Code
|
Informant
|
Quote
|
Health policy level
|
|
Budget constraints
|
Endoscopy medical personnel
|
We are historically used to investing in resources for treatment of advanced colon cancer, palliative care, chemotherapy, radiotherapy, studies for staging and follow-up, but we have not invested in prevention and diagnostics. We need to guarantee the funding of programs like this, and find out how much they can actually expand otherwise the effort will be useless. Its funding needs to be guaranteed by Seguro Popular or something of the sort for the (screening) program to keep running.
|
Lack of interest of decision makers
|
Endoscopy medical personnel
|
This kind of programs could fail due to the lack of support of decision makers. I see that many authorities are not interested in colorectal cancer, they don't think for a minute about the possibility of having a prevention program. Some authorities in our hospital are aware of the relevance of this, but not all...
|
Insufficient promotion of CRC screening
|
Endoscopy medical personnel
|
The main challenge is that more people need to get into the program. We need a lot of promotion, a lot of promotion, a lot of promotion, we need to increase the number of participants, yes!
|
Social context level
|
|
Poverty
|
Male lay participant
|
I owed the payment of two months of my water service. So I saved money, about $1000 (USD 50) but still I could not pay it. Somebody told me I could get a discount with my elderly person card, but it turned out that it only works for transportation. I had to pay $ 2026... I told him I have nothing more, so I just paid what I could and I still owe $ 1026.
|
Primary care personnel: doctor
|
The people are humble, they are very noble people... but when you talk to them about their children's nutrition, and insist that they need to feed their malnourished children, they cannot stand it, they ask you: what can I feed them if I only have an egg for each day?
|
Beliefs: Gender
|
Male lay participant
|
Men my age and older, it is very difficult that they will agree (to having a colonoscopy), because they are going to say that they are being raped. They will say: at this age they are going to rape me with the finger? No, you are crazy, I tell you the truth.
|
Female lay participant
|
We are far from many things, because first we start under the assumption that us women are destined to be nothing more than a housewife, and if you have a controlling and jealous husband, forget it, how do you think you are going to go get this tests done?
|
Beliefs: Cancer
|
Female lay participant
|
I was told by a doctor that sometimes women can get colorectal cancer because when you are in labor you push a lot, and pushing so hard brings problems in the colon.
|
Health literacy
|
Primary care personnel: doctor
|
The patients have low levels of school education, people with maximum 3 years of primary school, so we face many complications because they do not understand how to take the treatment or how to take samples for lab tests
|
Conditional participation in health programs
|
Primary care personnel: doctor
|
Above all, I have seen it happen a lot in the pap smear tests. It is very common that the results are not picked up, despite the fact that they are visited at their homes, that they receive phone calls... it is a lack of interest because they have already received the money and everything they can get and that´s it.
|
Insecurity (violence)
|
Primary health care: social worker
|
I feel, well not feel, I have perceived that many people, maybe approximately sixty percent, has had or has a relative in jail, and I don't think that is without reason. In the area there has been violence... any act or infraction committed by their relatives or themselves is because there has been violence.
|
Cultural diversity
|
Primary health care: social worker
|
In this particular area there are very different cultures, I see it within the same group of people. One lady behaves differently from the other and suddenly there are many cultural shocks, right? Because there is one that says: "this is how things are done", and there is another one that says: "no, how can you think that?"... I think this makes it difficult to form community groups in this health center... this is a particular situation that I see in this area.
|
Floating population
|
Primary health care: social worker
|
While the patients are from this health center, as long as they do not change residence there is no problem for the follow-up ... but it is common that they move, change their address. So you go looking for them and they are gone and you don’t know where they moved to... we have to deliver results and they are no longer there.
|
Organizational level (health services)
|
Tests costs
|
Male lay participant
|
If the cost of the tests is covered by popular insurance or if the cost is low, it is most likely to be done, if it is not covered or if the cost is very high, it is difficult for a patient to perform it.
|
Experiences of abuse in health services
|
Male lay participant
|
It is true that security guards are sometimes very bad, completely inhuman, right? They say: you are not from around here, you need to show me your health service identity card, if not then look elsewhere... If it is already a hardship to get to one hospital, then imagine having to move from one place to another.
|
Experiences of abuse in health services
|
Primary health care: social worker
|
If they would explain to the patient what they are going to do with him, the patient would be relaxed, he would know that there is not going to be a bigger problem, right? But no, they go "let´s see, get on here, take your clothes off, hold on and shut up!"
|
Poor quality of health services
|
Primary care personnel: doctor
|
As health personnel we have to keep updating, then they send us to a course for anything and it is to reduce the attention time and the quality of attention
|
Doctor-patient communication problems
|
Male lay participant
|
I did not understand. I got confused. He sent me to pathology, and he sent me to do some chest studies, and some study of my entire skeleton. I did not understand what they were for. I thought that with those same papers I had to come back to the hospital in my next visit. It was not like that... now I pay more attention to what this is and that... They give you so many different papers.
|
Lack of CRC knowledge
|
Primary care personnel: doctor
|
I think we would need more information, we would need more in the sense that maybe, well in my case, I do not know anything about the disease and about the test, I do not know about which one is the best. I think the specialist that has to do the study would be the proctologist, but I do not have more information, nothing more. I would say that in my service we require more information.
|
Work overload
|
Primary care personnel: doctor
|
It's only a nurse, a doctor, a social worker and a lot of people, so obviously you cannot cope with the attention for all the patients. You have to organize your times, because there are so many activities. If a procedure gets a bit complicated or takes you a little extra time, you will not be able to perform two or three pap smears. I would like to be able to organize my activities, but there is so much to be done by one person, and also there is so much administrative work.
|
Lack of supplies
|
Primary care personnel: doctor
|
In primary care clinics we are tied of hands, because sometimes we do not even have medicines, so to do specific studies is very difficult.
|
Insufficient infrastructure
|
Primary health care: social worker
|
We are very tight as you can see, there are no spaces, obviously the planning of this unit was a result, as in many cases, to an emergent situation, and there is no planning for the future, they do not have that kind of vision, that the population is going to keep growing.
|
Lack of personnel
|
Primary care personnel: doctor
|
I was in a health center and they moved the nurse suddenly, the nurse had to do another nursing activity and she was called from one day to the next, suddenly. So, if you have programmed activities with a nurse, you cannot perform them as planned because suddenly they have sent him/her to another site.
|
Lack of interest
|
Primary health care: social worker
|
I am sincere, if someone is not interested, for example: there will be a partner who will propose you a new program and if that person is not interested so how I am going to work in that project? more if it's his/her job, I'm going to support you but if you're not enthusiastic, how I'm going to get excited if you do not
|
Distant medical appointments
|
Male lay participant
|
And then, you have the appointments after a month. Now, for example, there are no appointments until March, April of the next year, there are no appointments, since June, July, since October there are no appointments for this year.
|
Long waiting time
|
Male lay participant
|
It takes a whole day at the health center to get an appointment, all day one goes to be there
|
Administrative procedures
|
Primary care personnel: doctor
|
Lately I don't go to my social security clinic anymore because there is too many people, they cannot treat us all. One arrives, takes a turn, and they send you to do the single line to wait to see a doctor, but not your family doctor. If you have studies you do not see your doctor, you have to see another one, it´s such a big mess! So, what is the point of going there?
|
Interpersonal level
|
|
Peers’ fear of colonoscopy
|
Primary health care doctor
|
Well, it's fear, right? Fear of the procedure (colonoscopy). More if a neighbor or relative tells them that colonoscopy is very painful. I think that would be a barrier.
|
Individual level
|
|
Fear of colonoscopy
|
Female lay participant
|
But that study is dangerous, right? You can die there or something? ... because they put a tube all the way up to here... I'm afraid I could die.
|
Fear of finding out about a serious disease
|
Female lay participant
|
I believe that when people already have certain symptoms and they need to have the study done, they have fear to be told they have a disease. That is what happened to my son-in-law. He was afraid to be told that he had cancer... that they will find something bad in him.
|
Embarrassment of having a colonoscopy
|
Female lay participant
|
I would be embarrassed that a doctor sees me, that a doctor introduces a camera, through my rectum.
|
Lack of time for use of health services
|
Male lay participant
|
Those comments are very frequent among my friends ... "They fired me from work, I went to the doctor, and it turns out that they fired me and right now I am unemployed." So I think: I have a job and I will take care of it. So that's what worries me, you do the study or not, but how are you going to detect your illness in your body? For example, now I have about four or five years since I found a job, which was hard to find.
|
Procrastination
|
Female lay participant
|
I have invited people to many programs and they tell me, oh yes, lets see, some day, once I decide I´ll go, let me check when I have time.
|
Disinterest towards health
|
Primary health care: social worker
|
I also believe, sorry to be very rough, but I think that some patients have no strengths. You call them for follow-up and referral and: “I haven't been able to go, I am not interested, the hospital is too far away”. I tell them, it's your health, I mean cancer is a priority, but people do not go, even if they have dysplasia or BIRADs 4, they don't go. They make up a thousand excuses.
|
Preference for traditional medicine
|
Primary health care: social worker
|
Many times there are people who have already arrived here from the countryside and they are not used to the use of medicines, they want to return to natural treatments, naturists, herbs, teas. There are people who are diabetic and say "I am going with a naturalist doctor and the doctor tells me that he will cure me … they swear that they are going to be cured of diabetes and when they come back with us they come in very uncontrolled states and it is very difficult.
|
Distrust in public medical services
|
Male lay participant
|
What do people go to IMSS for? What do people go to see the doctor for? If they don't not give an adequate answer to your illness, so, what for? It's better this way, I prefer to look for a doctor close-by, even if I have to pay, it is better quality and it doesn´t take all day long to get an appointment.
|
Reluctance to use health services
|
Male lay participant
|
Because one as a man has a little pain and we think that it will disappear, and we continue working, but you do not know if that is advancing, it is progressing and when it is until it is well advanced that you regret it.
|
Low perceived risk of CRC
|
Male lay participant
|
Well, one as a man does not know, because the ladies get breast cancer. I've heard only women with cancer, not men.
|
Non-acceptance of biopsy
|
Endoscopy medical personnel
|
There were 8 patients who still did not come to schedule their colonoscopy study, so I started to communicate with them and one of them, told me that she already knew about the program, but she did not want it because of the biopsy.
|
Lack of self-care
|
Primary health care: social worker
|
Thirty percent do not return for their results, they do not do it for indifference, not self-care, not being responsible for their own health
|
Low self-esteem
|
Female lay participant
|
For all that we carry as women, like stress, illnesses are for us, so if we as women do not love ourselves then we´ll die tomorrow.
|