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      Barreras de acceso a los servicios de salud: narrativas de mujeres con cáncer de mama en Colombia Translated title: Barriers to healthcare access: narratives of women with breast cancer in Colombia

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          Abstract

          OBJETIVO: explorar la existencia de barreras de acceso a los servicios de salud en las historias de mujeres con cáncer de mama, que han recibido apoyo de seis ONG colombianas. METODOLOGIA: se llevó a cabo un estudio cualitativo descriptivo interpretativo, en cinco ciudades colombianas: Bogotá, Medellín, Cali, Valledupar y Santa Marta, incluyendo 44 mujeres apoyadas por seis ONG. Se realizaron grupos focales y entrevistas en profundidad. RESULTADOS : en el proceso emergieron cuatro categorías: barreras ligadas a los determinantes estructurales, barreras originadas en los determinantes intermedios, herramientas para enfrentar las barreras y una categoría que hace referencia a la oportunidad de obtener un diagnóstico y un tratamiento de cáncer de mama. A partir de estas categorías, se propone un modelo de barreras de acceso en cáncer de mama, desde la perspectiva de los determinantes sociales. DISCUSION:a pesar de los esfuerzos del país por mejorar la oportunidad en prevención, diagnóstico y tratamiento del cáncer -incluyendo la promulgación de la ley 1384 de 2010 (Ley Sandra Ceballos)-, las mujeres con cáncer de mama enfrentan barreras de acceso a los servicios de salud, que están determinadas socialmente, y frente a las cuales el sistema muestra cierto nivel de incapacidad.

          Translated abstract

          OBJECTIVE: to explore the existence of barriers to healthcare access in the narratives of women with breast cancer who have received the support of six Colombian NGOs. METHODOLOGY: a descriptive qualitative interpretive study was carried out in five Colombian cities: Bogotá, Medellín, Cali, Santa Marta and Valledupar. Data was collected through focus groups and interviews with 44 women supported by six NGOs. RESULTS :in the process, four categories emerged: barriers linked to structural determinants, barriers arising from intermediate determinants, tools to address barriers and a category referring to the opportunity for diagnosis and breast cancer treatment. From these categories, a model of barriers preventing access to breast cancer-related healthcare is proposed from the perspective of social determinants. DISCUSSION:despite the Country's efforts to improve the opportunity for prevention, diagnosis and treatment of cancer -including the enactment of Act 1384 of 2010 (Sandra Ceballos Act)- women with breast cancer face barriers to healthcare access which are socially determined and against which the system shows some degree of inability.

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          What we mean by social determinants of health.

          This article analyzes the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies. It challenges interpretations by the analysts of "globalization", including the common assumption that states are disappearing. The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries-a class alliance responsible for the promotion of its ideology, neoliberalism. This is the cause of the enormous health inequalities in the world today. The article concludes with a critical analysis of the WHO report on social determinants of health, applauding its analysis and many of its recommendations, but faulting it for ignoring the power relations that shape these social determinants. It is not inequalities that kill people, as the report states; it is those who are responsible for these inequalities that kill people.
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            Anuario Estadístico 2011

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              The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project.

              The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men's use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rfnsp
                Revista Facultad Nacional de Salud Pública
                Rev. Fac. Nac. Salud Pública
                Universidad de Antioquia (Medellín )
                0120-386X
                December 2014
                : 32
                : 3
                : 305-313
                Affiliations
                [1 ] Fundación Universitaria de Ciencias de la Salud Colombia
                [2 ] Fundación Universitaria de Ciencias de la Salud Colombia
                [3 ] Fundación SIMMON Colombia
                [4 ] Fundación SIMMON Colombia
                Article
                S0120-386X2014000300005
                12b0d5e2-c2ff-47ed-a9ad-f4c2cb697542

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0120-386X&lng=en
                Categories
                PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

                Public health
                breast neoplasms,accessibility to healthcare services,health systems,delivery of healthcare,healthcare services research,public health policies,neoplasias de la mama,accesibilidad a los servicios de salud,sistemas de salud,prestación de atención de salud,investigación sobre servicios de salud,políticas públicas de salud

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