On World Cancer Day, a striking campaign by the Spanish Association Against Cancer reached media outlets across the country with the following slogan: “Cancer is the same for everyone, but not everyone is equal in the face of cancer.”
The Association highlighted that, if we want to talk about equity and a fair world, we must work to ensure that “everyone” truly means “everyone”. Every person should have the same opportunities to prevent cancer, live with it and access research outcomes, regardless of their social circumstances. But cancer, significant as it is, is not the whole picture.
Recent research conducted by Dr Beatriz Vallina addresses the same dilemma but extends it to highly prevalent chronic diseases, such as cardiovascular diseases, type 1 and type 2 diabetes, as well as cancer.
Her thesis examines the barriers and difficulties that the most vulnerable sectors of the population face in accessing healthcare in all its dimensions. These are social groups that the scientific literature considers “hard to reach”, including ethnic, linguistic and cultural minorities, people with addictions, people experiencing homelessness, groups with limited resources and severe financial difficulties, and sex workers, among others.
Structural mechanisms underlie communication difficulties and disparities with patients and communities #QualitativeResearch @Maiferrando @Jordi_Garces @Polibienestar @GVAavi #PublicHealth #SocialDeterminants #SociologyOfHealth pic.twitter.com/c7GDwQ5kGt
— Kveloce R&D&I (@Kveloce_I_D_i) February 24, 2022
Dr Beatriz Vallina conducted the research for a doctoral thesis at Kveloce R&D&I within the framework of the COMSALUD project, funded by the AVI (Valencian Innovation Agency).
Her research highlights weaknesses in the healthcare system that prevent information from reaching the most vulnerable groups and ensuring they are aware of the treatments available, particularly when they are living with chronic diseases that are highly prevalent in these communities.
It also examines how to reach communities excluded from the healthcare system itself and how to provide genuinely effective clinical and health communication for them. The research considers issues of power, the reproduction of inequality, stigma and marginalisation, as well as socio-historical, socio-cultural and socio-economic barriers to healthcare access.
Education and low-skilled occupations
Dr Vallina’s research highlights the importance of addressing the issue from multiple perspectives, as there are many factors that contribute to these barriers.
For example, the researcher explains that both nutrition and education have an impact on children’s current and future health. Extending the number of years that children spend in education significantly reduces health problems during youth and adulthood. Education and income are closely related, particularly through occupational category and job characteristics. The literature has identified a significant correlation between chronic diseases and low-skilled, low-income occupational groups.
One of the key conclusions of this meta-study was that education, within the context of social class, represented a major barrier to health education and to developing patients’ capacity for appropriate self-care and autonomous decision-making. This, in turn, can affect their health status and prognosis in the medium and long term.
Dr Vallina’s research includes 103 studies focusing on clinical communication, access to health information and the healthcare system, health and social care interventions, adherence, and health self-management among adults aged 18 to 65 experiencing particular social and psychosocial vulnerability, especially those experiencing or at risk of social exclusion. Studies incorporating testimonies from healthcare and social work professionals, civil society organisations and community stakeholders involved in caring for these communities were also included.
More than 4,000 titles were screened to prepare a major meta-synthesis on #Empowerment for patients and communities, giving us extensive experience in #QualitativeResearch @Maiferrando @Jordi_Garces @Polibienestar @GVAavi #PublicHealth #SocialDeterminants pic.twitter.com/v8m1NO0blF
— Kveloce R&D&I (@Kveloce_I_D_i) February 24, 2022
From these studies, the authors’ comments, participants’ opinions and beliefs about health, and their impressions and experiences of communication between doctors, specialists, nurses, healthcare professionals and patients were systematically collected. This communication was, of course, considered in both directions. Experiences from both offline and online patient communities were also included.
Main conclusions
- Communication during clinical consultations with vulnerable populations requires sufficient information to be provided in line with each patient’s information needs. It must be understandable and culturally appropriate, and linguistically adapted where necessary.
- The importance of health literacy. It is linked to knowledge about medicines, self-care and the self-management of chronic diseases and, importantly, is influenced by previous education.
- The need to “empower” these communities in relation to their health. “Power” reflects patients’ capacity to participate in consultations and make decisions about their own self-management pathways and treatment.
- The need to develop plans for clinical and social care in cases of chronic disease, taking into account the risk of exclusion and situations of marginalisation.
- Actions aimed at addressing underlying issues and promoting social change have the potential to improve the health of these communities and, consequently, public health as a whole. In doing so, they can contribute to the sustainability of healthcare systems, the welfare state, and the inclusion and equality of all citizens.
In conclusion, the doctoral thesis proposes what is known as Critical Clinical Practice. This involves a comprehensive and structural understanding of power differences within the medical model and social structure, awareness of how these differences are reflected in medical relationships, and an understanding of their historical, social, cultural and structural foundations.
The #PhD dissertation proposes a fundamental framework for carrying out comprehensive interventions and research within the community https://t.co/xk5930XTcN #QualitativeResearch #Research #CoProduction @Maiferrando @Jordi_Garces @Polibienestar @GVAavi @IJERPH_MDPI pic.twitter.com/zxfe3nzNjz
— Kveloce R&D&I (@Kveloce_I_D_i) February 24, 2022
Critical Clinical Practice requires consideration of how intersecting forms of oppression, discrimination and stigma affect community and individual health. These must always be understood as social rather than natural problems and, therefore, as issues that can be transformed.
This meta-study was the first industrial doctoral thesis ever defended at the Faculty of Social Sciences of the University of Valencia. It was also the first doctoral thesis defended within the doctoral programme in the Design, Evaluation and Management of Public Social Welfare Policies.
The doctoral thesis, entitled Strategies for enhancing the impact of interventions in chronic health: a transnational qualitative metastudy on sampling, recruiting and communicating with vulnerable populations, was conducted within the doctoral programme in “Design, Management and Evaluation of Public Social Welfare Policies” and, more specifically, within the second research line, “Inequality, inclusive societies and social and individual wellbeing within the framework of public policies”. It was carried out within the COMSALUD project, promoted by the University of Valencia – Research Institute on Social Welfare Policy (Polibienestar) and Senior Europa S.L., operating under the Kveloce R&D&I brand.
