Papers by Juan Pedro Alonso
Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRM... more Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI+ population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper discusses the findings of a qualitative component of a broader scoping study aimed at developing a priority research agenda to address the health gaps that affect SRHR of vulnerable populations. This study aimed to identify critical chal...
Interface - Comunicação, Saúde, Educação, Mar 1, 2012
This paper examines medical decisionmaking at the end of life, analyzing lay and professional not... more This paper examines medical decisionmaking at the end of life, analyzing lay and professional notions of a "good death". Based on an ethnographic approach in a palliative care unit in the city of Buenos Aires, Argentina, this paper empirically addresses the way in which the meanings surrounding these notions are negotiated in practical and situational contexts. Analysis on specific cases of decision-making at the end of life shows the problematic nature of defining these notions in medical settings. The meanings and definition of a "good death" are subject to interpretations by the players involved. The paper also identifies the tensions between projects for "humanization" of care at the end of life and the medicalization of death and dying.
Agradezco a uno de los evaluadores anónimos por los comentarios y sugerencias que enriquecieron e... more Agradezco a uno de los evaluadores anónimos por los comentarios y sugerencias que enriquecieron el texto.
La construcción del morir como un proceso: la gestión del personal de salud en el final de la vid... more La construcción del morir como un proceso: la gestión del personal de salud en el final de la vida Resumen El objetivo del artículo es analizar la forma en que profesionales de cuidados paliativos-disciplina médica especializada en la atención de pacientes con enfermedades terminalesdefinen, proyectan y comunican el estatuto de "terminalidad" de pacientes con enfermedades oncológicas avanzadas. El artículo se basa en observaciones etnográficas y en entrevistas a profesionales de un servicio de cuidados paliativos de la ciudad de Buenos Aires. Se analizan las tareas de definición y proyección del proceso de morir y la forma en que los profesionales manejan la información sobre el pronóstico de la enfermedad. El análisis de estas prácticas evidencia la forma en que el "final de la vida" es construido en un doble sentido: como una etapa de preparación psicológica para pacientes y familiares-y, por ende, en un objeto de intervención profesional-, y como un proceso gradual que culmina en la muerte.
The article addresses the perspective of oncologist and palliative care professionals of Argentin... more The article addresses the perspective of oncologist and palliative care professionals of Argentina on the advance end of life care planning for patients with advanced cancer. Based on semi-structured interviews with professionals from different disciplines, the paper explores barriers for the patient participation in the decision-making process in end of life care. Despite the acceptance of advance care planning and instruments such as advance directives, barriers to the implementation of these practices are identified. The lack of communication skills to deal with this type of conversation with patients, the concealment of information on the diagnosis and prognosis of the disease, the lack of coordination between teams that keep track of patients with advanced disease, and the resistance from relatives and patients, limit the margins of decision and consent by patients.
Chronic Illness, Sep 4, 2022
Objectives To describe how patients with CKD negotiated assigned responsibilities in the manageme... more Objectives To describe how patients with CKD negotiated assigned responsibilities in the management of their disease, resulting in potential relational nonadherence. Methods Qualitative study performed in two healthcare facilities in Buenos Aires, Argentina, including 50 patients and 14 healthcare providers. We conducted semistructured interviews which were analysed using a frame of reference with concepts of Burden of Treatment and Cognitive Authority theories. Findings Adherence to treatment defined “good patients”. Patients needed to negotiate starting treatment, its modality and dialysis schedule, although most patients felt they did not participate in the decision process and that providers did not acknowledge implications of these decisions on their routine. Some patients skipped dialysis if concerns were not attended. Regularly, patients negotiated frequency of visits, doses, dietary restrictions and redefined relationships with their support networks, sometimes with devasting effects. As a result of overwhelming uncertainty some patients refused enrolling into a transplant program. When the frequency of complications increased, patients considered abandoning dialysis. Conclusion When patients perceived demands were excessive or conflicting, they entered into negotiations. Relationally induced nonadherence may arise when professionals do not or cannot enter into negotiations over patients’ beliefs or knowledge about what is possible for them to do.
Colorectal cancer is the third most common neoplasm. The immunochemical fecal occult blood test (... more Colorectal cancer is the third most common neoplasm. The immunochemical fecal occult blood test (iFOBT) is recommended for screening. The worksite setting has great potential to deliver preventive interventions. We aimed to design and evaluate the feasibility and potential impact of a multicomponent strategy in a workplace [Internal Revenue Agency of the Province of Buenos Aires (ARBA from its acronym in Spanish “Agencia de Recaudación de Buenos Aires”) in Argentina].We used a quasi-experimental research design, a controlled interrupted time-series (ITS). The study involved: (i) a preintervention period (July 2015–September 2018); and (ii) an intervention period (October 2018–February 2019). We used semi-structured interviews and focus groups to design the intervention and to ensure feasibility and implementability. We fitted segmented linear regression models to evaluate changes in the monthly rates per 10,000 tests done in ARBA employees and controlling for the proportion of tests...
Supplementary Data from Implementing Strategies at the Workplace Level to Increase Colorectal Can... more Supplementary Data from Implementing Strategies at the Workplace Level to Increase Colorectal Cancer Screening Uptake in Argentina: A Controlled Interrupted Time-series Study
Cadernos De Saude Publica, 2023
The article analyzes the perceived challenges and strategies implemented in five Latin American a... more The article analyzes the perceived challenges and strategies implemented in five Latin American and Caribbean countries to ensure continuity of care and access to health services for women, newborns, children, and adolescents during the COVID-19 pandemic. The study corresponds to a quick assessment based on semi-structured interviews with key informants in countries selected by convenience: Colombia, Ecuador, Guatemala, Grenada, and the Dominican Republic. Interviews were conducted with 23 key informants: (a) decision makers at the national and/or subnational level, (b) healthcare professionals, and (c) representatives of civil society organizations; from December 2020 to January 2021. Among the findings, at the beginning of the pandemic, priority was given to the COVID-19 care, with measures to limit the flow of people to health facilities in the countries involved, closing or limiting outpatient visits and restricting care schedule. For women, this affected family planning services and access to contraceptive methods, implying a reduction in prenatal check-ups. As a result of this deinstitutionalization of care, among newborns, a decrease in pediatric check-ups, a decrease in timely immunization and late detection of pathologies or growth problems were reported. Among adolescents, a strong restriction of family planning services, the limitation of other friendly counseling spaces and difficulties in accessing contraceptives were observed.
Rev. argent. salud publica, 2021
Revista Argentina de Salud Pública, Jul 28, 2021
Vaccine, 2020
Background: Antenatal care providers have a key role in providing appropriate information and imm... more Background: Antenatal care providers have a key role in providing appropriate information and immunization recommendations to improve pregnant women's vaccine uptake. The objective of this study is to describe health care providers' perspectives and experience regarding the implementation of maternal immunization programs in Latin America. Methods: We conducted 33 in-depth interviews of health care providers from Argentina, Brazil, Honduras, Mexico, and Peru (6-7 per country). Qualitative data analysis was conducted using a combination of both manual techniques and the computer software program NVivo. We identified and coded main themes related to maternal immunization. Results: The main themes identified in this analysis were practices related to maternal immunization, knowledge and training, resource availability and interactions with pregnant women. Healthcare providers knew that recommendations exists but some did not know their content; they expressed concerns about insufficient training. Providers from all five countries expressed the need for additional human resources and supplies. They also expressed a desire for women to be more proactive and ask more questions during the health visits. Conclusion: This is the first multi-country study assessing the perspectives of health care providers about maternal immunization practices at the facility level in Latin America. Recommendations based on the results from this study include implementing additional trainings around maternal immunization, especially targeting obstetricians and midwives. These trainings should be conducted in coordination with improvements to supply chain and other structural issues.
Social Science & Medicine, 2022
A new chronic patient has emerged, with a burden of symptoms and treatment. Patients with kidney ... more A new chronic patient has emerged, with a burden of symptoms and treatment. Patients with kidney failure (KF) require complex and expensive treatments, and in underresourced contexts, they struggle to obtain quality and timely care, even in countries with universal health coverage. We describe how, in such a setting, social structural factors and control over services placed by the system affect the burden of treatment of patients. This qualitative study was undertaken in Buenos Aires, Argentina. Semistructured interviews were conducted with patients with KF (n = 50) and health professionals (n = 14) caring for these patients. Additionally, three types of health coverage were included: public health, social security and private healthcare, with diverse socioeconomic backgrounds. Patients' agency to meet demands is extended by relational networks with redistributed responsibilities and roles. Networks provided logistical, financial, emotional support; indeed, patients with limited networks were susceptible to rapid health deterioration, as treatment interruptions could not be identified in time. Control over services translated into scarce information about treatment options, changing dialysis schedules, lack of contact with transplant teams, and new rules to access medication or make requests. For any type of coverage, there was an economic burden related to noncovered medication, copayments, travel, caregivers, specialized diets, and moving to a city offering treatment. Many patients reported economic difficulties that prevented them from even affording meals. Hardships worsened by unemployment because of the disease. Some patients had migrated seeking treatment, leaving everything behind, but could not return without risking their life. Transplanted patients often needed to re-enter the labor market against a background of high unemployment rates. While health policy and practices encourage self-management, the patient may not have the capacity to meet the system's demands. A better understanding of BoT could contribute to improving how patients experience their illness.
Vaccine, 2022
Throughout this article we refer to four administrative levels, which are defined using varying t... more Throughout this article we refer to four administrative levels, which are defined using varying terms in different countries. For clarity, the regional level refers to Latin American and the Caribbean (LAC) and the Pan American Health Organization (PAHO). The national level refers to the country-level, such as Colombia and the Ministry of Health and Social Protection. The subnational level refers to first-level, incountry divisions, such as departments, regions, and provinces, and corresponding health authorities. Finally, the local level refers to second-level divisions, which include districts, cities, and municipalities, and associated health facilities.
Organización Panamericana de la Salud, Jun 1, 2017
Objetivos: Mejorar la distribución del tratamiento del Chagas mediante la identificación de barre... more Objetivos: Mejorar la distribución del tratamiento del Chagas mediante la identificación de barreras para su descentralización.Métodos: Se llevó a cabo un estudio cualitativo, de carácter exploratorio y descriptivo, en base a entrevistas semi-estructuradas con actores clave pertenecientes al Programa Nacional de Chagas y miembros de los equipos de salud del primer nivel de atención con el objetivo de identificar barreras para el diagnóstico y tratamiento del Chagas en diferentes niveles (administrativo, efectores de salud y comunidad) que podrían afectar una estrategia descentralizada de distribución. Adicionalmente se implementó un piloto de descentralización en 10 Centros de Atención Primaria en una provincia Argentina.Resultados: Se realizaron 23 entrevistas semi-estructuradas con responsables de programas y profesionales de la salud. Los principales obstáculos hallados fueron la falta de búsqueda sistemática de casos, la poca articulación entre niveles de atención y actores del sistema de salud, falta de capacitación del equipo de salud respecto al tratamiento (indicaciones del mismo), seguimiento de los pacientes y barreras asociadas a los pacientes. Se llevó a cabo un piloto de descentralización y se evaluaron estrategias para optimizar la intervención a gran escala.Conclusiones: Los resultados permitieron mejorar la implementación del plan de descentralización del tratamiento a través de una mejor articulación interprogramática, la capitalización de herramientas de monitoreo y de comunicación ya existentes, y la sensibilización de los equipos de salud. Además se formularon recomendaciones tendientes a mejorar el diagnóstico y el tratamiento de la enfermedad de Chagas.Fil: Klein, Karen. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Burrone, Maria Soledad. Ministerio de Salud de la Nación; ArgentinaFil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; ArgentinaFil: Rey Ares, Lucila. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: García Martí, Sebastián. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Lavenia, Antonia. Ministerio de Salud de la Nación; ArgentinaFil: Calderon, Estela. Ministerio de Salud de la Nación; ArgentinaFil: Sipllman, Cynthia. Ministerio de Salud de la Nación; ArgentinaFil: Sosa-Estani, Sergio Alejandro. Ministerio de Salud de la Nación; Argentin
The objective of this study was to evaluate the perception of the healthcare teams and target pop... more The objective of this study was to evaluate the perception of the healthcare teams and target population about the facilitators and barriers to address Chagas disease in primary level in an endemic area in Argentina. Twelve semi-structured interviews and focus groups were conducted in Primary Health Care Centres in Resistencia, Chaco. The study was guided by the Consolidated Framework for Implementation Research. While professionals had a positive perception of the proposed intervention to address Chagas, they showed concern about complexity and feasibility. Professionals perceive an excessive number of programs, limited material and resources, a lack of training in Chagas, outdated information material, bureaucratic obstacles to requesting supplies and medication, unrelated levels of care and fragmented records on Chagas. This research would contribute to the design of interventions that can be adapted to the existing barriers and facilitators.
Death Across Cultures, 2019
In this chapter we describe and analyse the public debates on death with dignity in Argentina, fr... more In this chapter we describe and analyse the public debates on death with dignity in Argentina, from the first attempts to regulate the rights of terminally ill patients to the political process that resulted in the ‘death with dignity’ Act. Based on documentary sources and sociology of public problems approach we discuss the process of legal change regarding treatment refusal at the end of life. After a short sketch of the history of the debates on death with dignity, we discuss the social and political factors that led to a legal change regarding death with dignity. We posit that the political context and how the debate on end-of-life care was introduced into the public domain explain the legal changes and ethical concerns related to a death with dignity in Argentina.
Vaccine, 2021
BACKGROUND Maternal immunization rates and vaccine uptake in Latin America vary from country to c... more BACKGROUND Maternal immunization rates and vaccine uptake in Latin America vary from country to country. This variability stems from factors related to pregnant women, vaccine recommendations from healthcare providers and the health system. The aim of this paper is to describe women's knowledge and attitudes to maternal immunziation, and barriers to access and vaccination related decision-making processes in Latin American countries. METHODS We conducted focus group discussions (FGD) with pregnant women in five middle-income countries: Argentina, Brazil, Honduras, Mexico and Peru, between July 2016 and July 2018. The FGDs were conducted by trained qualitative researchers in diverse clinics located in the capital cities of these countries. RESULTS A total of 162 pregnant women participated in the FGDs. In general, participants were aware of the recommendation to receive vaccines during pregnancy but lacked knowledge regarding the diseases prevented by these vaccines. Pregnant women expressed a desire for clearer and more detailed communication on maternal vaccines by their healthcare professionals instead of relying on other sources of information such as the internet. Overall, participants had positive attitudes towards maternal immunization and were open to receiving vaccines in pregnancy based on general trust they have in recommendations made by their healthcare providers. The main obstacles pregnant women said they encounter were mainly centered around their clinical experience: long waiting times, vaccine shortages, and impolite behavior of healthcare providers or clinical staff. CONCLUSION Important advances have been made in Latin America to promote maternal immunization. Results from this study show that an important aspect that remains to be addressed, and is crucial in improving vaccine uptake in pregnancy, is women's clinical experience. We recommend pregnant women to be treated as a priority population for providing immunization and related healthcare education. It is imperative to train healthcare providers in health communication so they can effectively communicate with pregnant women regarding maternal vaccines and can fill knowledge gaps that otherwise might be covered by unreliable sources dispensing inaccurate information.
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 2021
The span of kidney failure (KF) has been extended by advances in treatment. To elucidate the live... more The span of kidney failure (KF) has been extended by advances in treatment. To elucidate the lived experiences of people with KF, we draw on Glaser and Strauss’s theory of status passage. Semi-structured interviews were conducted with 50 patients with KF and 14 health professionals, from two healthcare facilities in Buenos Aires, Argentina. The theory informed on the temporal dimensions of people’s passages and dimensions related to what actors know of this passage. We described the status passage as a sequence of transitions (starting dialysis, receiving a transplant, returning to dialysis) that have devastating effects on patient’s roles, and are accompanied with fear and experience of wasting time. Temporal aspects were crucial and planning was useless; indeed, timing of statuses was uncertain. With a transplant, certain roles and capacities could be regained. Some patients were not aware of the chronic nature of the disease and the ultimate reversibility of the transplant. Contr...
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Papers by Juan Pedro Alonso