Roura Maria, Bisoffi Federico, Navaza Barbara, Pool Robert
ISGlobal, Barcelona Centre for International Health Research (CRESIB) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Centre for Social Science and Global Health University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2015 Aug 28;10(8):e0136315. doi: 10.1371/journal.pone.0136315. eCollection 2015.
An estimated 2.7 million Latin Americans reside in Europe, mostly in Spain. Part of a broader project aimed at developing a research agenda on the health status and determinants of this population, this qualitative study engaged Latin American migrants in the identification of research priorities.
We conducted 30 group discussions between November 2012-March 2013 with 84 participants purposively selected for maximum diversity in Madrid and Barcelona (Spain). We facilitated sequences of task-oriented visual activities to explore their views on priority health concerns. We tape-recorded and transcribed discussions and developed a coding frame based on socio-ecological frameworks, which we applied to all the data using NVIVO-10. A final round of eight group discussions allowed us to triangulate and enrich interpretations by including participants' insights.
The cumulative toll of daily stresses was the major health concern perceived by a population that conceptualised ill-health as a constellation of symptoms rather than as specific diseases. Work-related factors, legislative frameworks regulating citizenship entitlements and feeling ethnically discriminated were major sources of psycho-social strain. Except for sexually transmitted infections, participants rarely referred to communicable diseases as a concern. The perception that clinicians systematically prescribed painkillers discouraged health seeking and fostered self-medication. Participants felt that the medicalised, chemicalised, sexually liberal and accelerated culture of the host society damaged their own, and the local populations' health.
Health systems bear a disproportionate responsibility in addressing health problems rooted in other sectors. Occupational and migration policies should be recognised explicitly as health policies. The mismatch between researchers' emphasis on communicable infections and the health concerns of Latin American migrants highlights the need for greater interaction between different forms of knowledge. In this process, the biomedical culture of reliance on pharmacological solutions should not remain unquestioned.
据估计，有270万拉丁美洲人居住在欧洲，其中大部分在西班牙。作为一个更广泛项目的一部分，该项目旨在制定一项关于这一人群健康状况及其决定因素的研究议程，这项定性研究让拉丁美洲移民参与确定研究重点。
2012年11月至2013年3月期间，我们在西班牙马德里和巴塞罗那进行了30次小组讨论，有目的地挑选了84名参与者，以确保最大限度的多样性。我们组织了一系列以任务为导向的视觉活动，以探讨他们对优先健康问题的看法。我们对讨论进行了录音和转录，并根据社会生态框架制定了一个编码框架，使用NVIVO-10将其应用于所有数据。最后一轮的八次小组讨论使我们能够通过纳入参与者的见解来进行三角测量并丰富解释。
日常压力的累积影响是这一人群主要关注的健康问题，他们将健康不佳概念化为一系列症状，而非特定疾病。与工作相关的因素、规范公民权利的立法框架以及感到受到种族歧视是心理社会压力的主要来源。除性传播感染外，参与者很少将传染病视为一个问题。认为临床医生系统性地开止痛药的看法阻碍了人们寻求医疗服务，并助长了自我用药。参与者认为，东道国社会的医疗化、化学化、性开放和快节奏文化损害了他们自己以及当地居民的健康。
卫生系统在解决源于其他部门的健康问题方面承担着不成比例的责任。职业和移民政策应被明确视为卫生政策。研究人员对传染病的重视与拉丁美洲移民所关注的健康问题之间的不匹配，凸显了不同形式知识之间加强互动的必要性。在这个过程中，依赖药物解决方案的生物医学文化不应再被视为理所当然。
