Cuaderno 3. Escuela de Verano: Salud en Comunidad 2007. Perspectives Concerning Prevention of Health Problems

7/29/2019 Cuaderno 3. Escuela de Verano: Salud en Comunidad 2007. Perspectives Concerning Prevention of Health Proble

1/39

CUADERNOS DE INVESTIGACIN

Escuela de Verano: Salud en Comunidad 200

INSTITUTO DE INVESTIGACIONES INTERDISCIPLINARIAS

UNIVERSIDAD DE PUERTO RICO EN CAYEY

Cuaderno 3

Ao 2008

Shirley Bejarano

Glaymar Domngue

Sarah Lince

David Nachi

Abbey Wells

Perspectives concerning prevention

of health problems


2/39

En la serie Cuadernos de Investigacin del Instituto de InvestigacionesInterdisciplinarias de la Universidad de Puerto Rico en Cayey se presentarnresultados parciales y preliminares de algunas de las investigacionesauspiciadas por el Instituto, versiones preliminares de artculos, informestcnicos emitidos por nuestras(os) investigadoras(es) as como versiones finales

de publicaciones que, por su naturaleza, sean de difcil publicacin por otrosmedios.

Los(as) autores(as) son responsables por el contenido y retienen los derechosde publicacin sobre el material contenido en estos Cuadernos.

Copias de los Cuadernos se pueden obtener solicitndolos por telfono, porcorreo regular o por correo electrnico al Instituto. Tambin se pueden descargarde nuestra pgina electrnica en formato pdf.

Instituto de Investigaciones InterdisciplinariasUniversidad de Puerto Rico en Cayey205 Ave. Antonio R. BarcelCayey, PR 00736

Tel. 787-738-2161, exts. 2615, 2616Fax 787-263-1625Correo electrnico: [email protected] web: http://webs.oss.cayey.upr.edu/iii/

Diseo de Portada: Prof. Harry HernndezEncargado de la serie de cuadernos: Dr. Errol L. Montes PizarroDirectora del Instituto: Dra. Isar P. GodreauDirectora Auxiliar: Sra. Vionex M. Marti

Instituto de Investigaciones InterdisciplinariasUniversidad de Puerto Rico en Cayey


3/39

Perspectives Concerning Prevention of Health Problems

Shirley Bejarano1, Glaymar Domnguez

2, Sarah Lince

3, David Nachi

4, Abbey Wells

5

1

Department of Anthropology and Pre-Medicine Program, University of South Florida2 Department of Biology, University of Puerto Rico-Cayey3 Department of Anthropology, Frances Perkins Scholar at Mount Holyoke College

4 Department of Biology, University of Puerto Rico-Cayey5 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 aswell as the hospitals 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 andspecific 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 specificallydescribes 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 toallow the hospital to interpret it and use it for developing current and future prevention

efforts.

________________________________________________________________________

INTRODUCTION

Our research was conducted in thesecond year of a five year field schoolproject named Health in Community

Salud en Comunidad. It builds onresearch conducted by students of thefirst year of this field school (2006).

Results from the previous years work

with the Hospital de Area en Cayey

identified prevention of health issues as

a topic for future research. The hospitalthen took up this topic as a focus of their

collaborative work with us in this yearscommunity-based research (2007).

This research project was

designed to provide the hospital with

information for developing preventionefforts. This project includes the

collected opinions of the clients of the

hospital personnel regarding the existing


4/39

2

and possibilities for future prevention

efforts. We gathered information aboutparticipants ideas about current and

future strategies and specific health

conditions for prevention efforts

strategies for implementing preventionefforts.

During our research we noticed different

ways that participants were talking aboutprevention as well as factors related to

maintaining health. We saw several

prevention discourses emerge based onindividual, socio-economic, andenvironmental factors effectingunderstandings of health and prevention.Our analysis of these discourses has

been informed by contrasting tendenciesin health promotion and prevention

discourse to concentrate on individualfactors 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 inindividual, socio-economic, andenvironmental terms is similar to thoseof 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 al2000: 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 peopleare rational, aware, self-creating agents

of their own health (ibid: 319). The

biopsychosocial model is based on theidea that the social, economic,

community, environmental context are

relevant to assessing health problems

and determining the efficacy of health

promotion/prevention efforts. It suggestschanging 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. Sachsidentifies another discourse based on

acknowledging socio-economic, cultural

context of health issues, what she callscausal relationships (ibid:632). She

identifies that differences in care andresponses to health issues are rooted in

different levels of [locating] the causeof 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 indeveloping instruments and interview

guides, as well as for identifying healthconditions and strategies for prevention

efforts from our data. Results from the

food security questionnaire were alsoanalyzed in a way that highlighted the

intertwined relationships between the

micro, individual factors, and the macro,

socio-economic and environmentalfactors, effecting health.

METHODS

The methods we used include:

preliminary interviews, fieldwork,

survey development, data collection, anddata analysis.

Through preliminary interviews

and lectures, we developed anunderstanding of our research topic and

community based research. Therefore,


5/39

3

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 usto familiarize ourselves and understand

the hospital area.

After gaining moreunderstanding of the hospital, we

developed surveys to conduct with the

hospital personnel and the clients of thehospital. We created two surveys for the

clients of the hospital. One for the clients

in waiting in the emergency room andone for the residents of the community

of Las Vegas that attended the healthclinic held in el Barrio Las Vegas. We

also created survey/interviews for thehospital personnel to understand their

points of view on the subject.

Also, we used the USAID andThe Food and Nutrition Technical

Assistance Projects, Food Security

Survey. This survey has beenconstructed to be used in the United

States and validated for useinternationally. This survey provides the

level of food security for a person by

grouping these participants in fourcategories: Food Secure, Mildly Food

Insecure, Moderately Food Insecure, and

Severely Food Insecure.

We collected the data from arange of participants during three

hospital visits and the health clinic. At

the hospital we collected twenty-sixquestionnaires 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 datausing 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 qualitativedata.

RESULTS

After collecting our data, we

organized it and received a plethora of

results. First we organized the sampleinto two groups: the Health Clinic and

the Hospital. This division helped to

determine what kind of sample we werelooking at, allowing us to evaluate the

questionnaire responses according togroup. This data included information

about gender- fifty-one females andtwenty males in total of the clients

questionnaires; age, medical insurance,

education level (for completedemographic information used: see

appendix 1). After organizing that data

we entered the quantitative data into adate base using SPSS Statistical Package

for Social Sciences. By doing this, wewere then able to compare the

demographic information to the

quantitative information given to usthrough our questionnaires. When

looking at our data, we realized that the

information could be broken down into

three categories of results: healthconditions that were mentioned, the

manner in which they receive or would

like to receive information, and finallythe 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 inquiredabout: a) what kind of health issues do

the participants see most often, b) what

kind of health issues do the participants


6/39

4

have, and c) what kind of health topicsissues do the participants see materialabout prevention programming. We

received a wide range of answers from

both the hospital personnel and the

hospitalclients. The top answers for thehospital personnel were gastroenteritis,

asthma, and cardiovascular issues-

mainly hypertension. One of thehospital 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 treatedfor gastroenteritis that same day. The

hospital personnel also mentionedseveral current prevention efforts that

there are already prevention efforts fordiabetes, depression, osteoporosis, and

cardiovascular health issues. One of the

hospital personnel emphasized the needfor prevention efforts surrounding

sexual education. They explained that

the hospital offers services such as a freetesting clinic on Tuesday afternoons,

where the hospital will test for sexuallytransmitted diseases including HIV, for

free. The hospital personnel also

specified different topics of health inwhich they provided information to their

patients about. These topics included

practicing good hygiene, regular

exercise, good diet and nutrition, usingdental services, and using optometry

services.

The clients from the emergencywaiting room and the health clinic

replied to these questions with similar

answers to those of the hospitalpersonnel. The top three responses that

we received from the clients at the health

fair consisted of asthma, cardiovascularissues- 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 areeither 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 theyhad any ideas for future strategies. The

hospital personnel answered this

question indicating that the efforts thatthe hospital has now are good, but they

want more. After a question regarding

their feelings on the current hospitalhealth prevention efforts, one hospital

personnel answered Excelente muybien (Excellentvery good), they then

specified that they believe that strategiesfor example, Charlas or talks, were

good already, receiving between sixty

and seventy participants, but that theywould 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 hospitalpersonnel to the patients, prevention

classes in schools, free blood pressure

tests, the STD testing clinic, recreationand 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. Theresponses that we received can be

summarized in the following: Oh, I

guess more talks, this quote suggeststhat not many of the responses were

suggestive of future different strategies.

They indicated that they attended thehealth clinics, talks, and read health

literature. The clients emphasized that

they enjoyed more interactive activities


7/39

5

when considering health prevention

strategies. Some also made a point thatthey did not find the pamphlets

regarding different health conditions

were helpful or effective. The main ideas

for how to get more people to participatein 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 thehospital).

Socio-economic factorsOne of the main problems noticed on

different interviews and questionnaireswith personnel from the hospital, was

that they identified various socio-economics factors as why they didnt

practice health problems prevention.

Socio-economics factors are consideredto be factors involving both social and

economic factors which can affect your

whole life in general. The mostimportant socio-economic factors they

identified were lack of orientation oreducation, 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 justloose interest in the matter and then

dont get motivated to take care of

themselves. Sexual taboo, presents animportant cultural problem because it

affects the education which people

receive concerning pregnancies andsexually transmitted diseases. It is the

problem behind unwanted pregnancies in

adolescents and people getting sexuallytransmitted 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 havethe best interest in practicing prevention

but needs to have at his disposition

health services or the resources to beable to afford or receive those services.

Lack of funds, present a problem to the

hospital and to the personnel becausethey 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 todevelop 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 problemprevention services or programs,

eventually it will finish expending more

money on health problem. One of themain problems also is that Puerto Ricos

public health plan, called La Reforma,presents a problem to peoples health

because they make it very difficult for

people to get their routine tests. Anotherquote concerning this problem is They

have to changeLa Reforma, there are toomuch obstacles.

The Cayey Hospital has health problemsprevention initiatives, but not

implemented programs. They do STD

(Sexually transmitted diseases) freeclinics on Tuesdays, where they make

free tests to clients. They offer chats on

different health topics and they have anurse which specializes on family

planning. One of the aspects that were

indicated was that the hospital is in needof a prevention activities infrastructure,

which includes prepared personnel in

different health topics, facilities, and


8/39

6

good advertisement, to interest people

and at the same time diminishes healthproblems which can be prevented.

Other socio-economic factors were

identified by clients of the hospital.

When clients were asked why theythought that other people did not practice

prevention measures, they answered that

it was because of individual factors likelack of interest, ignorance and behavior.

But, when we asked people why they

didnt practice prevention it turned outthat it was because of socioeconomic

factors like transportation, lack of money

for medicines and food, and lack ofhealth insurance. Transportation

presented a problem because forexample, a person who has to go to the

hospital for a certain treatment at acertain day or time will not have the

transportation to get there so the person

will not receive the treatment. Lack offood and medicines presents a problem

for example for people with diabetes

because they need to eat well and getinsulin daily to keep it from turning

worst. Lack of health insurance is also abig obstacle for people because a person

who does not have health insurance has

to pay for all the services and themedicines and sometimes people cannot

afford it so they dont get their medical

services like they should. All this

problems are individual factors, all resultof socio-economic factors.

Environmental FactorsIn interviews and surveys done to the

hospital personnel we noticed that

environmental conditions were crucial tothe most common health problems in the

Hospital. In the hospital there are a

great number of cases in chronic asthmaand 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

Cayeys climate affect peoples health.One of the most common problems in

the emergency room is one that concerns

the quality of water and foods. Theemergency room receives numerous

cases of gastrointestinal problems like,

gastritis and gastroenteritis. These casesare commonly seen in people of all ages

but very rare in infants, because of the

type of water they consume which isdistilled. Security or quality of food and

water are determinant factors forgastrointestinal 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 casesof diarrhea and vomiting in the

emergency room.

CONCLUSION

During the analyzing process ofthe data we found a very interesting

pattern that was seen through out the

responses of the questionnaires and theinterviews. This trend was based on howthe people were being affected by

various factors that impeded them to

practice prevention for health. We thencategorized 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 ofCayey and to the administration of the

Hospital de Area, and another to theresidence of Las Vegas. First, we wereable give an insight on the perspectives

of prevention and what it meant to the

residence that participated in the health


9/39

7

fair, clients and personnel of the

hospital, on the their definition ofprevention. We were then able to bringto the attention of the hospital and the

municipality personnel the main health

conditions that were most frequentlymentioned which the residence and

clients of the hospital suffer from.

During our presentation we were able tothe municipality and the Hospital deAreapersonnel about our investigation.

FUTURE INVESTIGATIONS

The results of our inquiry have led us to

identify various aspects that could befurther studied.

Our research provided to theHospital derea with preliminary baselineinformation that could possibly assist thepersonnel of the hospital to take the first

step in constructing an efficient program

that will teach their patients and otherpeople of the community about health

prevention. Our results suggested that a

possible next step to discover themissing existing pieces to this

investigation is to further study theeffectiveness of the current health

prevention strategies and programs

efforts. Another recommendation thatcan 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 preventionefforts.

In addition, we factors that further

investigations can possibly facilitate thecommunity 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 offoods? Or were they referring to not

being able to have access to essential

nutritional foods? These are the

questions that should be asked in afuture investigation of Las Vegas where

the focus would be on nutrition. This

would help to explain the accumulativenumber of the 50 + % of the sample of

people that expressed food insecurity.

In addition, to the food insecurityquestionnaire, another factor from our

results that stood out from our research

was the fact that several of the hospitalclientele and residence that participated

in the health fair mentioned that a mainproblem 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 ofPuerto Rico at Cayey and the University

of South Florida at Tampa for hostingthe summer programEscuela de Verano:Salud En Comunidad. We would alsolike to thank the Institute ofInterdisciplinary Research at UPR

Cayey; especially our program director

Dr. Jannette Gavilln-Surez. Also, to

the staff at the Hospital de Area enCayey, the clients of the hospital, and

residents of Las Vegas; Thank you so

much for your cooperation andparticipation, without you our research

would not have been possible. In

addition, we would like to recognize theNational Institutes of Health (NIH-RIMI

Grant #1-P2MD001112-0), and the

American Folklife Center from theLibrary of Congress for their support of

our project.


10/39

8

Thank you to our mentors, Federico

Cintrn-Moscoso and Orqudea 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 Alemn, Jos 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 threedifferent universities studying at the

Institute of Interdisciplinary Research,

University of Puerto Rico at Cayey. Thisis a one month internship program part

of a five year project sponsored by theNational Institutes of Health, in which

students and faculty participate inresearch concerning community health

within the municipality of Cayey, Puerto

Rico.

Shirley Bejarano is entering hersenior year at University South Florida-

Tampa; she is Pre-Med andAnthropology. Spanish proficiency:

native speaker. Glaymar Dominguez is enteringher senior year at the University ofPuerto Rico-Cayey and is studying

Biology. Spanish proficiency: native

speaker.

Sarah Lince is a Frances PerkinsScholar at Mount Holyoke College, also

studying Anthropology. Spanish

proficiency: intermediate.

David Nachi is entering his fifthyear at the University of Puerto Rico-Cayey, majoring in biology. Spanish

proficiency: native speaker.

Abbey Wells is entering her thirdyear at Mount Holyoke College. She isstudying Anthropology and Film

Studies, and this is her first research

experience. Spanish proficiency:

intermediate.

REFERENCES

Chin, Nancy, P., Monroe, Alicia;Fiscella, Kevin. 2000. 2000Implicationsfor Institutions/Policy Issues: SocialDeterminants of (Un)HealthyBehaviors. Education for Health Vol.13, No. 3:317-328.

Sachs, Lisbeth, 1996 Causality,Responsibility and Blame Core Issuesin the Cultural Construction and Subtextof Prevention. Sociology of Health and

Illness Vol. 18, No. 5:632-652.

Porter, Dorothy 2006How Did SocialMedicine Evolve, and Where Is ItHeading? PLOS Medicine Vol. 3, No.10, October: 1667-1672.

WORKS CONSIDERED

Center for Disease Control website:

2007 [2005] Chronic Disease PreventionElectronic Document,

http://www.cdc.gov/nccdphp/overview.h

tm, accessed June 20, 2007.

Castro, Arachu; Farmer, Paul 2005

Understanding and Addressing AIDS-related Stigma: From AnthropologicalTheory 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. 1999An Ounce ofPreventionWhat Are the Returns?American Journal of PreventiveMedicine Vol. 16, No. 3: 248-262.
http://www.cdc.gov/nccdphp/overview.htmhttp://www.cdc.gov/nccdphp/overview.htmhttp://www.cdc.gov/nccdphp/overview.htmhttp://www.cdc.gov/nccdphp/overview.htm


11/39

9

Nizeye, Bruce; Stulac, Sara; Kashavjee,

Salmaan 2006 Structural Violence andClinical Medicine. PLOS Medicine Vol.3, No. 10, October: 1686-1691.

Rylko-Bauer, Barbara; Farmer, Paul2002 Managed Care or ManagedInequility? A Call for Critiques ofMarket-Based Medicine. MedicalAnthropology Quarterly Vol. 16, No. 4:

47.

Tables and Figures

Demographics

Health Clinic- ClientsSEX 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 InsurancePrivate 12

Public 26

None 1

Hospital- ClientsSEX N=26

Male 4

Female 22

AGE N=26

Less than 25yrs 525-64 yrs 17

Greater than or equal to 65 3

Highest Education level

Elementary 4

Intermediate 2

High School 8

Bachelor/Graduate 9


12/39

10

29.5%

22.7%

18.2%

11.4%

9.1%

4.5% 4.5%

Visit the doctor

regularly

Visit the hospital

in case of

complications

Nutrition Others Take

homemade

remedies

Exercises

routines

Other

institutions

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).


13/39

11

11

10

12

4 4

6

5

Lackofinterest

Serviceprov

idersofficehours

Lackoftim

e

Transportation

Lackofmoneyforf

ood

Lackofmone

yformedications

Medicalinsurancepo

licy

Relative Frequencies of Behavioral, Individual, and Socioeconomical Barriers for Prevention in Cayeys 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.


14/39

12

18

11

15

20

8

13

Del mdico De la familia Peridicos 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 CayeyMunicipality Hospital patients obtain their health care information.


15/39

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.


16/39

14

8 8

4

3

2 2

0

Noresponse

Others:

Vacc

ines,

Infec

tions,

Rou

tinary

exams,

Psyc

hiatrist

Resp

ira

tory

/As

thma

Emergenc

ies

Card

iovascu

lar

pro

blems

Me

dica

tions

Gas

tro

intes

tina

l

pro

blems

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.


17/39

Perspectivade la prevenproblemas d

Shirley Bejarano, Glaymar Do

Sarah Lince, David NacAbbey Wells

2007 III


18/39

Estudiantes de UPR-C, USFHolyoke College

Curso de veranoSalud en Comunidad

Ofrecido por el Instituto deInvestigaciones Interdisciplin

Quines Somos?


19/39

Explorar las perspectivas acerca dprevencin de problemas de salud

Los clientes del hospital

Personal del hospital

Residentes de Las Vegas

Objetivos


20/39

Trabajo de campo

Entrevistas

Desarrollo de cuestionarios pclientes Clnica de salud

Hospital de rea de Cayey Cuestionario de Inseguridad A

Metodologa


21/39

En el Hospital de rea26 cuestionarios a clientes

5 entrevistas con el personal

En la Clnica de Salud

40 cuestionarios a participantes Inseguridad Alimenticia

Muestra


22/39

Clnica de SaludN=40 Sexo

Masculino = 14

Femenino = 26

Edad

< 25 = 3

25 64 = 30

> 65 = 5

Seguro Mdico

Privado = 12

Pblico = 26

No tiene = 1

En el Hos Sexo

Masculin

Femenin

Edad

< 25

25 - 64

> 65

Nivel de

Elementa

Intermed

Superior

Bachill. &

Datos Demogrfico


23/39

RESULTADOS

Personal delHospital:1. Gastroenteritis

2. Asma

3. Cardiovascular

(hipertensin)

Clnica

1. Asma

2. Cardi(hiper

3. Diabe

Condiciones Menciona


24/39

RESULTADOS

Estrategias actuales:

Ferias de salud/ charlas

Unidad clnica mvil

Planificacin Familiar

Sugerencias para Clientes

Estrategias p Personal de

en educaci

Propuesta dpreventiva e

Programas deportes papreventiva

Estrategiasde Prevenc

Personal del Hospita


25/39

Televisin

Participacin activa

Educacin en las escuelas y encomunidades

Estrategias de Preven

Perspectivas de los clie


26/39

Factores individuale

Perspectiva de los clientes ydel hospital

Por qu usted cree que las pe

utilizan la informacin provista prevencin de problemas de sa

Falta de inters

DesconocimientoComportamiento

RESULTADOS:


27/39

Factores Socio-econm

Perspectiva personal del

Acceso a recursos y servicios d

Falta de Orientacin y Educaci Tab

Fondos

RESULTADOS:


28/39

Factores Socio-econm

Perspectiva de clien

Cul de los siguientes le impidecabo actividades de prevencin?

TransportacinFalta de dinero para comidaFalta de dinero para medicinaFalta de cubierta de salud

RESULTADOS:


29/39

Inseguridad AlimenticiaLas Vegas

INSEGU

ALIMENSEVE

26%

INSEGURIDAD

ALIMENTICIA

MODERADA

13%IN

AL

52 % Inseguridad alimenticia

- 3 factores inseguridadsevera:

Quedarse sin comer unda o ms

Irse a la cama conhambre

Quedarse sin comida

RESULTADOS:

N =


30/39

Factores ambientale

Perspectiva personal de h

Cayey- gran incidencia de prorespiratoriosFbrica de cigarros

Calidad del aire

Problemas gastrointestinalesCalidad del agua

Calidad y manejo de los aliment

RESULTADOS:


31/39

Resumen

Asma

Enfermedades cardiovasculare

Gastroenteritis

Perspectivas personal del h

clientesCondiciones Similare


32/39

Estudiar la efectividad de los pde prevencin actuales

Entender la relacin entre los faidentificados (individual, socio-

y ambiental) para mejorar la efelos esfuerzos para prevencin

Futuras Investigacion


33/39

Agradecimientos

Instituto de Investigaciones Interdis

Universidad de Puerto Rico - Cayey

Universidad del Sur de la Florida

American Folklife Center NIH - National Institutes of Health

Hospital de rea de Cayey

Comunidad del Barrio Las Vegas Municipio de Cayey


34/39

Gracias por su aten

Alguna pregunta?


35/39

Texto Presentacin Oral Perspectivas acerca de la prevencin de problemas de salud

Quines somos?Nosotros somos estudiantes de la Universidad de Puerto Rico en Cayey, la Universidaddel Sur de la Florida, y Mount Holyoke. Nuestra investigacin es parte del curso de

verano, Salud en Comunidad, ofrecido por el Instituto de InvestigacionesInterdisciplinarias en la UPR-Cayey.

ObjetivosCules son las perspectivas acerca de prevencin de asuntos de salud de los

clientes del hospital, los clientes en el barrio Las Vegas que participaron en la feria desalud y el personal del hospital?

Presentar la informacin al Hospital de rea y a la comunidad del Barrio LasVegas

[Segn la ONU (Organizacin de Naciones Unidas) prevencin es la adopcin de

medidas encaminadas a impedir que se produzcan deficiencias fsicas, mentales ysensoriales o a impedir que las deficiencias, cuando se han producido, tenganconsecuencias fsicas, psicolgicas y sociales negativas.]

ProcedimientoEn esta seccin, les explicaremos las diferentes partes de nuestro procedimiento,

de las cuales recopilamos informacin para la investigacin.Primero, hicimos trabajo de campo basado en observaciones, y un mapa de los

alrededores del hospital. Esto nos permiti familiarizarnos con el rea y medio ambientedel hospital.

Segundo, utilizamos entrevistas con el personal del hospital para enfocar lainvestigacin y as entender nuestro tema.

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

Adems, usamos el cuestionario de Inseguridad Alimenticia en la Feria deSalud con los clientes de Las Vegas. Este es un cuestionario que fue desarrollado porUSAID y el Proyecto de asistencia tcnica sobre comida y nutricin y es utilizado enlos Estados Unidos y vlido a nivel internacional.

Finalmente, analizamos los datos y los estamos presentando a ustedes.

DemogrficosNosotros usamos datos que recopilamos en la Feria de Salud y en el Hospital de

rea.En el Hospital, recopilamos:

25 cuestionarios de los clientes5 entrevistas de personales del hospital

En la Feria de Salud, recopilamos:40 cuestionarios de los clientes40 cuestionarios de Inseguridad Alimenticia


36/39

Fuera de estos datos:XX fueron mujeres, y XX fueron hombresLas edades estn en un intervalo de XX a XX

MtodosNosotros usamos

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

mapping, familiarizarnos con el rea 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 rea.Desarrollamos cuestionarios para los profesionales de salud en el hospital.

4. Despus, nosotros Recolectamos los datosa. En la Feria de Salud hicimos

i.

40 Cuestionarios/Entrevistas con las personas en la Feria de Saludb. En el Hospital hicimosi. 25 Cuestionarios/Entrevistas con las pacientes en la Sala de

Emergenciaii. 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 estadstico

SPSSii. las Frecuencias

iii.

y las GrficasResultados

Ahora le vamos a hablar de lo descubierto despus de analizar toda la informacincuidadosamente. Los factores identificados para prevencin o cmo las personas seexpresan sobre como prevenir problemas de salud los dividimos en factores individuales,estructurales y ambientales. Tambin les hablaremos sobre las maneras ms efectivas deacuerdo a los pacientes entrevistados, para llevarles el mensaje de prevencin deproblemas de salud. Por ltimo, veremos los temas ms significativos de prevencin.

Perspectiva de los profesionales de la salud - Factores individuales

Esta cita, explica uno de los grandes problemas ante la prevencin. Mencionadapor varios profesionales de la salud los pacientes no se motivan a practicarprevencin.

La educacin lo es todo es otra cita la cual demuestra el problema quepresenta no orientarse en varios aspectos de la salud.


37/39

Otro problema es la higiene lo cual significa que varios de los problemasocurridos son por falta de limpieza, calidad o contaminacin de agua y comida.

There is a tendency to approach prevention in public health by focusing on individualpatient factors/issues. Sometimes health issues are also connected to socio-economic

factors. We noticed that participants in our research both clients and hospital personneltalked about prevention from both perspectives in different ways

Perspectiva de los clientes - Observamos en al grafica porque las personas no practicanmedidas de prevencin.

Perspectiva de los profesionales de la salud Factores Estructurales

Educacin: Falta de orientacin o informacin lleva a falta de inters y por lotanto de motivacin (Como se puede apreciar en la grafica mostrada en el slideanterior).

Condiciones socio-econmicas de los clientes del hospital afectan la calidad decomida, agua o vida en general. Logrando que la poblacin sea mas susceptible aenfermedades.

Problemas culturales como el taboo al tema del sexo por lo cual ocurren tantosembarazos no deseados en adolescentes. Tambin orientar en el tema deenfermedades venreas para evitar contagios por falta de orientacin. Tambin senecesita mas educacin sexual en las escuelas que es donde ms se ven losproblemas mencionados.

Para hablar de los factores polticos voy a citar a una persona que dijo Tienenque cambiar la reforma de salud /Hay muchos obstculos porque presentaun 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

prevencin, a la larga terminaran gastando mas en problemas de salud.Porque presenta un posible problema si no se hacen programas efectivos paraprevenir enfermedades.

Hace falta una infraestructura de actividades de prevencin, con personaspreparadas en varios temas, facilidades y buena propaganda para llevar a cabo elpropsito de disminuir problemas de salud que son prevenibles.

El hospital tiene iniciativas, pero no programas implantados, como las clnicas deenfermedades venreas todos los martes en las que hacen pruebas gratis aunqueno muchos asisten, las charlas a las que asiste un gran numero de personas y una

enfermera que se ocupa de planificacin familiar de jvenes embarazadas.

Perspectiva de los clientes Factores Estructurales

Primero les explico esta grfica la cual demuestra cules son los obstculos mscomunes por lo cual los pacientes no practican prevencin. (CHART)


38/39

Uno de los pacientes mencion Uso el hospital Menonita porque no hacenfalta tantos requisitos como en el Hospital de rea

Entre los problemas ambientales identificados por los profesionales de la salud del

hospital - Factores ambientales

Podemos ver el problema de asma crnica y las causas de problemas respiratoriosasociados con: ;a fbrica de tabacos y la calidad del aire. Se han visto varioscasos de trabajadores jvenes de la fbrica con problemas respiratorios. Tambin,la calidad del aire en Cayey dado a los polvos de volcanes/desiertos que llegan aP.R. y las fluctuaciones del tiempo.

Tambin, vemos que hay problemas gastrointestinales muy comunes por lacalidad del agua y la seguridad o calidad alimenticia. Estos fueron identificadoscomo graves factores por los altos casos de vmitos y diarreas en la Sala deEmergencia.

Para hablar de los factores polticos voy a citar a una persona que dijo Tienenque cambiar la reforma de salud /Hay muchos obstculos porque presentaun problema para la salud ya que las personas no se hacen estudios rutinarios porlo complicado que se les hace llegar a ellos.

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

Porque presenta un posible problema si no se hacen programas efectivos paraprevenir enfermedades.

Hace falta una infraestructura de actividades de prevencin, con personaspreparadas en varios temas, facilidades y buena propaganda para llevar a cabo el

propsito de disminuir problemas de salud que son prevenibles. El hospital tiene iniciativas, pero no programas implantados, como las clnicas de

enfermedades venreas todos los martes en las que hacen pruebas gratis aunqueno muchos asisten, las charlas a las que asiste un gran numero de personas y unaenfermera que se ocupa de planificacin familiar de jvenes embarazadas.

Inseguridad Alimenticia

Muchos de los clientes y tambin el personal del hospital identificaron enparticular factores socio-econmicos como la alimentacin y la relacin con laprevencin de problemas de salud por ejemplo falta de dinero para comida.

Tambin, mencionaron la nutricin y la buena comida como parte importante paramantener la salud.

En la encuesta sobre seguridad alimenticia se administr un cuetionarrio que sellama: Escala de Seguridad Alimenticia a Nivel del Hogar. Lo administramosen la Clnica de Salud en Las Vegas a 39 personas.


39/39

Segn USAID, la seguridad alimenticia se define : A cualquier persona, acualquier tiempo, tiene acceso fisicamente y econmico a comida suficiente para

satisfacer sus necesidades para una vida productiva y saludable. Los resultadosde este cuestionario muestran una medida de los niveles de inseguridadalimenticia en un rango que va desde tener ansiedad o preocupacin por falta de

comida a no tener comida de suficiente calidad a lo mas severo: no tenerregularmente acceso fisico a comida.

En esta grfica se muestra que poco ms del cincuenta porciento (50%) de losparticipantes mostraban signos de inseguridad alimenticia. Y que el 26% seidentific como inseguro en cuanto a su comida por los 3 factores: que semuestran en la figura.

Temas de Prevencin: Pacientes/Clientes

En esta tabla vemos las condiciones mas frecuentes de salud en los pacientes delHospital

Nos sirve para determinar para que condiciones son ms necesarios los programasde prevencin.

Agradecimientos

Gracias - Muchas gracias por venir a nuestra presentacin. Esperamos que haya sido desu agrado y que les sirva de provecho. Alguna pregunta? Buenas Tardes a todos.

2007 Instituto de Investigaciones Interdisciplinarias

Documents

Cuaderno 3. Escuela de Verano: Salud en Comunidad 2007. Perspectives Concerning Prevention of Health Problems