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

Acosta, María Paula Jassir; Charry, María Paula Cárdenas; Uribe-Restrepo, José Miguel; Cepeda, M. Soledad; Cubillos, Leonardo; Bartels, Sophie M.; Castro, Sergio M. Alcocer Martínez De; Marsch, Lisa A.; Gómez‐Restrepo, Carlos

doi:10.1016/j.rcpeng.2021.06.009

Cited by 6 publications

(17 citation statements)

References 16 publications

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“…Finally, it is important to consider the possible impact of factors that may influence treatment-seeking behavior for mood and psychotic disorders but for which relevant data are currently unavailable and may be difficult to obtain on a sufficiently large scale to permit their use in detailed geospatial analyses. For example, several studies have suggested that stigma and the fear of discrimination may be important barriers to utilization of mental healthcare, in Colombia, but have focused on outpatient treatment 63 , excluded individuals living with psychotic disorders 17 or were based on qualitative analyses of very small samples 64 .…”

Section: Discussionmentioning

confidence: 99%

Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders

Song,

Ramírez,

Okano

et al. 2024

Commun Med

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Background Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas. Methods We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters. Results We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients. Conclusions Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.

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Section: Discussionmentioning

confidence: 99%

Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders

Song,

Ramírez,

Okano

et al. 2024

Commun Med

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“…82 Many rapid studies seeking to understand barriers to healthcare access make use of deductive templates or matrices to chart data or use 'one sheet of paper' techniques to aid rapid analysis and presentation of findings. [82][83][84][85][86] Miles and Huberman have argued that data reduction, display, and the drawing of conclusions happens simultaneously in qualitative analysis (p10), 87 and that the use of matrices can drive credibility and trustworthiness. 88 Whilst the use of a priori codes and/or themes to populate a framework template may save time at the analysis stage and potentially reduce the skill requirement, the burden of work is shifted to an earlier stage of the project rather than eliminated.…”

Section: Figure 3: Overview Of the Sequential Mixed-methods Approachmentioning

confidence: 99%

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Allen,

Karanja,

Gichangi

et al. 2024

Preprint

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Introduction Evidence suggests that certain groups face substantial barriers to accessing eye care services. This study seeks to explore barriers and potential solutions as perceived by members of the population groups who are least able to access care in the context of four national eye screening programmes. We aim to use rapid yet robust mixed methods that allow us to identify generalisable findings and testable service modifications to improve equitable access to care. Methods and analysis This is a multi-phased exploratory sequential mixed methods study. First, we will conduct interviews with people purposively selected from the sociodemographic subgroups with the lowest odds of accessing care within each screening programme. Taking a phenomenological approach, we will explore their perceptions of barriers and potential service modifications that could boost attendance at eye clinics among people from these "left behind" groups. We will use a deductive analytic matrix to facilitate the rapid analysis of qualitative data. Space will be made for the inductive identification of themes that are not necessarily captured in the framework. Sample size will be determined by thematic saturation. Next we will conduct a survey with a representative sample of non-attenders from the same left behind groups, asking them to rank each suggested service modification by likely impact. Finally, we will convene a multistakeholder workshop to asses each service modification based on ranking, likely impact, feasibility, cost, and potential risks. The most promising service modifications will be implemented and evaluated in a follow-on randomised controlled trial, the methods for which will be reported elsewhere. Ethics and dissemination This project has been approved by independent research ethics committees in Botswana, Kenya, India, Nepal and the UK. We will disseminate our findings through local community advisory boards, national eye screening meetings, in peer-reviewed journals, and at conferences.

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“…A single study 41 that stated it took a length of <14 days to complete was also included (totalling 44 studies; Figure 1). Across the 44 included studies, 41-84 30 countries were represented, with 19 studies (43%) based in high-income countries 41,48,52,53,55,56,63,[65][66][67]70,71,73,74,76,79,81,82,84 and the remaining 57% based in lowand middle-income countries (LMICs). [42][43][44][45][46][47][49][50][51]54,[57][58][59][60][61][62]64,68,69,72,75,77,78,80,83 Overall, 12 studies came from the US; 41,48,52,56,[65...…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nearly three-quarters of studies (73%) had been published since 2010 (Figure 3). [41][42][43][44][46][47][48][49][50][51][52][53][56][57][58][59][60][61][62][63][64][65]67,68,71,[73][74][75][76][77][78]80 All studies were published in English.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…51,58,59,68,72,78,79,83 Many more RAAB surveys were screened but excluded because they did not report barriers or stated that they took >14 days to complete. The next most commonly assessed service was HIV (11% of all included studies), 49,63,73,77,82 followed by developmental disabilities (9%) [54][55][56]60 ; immunisation (9%); 46,52,62,80 diabetes (9%); [43][44][45]84 access to medicines (5%); 45,47 cancer screening (5%); 41,81 substance misuse (5%); 71,74 mental health (5%); 53,66 public health intervention (5%); 54,69 reproduction (5%); 50,65 and single studies assessing community needs and barriers related to access in the areas of hypercholesterolemia care, stem cell transplant, malaria, pain management, psychosocial needs, and tuberculosis (Figure 4). 42,48,57,64,67,70,76 Eliciting barriers to access and/or solutions was the sole focus of ...…”

Section: Servicesmentioning

confidence: 99%

See 1 more Smart Citation

Rapid Methods for Identifying Barriers and Solutions to Improve Access to Community Health Services: A Scoping Review

Allen

Azab

Jonga³

et al. 2023

SSRN Journal

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

Cited by 6 publications

References 16 publications

Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders

Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

Rapid Methods for Identifying Barriers and Solutions to Improve Access to Community Health Services: A Scoping Review

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