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Obach, Alexandra

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Alexandra Obach

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    Quemaduras: ¿por qué prestarles especial atención a los adolescentes en América Latina y El Caribe desde un enfoque de prevención primaria en salud?
    (2023) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; Fuentes, Rodrigo; Carmina, Domic; Peredes, Carola; Saavedra, Rolando; Rojas, Jorge
    La evidencia existente en materia de quemaduras en población menor de edad a nivel global se ha enfocado principalmente en niños y niñas menores de 10 años, dejando atrás al grupo etario definido como "adolescente" por la Organización Mundial de la Salud. Sin embargo, la etapa de la adolescencia presenta características propias que la diferencian de los rangos etarios menores con respecto a las quemaduras. Estas diferencias son relevantes desde una perspectiva de prevención primaria, la cual se centra en evitar la enfermedad o lesión. En este contexto, el presente artículo reflexiona en torno a los motivos por los cuales es necesario prestarles especial atención a las y los adolescentes en el marco de la prevención primaria de las quemaduras, con relevancia para Latinoamérica y El Caribe. Primero, los escenarios de quemaduras en adolescentes muchas veces se vinculan con la participación en actividades de riesgo por presión, deseabilidad social o baja percepción de los riesgos asociados. Segundo, es importante recalcar que los adolescentes pueden experimentar vulnerabilidad social, la cual los puede exponer al riesgo de sufrir una quemadura intencional o no. Tercero, el riesgo de quemaduras en adolescentes se puede asociar con la salud mental y escenarios de autolesión. Se requiere indagar en estos aspectos, tanto a través de estudios cuantitativos epidemiológicos como de estudios cualitativos, para poder diseñar e implementar estrategias de prevención primarias relevantes para este grupo de población en la región.
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    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, Manuel
    Background: 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.
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    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 Díaz
    Background: 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.
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    Barriers to access to insulin pumps in Chile: A qualitative study of a high-cost technology
    (2025) Cabieses, Báltica; Obach, Alexandra; Madrid, Paula; Paredes, Daniela
    Objective: 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.
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    “Viajar para estar mejor”: trayectorias migratorias de niños, niñas y adolescentes que han ingresado por paso no habilitado a Chile durante la crisis por COVID-19
    (2023) Carreño Calderón, Alejandra; Obach, Alexandra; Correa, Eliana
    Chile ha experimentado un importante aumento de población migrante y refugiada en los últimos años. A pesar de su invisibilidad, muchos de los recién llegados son niños, niñas y adolescentes (NNA), la mayor parte provenientes de países latinoamericanos. El artículo se basa en una investigación cualitativa en curso que se propone comprender las experiencias, significados y prácticas que han desarrollado en torno a la salud y enfermedad los núcleos con NNA que han cruzado la frontera norte de Chile, durante el periodo de crisis sanitaria por COVID-19. En el artículo nos interrogamos sobre sus experiencias y trayectorias de migración, así como sobre el impacto que éstas generan sobre su salud, reconociendo la importancia de visibilizar las rupturas y continuidades que la niñez y la adolescencia enfrentan en este momento del ciclo vital, destacando a su vez la capacidad que tienen los NNA de repensarse desde sus pertenencias múltiples en el contexto migratorio.
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    “Hasta que me embaracé no conocí matrona”: salud sexual y reproductiva de jóvenes mujeres mapuche, Chile
    (2024) Carreño Calderón, Alejandra; Obach, Alexandra; Correa Matus, M. Eliana
    Este estudio pretende explorar la prevención y promoción de salud sexual y reproductiva en jóvenes mapuche de entre 18 y 24 años, indagando en las relaciones que establecen con el sistema de salud biomédico y en los desafíos para la inclusión de la interculturalidad en las prestaciones dirigidas a esta población. Se trata de una investigación cualitativa de estudio de caso. Se aplicaron 32 entrevistas en profundidad a jóvenes mapuche de sectores rurales y urbanos de la región de la Araucanía, Chile. Se identifica la persistencia un abordaje sanitario que carece de herramientas interculturales y de enfoque de derechos sexuales y reproductivos. Las jóvenes reportan falta de acceso a educación sexual tanto por la distancia que establecen con los servicios biomédicos de atención primaria como por las dificultades de hablar de sexualidad con los adultos de sus comunidades. Se concluye que persisten inequidades en el derecho a la salud sexual y reproductiva de jóvenes indígenas, especialmente en mujeres. Es necesario incorporar el enfoque intercultural y de derechos en la formulación de políticas públicas para esta población. Tales intervenciones requieren ser diseñadas e implementadas involucrando tanto a a población joven como a los agentes de salud de sus comunidades de origen.
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    The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change
    (2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Esnouf, Sophie; Mezones, Edward; Espinoza, Manuel; DeJong, Jocelyn
    Background: A sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the "Agreement for Social Peace and the New Constitution" was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the "Popular Initiative for Norms" was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health. Methods: We conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Results: Four main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Conclusions: The 'Popular Initiative for Norms' was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft-and despite the final draft being rejected last September 2022-the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants' health in Chile, this study demonstrated that civil awareness and interest are still insufficient.
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    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, Diego
    Background: 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.
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    Desafíos para el abordaje de la salud de los migrantes en Chile durante la pandemia por Covid-19: una revisión de alcance
    (2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Rada, Isabel; Carreño Calderón, Alejandra; Mezones, Edward
    Objetivo.Indagar sobre los principales desafíos reportados en el marco de la emergencia sanitaria de SARS-CoV-2 según la evidencia científica disponible a la fecha en esta materia en Chile. Material y métodos. Revisión de alcance con base en tres búsquedas en Web of Science, PubMed y Google Scholar de publicaciones en inglés y español publicadas entre 2020 y 2023. Resultados. Se identificaron tres áreas clave: desafíos de acceso y uso efectivo del sistema de salud, desafíos más allá del sistema de salud, incluyendo aquellas relaciones con determinantes sociales de la salud, autocuidado e información y, finalmente, desafíos de integración de los enfoques de interculturalidad, género y cooperación internacional. Conclusiones. Se evidencian oportunidades de mejorar el abordaje de la salud de personas migrantes internacionales en Chile a raíz de la pandemia por Covid-19, de cara a futuras crisis sanitarias y para reducir brechas e inequidades que impactan la salud poblacional. Objective. To investigate the main challenges in the context of the SARS-CoV-2 health emergency according to the scientific evidence available to date in this area in Chile. Materials and methods. Scoping review based on three searches in Web of Science, PubMed and Google Scholar of publications in English and Spanish published between 2020 and 2023. Results. Three key areas were identified: the challenges of access and effective use of the health system, the challenges beyond the health system, including those related to social determinants of health, self-care and information, and finally, the challenges of integrating intercultural, gender and international cooperation approaches. Conclusions. There are opportunities to better address the health of international migrants in Chile in the wake of the Covid-19 pandemic, anticipating future health crises and to reduce gaps and inequities that impact population health.
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    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, Gabriela
    Background 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.

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