CUADERNOS DE INVESTIGACIÓN

INSTITUTO DE INVESTIGACIONES INTERDISCIPLINARIAS

UNIVERSIDAD DE PUERTO RICO EN CAYEY

Escuela de Verano: Salud en Comunidad 2007

Perspectives concerning prevention

of health problems
Shirley Bejarano
Glaymar Domínguez
Sarah Lince
David Nachi
Abbey Wells

Cuaderno 3
Año 2008
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© Instituto de Investigaciones Interdisciplinarias

Universidad de Puerto Rico en Cayey
Perspectives Concerning Prevention of Health Problems
Shirley Bejarano1, Glaymar Domínguez2, Sarah Lince3, David Nachi4, Abbey Wells5
1
Department of Anthropology and Pre-Medicine Program, University of South Florida
2
Department of Biology, University of Puerto Rico-Cayey
3
Department of Anthropology, Frances Perkins Scholar at Mount Holyoke College
4
Department of Biology, University of Puerto Rico-Cayey
5
Department of Anthropology, Mount Holyoke College

Submitted as partial fulfillment of the Research Methodologies in Community Health Fieldschool

(INTD 4996) requisites, June 2007.
©2007 Institute of Interdisciplinary Research, University of Puerto Rico-Cayey.
________________________________________________________________________

ABSTRACT

Our research was conducted in collaboration with the Hospital de Area in Cayey.
Building on research conducted by field school students in 2006, we focused on
documenting perspectives about “prevention of health issues”. We documented
perspectives of clients (people attending the hospital-field school sponsored health fair as
well as the hospital’s public sector waiting rooms), as well as personnel of the hospital
(including doctors, nurses, and the administrators). We asked each group what
“prevention” meant to them and about their ideas about current and future strategies and
specific health conditions for prevention efforts. We have also incorporated results from
an internationally verified food security survey conducted at the health fair. This report
includes an analysis of participants responses in terms of “individual”, “socio-economic”
and “environmental” factors associated with maintaining health. It also specifically
describes participants’ ideas about strategies for implementing prevention efforts, and
preventable conditions commonly mentioned as needing attention in prevention efforts.
This information is provided to our collaborators at the Hospital de Area en Cayey to
allow the hospital to interpret it and use it for developing current and future “prevention”
efforts.
________________________________________________________________________

identified prevention of health issues as

INTRODUCTION
Our research was conducted in the
second year of a five year field school
project named Health in Community
“Salud en Comunidad”. It builds on
research conducted by students of the
first year of this field school (2006).
Results from the previous year’s work
with the Hospital de Area en Cayey
a topic for future research. The hospital
then took up this topic as a focus of their
collaborative work with us in this year’s
community-based research (2007).
This research project was
designed to provide the hospital with
information for developing prevention
efforts. This project includes the
collected opinions of the clients of the
hospital personnel regarding the existing

and possibilities for future prevention
efforts. We gathered information about
participants’ ideas about current and
future strategies and specific health
conditions for prevention efforts
strategies for implementing prevention
efforts.
During our research we noticed different
ways that participants were talking about
prevention as well as factors related to
maintaining health. We saw several
prevention discourses emerge based on
individual, socio-economic, and
environmental factors effecting
understandings of health and prevention.
Our analysis of these discourses has
been informed by contrasting tendencies
in health promotion and prevention
discourse to concentrate on individual
factors related to maintaining health, and
emerging assertions that health issues
are also related to factors such as social,
economic, and environmental contexts.
Our theoretical approach to analyzing
our participants’ discourses in
individual, socio-economic, and
environmental terms is similar to those
of Nancy P. Chin with Alicia Monroe
and Kevn Fiscella (2000), and Lisbeth
Sachs (1996).
Chin et al (200) differentiate between a
“rational choice model” for health
promotion and prevention efforts and a
“biopsychosocial model” (Chin et al
2000: 318). Chin et al describe the
rational choice model as based on
individualistic “Western” (2000:319)
values. It focuses health promotion and
prevention on the individual actions of a
single person/patient. It “assumes people
are rational, aware, self-creating agents
of their own health…” (ibid: 319). The
biopsychosocial model is based on the
idea that the social, economic,
community, environmental context are
relevant to assessing health problems
2
and determining the efficacy of health
promotion/prevention efforts. It suggests
changing the “rational choice model’ to
one based on “integrating socio-cultural
factors into a patient-centered approach
to health care…” (ibid:325).
Sachs (1996) describes the
impacts of similar differentiations of
health promotion/prevention discourses.
The “responsability and blame” (Sachs
1996:632) discourse describes health
based in individual factors. Sachs
identifies another discourse based on
acknowledging socio-economic, cultural
context of health issues, what she calls
“causal relationships” (ibid:632). She
identifies that differences in care and
responses to health issues are rooted in
different levels of “[locating] the cause
of sickness” (ibid:635) as individual
“responsibility” or within a “causal
relationship” with socio-economic,
economic pr environmental factors.
We have also used similar
structures as Chin et al and Sachs in
developing instruments and interview
guides, as well as for identifying health
conditions and strategies for prevention
efforts from our data. Results from the
food security questionnaire were also
analyzed in a way that highlighted the
intertwined relationships between the
micro, individual factors, and the macro,
socio-economic and environmental
factors, effecting health.
METHODS
The methods we used include:
preliminary interviews, fieldwork,
survey development, data collection, and
data analysis.
Through preliminary interviews
and lectures, we developed an
understanding of our research topic and
community based research. Therefore,

this initial work allowed us to develop
our ultimate objectives.
We did fieldwork that included;
observations and mapping exercises.
This initial introduction to the setting
and the hospital community assisted us
to familiarize ourselves and understand
the hospital area.
After gaining more
understanding of the hospital, we
developed surveys to conduct with the
hospital personnel and the clients of the
hospital. We created two surveys for the
clients of the hospital. One for the clients
in waiting in the emergency room and
one for the residents of the community
of Las Vegas that attended the health
clinic held in el Barrio Las Vegas. We
also created survey/interviews for the
hospital personnel to understand their
points of view on the subject.
Also, we used the USAID and
The Food and Nutrition Technical
Assistance Projects’, Food Security
Survey. This survey has been
constructed to be used in the United
States and validated for use
internationally. This survey provides the
level of food security for a person by
grouping these participants in four
categories: Food Secure, Mildly Food
Insecure, Moderately Food Insecure, and
Severely Food Insecure.
We collected the data from a
range of participants during three
hospital visits and the health clinic. At
the hospital we collected twenty-six
questionnaires and five interviews. At
the health clinic, we collected thirty-nine
of our own questionnaires, and thirty-
nine food security questionnaires, from
the residents of Las Vegas.
Finally, after collecting the data
using these instruments, we used data
analysis to draw conclusions from our
research. We used the SPSS program to
3
analyze the quantitative data through
finding frequencies, means, modes,
medians, and created graphs. We also
did qualitative analysis practices such as
code, categorizing common topics, and
created theories from the qualitative
data.
RESULTS
After collecting our data, we
organized it and received a plethora of
results. First we organized the sample
into two groups: the Health Clinic and
the Hospital. This division helped to
determine what kind of sample we were
looking at, allowing us to evaluate the
questionnaire responses according to
group. This data included information
about gender- fifty-one females and
twenty males in total of the clients’
questionnaires; age, medical insurance,
education level (for complete
demographic information used: see
appendix 1). After organizing that data
we entered the quantitative data into a
date base using SPSS Statistical Package
for Social Sciences. By doing this, we
were then able to compare the
demographic information to the
quantitative information given to us
through our questionnaires. When
looking at our data, we realized that the
information could be broken down into
three categories of results: health
conditions that were mentioned, the
manner in which they receive or would
like to receive information, and finally
the individual, socio-economic, and
environmental factors that affected these
people to practice preventive health.
Some of the questions on the
hospital client questionnaire and in the
hospital personnel interview inquired
about: a) what kind of health issues do
the participants see most often, b) what
kind of health issues do the participants

have, and c) what kind of health topics
issues do the participants see material
about prevention programming. We
received a wide range of answers from
both the hospital personnel and the
hospital clients. The top answers for the
hospital personnel were gastroenteritis,
asthma, and cardiovascular issues-
mainly hypertension. One of the
hospital personnel emphasized the fact
that gastroenteritis is one of the main
health issues that they see at the hospital.
Also, the day of the interview the
hospital personnel had mentioned that
three patients had already been treated
for gastroenteritis that same day. The
hospital personnel also mentioned
several current prevention efforts that
there are already prevention efforts for
diabetes, depression, osteoporosis, and
cardiovascular health issues. One of the
hospital personnel emphasized the need
for prevention efforts surrounding
“sexual education”. They explained that
the hospital offers services such as a free
testing clinic on Tuesday afternoons,
where the hospital will test for sexually
transmitted diseases including HIV, for
free. The hospital personnel also
specified different topics of health in
which they provided information to their
patients about. These topics included
practicing good hygiene, regular
exercise, good diet and nutrition, using
dental services, and using optometry
services.
The clients from the emergency
waiting room and the health clinic
replied to these questions with similar
answers to those of the hospital
personnel. The top three responses that
we received from the clients at the health
fair consisted of asthma, cardiovascular
issues- mainly hypertension, and
diabetes. The other responses ranged
from typical trauma type issues (cuts and
4
animals bites) to obesity, back pain, and
HIV/AIDs. They identified that they are
either experiencing these issues, believe
that they are common, or have seen or
would like to see prevention efforts for
them.
We also asked both sets of
participant the strategies in which they
have seen prevention efforts and if they
had any ideas for future strategies. The
hospital personnel answered this
question indicating that the efforts that
the hospital has now are good, but they
want more. After a question regarding
their feelings on the current hospital
health prevention efforts, one hospital
personnel answered “Excelente… muy
bien” (Excellent…very good), they then
specified that they believe that strategies
for example, “Charlas” or talks, were
good already, receiving between sixty
and seventy participants, but that they
would like to see them more often. Other
current and suggested strategies
mentioned were more health clinics,
more Mobile visits, family planning
services, suggestions by the hospital
personnel to the patients, prevention
classes in schools, free blood pressure
tests, the STD testing clinic, recreation
and sports that promote health, free
health insurance, better access to the
laboratory for testing, and more
resources for the hospital.
When the clients were asked
about the current and future prevention
strategies they answered timidly. The
responses that we received can be
summarized in the following: “Oh, I
guess more talks”, this quote suggests
that not many of the responses were
suggestive of future different strategies.
They indicated that they attended the
health clinics, talks, and read health
literature. The clients emphasized that
they enjoyed more interactive activities

when considering health prevention
strategies. Some also made a point that
they did not find the pamphlets
regarding different health conditions
were helpful or effective. The main ideas
for how to get more people to participate
in prevention efforts were television,
health promotion or television programs,
active participation, more talks, one-on-
one with doctors, health clinics with
games and food, and education in the
schools and community, (outside of the
hospital).
Socio-economic factors
One of the main problems noticed on
different interviews and questionnaires
with personnel from the hospital, was
that they identified various socio-
economics factors as why they didn’t
practice health problems prevention.
Socio-economics factors are considered
to be factors involving both social and
economic factors which can affect your
whole life in general. The most
important socio-economic factors they
identified were lack of orientation or
education, cultural problems such as
sexual taboo, no funds and access to
resources and health services.
Lack of orientation and education, is one
of the major problems because when
people are not familiar with prevention
and different health problems they just
loose interest in the matter and then
don’t get motivated to take care of
themselves. Sexual taboo, presents an
important cultural problem because it
affects the education which people
receive concerning pregnancies and
sexually transmitted diseases. It is the
problem behind unwanted pregnancies in
adolescents and people getting sexually
transmitted diseases. According to
hospital personnel, there should be more
5
sexually transmitted diseases orientation
and more sexual education in schools.
Access to resources and health services,
present an obstacle to many people who
are interested in taking care of
themselves because a person may have
the best interest in practicing prevention
but needs to have at his disposition
health services or the resources to be
able to afford or receive those services.
Lack of funds, present a problem to the
hospital and to the personnel because
they have a lot of motivation and
initiatives but are not able to realize
them because there are no resources.
If there are no funds from the
government or from other agencies to
develop and put to work prevention
programs, then all efforts are worthless.
An interesting quote from personnel
from the hospital is: “If the government
does not invest on health problem
prevention services or programs,
eventually it will finish expending more
money on health problem”. One of the
main problems also is that Puerto Rico’s
public health plan, called La Reforma,
presents a problem to people’s health
because they make it very difficult for
people to get their routine tests. Another
quote concerning this problem is “They
have to change La Reforma, there are too
much obstacles”.
The Cayey Hospital has health problems
prevention initiatives, but not
implemented programs. They do STD
(Sexually transmitted diseases) free
clinics on Tuesdays, where they make
free tests to clients. They offer chats on
different health topics and they have a
nurse which specializes on family
planning. One of the aspects that were
indicated was that the hospital is in need
of a prevention activities infrastructure,
which includes prepared personnel in
different health topics, facilities, and

good advertisement, to interest people
and at the same time diminishes health
problems which can be prevented.
Other socio-economic factors were
identified by clients of the hospital.
When clients were asked why they
thought that other people did not practice
prevention measures, they answered that
it was because of individual factors like
lack of interest, ignorance and behavior.
But, when we asked people why they
didn’t practice prevention it turned out
that it was because of socioeconomic
factors like transportation, lack of money
for medicines and food, and lack of
health insurance. Transportation
presented a problem because for
example, a person who has to go to the
hospital for a certain treatment at a
certain day or time will not have the
transportation to get there so the person
will not receive the treatment. Lack of
food and medicines presents a problem
for example for people with diabetes
because they need to eat well and get
insulin daily to keep it from turning
worst. Lack of health insurance is also a
big obstacle for people because a person
who does not have health insurance has
to pay for all the services and the
medicines and sometimes people cannot
afford it so they don’t get their medical
services like they should. All this
problems are individual factors, all result
of socio-economic factors.
Environmental Factors
In interviews and surveys done to the
hospital personnel we noticed that
environmental conditions were crucial to
the most common health problems in the
Hospital. In the hospital there are a
great number of cases in chronic asthma
and respiratory problems which are
associated with the cigar factory and the
quality of the air. There have been seen
6
numerous cases of young workers of the
factory with respiratory problems. Also,
the quality of the air because of
volcanoes and deserts dusts which arrive
to Puerto Rico and the fluctuations in
Cayey’s climate affect people’s health.
One of the most common problems in
the emergency room is one that concerns
the quality of water and foods. The
emergency room receives numerous
cases of gastrointestinal problems like,
gastritis and gastroenteritis. These cases
are commonly seen in people of all ages
but very rare in infants, because of the
type of water they consume which is
distilled. Security or quality of food and
water are determinant factors for
gastrointestinal problems because most
cases are because of food intoxication,
poisoning or for drinking contaminated
water. These factors were identified as
serious factors guilty for so many cases
of diarrhea and vomiting in the
emergency room.
CONCLUSION
During the analyzing process of
the data we found a very interesting
pattern that was seen through out the
responses of the questionnaires and the
interviews. This trend was based on how
the people were being affected by
various factors that impeded them to
practice prevention for health. We then
categorized some of the quantitative data
and quantified the qualitative responses
into three factors: individual, socio-
economic and environmental.
We gave two presentations on our
research, one to the municipality of
Cayey and to the administration of the
Hospital de Area, and another to the
residence of Las Vegas. First, we were
able give an insight on the perspectives
of prevention and what it meant to the
residence that participated in the health

fair, clients and personnel of the
hospital, on the their definition of
prevention. We were then able to bring
to the attention of the hospital and the
municipality personnel the main health
conditions that were most frequently
mentioned which the residence and
clients of the hospital suffer from.
During our presentation we were able to
the municipality and the Hospital de
Area personnel about our investigation.
FUTURE INVESTIGATIONS
The results of our inquiry have led us to
identify various aspects that could be
further studied.
Our research provided to the Hospital de
Área with preliminary baseline
information that could possibly assist the
personnel of the hospital to take the first
step in constructing an efficient program
that will teach their patients and other
people of the community about health
prevention. Our results suggested that a
possible next step to discover the
missing existing pieces to this
investigation is to further study the
effectiveness of the current health
prevention strategies and programs
efforts. Another recommendation that
can suggest a better understanding is to
do follow up studies to understand the
relationships between three factors
identified: individual, socio-economical,
and environmental. These studies can
possibly improve the effectiveness of the
current and future health prevention
efforts.
In addition, we factors that further
investigations can possibly facilitate the
community of Las Vegas can determine
an answer to why the people of this area
were demonstrating food insecurity.
Some of the pressing questions that can
be drawn are: Were these people
referring to foods that they simply
7
enjoyed to eat but did not have the
luxury to afford these extra types of
foods? Or were they referring to not
being able to have access to essential
nutritional foods? These are the
questions that should be asked in a
future investigation of Las Vegas where
the focus would be on nutrition. This
would help to explain the accumulative
number of the 50 + % of the sample of
people that expressed food insecurity.
In addition, to the food insecurity
questionnaire, another factor from our
results that stood out from our research
was the fact that several of the hospital
clientele and residence that participated
in the health fair mentioned that a main
problem that impeded them to practice
health prevention was transportation.
This could also be another possible
explanation to why people showed food
insecurity.
ACKNOWLEDGEMENTS
We would like to thank the University of
Puerto Rico at Cayey and the University
of South Florida at Tampa for hosting
the summer program Escuela de Verano:
Salud En Comunidad. We would also
like to thank the Institute of
Interdisciplinary Research at UPR
Cayey; especially our program director
Dr. Jannette Gavillán-Suárez. Also, to
the staff at the Hospital de Area en
Cayey, the clients of the hospital, and
residents of Las Vegas; Thank you so
much for your cooperation and
participation, without you our research
would not have been possible. In
addition, we would like to recognize the
National Institutes of Health (NIH-RIMI
Grant #1-P2MD001112-0), and the
American Folklife Center from the
Library of Congress for their support of
our project.

Thank you to our mentors, Federico
Cintrón-Moscoso and Orquídea Frias;
the faculty, Dr. David Himmelgreen, Dr.
Nancy Romero-Daza, Dr. Mariolga
Reyes, and Dr. Guha Shankar; and
everyone else who made this possible,
Aixa Alemán, José Alvarado, Dr. Jessica
Gaspar, Dr. Isar P. Godreau, and all the
presenters that took time to meet with us.
RESEARCH TEAM
We are students from three
different universities studying at the
Institute of Interdisciplinary Research,
University of Puerto Rico at Cayey. This
is a one month internship program part
of a five year project sponsored by the
National Institutes of Health, in which
students and faculty participate in
research concerning community health
within the municipality of Cayey, Puerto
Rico.
• Shirley Bejarano is entering her
senior year at University South Florida-
Tampa; she is Pre-Med and
Anthropology. Spanish proficiency:
native speaker.
• Glaymar Dominguez is entering
her senior year at the University of
Puerto Rico-Cayey and is studying
Biology. Spanish proficiency: native
speaker.
• Sarah Lince is a Frances Perkins
Scholar at Mount Holyoke College, also
studying Anthropology. Spanish
proficiency: intermediate.
• David Nachi is entering his fifth
year at the University of Puerto Rico-
Cayey, majoring in biology. Spanish
proficiency: native speaker.
• Abbey Wells is entering her third
year at Mount Holyoke College. She is
studying Anthropology and Film
Studies, and this is her first research
8
experience. Spanish proficiency:
intermediate.
REFERENCES
Chin, Nancy, P., Monroe, Alicia;
Fiscella, Kevin. 2000. 2000 Implications
for Institutions/Policy Issues: Social
Determinants of (Un) Healthy
Behaviors. Education for Health Vol.
13, No. 3:317-328.
Sachs, Lisbeth, 1996 Causality,
Responsibility and Blame – Core Issues
in the Cultural Construction and Subtext
of Prevention. Sociology of Health and
Illness Vol. 18, No. 5:632-652.
Porter, Dorothy 2006 How Did Social
Medicine Evolve, and Where Is It
Heading? PLOS Medicine Vol. 3, No.
10, October: 1667-1672.
WORKS CONSIDERED
Center for Disease Control website:
2007 [2005] Chronic Disease Prevention
Electronic Document,
http://www.cdc.gov/nccdphp/overview.h
tm, accessed June 20, 2007.
Castro, Arachu; Farmer, Paul 2005
Understanding and Addressing AIDS-
related Stigma: From Anthropological
Theory to Clinical Practice in Haiti.
American Journal of the Public Health
Vol. 95, No. 1: 53-58.
Messonier, Mark; Corso, Phaedra;
Teutch, Steven M.; Haddix, Anne C.;
Harris, J.R. 1999 An Ounce of
Prevention…What Are the Returns?
American Journal of Preventive
Medicine Vol. 16, No. 3: 248-262.
 9

Nizeye, Bruce; Stulac, Sara; Kashavjee,

Salmaan 2006 Structural Violence and
Clinical Medicine. PLOS Medicine Vol.
3, No. 10, October: 1686-1691.

Rylko-Bauer, Barbara; Farmer, Paul

2002 Managed Care or Managed
Inequility? A Call for Critiques of
Market-Based Medicine. Medical
Anthropology Quarterly Vol. 16, No. 4:
47.

Tables and Figures

Demographics

Health Clinic- Clients

SEX N=39
Male 14
Female 26

AGE N=39
Less than 25yrs 3
25-64 yrs 30
Greater than or equal to 65 5

Health Insurance
Private 12
Public 26
None 1

Hospital- Clients
SEX N=26
Male 4
Female 22

AGE N=26
Less than 25yrs 5
25-64 yrs 17
Greater than or equal to 65 3

Highest Education level

Elementary 4
Intermediate 2
High School 8
Bachelor/Graduate 9
 10

Patients’ responses about their health care

29.5%

22.7%

18.2%

11.4%

9.1%

4.5% 4.5%

Visit the doctor Visit the hospital Nutrition Others Take Exercises Other
regularly in case of homemade routines institutions
complications remedies

Total

Figure 1: This chart represents the total percentages of responses from the clients
(N=26) about their health care measures for themselves and their families.
(Others=visits to the pharmacy, restriction of addictions, work at a laboratory,
health-related courses, follow-up of instructions, and reading press.

High Food
Insecurity
26% Food Security
45%
Moderate Food
Insecurity
13%

Light Food
Insecurity
15%

Figure 2: This pie chart shows the results obtained at the Health Fair in Barrio Las
Vegas where the Food Insecurity was administered (N=39).
 11

Relative Frequencies of Behavioral, Individual, and Socioeconomical Barriers for Prevention in Cayey’s Municipality
Hospital

12

11

10

4 4

f inter
es t
ours f time portati
on
r food o ns policy
Lac k o o ffice h Lac k o Trans oney fo m edicati l insurance
id e rs o f m fo r a
e prov Lac k f mon
ey Medic
Servic Lac k o

Figure 3: This table of frequencies shows some aspects that impede patients to carry
on preventive measures according to the information obtained from the
Municipality Hospital Questionnaires.
 12

Methods used by patients on how they obtain health care information

20

18

15

13

11

Del médico De la familia Periódicos Programas de TV Programas radiales Otros

Relative Frequencies

Figure 4: This table of frequencies represents the common ways on how the Cayey
Municipality Hospital patients obtain their health care information.
 13

Common conditions found at the Cayey Municipality Hospital

5 5

Cardiovascular Diabetes Asthma Back pain Migrain Cholesterol Gastroenteritis

diseases

Common conditions found at the Cayey Municipality Hospital

Figure 5: This chart represents the incidence of the most common conditions found
at the Cayey Municipality Hospital.
 14

Types of treatment provided by the Cayey Municipality Hospital collected at the health fair

8 8

2 2

0
Respiratory/Asthma
Infections, Routinary
No response

Cardiovascular

Medications

Gastrointestinal
Emergencies
exams, Psychiatrist
Others: Vaccines,

problems

problems
Frequencies

Figure 6: This chart shows the most common treated problems at the Cayey
Municipality Hospital ER.
 JUNIO 2007

Perspectivas acerca
de la prevención de
© 2007 III problemas de salud
Shirley Bejarano, Glaymar Dominguez,
Sarah Lince, David Nachi,
Abbey Wells
 ¿Quiénes Somos?
„ Estudiantes de UPR-C, USF y Mount
Holyoke College

„ Curso de verano
“Salud en Comunidad”

„ Ofrecido por el Instituto de

Investigaciones Interdisciplinarias
 Objetivos

„ Explorar las perspectivas acerca de la

prevención de problemas de salud

… Los clientes del hospital

… Personal del hospital

… Residentes de Las Vegas

 Metodología

„ Trabajo de campo
„ Entrevistas
„ Desarrollo de cuestionarios para los
clientes
… Clínica de salud
… Hospital de Área de Cayey
„ Cuestionario de Inseguridad Alimenticia
 Muestra

„ En el Hospital de Área
… 26 cuestionarios a clientes
… 5 entrevistas con el personal

„ En la Clínica de Salud
… 40 cuestionarios a participantes
… Inseguridad Alimenticia
 Datos Demográficos
„ Clínica de Salud „ En el Hospital N= 26
N=40 … Sexo
… Sexo Masculino = 4
Masculino = 14 Femenino = 22
Femenino = 26 … Edad
… Edad < 25 =5
< 25 =3 25 - 64 = 17
25 – 64 = 30 > 65 =3
> 65 =5 … Nivel de Educación
… Seguro Médico Elemental =4
Privado = 12 Intermedio =2
Público = 26 Superior =8
No tiene = 1 Bachill. & Asoc. = 9
 RESULTADOS

Condiciones Mencionadas

„ Personal del „ Clínica de Salud:

Hospital:
1. Gastroenteritis 1. Asma
2. Asma 2. Cardiovascular
3. Cardiovascular (hipertensión)
(hipertensión) 3. Diabetes
RESULTADOS

Estrategias de Prevención
Personal del Hospital
„ Estrategias actuales: „ Estrategias propuestas
… Personal del hospital capacitado
en educación: salud preventiva
… Ferias de salud/ charlas
… Propuesta de educación: salud
… Unidad clínica móvil preventiva en las escuelas

… “Planificación Familiar” … Programas de recreación y

deportes para promover la salud
… Sugerencias para Clientes preventiva
 Estrategias de Prevención
Perspectivas de los clientes

„ Televisión

„ Participación activa

„ Educación en las escuelas y en

comunidades
RESULTADOS:

Factores individuales
Perspectiva de los clientes y personal
del hospital
„ ¿Por qué usted cree que las personas no
utilizan la información provista para
prevención de problemas de salud?
… Falta
de interés
… Desconocimiento
… Comportamiento
RESULTADOS:

Factores Socio-económicos
Perspectiva personal del hospital

„ Acceso a recursos y servicios de salud

„ Falta de Orientación y Educación
„ Tabú
„ Fondos
RESULTADOS:

Factores Socio-económicos
Perspectiva de clientes
“¿Cuál de los siguientes le impide llevar a
cabo actividades de prevención?”

„ Transportación

„ Falta de dinero para comida

„ Falta de dinero para medicinas

„ Falta de cubierta de salud

RESULTADOS:

Inseguridad Alimenticia
Las Vegas

52 % Inseguridad alimenticia
INSEGURIDAD

- 3 factores inseguridad ALIMENTICIA

SEVERA

severa: 26% SEGURIDAD

ALIMENTICIA

•Quedarse sin comer un INSEGURIDAD

45%

ALIMENTICIA
día o más MODERADA

•Irse a la cama con 13%

INSEGURIDAD
ALIMENTICIA
hambre BAJA
15%
•Quedarse sin comida

N = 39 personas
RESULTADOS:
Factores ambientales
Perspectiva personal de hospital

„ Cayey- gran incidencia de problemas

respiratorios
… Fábrica de cigarros
… Calidad del aire

„ Problemas gastrointestinales
… Calidad del agua
… Calidad y manejo de los alimentos
Resumen
Perspectivas personal del hospital y
clientes
Condiciones Similares
„ Asma

„ Enfermedades cardiovasculares

„ Gastroenteritis
 Futuras Investigaciones

„ Estudiar la efectividad de los programas

de prevención actuales

„ Entender la relación entre los factores

identificados (individual, socio-económico
y ambiental) para mejorar la efectividad de
los esfuerzos para prevención
 Agradecimientos

„ Instituto de Investigaciones Interdisciplinarias

„ Universidad de Puerto Rico - Cayey
„ Universidad del Sur de la Florida
„ American Folklife Center
„ NIH - National Institutes of Health
„ Hospital de Área de Cayey
„ Comunidad del Barrio Las Vegas
„ Municipio de Cayey
¡Gracias por su atención!

¿Alguna pregunta?
Texto Presentación Oral “Perspectivas acerca de la prevención de problemas de salud”

¿Quiénes somos?
Nosotros somos estudiantes de la Universidad de Puerto Rico en Cayey, la Universidad
del Sur de la Florida, y Mount Holyoke. Nuestra investigación es parte del curso de
verano, “Salud en Comunidad”, ofrecido por el Instituto de Investigaciones
Interdisciplinarias en la UPR-Cayey.

Objetivos
¿Cuáles son las perspectivas acerca de prevención de asuntos de salud de los
clientes del hospital, los clientes en el barrio Las Vegas que participaron en la feria de
salud y el personal del hospital?
Presentar la información al Hospital de Área y a la comunidad del Barrio Las
Vegas

[Según la ONU (Organización de Naciones Unidas) prevención es la adopción de

medidas encaminadas a impedir que se produzcan deficiencias físicas, mentales y
sensoriales o a impedir que las deficiencias, cuando se han producido, tengan
consecuencias físicas, psicológicas y sociales negativas».]

Procedimiento
En esta sección, les explicaremos las diferentes partes de nuestro procedimiento,
de las cuales recopilamos información para la investigación.
Primero, hicimos trabajo de campo basado en observaciones, y un mapa de los
alrededores del hospital. Esto nos permitió familiarizarnos con el área y medio ambiente
del hospital.
Segundo, utilizamos entrevistas con el personal del hospital para enfocar la
investigación y así entender nuestro tema.
Tercero, desarrollamos dos cuestionarios para los clientes. Uno para los clientes
del Hospital de Área en la Feria de Salud del 16 de junio y uno para los clientes del
Hospital de Área en la Sala de Emergencia.
Además, usamos el cuestionario de “Inseguridad Alimenticia” en la Feria de
Salud con los clientes de Las Vegas. Este es un cuestionario que fue desarrollado por
USAID y el “Proyecto de asistencia técnica sobre comida y nutrición” y es utilizado en
los Estados Unidos y válido a nivel internacional.
Finalmente, analizamos los datos y los estamos presentando a ustedes.

Demográficos
Nosotros usamos datos que recopilamos en la Feria de Salud y en el Hospital de
Área.
En el Hospital, recopilamos:
25 cuestionarios de los clientes
5 entrevistas de personales del hospital
En la Feria de Salud, recopilamos:
40 cuestionarios de los clientes
40 cuestionarios de “Inseguridad Alimenticia”
Fuera de estos datos:
XX fueron mujeres, y XX fueron hombres
Las edades están en un intervalo de XX a XX

Métodos

Nosotros usamos
1. Entrevistas para enfocar la investigación, entender nuestro tema.
2. Completamos Trabajo de campo, como observaciones y un ejercicio de
“mapping”, familiarizarnos con el área y medio ambiente del hospital.
3. Desarrollamos los cuestionarios para las personas que asistieron la Feria de Salud
en el barrio Las Vegas, el 16 de junio; y para los pacientes en el Hospital de Área.
Desarrollamos cuestionarios para los profesionales de salud en el hospital.
4. Después, nosotros Recolectamos los datos
a. En la Feria de Salud hicimos
i. 40 Cuestionarios/Entrevistas con las personas en la Feria de Salud
b. En el Hospital hicimos
i. 25 Cuestionarios/Entrevistas con las pacientes en la Sala de
Emergencia
ii. 4 entrevistas con los profesionales de salud
5. Finalmente, analizamos los datos.
a. Analizamos datos cualitativos de
i. Las entrevistas
• y b. Analizamos datos cuantitativos con utilizando el programa estadístico
“SPSS”
ii. las Frecuencias
iii. y las Gráficas

Resultados

Ahora le vamos a hablar de lo descubierto después de analizar toda la información

cuidadosamente. Los factores identificados para prevención o cómo las personas se
expresan sobre como prevenir problemas de salud los dividimos en factores individuales,
estructurales y ambientales. También les hablaremos sobre las maneras más efectivas de
acuerdo a los pacientes entrevistados, para llevarles el mensaje de prevención de
problemas de salud. Por último, veremos los temas más significativos de prevención.

Perspectiva de los profesionales de la salud - Factores individuales

• Esta cita, explica uno de los grandes problemas ante la prevención. Mencionada
por varios profesionales de la salud “los pacientes no se motivan a practicar
prevención”.
• “La educación lo es todo” es otra cita la cual demuestra el problema que
presenta no orientarse en varios aspectos de la salud.
 • Otro problema es la higiene lo cual significa que varios de los problemas
ocurridos son por falta de limpieza, calidad o contaminación de agua y comida.

There is a tendency to approach prevention in public health by focusing on individual

patient factors/issues. Sometimes health issues are also connected to socio-economic
factors. We noticed that participants in our research –both clients and hospital personnel
talked about prevention from both perspectives in different ways

Perspectiva de los clientes - Observamos en al grafica porque las personas no practican

medidas de prevención.

Perspectiva de los profesionales de la salud – Factores Estructurales

• Educación: Falta de orientación o información lleva a falta de interés y por lo

tanto de motivación (Como se puede apreciar en la grafica mostrada en el slide
anterior).
• Condiciones socio-económicas de los clientes del hospital afectan la calidad de
comida, agua o vida en general. Logrando que la población sea mas susceptible a
enfermedades.
• Problemas culturales como el taboo al tema del sexo por lo cual ocurren tantos
embarazos no deseados en adolescentes. También orientar en el tema de
enfermedades venéreas para evitar contagios por falta de orientación. También se
necesita mas educación sexual en las escuelas que es donde más se ven los
problemas mencionados.
• Para hablar de los factores políticos voy a citar a una persona que dijo “Tienen
que cambiar la reforma de salud “/“Hay muchos obstáculos” porque presenta
un problema para la salud ya que las personas no se hacen estudios rutinarios por
lo complicado que se les hace llegar a ellos.
• Otra cita interesante es “Si el gobierno no invierte en sistemas o programas de
prevención, a la larga terminaran gastando mas en problemas de salud.”
Porque presenta un posible problema si no se hacen programas efectivos para
prevenir enfermedades.
• Hace falta una infraestructura de actividades de prevención, con personas
preparadas en varios temas, facilidades y buena propaganda para llevar a cabo el
propósito de disminuir problemas de salud que son prevenibles.
• El hospital tiene iniciativas, pero no programas implantados, como las clínicas de
enfermedades venéreas todos los martes en las que hacen pruebas gratis aunque
no muchos asisten, las charlas a las que asiste un gran numero de personas y una
enfermera que se ocupa de planificación familiar de jóvenes embarazadas.

Perspectiva de los clientes – Factores Estructurales

• Primero les explico esta gráfica la cual demuestra cuáles son los obstáculos más
comunes por lo cual los pacientes no practican prevención. (CHART)
 • Uno de los pacientes mencionó “Uso el hospital Menonita porque no hacen
falta tantos requisitos como en el Hospital de Área”

Entre los problemas ambientales identificados por los profesionales de la salud del
hospital - Factores ambientales

• Podemos ver el problema de asma crónica y las causas de problemas respiratorios

asociados con: ;a fábrica de tabacos y la calidad del aire. Se han visto varios
casos de trabajadores jóvenes de la fábrica con problemas respiratorios. También,
la calidad del aire en Cayey dado a los polvos de volcanes/desiertos que llegan a
P.R. y las fluctuaciones del tiempo.
• También, vemos que hay problemas gastrointestinales muy comunes por la
calidad del agua y la seguridad o calidad alimenticia. Estos fueron identificados
como graves factores por los altos casos de vómitos y diarreas en la Sala de
Emergencia.

• Para hablar de los factores políticos voy a citar a una persona que dijo “Tienen
que cambiar la reforma de salud “/“Hay muchos obstáculos” porque presenta
un problema para la salud ya que las personas no se hacen estudios rutinarios por
lo complicado que se les hace llegar a ellos.
• Otra cita interesante es “Si el gobierno no invierte en sistemas o programas de
prevención, a la larga terminaran gastando mas en problemas de salud.”
• Porque presenta un posible problema si no se hacen programas efectivos para
prevenir enfermedades.
• Hace falta una infraestructura de actividades de prevención, con personas
preparadas en varios temas, facilidades y buena propaganda para llevar a cabo el
propósito de disminuir problemas de salud que son prevenibles.
• El hospital tiene iniciativas, pero no programas implantados, como las clínicas de
enfermedades venéreas todos los martes en las que hacen pruebas gratis aunque
no muchos asisten, las charlas a las que asiste un gran numero de personas y una
enfermera que se ocupa de planificación familiar de jóvenes embarazadas.

Inseguridad Alimenticia

• Muchos de los clientes y también el personal del hospital identificaron en

particular factores socio-económicos como la alimentación y la relación con la
prevención de problemas de salud –por ejemplo falta de dinero para comida.
También, mencionaron la nutrición y la buena comida como parte importante para
mantener la salud.

• En la encuesta sobre seguridad alimenticia se administró un cuetionarrio que se

llama: “Escala de Seguridad Alimenticia a Nivel del Hogar”. Lo administramos
en la Clínica de Salud en Las Vegas a 39 personas.
 • Según USAID, la seguridad alimenticia se define : “A cualquier persona, a
cualquier tiempo, tiene acceso fisicamente y económico a comida suficiente para
satisfacer sus necesidades para una vida productiva y saludable”. Los resultados
de este cuestionario muestran una medida de los niveles de inseguridad
alimenticia en un rango que va desde ‘tener ansiedad o preocupación por falta de
comida’ a ‘no tener comida de suficiente calidad’ a –lo mas severo: ‘no tener
regularmente acceso fisico a comida’.

• En esta gráfica se muestra que poco más del cincuenta porciento (50%) de los
participantes mostraban signos de inseguridad alimenticia. Y que el 26% se
identificó como “inseguro en cuanto a su comida” por los 3 factores: que se
muestran en la figura.

Temas de Prevención: Pacientes/Clientes

• En esta tabla vemos las condiciones mas frecuentes de salud en los pacientes del
Hospital
• Nos sirve para determinar para que condiciones son más necesarios los programas
de prevención.

Agradecimientos

Gracias - Muchas gracias por venir a nuestra presentación. Esperamos que haya sido de
su agrado y que les sirva de provecho. ¿Alguna pregunta? Buenas Tardes a todos.

©2007 Instituto de Investigaciones Interdisciplinarias