16, No. 4: 47. Tables and Figures Demographics Health Clinic- Clients SEX N=39 Male 14 Female 26 AGE N=39 Less than 25yrs 3 25-64 yrs 30 Greater than or equal to 65 5 Health Insurance Private 12 Public 26 None 1 Hospital- Clients SEX N=26 Male 4 Female 22 AGE N=26 Less than 25yrs 5 25-64 yrs 17 Greater than or equal to 65 3 Highest Education level Elementary 4 Intermediate 2 High School 8 Bachelor/Graduate 9

10

29.5%

22.7%

18.2%

11.4%

9.1%

4.5% 4.5%

Visit the doctorregularly

Visit the hospitalin case of

complications

Nutrition Others Takehomemaderemedies

Exercisesroutines

Otherinstitutions

Patients’ responses about their health care

Total Figure 1: This chart represents the total percentages of responses from the clients (N=26) about their health care measures for themselves and their families. (Others=visits to the pharmacy, restriction of addictions, work at a laboratory, health-related courses, follow-up of instructions, and reading press.

Food Security 45%

High Food Insecurity

26%

Moderate Food Insecurity

13%

Light Food Insecurity

15%

Figure 2: This pie chart shows the results obtained at the Health Fair in Barrio Las Vegas where the Food Insecurity was administered (N=39).

11

11

10

12

4 4

6

5

Lack of interest

Service providers office hours Lack of timeTransportation

Lack of money for food

Lack of money for medications

Medical insurance policy

Relative Frequencies of Behavioral, Individual, and Socioeconomical Barriers for Prevention in Cayey’s Municipality Hospital

Figure 3: This table of frequencies shows some aspects that impede patients to carry on preventive measures according to the information obtained from the Municipality Hospital Questionnaires.

12

18

11

15

20

8

13

Del médico De la familia Periódicos Programas de TV Programas radiales Otros

Methods used by patients on how they obtain health care information

Relative Frequencies

Figure 4: This table of frequencies represents the common ways on how the Cayey Municipality Hospital patients obtain their health care information.

13

9

8

5 5

4

3

2

Cardiovasculardiseases

Diabetes Asthma Back pain Migrain Cholesterol Gastroenteritis

Common conditions found at the Cayey Municipality Hospital

Common conditions found at the Cayey Municipality Hospital

Figure 5: This chart represents the incidence of the most common conditions found at the Cayey Municipality Hospital.

14

8 8

4

3

2 2

0

No

resp

onse

Oth

ers:

Vac

cine

s,In

fect

ions

, Rou

tinar

yex

ams,

Psy

chia

trist

Res

pira

tory

/Ast

hma

Em

erge

ncie

s

Car

diov

ascu

lar

prob

lem

s

Med

icat

ions

Gas

troin

test

inal

prob

lem

s

Types of treatment provided by the Cayey Municipality Hospital collected at the health fair

Frequencies

Figure 6: This chart shows the most common treated problems at the Cayey Municipality Hospital ER.

Perspectivas acerca de la prevención de problemas de salud

Shirley Bejarano, Glaymar Dominguez,Sarah Lince, David Nachi,

Abbey Wells

JUNIO 2007

© 2007 III

Estudiantes de UPR-C, USF y MountHolyoke College

Curso de verano“Salud en Comunidad”

Ofrecido por el Instituto de Investigaciones Interdisciplinarias

¿Quiénes Somos?

Explorar las perspectivas acerca de la prevención de problemas de salud

Los clientes del hospital

Personal del hospital

Residentes de Las Vegas

Objetivos

Trabajo de campoEntrevistasDesarrollo de cuestionarios para los clientes

Clínica de saludHospital de Área de Cayey

Cuestionario de Inseguridad Alimenticia

Metodología

En el Hospital de Área 26 cuestionarios a clientes5 entrevistas con el personal

En la Clínica de Salud40 cuestionarios a participantes Inseguridad Alimenticia

Muestra

Clínica de Salud N=40

SexoMasculino = 14Femenino = 26

Edad< 25 = 325 – 64 = 30> 65 = 5

Seguro MédicoPrivado = 12Público = 26No tiene = 1

En el Hospital N= 26 SexoMasculino = 4Femenino = 22Edad< 25 = 525 - 64 = 17> 65 = 3Nivel de EducaciónElemental = 4Intermedio = 2Superior = 8Bachill. & Asoc. = 9

Datos Demográficos

RESULTADOS

Personal del Hospital:1. Gastroenteritis2. Asma3. Cardiovascular

(hipertensión)

Clínica de Salud:

1. Asma2. Cardiovascular

(hipertensión)3. Diabetes

Condiciones Mencionadas

RESULTADOS

Estrategias actuales:

Ferias de salud/ charlas

Unidad clínica móvil

“Planificación Familiar”

Sugerencias para Clientes

Estrategias propuestas Personal del hospital capacitado en educación: salud preventiva

Propuesta de educación: salud preventiva en las escuelas

Programas de recreación y deportes para promover la salud preventiva

Estrategiasde Prevención Personal del Hospital

Televisión

Participación activa

Educación en las escuelas y en comunidades

Estrategias de Prevención Perspectivas de los clientes

Factores individualesPerspectiva de los clientes y personal

del hospital¿Por qué usted cree que las personas no utilizan la información provista para prevención de problemas de salud?

Falta de interésDesconocimientoComportamiento

RESULTADOS:

Factores Socio-económicosPerspectiva personal del hospital

Acceso a recursos y servicios de salud Falta de Orientación y EducaciónTabúFondos

RESULTADOS:

Factores Socio-económicosPerspectiva de clientes

“¿Cuál de los siguientes le impide llevar a cabo actividades de prevención?”

TransportaciónFalta de dinero para comidaFalta de dinero para medicinasFalta de cubierta de salud

RESULTADOS:

Inseguridad Alimenticia Las Vegas

SEGURIDAD ALIMENTICIA

45%

INSEGURIDAD ALIMENTICIA

SEVERA 26%

INSEGURIDAD ALIMENTICIA MODERADA

13%INSEGURIDAD ALIMENTICIA

BAJA15%

52 % Inseguridad alimenticia

- 3 factores inseguridad severa:

•Quedarse sin comer un día o más•Irse a la cama con hambre•Quedarse sin comida

RESULTADOS:

N = 39 personas

Factores ambientalesPerspectiva personal de hospital

Cayey- gran incidencia de problemas respiratorios

Fábrica de cigarrosCalidad del aire

Problemas gastrointestinalesCalidad del aguaCalidad y manejo de los alimentos

RESULTADOS:

Resumen

Asma

Enfermedades cardiovasculares

Gastroenteritis

Perspectivas personal del hospital y clientes

Condiciones Similares

Estudiar la efectividad de los programas de prevención actuales

Entender la relación entre los factores identificados (individual, socio-económico y ambiental) para mejorar la efectividad de los esfuerzos para prevención

Futuras Investigaciones

Agradecimientos

Instituto de Investigaciones InterdisciplinariasUniversidad de Puerto Rico - CayeyUniversidad del Sur de la FloridaAmerican Folklife CenterNIH - National Institutes of Health Hospital de Área de CayeyComunidad del Barrio Las VegasMunicipio de Cayey

¡Gracias por su atención!

¿Alguna pregunta?

Texto Presentación Oral “Perspectivas acerca de la prevención de problemas de salud” ¿Quiénes somos? Nosotros somos estudiantes de la Universidad de Puerto Rico en Cayey, la Universidad del Sur de la Florida, y Mount Holyoke. Nuestra investigación es parte del curso de verano, “Salud en Comunidad”, ofrecido por el Instituto de Investigaciones Interdisciplinarias en la UPR-Cayey. Objetivos ¿Cuáles son las perspectivas acerca de prevención de asuntos de salud de los clientes del hospital, los clientes en el barrio Las Vegas que participaron en la feria de salud y el personal del hospital? Presentar la información al Hospital de Área y a la comunidad del Barrio Las Vegas [Según la ONU (Organización de Naciones Unidas) prevención es la adopción de medidas encaminadas a impedir que se produzcan deficiencias físicas, mentales y sensoriales o a impedir que las deficiencias, cuando se han producido, tengan consecuencias físicas, psicológicas y sociales negativas».] Procedimiento En esta sección, les explicaremos las diferentes partes de nuestro procedimiento, de las cuales recopilamos información para la investigación.

Primero, hicimos trabajo de campo basado en observaciones, y un mapa de los alrededores del hospital. Esto nos permitió familiarizarnos con el área y medio ambiente del hospital.

Segundo, utilizamos entrevistas con el personal del hospital para enfocar la investigación y así entender nuestro tema.

Tercero, desarrollamos dos cuestionarios para los clientes. Uno para los clientes del Hospital de Área en la Feria de Salud del 16 de junio y uno para los clientes del Hospital de Área en la Sala de Emergencia.

Además, usamos el cuestionario de “Inseguridad Alimenticia” en la Feria de Salud con los clientes de Las Vegas. Este es un cuestionario que fue desarrollado por USAID y el “Proyecto de asistencia técnica sobre comida y nutrición” y es utilizado en los Estados Unidos y válido a nivel internacional.

Finalmente, analizamos los datos y los estamos presentando a ustedes. Demográficos Nosotros usamos datos que recopilamos en la Feria de Salud y en el Hospital de Área. En el Hospital, recopilamos: 25 cuestionarios de los clientes 5 entrevistas de personales del hospital En la Feria de Salud, recopilamos: 40 cuestionarios de los clientes 40 cuestionarios de “Inseguridad Alimenticia”

Fuera de estos datos: XX fueron mujeres, y XX fueron hombres Las edades están en un intervalo de XX a XX Métodos Nosotros usamos

1. Entrevistas para enfocar la investigación, entender nuestro tema. 2. Completamos Trabajo de campo, como observaciones y un ejercicio de

“mapping”, familiarizarnos con el área y medio ambiente del hospital. 3. Desarrollamos los cuestionarios para las personas que asistieron la Feria de Salud

en el barrio Las Vegas, el 16 de junio; y para los pacientes en el Hospital de Área. Desarrollamos cuestionarios para los profesionales de salud en el hospital.

4. Después, nosotros Recolectamos los datos a. En la Feria de Salud hicimos

i. 40 Cuestionarios/Entrevistas con las personas en la Feria de Salud b. En el Hospital hicimos

i. 25 Cuestionarios/Entrevistas con las pacientes en la Sala de Emergencia

ii. 4 entrevistas con los profesionales de salud 5. Finalmente, analizamos los datos.

a. Analizamos datos cualitativos de i. Las entrevistas

• y b. Analizamos datos cuantitativos con utilizando el programa estadístico “SPSS”

ii. las Frecuencias iii. y las Gráficas

Resultados Ahora le vamos a hablar de lo descubierto después de analizar toda la información cuidadosamente. Los factores identificados para prevención o cómo las personas se expresan sobre como prevenir problemas de salud los dividimos en factores individuales, estructurales y ambientales. También les hablaremos sobre las maneras más efectivas de acuerdo a los pacientes entrevistados, para llevarles el mensaje de prevención de problemas de salud. Por último, veremos los temas más significativos de prevención. Perspectiva de los profesionales de la salud - Factores individuales

• Esta cita, explica uno de los grandes problemas ante la prevención. Mencionada

por varios profesionales de la salud “los pacientes no se motivan a practicar prevención”.

• “La educación lo es todo” es otra cita la cual demuestra el problema que presenta no orientarse en varios aspectos de la salud.

• Otro problema es la higiene lo cual significa que varios de los problemas ocurridos son por falta de limpieza, calidad o contaminación de agua y comida.

There is a tendency to approach prevention in public health by focusing on individual patient factors/issues. Sometimes health issues are also connected to socio-economic factors. We noticed that participants in our research –both clients and hospital personnel talked about prevention from both perspectives in different ways Perspectiva de los clientes - Observamos en al grafica porque las personas no practican medidas de prevención. Perspectiva de los profesionales de la salud – Factores Estructurales

• Educación: Falta de orientación o información lleva a falta de interés y por lo

tanto de motivación (Como se puede apreciar en la grafica mostrada en el slide anterior).

• Condiciones socio-económicas de los clientes del hospital afectan la calidad de comida, agua o vida en general. Logrando que la población sea mas susceptible a enfermedades.

• Problemas culturales como el taboo al tema del sexo por lo cual ocurren tantos embarazos no deseados en adolescentes. También orientar en el tema de enfermedades venéreas para evitar contagios por falta de orientación. También se necesita mas educación sexual en las escuelas que es donde más se ven los problemas mencionados.

• Para hablar de los factores políticos voy a citar a una persona que dijo “Tienen que cambiar la reforma de salud “/“Hay muchos obstáculos” porque presenta un problema para la salud ya que las personas no se hacen estudios rutinarios por lo complicado que se les hace llegar a ellos.

• Otra cita interesante es “Si el gobierno no invierte en sistemas o programas de prevención, a la larga terminaran gastando mas en problemas de salud.” Porque presenta un posible problema si no se hacen programas efectivos para prevenir enfermedades.

• Hace falta una infraestructura de actividades de prevención, con personas preparadas en varios temas, facilidades y buena propaganda para llevar a cabo el propósito de disminuir problemas de salud que son prevenibles.

• El hospital tiene iniciativas, pero no programas implantados, como las clínicas de enfermedades venéreas todos los martes en las que hacen pruebas gratis aunque no muchos asisten, las charlas a las que asiste un gran numero de personas y una enfermera que se ocupa de planificación familiar de jóvenes embarazadas.

Perspectiva de los clientes – Factores Estructurales • Primero les explico esta gráfica la cual demuestra cuáles son los obstáculos más

comunes por lo cual los pacientes no practican prevención. (CHART)

• Uno de los pacientes mencionó “Uso el hospital Menonita porque no hacen falta tantos requisitos como en el Hospital de Área”

Entre los problemas ambientales identificados por los profesionales de la salud del hospital - Factores ambientales

• Podemos ver el problema de asma crónica y las causas de problemas respiratorios

asociados con: ;a fábrica de tabacos y la calidad del aire. Se han visto varios casos de trabajadores jóvenes de la fábrica con problemas respiratorios. También, la calidad del aire en Cayey dado a los polvos de volcanes/desiertos que llegan a P.R. y las fluctuaciones del tiempo.

• También, vemos que hay problemas gastrointestinales muy comunes por la calidad del agua y la seguridad o calidad alimenticia. Estos fueron identificados como graves factores por los altos casos de vómitos y diarreas en la Sala de Emergencia.

• Para hablar de los factores políticos voy a citar a una persona que dijo “Tienen

que cambiar la reforma de salud “/“Hay muchos obstáculos” porque presenta un problema para la salud ya que las personas no se hacen estudios rutinarios por lo complicado que se les hace llegar a ellos.

• Otra cita interesante es “Si el gobierno no invierte en sistemas o programas de prevención, a la larga terminaran gastando mas en problemas de salud.”

• Porque presenta un posible problema si no se hacen programas efectivos para prevenir enfermedades.

• Hace falta una infraestructura de actividades de prevención, con personas preparadas en varios temas, facilidades y buena propaganda para llevar a cabo el propósito de disminuir problemas de salud que son prevenibles.

• El hospital tiene iniciativas, pero no programas implantados, como las clínicas de enfermedades venéreas todos los martes en las que hacen pruebas gratis aunque no muchos asisten, las charlas a las que asiste un gran numero de personas y una enfermera que se ocupa de planificación familiar de jóvenes embarazadas.

Inseguridad Alimenticia

• Muchos de los clientes y también el personal del hospital identificaron en particular factores socio-económicos como la alimentación y la relación con la prevención de problemas de salud –por ejemplo falta de dinero para comida. También, mencionaron la nutrición y la buena comida como parte importante para mantener la salud.

• En la encuesta sobre seguridad alimenticia se administró un cuetionarrio que se

llama: “Escala de Seguridad Alimenticia a Nivel del Hogar”. Lo administramos en la Clínica de Salud en Las Vegas a 39 personas.

• Según USAID, la seguridad alimenticia se define : “A cualquier persona, a cualquier tiempo, tiene acceso fisicamente y económico a comida suficiente para satisfacer sus necesidades para una vida productiva y saludable”. Los resultados de este cuestionario muestran una medida de los niveles de inseguridad alimenticia en un rango que va desde ‘tener ansiedad o preocupación por falta de comida’ a ‘no tener comida de suficiente calidad’ a –lo mas severo: ‘no tener regularmente acceso fisico a comida’.

• En esta gráfica se muestra que poco más del cincuenta porciento (50%) de los

participantes mostraban signos de inseguridad alimenticia. Y que el 26% se identificó como “inseguro en cuanto a su comida” por los 3 factores: que se muestran en la figura.

Temas de Prevención: Pacientes/Clientes

• En esta tabla vemos las condiciones mas frecuentes de salud en los pacientes del Hospital

• Nos sirve para determinar para que condiciones son más necesarios los programas de prevención.

Agradecimientos Gracias - Muchas gracias por venir a nuestra presentación. Esperamos que haya sido de su agrado y que les sirva de provecho. ¿Alguna pregunta? Buenas Tardes a todos. ©2007 Instituto de Investigaciones Interdisciplinarias