Carlos Gómez-Restrepo1, Paula Cárdenas2, Arturo Marroquín-Rivera2, Magda Cepeda2, Fernando Suárez-Obando3, José Miguel Uribe-Restrepo4, Sergio Castro2, Leonardo Cubillos5, William C Torrey5, Sophia M Bartels5, Catherine Van Arcken-Martínez6, Sena Park5, Deepak John5, Lisa A Marsch5. 1. Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría, Hospital Universitario San Ignacio, Bogotá, Colombia. Electronic address: cgomez@javeriana.edu.co. 2. Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Bogotá, Colombia. 3. Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia. 4. Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia. 5. Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States. 6. ESE Salud del Tundama, Bocayá, Colombia.
Abstract
INTRODUCTION: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
INTRODUCTION: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
Authors: K S Jacob; P Sharan; I Mirza; M Garrido-Cumbrera; S Seedat; J J Mari; V Sreenivas; Shekhar Saxena Journal: Lancet Date: 2007-09-22 Impact factor: 79.321
Authors: Carlos Gómez-Restrepo; Magda Cepeda; William C Torrey; Fernando Suarez-Obando; José Miguel Uribe-Restrepo; Sena Park; María Paula Jassir Acosta; Pablo Martínez Camblor; Sergio M Castro; Jeny Aguilera-Cruz; Lilian González; Natalia Chaparro; Ana María Gómez-Gamez; Kathleen Bell; Lisa A Marsch Journal: Front Public Health Date: 2022-09-07