Browsing by Author "González, Karla"

Now showing 1 - 17 of 17
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    Brief interventions for alcohol use in primary care: opportunities and challenges for the case of Chile
    (2022) González, Karla
    Alcohol use disorders (AUD) are associated with several mental health, family, and social consequences. This paper analyzes the few studies on BIs in primary care in Chile and Latin America through a culturally critical view. Future research should address the need of culturally appropriate BI for AUD, so that decisions on policies and programs are made based on evidence-based, culturally appropriated practices. The Chilean context presents a unique opportunity to implement BI, since primary care counts on resources and protocols already installed. Clinical social workers should play a key role in this challenge.
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    Clinical Research Ethics: Critical and Qualitative Analysis of Facilitators and Barriers
    (2020) Valera, Luca; González, Karla; Ramos, Paulina; Altermatt, Fernando
    To analyze the ethical challenges dealing with clinical research, we carried out a systematic review of the literature and qualitative research, determining facilitators, barriers, and ethical paradigms perceived by Chilean clinical researchers. Through the analysis of the literature, we identified the main ethical challenges involved “in” clinical research (hic et nunc) and those that arise “from” clinical research itself (ex post). Semi-structured interviews showed four critical knots associated with clinical research (founding, legislation, multi-center research, and the relationship with regulatory entities), together with facilitating aspects and barriers when implementing researches.
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    Clinical social work in Chile
    (2022) Muñoz-Guzmán, Carolina; Grau, María Olaya; González, Karla; Garrido López, Valentina
    Social work in Latin America has been framed by an ethical-political dimension committed to democracy and change in social structures to ensure social justice. This has put under dispute the possibilities of clinical social work, which has been defined as a reduced understanding of social problems in Latin America. The increasing complexity of people’s lives, related not only to poverty but to the convergence of many difficulties across life’s course, provides a disciplinary opportunity for social workers to innovate in ways to deliver effective tools and skills in coping with violence, addiction, mental health problems, discrimination, and exclusion. Thus, supplementing traditional social work practice in the region, with clinical social work as a specialised area of intervention, seems urgent. This chapter examines the contributions that clinical social work can make to reach social justice in Latin America, specifically in Chile. The discussion focuses on the need for a specialised professional training in clinical social work, one that acknowledges critical social work perspectives in order to avoid reductionism when understanding social problems.
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    Diseño y validación del instrumento SALUFAM: Un instrumento de valoración de la salud familiar con alto valor predictivo clínico para la atención primaria chilena
    (2012) Püschel, Klaus; Repetto, Paula; Solar, María Olga; Soto, Gabriela; González, Karla
    Background: There is a paucity of screening instruments with a high clinical predictive value to identify families at risk and therefore, develop focused interventions in primary care. Aim: To develop an easy to apply screening instrument with a high clinical predictive value to identify families with a higher health vulnerability. Material and Methods: In the first stage of the study an instrument with a high content validity was designed through a review of existent instruments, qualitative interviews with families and expert opinions following a Delphi approach of three rounds. In the second stage, concurrent validity was tested through a comparative analysis between the pilot instrument and a family clinical interview conducted to 300families randomly selected from a population registered at a primary care clinic in Santiago. The sampling was blocked based on the presence of diabetes, depression, child asthma, behavioral disorders, presence of an older person or the lack of previous conditions among family members. The third stage, was directed to test the clinical predictive validity of the instrument by comparing the baseline vulnerability obtained by the instrument and the change in clinical status and health related quality of life perceptions of the family members after nine months of follow-up. Results: The final SALUFAM instrument included 13 items and had a high internal consistency (Cronbach's alpha: 0.821), high test re-test reproducibility (Pearson correlation: 0.84) and a high clinical predictive value for clinical deterioration (Odds ratio: 1.826; 95% confidence intervals: 1.101-3.029). Conclusions: SALUFAM instrument is applicable, replicable, has a high content validity, concurrent validity and clinical predictive value.
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    "If I feel something wrong, then I will get a mammogram": Understanding barriers and facilitators for mammography screening among Chilean women
    (2009) Püschel, Klaus; Thompson, Beti; Coronado, Gloria; González, Karla; Rain, Carolina; Rivera, Soledad
    Background. Breast cancer is the leading cause of cancer among women in Chile and in many Latin American countries. Breast cancer screening is an effective strategy to reduce mortality, but it has a very low compliance among Chilean women. Objective. To understand barriers and facilitators for breast cancer screening in a group of Chilean women aged 50–70. Methods. Following the Predisposing, Enabling and Reinforcing (PRECEDE) framework, seven focus groups (N = 48 women) were conducted with women that have had diverse experiences with breast cancer and screening practices. Information was collected using field notes and audio and video recording. Following the grounded theory model, a sequential process of open, axial and selective coding was used for the information analysis. Atlas ti 5.5 software was used for coding and segmenting the data obtained from the interviews. Results. The presence of symptoms and/or the finding of lumps through breast self-examination (BSE) were the main predisposing factors for getting a mammogram. Secrecy, embarrassment and fatalism about breast cancer were significant cultural factors that influenced the decision to seek mammogram screening. Confidence in medical staff and dignity in the treatment at the clinic were important enabling factors. The main reinforcing factors for getting the test were a sense of fulfilment by doing something good for themselves and getting timely information about the results. Conclusions. Primary health care providers should use culturally appropriate strategies to better inform women about the importance of mammography screening and the limitations of BSE for preventing advanced breast cancer.
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    Implementación piloto del programa WOWW en una escuela privada en Chile
    (2021) Barrera Morales, María Amelia; González, Karla; Carrasco Moraga, Sofía Daniela; Hernández Tapia, Alejandra
    Se da cuenta del procedimiento en la implementación en un colegio privado de Santiago-Chile, del modelo “trabajando en lo que funciona” (WOOWW) creado por Berg y Shilts (2004, 2005), usando una metodología de estudio de casos cualitativo. El objetivo del presente artículo es levantar y describir todas las etapas que conlleva la implementación del programa desde el acercamiento al establecimiento escolar hasta el abandono del campo, dividiendo el procedimiento en 5 etapas. La implementación estuvo a cargo de profesionales entrenados en el modelo. Se realizaron tres sesiones de coaching con profesores tutores de ocho cursos y ocho sesiones de una hora en el aula con cada curso. Se recogieron las percepciones de la comunidad escolar mediante grupos focales. De este proceso se desprendieron una serie de aprendizajes que se discuten en los resultados, destacando una acogida positiva de parte de los profesores y estudiantes.
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    La importancia y alcance del trabajo social clínico
    (2021) González, Karla; Grau Rengifo, Olaya
    María Tapia es Senior Research Associate en la Universidad de Miami, además de Entrenadora Maestra y Supervisora Clínica del programa Familias Unidas, de la misma universidad, el cual se centra en evidencia científica para prevenir comportamientos riesgosos en jóvenes hispanos. En esta entrevista dialoga en torno a las habilidades necesarias para la especialidad del trabajo social clínico, realizando cierta distinción respecto de otras disciplinas, en especial de psicología en el ejercicio práctico. Explica también sus consideraciones respecto de la implementación de intervenciones basadas en la evidencia por parte de profesionales de trabajo social. El trabajo social clínico es una línea de especialización de la profesión que ha evolucionado a lo largo del tiempo en Chile. En su origen su objetivo fue mejorar las condiciones sanitarias de la población, desarrollándose en contextos hospitalarios y de salud mental con un fuerte énfasis en el trabajo de casos y de familia, entre las décadas de 1920 y 1950 (Aylwin y Solar, 2011, González, 2010). Durante la época de la “Reconceptualización”, entre 1965 y 1973 aproximadamente, hubo una preponderancia del trabajo social con comunidades, con una fuerte crítica al trabajo social de casos como un ejercicio para el control social, desde una perspectiva funcionalista que no cuestionaba el status quo (Aylwin y Solar, 2011 Cuevas, 2010). Este movimiento se desarrolló con mayor fuerza en el ámbito académico, mientras que desde el Colegio de Asistentes Sociales se relevaba el ejercicio de la profesión desplegado hasta ese momento (Aylwin, 1995). Sin duda, esta época establece la reflexión profesional desde una mirada contextual y política que enriquece el tradicional trabajo de casos. Luego de la irrupción de la dictadura cívico militar en 1973 y la consecuente violación a los derechos humanos en el país, los profesionales comenzaron a implementar intervenciones psicosociales terapéuticas de acompañamiento a los familiares de víctimas y de reparación (Aylwin, 1995Cuevas, 2010). La recuperación de la democracia trajo consigo una revalidación de los principios y valores de trabajo social como la justicia social y el respeto a los derechos humanos dando mayor sentido a las reflexiones de la “Reconceptualización” que se interrumpieron con el Golpe Cívico Militar en 1973 junto con ello, los profesionales se siguen ubicando laboralmente en los programas gubernamentales sectoriales cuyo foco central de intervención son las problemáticas que afectan a las personas más vulnerables en instituciones de salud, protección de la infancia, cárcel y municipios (Quiroz, 2000).
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    Lineamientos para una intervención social clínica hospitalaria en crisis sanitaria
    (Centro de Políticas Públicas UC, 2021) Muñoz Guzmán, Carolina Beatriz; González, Karla; Grau Rengifo, María Olaya; Farah Ojeda, Jorge; Miranda Sánchez, Paula; Alamo Anich, Nicolle Anette; Toro Consuagra, Ximena de; Cillero, Sofía; Cillero Bruñol, Miguel
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    Perceived importance and interest in research by Chilean primary care providers
    (2023) García-Huidobro Munita, Diego Nicolás; Aracena Álvarez, Marcela; Bravo Valenzuela, Paulina Fabiola; González, Karla; Soto, Mauricio; von Borries, Pamela; Sapag, Jaime C.
    Background: Primary care providers (PCPs) are relevant stakeholders for primary care research (PCR). Objective: We report the perceived importance and interest in PCR of a national sample of Chilean PCPs. Methods: We conducted a cross-sectional study targeting Chilean PCPs. An electronic survey assessing perceived relevance of PCR, research training and experience, training interests, and demographics was disseminated through emails and WhatsApp messages. Descriptive statistics were used to summarize data. Logistic regression models were used to estimate adjusted probabilities and 95% confidence intervals for high interest in PCR, high interest in using research methods, and high interest in receiving research training, and predictors of these outcomes. Results: A total of 387 providers completed the online survey. Only 26.4% of PCPs had research experience as a principal or co-investigator. However, most clinicians perceived PCR as very important (92.5%) and were interested in using research methods (90.7%) and receiving training (94.3%). There were no statistically significant differences in these perceptions between provider’s discipline, role, sex, age, and geographical location after adjusting for covariates. Conclusions: Despite few Chilean PCPs have research training, a large majority perceive it as important, are interested in using it in their practice and would like to receive training.
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    Predictive utility of alcohol use disorder symptoms across race/ethnicity
    (2015) González, Karla; Castro, Yessenia; Caetano, Raúl; Field, Craig A.
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    Solution-focused brief therapy for Chilean primary care patients: Exploring a linguistic adaptation
    (2017) González, Karla; Franklin, Cynthia; Cornejo, Rayen; Castro, Yessenia; Smock Jordan, Sara
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    Solution-Focused Brief Therapy for Individuals With Alcohol Use Disorders in Chile
    (2017) González, Karla; Gerlado, Pablo; Estay, Marlene; Franklin, Cynthia
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    Solution-Focused Brief Therapy With Latinos : a systematic review
    (2016) González, Karla; Franklin, Cynthia; Kim, Johny
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    Strategies for increasing mammography screening in primary care in Chile: Results of a randomized clinical trial
    (2010) Püschel, Klaus; Coronado, Gloria; Soto, Gabriela; González, Karla; Martínez, Javiera; Holte, Sarah; Thompson, Beti
    Background: Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.Methods: We compared the effects on mammography screening rates of standard care, of a low-intensity intervention based on mail contact, and of a high-intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women with the age of 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past 2 years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self-report and by electronic clinical records. An intention to treat model was used to analyze the results. Results: Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low-intensity group and 70.1% in the high-intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low- and high-intensity groups received the mail contact, and 50% in the high-intensity group received a telephone or personal contact. Conclusion: A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates. Impact: A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities
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    The challenge of medication adherence to reduce cardiovascular risk in primary care: a mixed design multi-center study in underserved populations
    (2023) Püschel, K.; González, Karla; Varas, J.; Sateler, J.; Aravena, H.; Greig, D.; Escalona, G.; Palominos, M.; Rioseco, A.; Cea, A.; Thompson, B.
    Background Cardiovascular disease is a leading cause of death in Latin America. Internationally, low medication adherence is associated with 15% to 40% of excess cardiovascular deaths. In Latin America, the magnitude of low medication adherence and the factors associated with it, are not well known, especially among socially vulnerable populations. The aim of this study is to estimate the magnitude and associated factors of low medication adherence in a socially vulnerable population with high cardiovascular risk in Chile. Methods The study is based on a mixed-methods design. It included a multicenter cross-sectional design of a randomly selected clinical population of 900 participants, and a qualitative design based on the analytical framework model, that included patients and health team members, from three primary care clinics in Chile. Results Only 24.6% from the 886 (out of 900) patients who completed the study had “high” medication adherence, 24.9% had “regular,” and 50.4% had “low” adherence. Depression was the main factor associated with regular and low adherence combined (OR: 2.12; 95%CI:1.55-2.89). Confusion and tiredness were identified as barriers for adherence. Main facilitators reported by patients included better understanding of the medications, and availability of reminders. Clearer information and family support were identified by team members as initiators for improving adherence. Conclusion Low medication adherence is highly prevalent among patients with high cardiovascular risk in a low-income population in Chile. Quantitatively, depression was a significant risk factor for regular and low adherence; qualitatively, confusion and tiredness were identified as barriers. Clearer information and family support are identified as potential facilitators.
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    La voz de la comunidad en la atención primaria : sistematización de una estrategia participativa en salud
    (2013) González, Karla; Cerda Espinoza, Paula; Morandé Dättwyler, Margarita María