Expectations of health care quality among rural Maya villagers in Solol\xe1 Department, Guatemala: a qualitative analysis

Matthew Ippolito,Michael Daniel,Anita Chary,Michelle Eakin,Anne Monroe,Joaquin Barnoya

doi:10.1186/s12939-017-0547-5

Abstract

BackgroundIndigenous populations in Latin America have worse health outcomes than their nonindigenous counterparts. Differences in access to and use of biomedical resources may explain some of the observed disparities. Efforts to address these differences could be aided in part by better understanding the socio-medical contexts in which they occur.MethodsWe performed a qualitative analysis of field notes collected during a 2008 program evaluation of a health post in a rural Maya village in Sololá Department, Guatemala. Forty-one interviews were conducted among a community-based convenience sample of adult men and women. Interviews focused on experiences, perceptions, and behaviors related to the local biomedical and ethnomedical health care resources.ResultsPenetrance of the local health post was high, with most (90%) of respondents having accessed it within the prior five years. The prevailing attitude toward the health post was positive. We identified facilitators and barriers to health post use that corresponded with three thematic areas: clinic operations, visits and consultations, and medical resources. Proximity to the home, free consultations and medications, and social support services were among the most commonly cited facilitators. Barriers included limited clinic hours, medication stock-outs, provision of care that did not meet patient expectations, and unavailability of diagnostic tests.ConclusionsIn a rural Maya community in Guatemala, operational and quality-based factors, independent of sociocultural considerations, informed the perception of and decision to access biomedical resources. Interventions that address these factors may increase health care utilization and alleviate some of the health disparities that accompany indigeneity in Guatemala and similar contexts.

Highlights

Indigenous populations in Latin America have worse health outcomes than their nonindigenous counterparts
Latin America is home to indigenous groups that fare worse than their nonindigenous counterparts by several socioeconomic determinants: there are large gaps in earnings, educational achievement, life expectancy, and maternal-child health outcomes [1]
Life expectancy countrywide for Maya peoples, who account for the majority of the indigenous population in Guatemala, is 13 years lower than among the non-indigenous population, rates of maternal mortality are up to four times higher, and childhood stunting is 50% more prevalent [3]

Summary

Introduction

Indigenous populations in Latin America have worse health outcomes than their nonindigenous counterparts. Life expectancy countrywide for Maya peoples, who account for the majority of the indigenous population in Guatemala, is 13 years lower than among the non-indigenous population, rates of maternal mortality are up to four times higher, and childhood stunting is 50% more prevalent [3]. Efforts to address these health disparities could be helped in part by elucidation of the sociomedical contexts in which they occur. Biomedical health services are underutilized worldwide, and in Latin America even more so than other low- and middle-income countries [6]

Methods

Results

Conclusion