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Vol. 23. Num. 2. 2014. Pages 125-133

The value of grounded theory for disentangling inequalities in maternal-childhealthcare in contexts of diversity: A psycho-sociopolitical approach

[La importancia de la Teoría Fundamentada para la investigación sobre la desigualdad en salud materno-Infantil en contextos de diversidad: una aproximación psicosociopolítica]

Sonia Hernández Plaza1 , Beatriz Padilla1 , Alejandra Ortiz2 , Elsa Rodrigues2

1Univ. Minho, Centre for Research in Social Sciences, Portugal ,2Inst. Univ. Lisboa, Centre for Research and Studies in Sociology, Portugal

Abstract

Adopting a psycho-sociopolitical approach, the present paper describes the results of a community-basedparticipatory needs assessment focusing on the perceived needs of women of reproductive age as users ofprimary healthcare in contexts of migration-driven diversity and socioeconomic vulnerability in theMetropolitan Area of Lisbon. The investigation comprised 64 in-depth interviews with women, includingnatives and immigrants to Portugal from the main origin countries in the context under study (Brazil, CapeVerde, and other Portuguese- speaking African countries) and a survey of 125 women, again natives andimmigrants from these countries. The central role of qualitative methodology and grounded theory, in theframework of a multi-method research, allowed understanding the needs of women as embedded incontexts characterized by asymmetrical power relations, in terms of unequal opportunities and resources,at multiple interrelated ecological levels (personal, relational, organizational, community, socioeconomic,health system/policy, cultural/migration). The priority perceived needs of women were primarily related tosocioeconomic disadvantage, severely aggravated in the current contexts of crisis; and factors at the healthsystem level, mainly unequal access to family doctors, excessive waiting lists, and increases in the directcosts of healthcare. Results allow questioning the adequacy of cultural competence approaches for thereduction of inequalities in maternal-child healthcare in the context under study, showing the critical andinnovative value of qualitative methodology and grounded theory in research on social justice and healthin contexts of diversity characterized by unequal power dynamics. 

Resumen

Adoptando una aproximación psico-sociopolítica, en el presente trabajo se describen los resultados de unaevaluación de necesidades percibidas por las mujeres en edad reproductiva como usuarias de cuidados desalud primarios en contextos de diversidad asociada a la inmigración y vulnerabilidad socio-económica, enel área metropolitana de Lisboa. Se llevaron a cabo 64 entrevistas en profundidad a mujeres, tanto autóctonascomo inmigrantes, de los principales países de origen en el contexto analizado (Brasil, Cabo Verde yotros países africanos de lengua oficial portuguesa) y una encuesta en la que participaron 125 mujeres,tanto autóctonas como inmigrantes, procedentes de los mencionados países. El papel central de la metodologíacualitativa y la Teoría Fundamentada, en el marco de una investigación multimétodo, permitió comprendercómo las necesidades de las mujeres se insertan en contextos caracterizados por relaciones de poderasimétricas, basadas en el acceso desigual a los recursos y oportunidades, a múltiples niveles ecológicos,interrelacionados entre sí (personal, relacional, organizacional, comunitario, socioeconómico, sistema/políticasde salud, cultura/migración). Las necesidades prioritarias identificadas se relacionan principalmentecon la situación de desventaja socio-económica en la que se encuentran las mujeres, agravada en el actualcontexto de crisis, y con factores a nivel de sistema de salud, tales como el acceso desigual al médico de familia,las elevadas listas de espera, o los costes cada vez mayores de la atención sanitaria. En este sentido,los resultados obtenidos permiten cuestionar la adecuación de la competencia cultural como estrategiapara reducir las desigualdades en salud materno-infantil en el contexto objeto de estudio, mostrando elvalor de la metodología cualitativa y la teoría fundamentada en la investigación sobre justicia social y saluden contextos de diversidad y dinámicas de poder asimétricas. 

Keywords

Inequalities
Maternal-child healthcare Immigration
Social justice
Grounded Theory

Palabras clave

Desigualdades
Salud materno-infantil Inmigración
Justicia social
Teoría Fundamentada
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