Therapeutic itineraries of migrant women with arterial hypertension: views from the health-disease-care process
Abstract
Introduction: Arterial hypertension (AH) is a global risk factor for morbidity and mortality and the main cause of premature death, largely affecting women. The purpose of the study was to understand how migrant women (MW) with AH configure their therapeutic itineraries (TI) in the search for health care in Colombia, from the health-disease-care process.
Methods: Qualitative study with a grounded theory approach. 16 interviews and two focus groups were conducted with MW with AH in Popayán Colombia. Intentional theoretical sampling was carried out until reaching theoretical saturation and the abstraction of emerging categories through open, axial and selective coding.
Results: Open coding generated 1,135 codes. The main emerging category was that TI in AH care are determined by social, cultural, political, and economic dynamics. As related subcategories emerged: the risks of getting sick from AH configure TI; heterogeneity of formal and informal therapeutic resources arises to attend to the disease; there are determinants of access to the health system; and mobilization of various practices for monitoring and control of the disease.
Conclusion: Women in a situation of migration with AH configure TI to achieve health care not only from the state health system, but from various elements of the social, cultural, political and economic order. To this extent, AH goes beyond morbid nominations exclusive to biomedicine and the doctor-patient relationship, to address and transcend towards a condition that requires resolving contingencies of the context.
Downloads
References
GBD 2017 Risk Factor Collaborators. 2018. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392(10159):1923–1994. DOI: https://doi.org/10.1016/S0140-6736(18)32225-6
WHO. Hypertension. 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension.
Lucumí Cuesta DI. Disparities in hypertension in Colombia: a mixed-method study. Ann Arbor: University of Michigan; 2014.
Hernandez-Hernandez Retal. Hypertension in seven Latin American cities: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study. Journal of Hypertension. 2010; 26(1): 24-34). doi: 10.1097/HJH.0b013e328332c353
Ji H, Kim A, Ebinger JE, et al. Sex Differences in Blood Pressure Trajectories Over the Life Course. JAMA Cardiol. 2020;5(3):255–262. doi:10.1001/jamacardio.2019.5306
Organización de las Naciones Unidas. Guilding Principles on Internal Displacement, 1998, [http://www.idpguidingprinciples.org/].
Boulle P, Sibourd-Baudry A, Ansbro É, Prieto Merino D, Saleh N, Zeidan RK, Perel P. Cardiovascular disease among Syrian refugees: a descriptive study of patients in two Médecins Sans Frontières clinics in northern Lebanon. Confl Health. 2019;13:37. doi: 10.1186/s13031-019-0217-x.
Rosenthal T. Immigration and acculturation: impact on health and well-being of immigrants. Curr Hypertens Rep. 2018;20(8):70. DOI:10.1007/s11906-018-0872-0.
Venturiello M. Itinerario terapéutico de las personas con discapacidad y mediaciones en el cuidado de la salud: la mirada de los familiares. Physis. 2012; 22(3):1063-83. DOI:10.1590/S0103-73312012000300012
Ruiz, R., González, C., Pulido, A. Itinerarios terapéuticos para el cuidado de la salud en la primera infancia en los municipios de Cundinamarca y Boyacá (Colombia). Investig Andin 2016. 18(32):1551-64. DOI:10.33132/01248146.560.
Menéndez, E. (2003), “Modelos de atención de los padecimientos: de exclusiones teóricas y articulaciones prácticas”, Revista Ciencia e Saúde Colectiva , vol. 8, no. 1, pp. 185-207.
Menéndez, E. La enfermedad y la curación. ¿Qué es medicina tradicional?, Revista Alteridades, vol. 4, no. 7, pp. 71-83. 1994.
De la Espriella, R., & Gómez Restrepo, C. Grounded theory. Teoría fundamentada. Revista Colombiana de psiquiatria (English ed.), 2020. 49(2), 127–133. https://doi.org/10.1016/j.rcp.2018.08.002
Blumer H. Alonso P. El interaccionismo simbólico: perspectiva y método. Barcelona: Hora; 1982.
Strauss A, Corbin J. Bases de la Investigación cualitativa. Técnicas y procedimientos para desarrollar la teoría fundamentada. Medellín: Universidad de Antioquia; 2002.
Asociación Médica Mundial. Declaración De Helsinki de la Asociación Médica Mundial. Principios éticos para las investigaciones médicas en seres humanos, 2008. Disponible en: http://www.wma.net/es/30publications/10policies/ b3/17c_es.pdf
Charmaz K. Shifting the Grounds. Constructivist Grounded Theory Methods. In: Corbin J, Clarke A, Charmaz K, Stern P, Bowers B, Morse JM, editors. Developing Grounded Theory The Second Generation. California: Left Coast Press; 2009. p. 127-147.
Lima NC, Baptista TWF, Vargas EP. Ensaio sobre ‘cegueiras’: itinerário terapêutico e barreiras de acesso em assistência oftalmológica. Interface (Botucatu). 2017;21(62). https://doi.org/10.1590/1807-57622016.0642
Ferrer-Lues M, Anigstein MS, Bosnich-Mienert M, Robledo C, Watkins L. De la teoría a la práctica: el discurso de estilos de vida saludable y su aplicación en la vida cotidiana de mujeres chilenas de sectores populares. Cad Saúde Pública [Internet]. 2021;37(12). DOI: https://doi.org/10.1590/0102-311X00333720
Osamor PE, Owumi BE. Complementary and alternative medicine in the management of hypertension in an urban Nigerian community. BMC Complement Altern Med. 2010;10:36. doi: 10.1186/1472-6882-10-36
Peltzer K, Pengpid S. Prevalence and determinants of traditional, complementary and alternative medicine provider use among adults from 32 countries. Chin J Integr Med. 2018;24(8):584–590. doi: 10.1007/s11655-016-2748-y.
Mera-Urbano GA, Sotelo-Daza J, Arias-Gordillo A. Implementación Política Atención Integral en Salud en el Cauca: Un estudio de caso 2016-2019. Hacia. Promoc. Salud. 2022; 27 (1): 67-85. DOI:10.17151/hpsal.2022.27.1.6
Galindo J, Morales O, Sánchez D, Celis C, Arboleda A. Barreras de acceso en la atención de las enfermedades pulmonares intersticiales en Colombia. Saúde e Sociedade 2019; 28, 102-112.
Bran L, Valencia A, Palacios L, Gómez S, Acevedo Y, Arias C. Barreras de acceso del sistema de salud colombiano en zonas rurales: percepciones de usuarios del régimen subsidiado. Colombia, 2013-2017. Hacia. Promoc. Salud. 2020; 25 (2): 29-38 DOI: 10.17151/hpsal.2020.25.2.6
García, J. El acceso a la consulta médica general en Colombia, 1997-2012. Econom & Reg. 2017; 9(1): 175-207.
Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018). J Immigr Minor Health. 2022;24(1):256-299. doi:10.1007/s10903-021-01184-w
Bempong, Nefti-Eboni, et al. "Critical reflections, challenges and solutions for migrant and refugee health: 2nd M8 Alliance Expert Meeting." Public Health Reviews 40.1 (2019): 1-12.
Benítez, A. y Velasco, C. Desigualdades en salud: Brechas en acceso y uso entre locales e inmigrantes. 2019. (pp. 191-235). Santiago, Chile: Fondo de Cultura Económica y Centro de Estudios Públicos.
Denollet, J., & Pedersen, S. Anger, depression, and anxiety in cardiac patients: the complexity of individual differences in psychological risk. Journal of the American College of Cardiology, 2009. 53(11), 947-949. doi:10.1016/j. jacc.2008.12.006
Barón C, M., Soto, M., Tobo M. Vivencia de la hipertensión arterial en la mujer adulta mayor: una experiencia silenciosa y en soledad. https://hdl.handle.net/10901/17539
The works published in this magazine are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) preserves the copyright of the published works, and encourages and allows the reuse of the works under the license for use stated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2011 (© Publications Service, University of Murcia, 2011)
2. The works are published in the electronic edition of the journal under Creative Commons Reconocimiento-NoComercial-SinObraDerivada 3.0 España(texto legal) “ a Attribution-NonCommercial-NoDerivatives 3.0 Spain license (legal text)”. They can be copied, used, broadcasted, transmitted and publicly displayed, provided that: i) the authorship and original source of their publication (journal, publisher and URL) are cited; (ii) are not used for commercial purposes; iii) the existence and specifications of this license is mentioned.
3. Conditions of self-archiving. Authors are allowed and encouraged to electronically disseminate the pre-print (pre-reviewed ) and / or post-print (reviewed and accepted for publication) versions of their works prior to publication, as it ensures a wider circulation and dissemination which may lead to a possible increase in its mention and a higher scope among the academic community. RoMEO color: green.
