umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
San Sebastian, MiguelORCID iD iconorcid.org/0000-0001-7234-3510
Alternative names
Publications (10 of 161) Show all publications
Wagenius, C. M., San Sebastian, M., Gustafsson, P. E. & Goicolea, I. (2019). Access for all?: Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden. Scandinavian Journal of Public Health, 47
Open this publication in new window or tab >>Access for all?: Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden.

METHODS: The study used data from the Health on Equal Terms survey (age group 16-24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables.

RESULTS: Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services.

CONCLUSIONS: These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.

Keywords
Inequity, Sweden, access to healthcare, youth
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150573 (URN)10.1177/1403494818774965 (DOI)000458888900001 ()29779450 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-04-16Bibliographically approved
Gaitonde, R., Muraleedharan, V. R., San Sebastian, M. & Hurtig, A.-K. (2019). Accountability in the health system of Tamil Nadu, India: exploring its multiple meanings. Health Research Policy and Systems, 17, Article ID 44.
Open this publication in new window or tab >>Accountability in the health system of Tamil Nadu, India: exploring its multiple meanings
2019 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 17, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: Accountability is increasingly being demanded of public services and is a core aspect of most recent frameworks of health system strengthening. Community-based accountability is an increasingly used strategy, and wasa core aspect of India's flagship National Rural Health Mission (NRHM; 2005-2014). Research on policy implementation has called for policy analysts to go beyond the superficial articulation of a particular policy intervention to study the underlying meaning this has for policy-makers and other actors of the implementation process and to the way in which problems sought to be addressed by the policy have been identified and problematised'.

Methods: This research, focused on state level officials and health NGO leaders, explores the meanings attached to the concept of accountability among a number of key actors during the implementation of the NRHM in the south Indian state of Tamil Nadu. The overall research was guided by an interpretive approach to policy analysis and the problematisation lens. Through in-depth interviews we draw on the interviewees' perspectives on accountability.

Results: The research identifies three distinct perspectives on accountability among the key actors involved in the implementation of the NRHM. One perspective views accountability as the achievement of pre-set targets, the other as efficiency in achieving these targets, and the final one as a transformative process that equalises power differentials between communities and the public health system. We also present the ways in which these differences in perspectives are associated with different programme designs.

Conclusions: This research underlines the importance of going beyond the statements of policy to exploring the underlying beliefs and perspectives in order to more comprehensively understand the dynamics of policy implementation; it further points to the impacts of these perspectives on the design of initiatives in response to the policy.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Accountability, Community-based accountability, National Rural Health Mission, Belief structures, problematisation, Policy implementation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-159067 (URN)10.1186/s12961-019-0448-8 (DOI)000466190800001 ()31029173 (PubMedID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
Mathias, K., Kermode, M., San Sebastian, M., Davar, B. & Goicolea, I. (2019). An asymmetric burden: experiences of men and women as caregivers of people with psycho-social disabilities in rural North India. Transcultural Psychiatry, 56(1), 76-102
Open this publication in new window or tab >>An asymmetric burden: experiences of men and women as caregivers of people with psycho-social disabilities in rural North India
Show others...
2019 (English)In: Transcultural Psychiatry, ISSN 1363-4615, E-ISSN 1461-7471, Vol. 56, no 1, p. 76-102Article in journal (Refereed) Published
Abstract [en]

Caring for a family member with a psycho-social disability can be both rewarding and burdensome. This study analyses the experiences of caregivers of people with psychosocial disabilities (PPSDs) in rural communities in North India using relational gender theory. In-depth interviews with 18 female and male caregivers of PPSDs probed the social, emotional and health impacts of their caregiving role. Nine themes were identified that were grouped under three meta-themes: intra-personal, inter-personal and institutional impacts. Under the intra-personal meta-theme, all caregivers experienced high tension, with women describing almost overwhelming stress. Women minimised their role as caregivers, and felt negative and hopeless about their futures, while men had a more positive view of the future and themselves. Embodied experiences of psychological and social distress were consistently described by women, but not by men. Within the interpersonal meta-theme, men experienced opportunity for social connection and social support that was seldom available to women. Interpersonal violence with other household members was described by both men and women. Within the institutional meta-theme, both men and women described strength in unity, and gestures leading to the reordering of gender relations. These findings underline the significant and diffuse impacts of a gender order that values males and disadvantages females as caregivers of PPSDs, with the asymmetry of a greater burden for women. The findings point to the urgent need for global mental health policies that support and empower caregivers and that strengthen gender equality.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
India, caregiver burden, gender, gender inequality, global mental health, psycho-social disability, qualitative
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Identifiers
urn:nbn:se:umu:diva-154005 (URN)10.1177/1363461518792728 (DOI)000454141000004 ()30141376 (PubMedID)
Note

Article first published online: August 24, 2018

Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-01-15Bibliographically approved
San Sebastian, M., Vives-Cases, C. & Goicolea, I. (2019). "Closer to the Unfair Reality": Magnitude and Spatial Analysis of Femicides in Ecuador. Journal of Interpersonal Violence, Article ID UNSP 0886260519863721.
Open this publication in new window or tab >>"Closer to the Unfair Reality": Magnitude and Spatial Analysis of Femicides in Ecuador
2019 (English)In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, article id UNSP 0886260519863721Article in journal (Refereed) Epub ahead of print
Abstract [en]

During the last 5 years, Ecuador has published a series of progressive laws aiming to protect girls and women against any type of violence. While these efforts are of extreme importance, concerns were raised by national nongovernmental organizations that the official numbers might be biased due to the restricted definition of femicide applied. The main objective of this study was to assess the magnitude and spatial distribution of the femicide rate by province in Ecuador in 2017. Data on cases were collected by a national network of nongovernmental organizations. Age-specific population data were obtained from the National Institute of Statistics for the year 2017. Thematic maps of overall and age-specific femicide rates were also constructed. Moran's index was used to identify clusters of provinces with similar risks for the occurrence of the outcome. The total number of femicides during 2017 was 155, but age could not be recorded in 9 of those cases. More than one-third of the cases (36.99%) occurred in young women aged 15 to 24 years. The total rate was 1.99/100,000 women. When the femicide definition was restricted to women 15 years and above, the total rate increased to 2.41 cases/100,000. The femicide rate in Orellana boosted to 10.21 cases/100,000 in the age group of 15 years and older, the highest in the country. No pattern of spatial autocorrelation was observed. Femicides in Ecuador is a big public health problem, particularly in certain Amazon provinces. The observed rate for women above the age of 15 years (2.41) places Ecuador among the countries in the Latin American and the Caribbean region with the highest femicide rates. While progressive policies have been implemented in the last years, more educational interventions are needed at all societal levels to eradicate this kind of violence.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2019
Keywords
femicide, domestic violence, violence exposure, Ecuador
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162331 (URN)10.1177/0886260519863721 (DOI)000478286300001 ()31313622 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-16
San Sebastian, M., Mosquera, P. A. & Gustafsson, P. E. (2019). Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis. BMC Public Health, 19, Article ID 202.
Open this publication in new window or tab >>Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 202Article in journal (Refereed) Published
Abstract [en]

Background: Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987-2013.

Methods: An ecological controlled interrupted time series design, with pre-intervention period defined as 1987-1993 and post-intervention period 1994-2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers.

Results: Impressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences.

Conclusions: Taken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Ischemic heart disease, Morbidity, Mortality, Interrupted time series analysis, Intervention, Northern Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-157210 (URN)10.1186/s12889-019-6514-x (DOI)000459132800003 ()30770750 (PubMedID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
Estalella, I., San Millán, J., Trincado, M. J., Maquibar, A., Martínez-Indart, L. & San Sebastian, M. (2019). Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay. Women and Birth
Open this publication in new window or tab >>Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay
Show others...
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed) In press
Abstract [en]

BACKGROUND: Late-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.

OBJECTIVE: The aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.

METHODS: The intervention was designed to promote parents' education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n=212) and an intervention group (n=161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.

RESULTS: Infants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p=0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p=0.009).

CONCLUSION: The intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Breast feeding, Hospital stay, Late preterm infant, Nursing care, Quasi experimental
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158190 (URN)10.1016/j.wombi.2018.11.003 (DOI)30527733 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-24
Szilcz, M., Mosquera, P., San Sebastian, M. & Gustafsson, P. E. (2019). Income inequalities in leisure time physical inactivity in northern Sweden: a decomposition analysis. Scandinavian Journal of Public Health
Open this publication in new window or tab >>Income inequalities in leisure time physical inactivity in northern Sweden: a decomposition analysis
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: Increasing income inequalities in leisure time physical inactivity have been reported in the relatively socially equal setting of northern Sweden. The present report seeks to contribute to the literature by exploring the contribution of different factors to the income inequalities in leisure time physical inactivity in northern Sweden.

METHODS: This study was based on the 2014 Health on Equal Terms survey, distributed in the four northernmost counties of Sweden. The analytical sample consisted of 21,000 respondents aged 16-84. Six thematic groups of explanatory variables were used: demographic variables, socioeconomic factors, material resources, family-, psychosocial conditions and functional limitations. Income inequalities in leisure time physical inactivity were decomposed by Wagstaff-type decomposition analysis.

RESULTS: Income inequalities in leisure time physical inactivity were found to be explained to a considerable degree by health-related limitations and unfavourable socioeconomic conditions. Material and psychosocial conditions seemed to be of moderate importance, whereas family and demographic characteristics were of minor importance.

CONCLUSIONS: This study suggests that in order to achieve an economically equal leisure time physical inactivity, policy may need to target the two main barriers of functional limitations and socioeconomic disadvantages.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Decomposition analysis, income, inequalities, leisure time physical inactivity, northern Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-158197 (URN)10.1177/1403494818812647 (DOI)30632908 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-08-15
Eid, D., San Sebastian, M., Hurtig, A.-K. & Goicolea, I. (2019). Leishmaniasis patients' pilgrimage to access health care in rural Bolivia: a qualitative study using human rights to health approach. BMC International Health and Human Rights, 19(1), Article ID 12.
Open this publication in new window or tab >>Leishmaniasis patients' pilgrimage to access health care in rural Bolivia: a qualitative study using human rights to health approach
2019 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 19, no 1, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Leishmaniasis is a neglected tropical disease endemic in Bolivia that disproportionately affects people with little social and political capital. Although the treatment is provided free of charge by the Bolivian government, there is an under-utilization of treatments in relation to the estimated affected population. This study explores the experiences of patients with leishmaniasis and the challenges faced when searching for diagnosis and treatment in Bolivia using a human rights approach.

Methods: We conducted open-ended interviews with 14 participants diagnosed with leishmaniasis. The qualitative data were analysed using thematic analysis and were interpreted under a human rights approach to health care.

Results: Four themes emerged during data analysis: (1) the decision for seeking a cure takes time; (2) the severity of symptoms and disruption of functioning drives the search for Western medicine; (3) the therapeutic journey between Western and traditional medicine; and (4) accessibility barriers to receive adequate medical treatment. This study showed that access to health care limitations were the most important factors that prevented patients from receiving timely diagnosis and treatment. Cultural factors played a secondary role in their decision to seek medical care.

Conclusions: Accessibility barriers resulted in a large pilgrimage between public health care and traditional medicinal treatments for patients with leishmaniasis. This pilgrimage and the related costs are important factors that determine the decision to seek health care. This study contributes to the understanding of the under-utilisation problems of medical services in leishmaniasis and other similar diseases in remote and poor populations.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Cutaneous leishmaniasis, human rights, health care, seeking behavior, Bolivia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-156786 (URN)10.1186/s12914-019-0196-4 (DOI)000460652900002 ()30837001 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency, 75000554
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-04-08Bibliographically approved
Hernandez, A., Lorena Ruano, A., Hurtig, A.-K., Goicolea, I., San Sebastian, M. & Flores, W. (2019). Pathways to accountability in rural Guatemala: a qualitative comparative analysis of citizen-led initiatives for the right to health of indigenous populations. World Development, 113, 392-401
Open this publication in new window or tab >>Pathways to accountability in rural Guatemala: a qualitative comparative analysis of citizen-led initiatives for the right to health of indigenous populations
Show others...
2019 (English)In: World Development, ISSN 0305-750X, E-ISSN 1873-5991, Vol. 113, p. 392-401Article in journal (Refereed) Published
Abstract [en]

Strengthening citizen-led accountability initiatives is a critical rights-based strategy for improving health services for indigenous and other marginalized populations. As these initiatives have gained prominence in health and other sectors, there is great interest in how they operate and what makes them effective. Scholarly focus is shifting from measuring the efficacy of their tools and tactics to deepening understanding of the context-sensitive pathways through which change occurs. This paper examines how citizen-led initiatives' actions to strengthen grassroots networks, monitor health services and engage with authorities interact with local sociopolitical conditions and contribute to accountability achievements for indigenous populations in rural Guatemala. We used qualitative comparative analysis to first systematize and score structured qualitative monitoring data gathered in 29 municipal-level initiatives, and then analyze patterns in the presence of different forms of citizen action, contextual conditions and accountability outcomes across cases. Our study identifies pathways of collective action through which citizen-led initiatives bolster their power to engage and negotiate with authorities and bring about solutions to some of the health system deficiencies that they face. While constructive engagement is widely advocated as the most effective approach to interaction with authorities, our study indicates that success depends on wider processes of community mobilization. To overcome the power asymmetries that marginalized groups face when engaging with authorities, iterative processes of network building and participatory monitoring as well as persistence in their demands are critical. These processes further provide an enabling environment for moving beyond the local and projecting indigenous voices to engage with authorities at higher governance levels. Initiatives also applied adversarial legal action as an alternative engagement strategy that contributed to bolster citizen power. Our findings indicate the potential of collective power generated by the actions of citizen-led initiatives to enable marginalized populations to hold authorities accountable for health system failures. 

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Accountability, Health system, Indigenous peoples, Qualitative comparative analysis, Guatemala
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:umu:diva-153629 (URN)10.1016/j.worlddev.2018.09.020 (DOI)000449310800029 ()
Funder
Swedish Research Council, 2015-05898
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Mamani-Ortiz, Y., San Sebastian, M., Armaza, A. X., Luizaga, J. M., Illanes, D. E., Ferrel, M. & Mosquera, P. (2019). Prevalence and determinants of cardiovascular disease risk factors using the WHO STEPS approach in Cochabamba, Bolivia. BMC Public Health, 19, Article ID 786.
Open this publication in new window or tab >>Prevalence and determinants of cardiovascular disease risk factors using the WHO STEPS approach in Cochabamba, Bolivia
Show others...
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 786Article in journal (Refereed) Published
Abstract [en]

Background: Cardiovascular diseases (CVDs) are considered the number one cause of death worldwide, especially in low- and middle-income countries, Bolivia included. Lack of reliable estimates of risk factor distribution can lead to delay in implementation of evidence-based interventions. However, little is known about the prevalence of risk factors in the country. The aim of this study was to assess the prevalence of preventable risk factors associated with CVDs and to identify the demographic and socioeconomic factors associated with them in Cochabamba, Bolivia.

Methods: A cross-sectional community-based study was conducted among youth and adults (N = 10,704) with permanent residence in Cochabamba, selected through a multistage sampling technique, from July 2015 to November 2016. An adapted version of the WHO STEPS survey was used to collect information. The prevalence of relevant behavioural risk factors and anthropometric measures were obtained. The socio-demographic variables included were age, ethnicity, level of education, occupation, place of residence, and marital status. Proportions with 95% confidence intervals were first calculated, and prevalence ratios were estimated for each CVD risk factor, both with crude and adjusted models.

Results: More than half (57.38%) were women, and the mean age was 37.89 ± 18 years. The prevalence of behavioural risk factors were: current smoking, 11.6%; current alcohol consumption, 42.76%; low consumption of fruits and vegetables, 76.73%; and low level of physical activity, 64.77%. The prevalence of overweight was 35.84%; obesity, 20.49%; waist risk or abdominal obesity, 54.13%; and raised blood pressure, 17.5%. Indigenous populations and those living in the Andean region showed in general a lower prevalence of most of the risk factors evaluated.

Conclusion: We provide the first CVD risk factor profile of people living in Cochabamba, Bolivia, using a standardized methodology. Overall, findings suggest that the prevalence of CVD risk factors in Cochabamba is high. This result highlights the need for interventions to improve early diagnosis, monitoring, management, and especially prevention of these risk factors.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
WHO STEPS approach, Cardiovascular risk factors, Obesity, Hypertension, Tobacco, Alcohol, Bolivia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-161716 (URN)10.1186/s12889-019-7064-y (DOI)000472845800006 ()31221119 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-11-05Bibliographically approved
Projects
Applying an equity lens to cardiovascular disease prevention in northern Sweden [2014-00451_Forte]; Umeå UniversityApplying systems thinking tools to strengthen health system accountability to marginalized populations in Guatemala [2015-05898_VR]; Umeå UniversityCan mental health and health care be promoted among young prisoners in Cambodia? An intervention study [2017-05441_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7234-3510

Search in DiVA

Show all publications