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      Healthcare and Health Problems from the Perspective of Indigenous Population of the Peruvian Amazon: A Qualitative Study

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          Abstract

          Indigenous communities usually experience higher levels of mortality and poorer access to healthcare services compared to non-indigenous communities. This study aims to understand the most prevalent health problems and their treatment in the Asháninka indigenous communities of the Peruvian Amazon. We conducted an ethnographic study in order to explore the perceived health problems, the use of traditional medicine and the resources offered by the official Peruvian healthcare system. Field notes and semi-structured interviews were used. A total of 16 indigenous and four non-indigenous people were interviewed, and interpretative analysis was used to identify themes. The Asháninka community is an overlooked population, which, due to distance restrictions, misconceptions and ethnical disparities, is far away from an appropriate healthcare system and is subjected to acute medical conditions such as infections and gastrointestinal problems. This group tends to seek traditional medicine, mostly herbal medications and traditional healers. The use of a health professional is seen as a last resort. Although the official Peruvian health system incorporates community participation strategies to improve the healthcare of indigenous people, the shortage of material, human resources and cultural sensitivity makes this difficult. Healthcare strategies should be devised and implemented in order to minimize health inequality in this population.

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Using and Reporting the Delphi Method for Selecting Healthcare Quality Indicators: A Systematic Review

            Objective Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice. Methodology and Main Finding Three electronic data bases were searched over a 30 years period (1978–2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility. Conclusion The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.
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              Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

              International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                22 October 2020
                November 2020
                : 17
                : 21
                : 7728
                Affiliations
                [1 ]Research Group PAIDI-CTS 1050 Complex Care, Chronicity and Health Outcomes, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; bbadanta@ 123456us.es (B.B.); sbarrientos@ 123456us.es (S.B.-T.); efernandez23@ 123456us.es (E.F.-G.)
                [2 ]School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil; g.lucchetti@ 123456yahoo.com.br
                [3 ]Research Group CTS 1054 “Interventions and Health Care. Red Cross, Spanish Red Cross Nursing School, University of Seville, 41009 Seville, Spain
                [4 ]Research Group CTS 969 Innovation in HealthCare and Social Determinants of Health, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; rdediego2@ 123456us.es
                Author notes
                [* ]Correspondence: ltarrino@ 123456us.es (L.T.-C.); juanvegadue@ 123456gmail.com (J.V.-E.)
                Author information
                https://orcid.org/0000-0001-6981-8378
                https://orcid.org/0000-0001-7618-3091
                https://orcid.org/0000-0002-7922-2663
                https://orcid.org/0000-0003-0158-5744
                https://orcid.org/0000-0002-6399-8571
                https://orcid.org/0000-0002-3453-003X
                Article
                ijerph-17-07728
                10.3390/ijerph17217728
                7672556
                33105800
                2506394d-2f15-4072-89d0-c4025149dd62
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 17 September 2020
                : 19 October 2020
                Categories
                Article

                Public health
                health inequalities,community-engaged research,culturally appropriate,indigenous,peruvian amazon,traditional medicine

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