RESUMO
There are multiple challenges in adhering to the principles of community-based participatory research (CBPR), especially when there is a wide range of academic preparation within the research team. This is particularly evident in the analysis phase of qualitative research. We describe the process of conducting qualitative analysis of data on community perceptions of public maternity care in the Dominican Republic, in a cross-cultural, CBPR study. Analysis advanced through a process of experiential and conversational learning. Community involvement in analysis provided lay researchers an imperative for improvements in maternity care, nurses a new perspective about humanized care, and academic researchers a deeper understanding of how to create the conditions to enable conversational learning.
Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Agentes Comunitários de Saúde/psicologia , Pesquisa Participativa Baseada na Comunidade/organização & administração , República Dominicana , Estudos de Avaliação como Assunto , Feminino , Humanos , Comunicação Interdisciplinar , Enfermagem Materno-Infantil/métodos , Gravidez , UniversidadesRESUMO
OBJECTIVE: to understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality. DESIGN: qualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change. SETTING: four urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital. PARTICIPANTS: adolescent women (15-20 years of age), adult women (21-49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team. MEASUREMENTS AND FINDINGS: following informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was 'no me hace caso', or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of 'cuña' emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services. KEY CONCLUSIONS AND IMPLICATIONS: this study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal-newborn health services.
Assuntos
Atitude Frente a Saúde/etnologia , Pesquisa Participativa Baseada na Comunidade , Características Culturais , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Centros de Saúde Materno-Infantil/organização & administração , Adolescente , Adulto , República Dominicana , Feminino , Humanos , Recém-Nascido , Masculino , Tocologia/organização & administração , Gravidez , Relações Profissional-Paciente , Percepção Social , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
A comparative study of the mean lead concentrations in enamel and dentin of human premolars and permanent molars was conducted by means of a systematic sampling procedure with energy-dispersive x-ray fluorescence analysis. In a first series of analyses, no significant statistical differences in mean lead concentrations at various levels of enamel and dentin were noted between young patients of Strasbourg and those of small villages of Alsace, nor between elderly patients living in these two locations, despite the fact that motor traffic was significantly lower in the rural zones. However, in both locations, a significantly higher concentration of lead was observed in enamel and dentin in relation to age. In a second series of analyses, the mean lead concentrations of both dental hard tissues of premolars and permanent molars of young individuals from Strasbourg, rural Alsace, and Mexico City were compared. Significantly higher mean lead concentrations were found in enamel and dentin samples from Mexico City. This was most evident for inner coronal dentin (5.7 and 6.1 times greater than in teeth of Strasbourg and rural zones of Alsace, respectively) and for pulpal root dentin (6.9 and 8.9 times greater than in teeth of Strasbourg and rural zones of Alsace). It is proposed that the higher lead concentrations are related to the higher lead content of motor gasoline and to more intense traffic conditions. The dental hard tissues appear to be of value for the study of environmental lead pollution.