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      Healthcare Inequities Experienced by Patients with Cancer: A Qualitative Study in Medellín, Colombia

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          Abstract

          Purpose

          This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín.

          Patients and Methods

          A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes.

          Results

          The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients’ experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class.

          Conclusion

          Patients’ lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens’ empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals’ preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.

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          Most cited references40

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          Qualitative and mixed methods provide unique contributions to outcomes research.

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            Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity.

            Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation of intersectionality can promote the creation of evidence that is directly useful in population-level interventions such as policy changes, or that is specific enough to be applicable within the social contexts of affected communities. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.
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              Health disparities and health equity: concepts and measurement.

              There is little consensus about the meaning of the terms "health disparities," "health inequalities," or "health equity." The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups-such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination-systematically experience worse health or greater health risks than more advantaged social groups. ("Social advantage" refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category-e.g., the wealthiest, the most powerful racial/ethnic group-and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.
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                Author and article information

                Journal
                Patient Prefer Adherence
                Patient Prefer Adherence
                ppa
                Patient preference and adherence
                Dove
                1177-889X
                05 August 2022
                2022
                : 16
                : 1983-1997
                Affiliations
                [1 ]Faculty of Medicine, Universidad Cooperativa de Colombia , Medellín, Colombia
                [2 ]School of Microbiology, Universidad de Antioquia , Medellín, Colombia
                Author notes
                Correspondence: Luis Felipe Higuita-Gutiérrez, Tel +57 312 774 52 56, Email luis.higuita@campusucc.edu.co
                Article
                369628
                10.2147/PPA.S369628
                9362511
                35916b54-c4bf-475c-b8c1-89a3ba96bfcb
                © 2022 Higuita-Gutiérrez et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 1, References: 45, Pages: 15
                Funding
                Funded by: the Universidad Cooperativa de Colombia;
                This study was supported by the Universidad Cooperativa de Colombia.
                Categories
                Original Research

                Medicine
                cancer,health inequities,grounded theory
                Medicine
                cancer, health inequities, grounded theory

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