RESUMO
INTRODUCTION: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system. METHODS: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data. RESULTS: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines. DISCUSSION: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
Assuntos
Depressão , Atenção Primária à Saúde , Colômbia , Atenção à Saúde , Depressão/diagnóstico , Humanos , Pesquisa QualitativaRESUMO
Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
Assuntos
Alcoolismo , Alcoolismo/diagnóstico , Colômbia/epidemiologia , Grupos Focais , Humanos , Atenção Primária à SaúdeRESUMO
BACKGROUND: The implementation of new technologies in medical research, such as novel big storage systems, has recently gained importance. Electronic data capture is a perfect example as it powerfully facilitates medical research. However, its implementation in resource-limited settings, where basic clinical resources, internet access, and human resources may be reduced might be a problem. METHODS: In this paper we described our approach for building a network architecture for data collection to achieve our objectives using a REDCap® tool in Colombia and provide guidance for data collection in similar settings. CONCLUSIONS: REDCap is a feasible and efficient electronic data capture software to use in similar contexts to Colombia. The software facilitated the whole data management process and is a way to build research capacities in resourced-limited settings.
Assuntos
Pesquisa Biomédica , Saúde Mental , Colômbia , Coleta de Dados , Humanos , SoftwareRESUMO
OBJECTIVE: Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medical information. METHODS: A survey was applied to adult patients who attended primary health care centers systems in 6 Colombian cities. The survey inquired about demographic characteristics, insurance, access to services, cell phone use, internet access, and the use of such technology to access health-related services and information. Data was collected and managed using REDCap. Summary statistics on each survey item were calculated and the differences between discrete variables were analyzed using chi-square. Multivariate analyses were performed using logistic regression analysis for binary dependent variables. RESULTS: A total of 1580 patients were surveyed across the six study sites. 93% of the patients reported they have a cell phone. Patients from urban healthcare centers showed a higher use of the Internet on their phone than less urban settings. Around half of the surveyed patients reported Internet use (49.7%). Among Internet users, 65% of participants use the Internet looking for health care information. Around one-third of patients use cellphones to arrange clinic visits. Around 24% of participants answered positively for both Whooley's questions. Of those who screened positive on the Whooley questions, 43% reported being moderately anxious, 47% reported being very anxious. 51% reported having moderate pain; 52% reported having severe pain. CONCLUSIONS: The patterns of technology use identified in this study are essential for developing future health interventions based on ICT. The design of ICT clinical interventions must take into account the cellphone payment plans, availability of internet connection, advantages, and disadvantages of messenger services, including SMS as a possible alternative to people who do not have smartphones.
Assuntos
Comunicação , Tecnologia da Informação , Colômbia , Humanos , Atenção Primária à Saúde , TecnologiaRESUMO
INTRODUCTION: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour). METHODS: As part of a larger scale-up study, we surveyed 1580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour. RESULTS: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%). CONCLUSIONS: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
Assuntos
Transtornos Mentais , Mídias Sociais , Colômbia , Feminino , Humanos , Saúde Mental , Atenção Primária à SaúdeRESUMO
OBJECTIVE: Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care. METHODS: A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [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)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of 3 months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at 3 months after study initiation. RESULTS: At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than 3 months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (95 % [CI] 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment. CONCLUSIONS: The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
Assuntos
Transtornos Mentais , Atenção Primária à Saúde , Colômbia , Seguimentos , Humanos , PrevalênciaRESUMO
Pre-exposure prophylaxis (PrEP) can reduce HIV transmission among gay and bisexual men (GBM). However, stigma can inhibit disclosure of PrEP use, which may limit uptake. This study's purpose was to explore PrEP disclosure experiences and how disclosure is associated with PrEP adherence among GBM at a sexual health clinic in Guatemala City. We conducted in-depth interviews with PrEP users (n = 18) and used an iterative content analysis approach. All participants had or planned to disclose their PrEP use to at least one person, most commonly friends and sex partners, though many were selective about who they told. Main reasons for disclosure were to educate others, gain social support, and clarify their HIV status. Concerns about stigma and emotional discomfort deterred disclosure. Disclosure facilitated PrEP access and adherence by enhancing emotional and instrumental support. Interventions providing opportunities for GBM to practice disclosure, including addressing others' misconceptions, could promote PrEP uptake and adherence.
RESUMEN: La profilaxis pre-exposición (PrEP) puede reducir la transmisión del VIH entre los hombres gay y bisexuales. Sin embargo, el estigma puede inhibir la divulgación del uso de la PrEP, lo que puede limitar su uso. El propósito de este estudio fue explorar las experiencias de divulgación de PrEP y cómo la divulgación está asociada con la adherencia a la PrEP entre los hombres gay y bisexuales en una clínica de salud sexual en la Ciudad de Guatemala. Realizamos entrevistas en profundidad con usuarios de PrEP (n = 18) y utilizamos un enfoque iterativo de análisis de contenido. Todos los participantes habían divulgado o planificado divulgar su uso de la PrEP a por lo menos una persona, por lo general a amigos y parejas sexuales, aunque muchos indicaron ser selectivos sobre a quién le decían. Las principales razones para la divulgación fueron educar a otros, conseguir apoyo social y aclarar su estado de VIH. Las preocupaciones sobre el estigma y el malestar emocional disuadieron la divulgación. La divulgación facilitó el acceso y la adherencia a la PrEP a través del apoyo emocional e instrumental. Una intervención que proporciona oportunidades para que los hombres gay y bisexuales practiquen las divulgaciones, incluyendo abordar los conceptos erróneos de los demás, podría promover la aceptación y el uso de la PrEP.
Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Revelação , Guatemala , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Comportamento SexualRESUMO
OBJECTIVE: Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article reports data from the first year of implementation of a technology-supported, systematic approach to identify and care for persons with these disorders in primary care in Colombia. METHODS: A care process that includes waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics as a treatment option was implemented in two primary care clinics, one urban and one in a small town. The project collected data on the number of people screened, diagnosed, and engaged in the research and their demographic characteristics. RESULTS: In the first year, 2,656 individuals were screened for depression and unhealthy alcohol use in the two clinics. Primary care doctors increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively. CONCLUSIONS: Early experience with implementing technology-supported screening and decision support for depression and alcohol use disorder into the workflow of busy primary care clinics in Colombia indicates that this care model is feasible and leads to dramatically higher rates of diagnoses of these conditions. Diagnosis in these settings appeared to be easier for depression than for alcohol use disorder.
Assuntos
Alcoolismo/diagnóstico , Técnicas de Apoio para a Decisão , Depressão/diagnóstico , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Alcoolismo/epidemiologia , Colômbia/epidemiologia , Prestação Integrada de Cuidados de Saúde/organização & administração , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Telemedicina/métodos , Adulto JovemRESUMO
Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the evaluation and diagnosis, treatment, and promotion and prevention of mental health disorders, as well as multiple nonmental health applications in the primary care setting. Potential barriers to the use of technology in this setting include challenges of digital literacy, access to technology, confidentiality, and financing. This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.
Assuntos
Alcoolismo , Alcoolismo/epidemiologia , Alcoolismo/terapia , Colômbia , Atenção à Saúde , Depressão/terapia , Humanos , Tecnologia da InformaçãoRESUMO
Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the capacity to provide integrated behavioral care in Colombian settings. Results indicate a minimal to partial integration level across all sites, and that it is possible to measure the degree of integrated care capacity and identify improvement areas for better behavioral health care provision.