Person: Cabieses, Báltica
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Publication Exploring the characteristics of cancer-centred civil society organisations in Chile: A qualitative study(2025) Roberts, Antonia; Vezzani, Francisca; Cabieses, Báltica; Obach, Alexandra; Campaña, Carla; Espinoza, ManuelBackground: In Chile, civil society organisations in health have been historically active in population health and specifically in cancer; they have had an important role in addressing patients' and families' necessities. Although they occupy a central role, there is no clarity about who they are, how they are organised, the goals that guide their performance and how they materialize social participation in health. Based on that, this study aimed to explore the characteristics of civil society organisations that work in cancer in Chile and to identify the networks they build with other actors to achieve their goals. Materials and methods: Qualitative case study using semi-structured online interviews with organisation representatives, politicians, decision-makers and academics related to cancer in Chile. Content analysis was performed, admitting emerging categories from the participants' narratives. Results: Three main profiles of organisations were identified: (i) Long-established organisations focused on influencing public policy and decision-making in cancer, (ii) Growing organisations focused on informing and supporting families and patients, (iii) Newly established organisations focused on patient well-being, such as sports activities. Relationships between groups and other actors involve perceived benefits like the growth of the organisations and funding for activities. However, perceived barriers and inequities are also identified, mainly lack of financial resources, competition between organisations and insufficient information. Discussion: The objectives of civil society organisations in cancer are diverse and reflect multiple ways of practising social participation in health. Tensions generate unequal participation and missed opportunities to promote public health in cancer in Chile. The study highlights the importance of recognising cancer social organisations as essential actors in public health. It is crucial to involve them in formulating and implementing comprehensive responses to maximise the opportunities for progress in this field.Publication Barriers and facilitators to access sexual and reproductive health services among young migrants in Tarapacá, Chile: a qualitative study(2024) Obach, Alexandra; Blukacz, Alice; Sadler, Michelle; Carreño Calderón, Alejandra; Cabieses, Báltica; Carolina DíazBackground: Chile has become a destination country for immigrants from Latin America, including youth. Guaranteeing access and use of sexual and reproductive health services for young migrants is crucial because of their overlapping experiences of transitioning to a new country and to adulthood. However, the existing evidence shows barriers to accessing sexual and reproductive healthcare among young migrant populations. In this context, the main objective of this article is to identify the barriers and facilitators that young migrants experience to access sexual and reproductive healthcare in the Tarapacá region of Chile. Methods: A qualitative study was conducted in the Tarapacá region of Chile. Semi-structured interviews with 25 young migrants from Venezuela, Colombia, and Ecuador, as well as 10 health workers, were carried out. The interviews were transcribed and thematically analysed. The study was approved by the Ethics Committee of the Universidad del Desarrollo (#2019-22). Results: Young migrants face barriers linked to structural shortcomings within the healthcare system, which may be similar to those faced by the local population. Barriers are also derived from reductionist sexual and reproductive health approaches, which prioritise the prevention of pregnancy, sexually transmitted infections, and HIV, with a predominantly heteronormative focus. The prevailing narratives from the health system are those of risk and lack of control and self-care among young people, and they are exacerbated in the case of migrants. Young migrants, especially from the Caribbean, are stereotyped as over-sexualised and liberal in comparison to the local population and believed to be engaging in riskier sexual behaviours that should be kept under check. This may translate into experiences of discrimination and mistreatment when receiving care. Facilitators include good-quality information and community-level interventions. Conclusions: This study shows a limited approach to the sexual and reproductive health of young migrants in Chile, severely hampering their reproductive and sexual rights. Policies and initiatives must work towards removing structural barriers, changing narratives, and empowering young migrants regarding their sexual and reproductive health.Publication Barriers to access to insulin pumps in Chile: A qualitative study of a high-cost technology(2025) Cabieses, Báltica; Obach, Alexandra; Madrid, Paula; Paredes, DanielaObjective: To investigate the barriers to accessing advanced insulin delivery system from the experiences of patients with type 1 diabetes (T1DM), family members, and treatment teams. Methods: A qualitative study, taking a comprehensive approach, investigated a person’s experience with T1DM and receiving insulin pump treatment, emphasizing the barriers to accessing it. A case study was conducted, considering a diverse range of individuals, including young patients, adult patients, family members or care givers, and health professionals. Twenty-nine semi-structured individual interviews provided a rich and varied perspective on the issue. Results: According to study participants, the main barriers to access to insulin pump treatment for T1DM patients in Chile were the following: (i) Geographic barriers, (ii) Socioeconomic barriers, (iii) Administrative barriers, and (iv) Barriers from health teams. Participants also identified emerging barriers related to the insulin pump’s adaptation process. Conclusions: Despite the barriers and bottlenecks identified, an effort to fill short gaps in access to insulin pump treatment by the Chilean health system is recognized. To keep improving in equitative access to high-cost treatments in T1DM and other chronic conditions, it is imperative to consider the active and meaningful participation of patients and their families in health decision-making. This can lead to more patient-centric and effective healthcare policies and practices.Publication Barriers to accessing formal cancer care from the perspective of informal caregivers: a qualitative study(2025) Campaña, Carla; Cabieses, Báltica; Obach, Alexandra; Vezzani, Francisca; Estay, Angela; Carrillo, DiegoBackground: Cancer is a significant public health concern in Chile, with breast and lung cancers being among the most common and deadly types. Informal caregivers provide essential healthcare procedures and physical, emotional, and financial support to cancer patients, taking on significant responsibilities they must balance with their lives. Many of these responsibilities are directly related to healthcare and patient care processes, so the healthcare system is critical to the caregiver's experience. This study aims to identify health system barriers in the healthcare of lung and breast cancer patients through the voice of informal caregivers in Chile. Methods: An exploratory qualitative case study design was used, following the COREQ criteria. Twenty informal caregivers of adult breast and lung cancer patients were recruited from different regions of Chile through snowball sampling and online outreach. Semi-structured interviews were conducted between March and June 2023. Data were analyzed using deductive thematic analysis guided by Tanahashi's effective coverage framework, which focuses on four dimensions of healthcare access: availability, accessibility, acceptability, and contact. Atlas.ti software was used for coding and thematic organization. Results: Caregivers reported significant barriers across the four dimensions: (i) availability, lack of medical equipment and home care resources, especially in public hospitals; (ii) accessibility, long wait times, fragmented care across institutions, and high out-of-pocket costs, particularly for those outside the public health insurance (FONASA) coverage; (iii) acceptability, inadequate communication from healthcare providers, with limited information on diagnosis and prognosis; (iv) contact, poor continuity of care, with a lack of coordination between healthcare providers, leading to feelings of isolation and frustration among caregivers. Conclusions: The study reveals critical gaps in Chile's healthcare system. Caregivers play an essential role in patient care but receive insufficient support from the healthcare system. Addressing the identified barriers, including improving communication, coordination, and support for caregivers, is crucial for achieving better healthcare outcomes and reducing disparities in cancer care. These findings have significant implications for policymakers, highlighting the need for reforms to support caregivers and enhance the cancer care continuum in Chile.Publication Therapeutic trajectories of families with rare diseases in Chile from the perspectives of patients, carers, and healthcare workers: a qualitative study(2025) Cabieses, Báltica; Obach, Alexandra; Roberts, Antonia; Repetto, GabrielaBackground Rare diseases are conditions that have a low prevalence in the population and a high disease burden and are often chronic and progressive. International evidence concerning the experience of people and families living with rare diseases is scarce, leading to late and erroneous diagnoses, as well as non-specific treatments. This study explored the therapeutic trajectories of people and families living with rare diseases within Chile’s public and private healthcare systems from the perspective of patients, caregivers, and medical teams, including the initial symptoms, first consultation, testing, diagnosis, treatment, and follow-up. Methods A qualitative exploratory study was conducted through multiple case studies. Sixty participants were interviewed in person and/or virtually: patients (n = 16), caregivers (n = 22), healthcare workers (n = 20), and two patient organisation leaders. The material was analysed using thematic analysis. The project was approved by the Scientific Ethics Committee of Facultad de Medicina Clínica Alemana, Universidad del Desarrollo. Results After similar initial symptoms and first consultation, three main types of trajectories were identified: (i) the path taken by those who reach a diagnosis for a disease that has specific treatment available; (ii) the journey of those who reach a diagnosis for their health condition, but their disease does not have a specific treatment available; and (iii) the trajectory of those who have not reached a diagnosis and receive symptomatic treatments for symptoms. Conclusions The therapeutic trajectories of patients with rare symptoms are similar in terms of initial symptoms and first consultation. However, their paths diverge at the diagnostic stage, with diverse experiences related to these journeys, largely based on having a diagnosis and whether there is a specific treatment. Rare conditions in Chile requires further attention and urgent action that considers those who live with them and their families.Publication Addressing health inequalities and barriers to access among adolescent migrants in Chile: a mixed methods study(2025) Carreño Calderón, Alejandra; Obach, Alexandra; Cabieses, Báltica; Oyarte, Marcela; Arias, AliciaBackground: The presence of adolescents in migration flows through Latin America and Caribbean (LAC) has increased in recent years. Adolescents are usually considered healthy due to their low mortality rates compared to the general population. However, existing research shows that adolescence is a phase of life in which mental health, sexual and reproductive health and other needs may increase. Migration, as a social determinant of health, can lead to experiencing compounded vulnerabilities among adolescent migrants, especially those already living in disadvantaged conditions. Objective: aims to estimate and compare social inequalities in health faced by adolescent migrants from LAC living in Chile versus locals, as well as to unveil perceptions and experiences related to additional barriers to accessing to healthcare in the country. Method: A mixed methods study was designed to socially and epidemiologically characterise the adolescent migrant population in Chile. First, two population-based surveys (CENSO 2017; CASEN 2022; REM 2021 and EH 2021) and national epidemiological records were analysed. Second, perceptions and experiences of accessing primary healthcare services were explored through 42 in-depth interviews with healthcare teams (n = 18) and parents of adolescent migrants (n = 24). Quantitative and qualitative data were analysed separately and then integrated to identify the main findings. The study was approved by the Ethics Committee of the Universidad del Desarrollo. Results: The study identified social inequalities negatively affecting adolescent migrant compared with their Chilean peers, including lower access to education, housing and higher chances of having to work. Regarding health, sexual and reproductive needs and experiences are identified, including adolescent pregnancy. Barriers to access to primary healthcare programmes dedicated to adolescent health, which are little known and underused by the migrant population, were also identified. Conclusions: Adolescent migrants in Chile face important social inequalities in health compared to locals and additional barriers to exercise their right to health, putting their current and future health at risk. Priority actions are needed for this specific group, and must focus on increasing the acceptability and coverage of preventive care, as well as strengthening their participation in the social and health decisions affecting them.Publication Mental health and the healthy immigrant effect in Chile: a comparative cross-sectional study with international migrants and locals(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Madrid, Paula; Obach, AlexandraIntroduction: The question of whether international migrants appear to be in better health than the locals, and whether this "healthy immigrant effect" declines over time is a highly relevant one, especially with regards to mental health. Based on a community-based survey conducted in Santiago, Chile, this study compares the mental health outcomes of international migrants versus local populations and examines differences within the international migrant group of respondents. Methods: Observational cross-sectional study. Data was collected with international migrants and Chilean participants in 2021-2022 through a structured questionnaire. The study examined self-reported stress and mood disorders in relation to demographic, socioeconomic, health, and migration-related factors. Descriptive analyses were conducted for all variables overall and stratified by perceived stress, mood disorders, and migration status. Associations were assessed using Chi-square or Fisher's exact tests, with Cramer's V used to evaluate effect size. Multiple imputation (m = 5) addressed missing data using the mice package in R, followed by generalised logistic regression models fitted across imputed datasets and combined using Rubin's rules; stepwise selection based on AIC was used for variable reduction, and models were run for the full sample and separately for the migrant population. Results: The sample included 1,656 international migrants and 1,664 locals. Being a migrant was negatively associated with reporting stress and mood disorders in all analyses. Among migrants, the main risk factors for stress were perceiving a high number of migrants in the neighbourhood and having experienced abuse as a migrant and for mood disorders the main risk factor was reporting having experienced abuse as a migrant as well as a longer stay in Chile. Discussion: We found a healthy immigrant effect for mental health among international migrants in Chile, which declined over time in the case of mood disorders. Chilean participants reported very high levels of mental health issues, consistent with existing studies. However, results for international migrants highlight both risk and protective factors linked to migration processes, which are unique to them, warranting a specific approach to their mental health needs.Publication Perceived barriers to reaching equity in effective access to diagnosis and treatment for women with breast cancer in Chile(2025) Campaña, Carla; Cabieses, Báltica; Obach, Alexandra; Vezzani, FranciscaGlobally, it has been reported inequities in breast cancer effective access to health care. The objective of this study was to explore perceived inequities in access to effective diagnosis and treatment in women with breast cancer according to Tanahashi model and social determinants of health model. An exploratory case study, under a qualitative paradigm, was conducted. Theoretical sampling guided the selection of diverse participant profiles, comprising breast cancer patients, healthcare professionals and a civil society leader. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. Online semi-structured interviews were conducted. Interviews were transcribed, anonymized, and coded using ATLAS.Ti for deductive thematic analysis. Barriers to effective healthcare access were identified in all components of Tanahashi model. Accessibility and acceptability were the components with most perceived barriers. From the determinants of health model, a woman from the public health system, with low income, under 30 or over 40, and residing in a different region from the metropolitan region faces more barriers to access to an effective healthcare. The main barriers were for the high centralisation of healthcare in Chile, not integrated health system network, misinformation to the patient, and non-humanized healthcare. The results of this study offer a comprehensive exploration of perceived barriers to effective breast cancer diagnosis and treatment in Chile, using a qualitative approach incorporating diverse perspectives. Findings underscore significant systemic challenges across Tanahashi’s model components, impacting the overall care experience. The study reveals structural inequities hindering healthcare access, reflecting global patterns in fragmented health systems.Publication Breast cancer diagnosis and staging in Chile: A nonrandomized survey-based study to assess frequency and delays(2024) Campaña, Carla; Oyarte, Marcela; Cabieses, Báltica; Obach, AlexandraIntroduction: Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods: Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results: A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions: Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.Publication Emergency preparedness and response sensitive of migrant populations in Chile: post-pandemic perspectives(2024) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; Carreño Calderón, Alejandra; Mezones, EdwardOn August 31, 2023, the Chilean government ended the health alert for COVID-19. This milestone invites us to reflect on lessons learned in emergency preparedness and response regarding migrant populations in the country. In this context, three perspectives are presented. The first focuses on avoiding pointing to individual responsibility for non-compliance with prevention measures, as this approach ignores structural and historical inequities. Emergency recommendations should be constructed considering a collective approach and diverse sociocultural and political contexts. The second perspective calls for considering and addressing migration as a social determinant of health. During the pandemic, changes in the governance of migration around the world made migration processes more precarious, with risks to the physical and mental health of migrants, which needs better planning and evidence-based decision-making in future pandemics. The third perspective focuses on promoting intercultural health, as effective communication of contagion risks and preventive measures were hampered among migrant populations with diverse worldviews and interpretations of health and disease processes. Responding to the needs of historically marginalized communities requires establishing ways of life that respect diversity in narratives and everyday practices. Governments and health systems must incorporate migration into their emergency preparedness and response strategies, creating the conditions for optimal compliance.