RESUMO
Introducción: La sexualidad y la salud sexual de las personas adultas mayores es una dimensión invisible en la prestación de los servicios de salud. Debido a esto, es importante conocer las percepciones y dificultades del personal de salud para brindar esta atención. Objetivo: Identificar diferencias y similitudes en la percepción que tienen los proveedores de servicios de salud en Colombia sobre la sexualidad y la salud sexual en el adulto mayor. Metodología: Se realizaron 5 grupos focales en Bogotá, Barranquilla, Cali y Medellín donde participaron 19 profesionales de la salud de una institución prestadora de servicios de salud sexual y reproductiva. Resultados: Los profesionales de la salud reconocen la sexualidad como un aspecto importante en la prestación de los servicios de salud en las personas mayores, a pesar de la invisibilidad actual del tema en la atención médica. Reconocen la complejidad de hablar sobre sexualidad en la interacción médico-paciente, en parte por la falta de entrenamiento de los profesionales de la salud y por las propias inhibiciones de los pacientes. Discusión: Persisten obstáculos sociales y teóricos para abordar los temas de sexualidad en consulta, al igual que diferencias de género para el tratamiento de temas de sexualidad y salud sexual. Conclusiones: Los prestadores de servicios de salud son claves para remover barreras a la atención, acompañamiento y comprensión de la salud sexual y la sexualidad de las personas mayores.
Introduction: The sexuality and sexual health of older people is an invisible dimension in the provision of health services. Therefore, it is important to know the perceptions and difficulties of health personnel to provide this care. Objective: To identify differences and similarities in the perception that health service providers in Colombia have about sexuality and sexual health in the elderly. Methodology: A total of 5 focus groups were held in Bogotá, Barranquilla, Cali and Medellín with the participation of 19 health professionals from an institution that provides sexual and reproductive health services. Results: Health professionals recognize sexuality as an important aspect in the provision of health services in the elderly, despite the current invisibility of the issue in medical care. They recognize the complexity of talking about sexuality in the doctor-patient interaction, partly due to the lack of training of health professionals, and due to the patients' own inhibitions. Discussion: Social and theoretical obstacles persist to address sexuality issues in consultation, as well as gender differences for the treatment of sexuality and sexual health issues. Conclusions: Health service providers are key to removing barriers to care, accompaniment and understanding of the sexual health and sexuality of the elderly.
RESUMO
The non-governmental organisation Profamilia developed and implemented medical abortion through telemedicine in response to the Covid-19 pandemic. This service is now integrated as an alternative to in-person care and available to abortion-seekers across Colombia. Previous research has emphasised bottlenecks in abortion provision, but less is known about implementation processes and experiences. We assessed the feasibility and acceptability of telemedicine for medical abortion from the perspectives of key informants involved in the implementation in Colombia. We conducted 15 in-depth interviews with healthcare professionals, coordinators and support staff implementing telemedicine for medical abortion in the early phase of implementation, between March and October 2021. We analysed the data using the framework method and applied the normalisation process theory in our analysis and interpretation of findings. Our findings show that strong leadership, organisational efforts on pre-implementation training, monitoring and evaluation, and collaboration between diversely skilled and experienced providers are essential for successful implementation. Participants were generally positive towards the use of telemedicine for medical abortion; concerns related to effectiveness, safety and safeguarding existed mainly among providers with less clinical experience. We identified contextual barriers, such as social opposition, regulatory barriers, providers' unavailability, and poor phone and internet connections in rural areas, which impacted the feasibility of the intervention negatively. In conclusion, to ensure stakeholders' buy-in and for the service to reach all abortion seekers in need, future implementation endeavours must address concerns about safety and effectiveness, and tackle identified contexual barriers.Plain Language SummaryIn telemedicine for medical abortion, all or some components of abortion care, such as initial consultations, home delivery of abortion medication, and post-abortion follow up are provided with the use of telecommunications. Telemedicine for medical abortion has been shown to be a safe and effective form of service delivery.In this study, we interviewed 15 healthcare providers and staff involved in the implementation of a telemedicine service for medical abortion in Colombia to determine whether they deemed the service to be acceptable and feasible. We found that collaboration between providers of different backgrounds and levels of experience, appropriate training and strong leadership were key factors for successfully implementing the service. However, some healthcare providers, especially those with less clinical experience, were concerned that telemedicine for medical abortion may not be safe and may risk the health and well-being of abortion-seekers. Further, social opposition to abortion, unclear regulation and limited access to technology were identified as barriers that need to be addressed to ensure the service reaches all abortion-seekers in need.In conclusion, despite contextual barriers and some provider's concerns about medical safety, telemedicine for medical abortion was viewed as a positive and feasible form of service delivery in Colombia.