Ortega Francisco, Bilbeny de Fortuny Beatriu, Albuixech-García Rocío, Raya Tena Antonia, Barceló-Prats Josep, Djurdjevic Marija
Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
Department of Philosophy, Anthropology and Social Work, University of Rovira i Virgili, Tarragona, Spain.
Front Public Health. 2025 May 6;13:1564009. doi: 10.3389/fpubh.2025.1564009. eCollection 2025.
This study aims to generate evidence on healthcare practitioners' initiatives to integrate community health principles into primary care. Two case studies explore the co-design and co-development of tailored solutions to address the emerging health needs of vulnerable populations in the Raval neighborhood of Barcelona. The interventions aimed to improve access to healthcare services by establishing new care pathways adapted to the unique needs of migrant communities, while promoting inclusivity and equity in healthcare delivery.
An action-research approach was used during interventions conducted from December 2021 to March 2023 in Barcelona. This participatory iterative method included qualitative research to understand barriers hindering healthcare access and delivery; co-design of tailored training programmes focusing on structural and intercultural competences for both community members and HC practitioners; suicide prevention trainings for Filipino community representatives and PC providers; implementation of a community-based suicide prevention initiative; and evaluation of its effectiveness. Convenience and judgemental sampling engaged key stakeholders and influential figures from the Raval neighborhood. Sampling methods and R&I techniques are detailed in Case study 1 and Case Study 2.
Case Study 1 identified significant obstacles to healthcare access among immigrant populations, including linguistic, cultural, and discrimination-related barriers, stemming from inadequate administrative procedures and limited professional awareness of structural and social determinants of health. Case Study 2 highlighted the elevated suicide risk in Raval during the COVID-19 pandemic, leading to the co-design and implementation of suicide prevention training and the establishment of a sustainable, multi-stakeholder network of collaboration. Results from research and innovation activities are categorized in a table included in the text, with lessons learned discussed in the Discussion section.
The findings underscore the critical role of primary care in identifying community needs and adapting services to meet the requirements of vulnerable populations through innovative approaches recommended by WHO and Medicus Mundi. Insights gained from these grassroots, bottom-up initiatives -driven by healthcare practitioners and conducted mostly during their free time- have been translated into actionable recommendations for policy and practice.
本研究旨在为医疗保健从业者将社区健康原则融入初级保健的举措提供证据。两项案例研究探讨了如何共同设计和共同开发量身定制的解决方案，以满足巴塞罗那拉瓦尔社区弱势群体新出现的健康需求。这些干预措施旨在通过建立适应移民社区独特需求的新护理途径来改善医疗服务的可及性，同时促进医疗服务提供的包容性和公平性。
2021年12月至2023年3月在巴塞罗那进行干预期间采用了行动研究方法。这种参与式迭代方法包括定性研究，以了解阻碍医疗服务获取和提供的障碍；共同设计针对社区成员和医疗保健从业者的侧重于结构和跨文化能力的量身定制培训计划；为菲律宾社区代表和初级保健提供者开展自杀预防培训；实施基于社区的自杀预防倡议；以及评估其有效性。便利抽样和判断抽样涉及拉瓦尔社区的关键利益相关者和有影响力的人物。案例研究1和案例研究2中详细介绍了抽样方法和研究与创新技术。
案例研究1确定了移民人群在获取医疗服务方面存在的重大障碍，包括语言、文化以及与歧视相关的障碍，这些障碍源于行政程序不足以及对健康的结构和社会决定因素的专业认识有限。案例研究2强调了在新冠疫情期间拉瓦尔的自杀风险升高，这导致了自杀预防培训的共同设计和实施以及建立了一个可持续的多利益相关者合作网络。研究和创新活动的结果在文本中的一个表格中进行了分类，讨论部分讨论了所吸取的经验教训。
研究结果强调了初级保健在识别社区需求以及通过世界卫生组织和世界医生组织推荐的创新方法调整服务以满足弱势群体需求方面的关键作用。从这些由医疗保健从业者推动且大多在他们的业余时间开展的基层、自下而上的举措中获得的见解已转化为针对政策和实践的可操作建议。
