Browsing by Autor "Basagoitia, Armando"

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Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study.
(2023) Basagoitia, Armando; Burrowes, Sahai; Solis-Soto, Maria Teresa; MacMillan, Genevieve; Sullivan, Sarah
BACKGROUND: Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. METHODS: Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. RESULTS: Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. CONCLUSIONS: Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.
Translation, cultural adaptation, and content validity evaluation of a mental health literacy instrument in Bolivia.
(2026) Basagoitia, Armando; Solís-Soto, María Teresa; Romero-Martínez, Martin; Alcalde-Rabanal, Jacqueline Elizabeth; Burrone, María Soledad
BACKGROUND: Mental health literacy (MHL)-individuals' knowledge, attitudes, and beliefs about mental health-plays a key role in promoting public mental health. Accurate MHL measurement helps identify knowledge gaps, reduce stigma, and encourage help-seeking. However, culturally validated instruments remain scarce in low- and middle-income countries, including Bolivia. OBJECTIVES: This study aimed to carry out the translation cultural adaptation and content validity assessment of an instrument designed to comprehensively assess the construct of mental health literacy in the Bolivian urban context. METHODS: A mixed-methods design was used, including forward and backward translation, following best practices for cultural adaptation of patient-reported outcomes. Three instruments were adapted: the Mental Health Literacy Scale (MHLS), O'Connor, 2015; the Perceived Devaluation and Discrimination Scale (PDDS), Link, 1987; and the Mental Health Problem Recognition module (MHPR), Burrone, 2021. Content validation assessment was conducted with eight experts who rated each item's relevance, comprehensiveness, and comprehensibility using a 4-point Likert scale. Item-level Content Validity Index (I-CVI), modified kappa, Scale-level Content Validity Index (S-CVI), and readability statistics were calculated. This was followed by semi-structured interviews with the same experts to refine items and assess conceptual clarity. A pilot test with 10 participants evaluated comprehension and usability. RESULTS: The I-CVI scores from the quantitative phase indicated that the majority of items were rated as "good" or "excellent" in terms of relevance (97.14%), comprehensiveness (83.02%), and comprehensibility (94.34%). The obtained S-CVI/UA scores fell well below the recommended threshold for relevance (0.32), comprehensiveness (0.25), and comprehensibility (0.32), indicating a lack of universal agreement among experts. The S-CVI/Ave scores indicated moderate consensus among experts for relevance (0.88), comprehensiveness (0.84), and comprehensibility (0.87). Items that did not achieve optimal I-CVI and modified kappa scores were examined during the qualitative phase. Experts identified minor issues related to terminology and phrasing that could affect clarity. Following minor revisions, all items were retained. CONCLUSION: This study presents a culturally adapted, content-validated instrument for assessing MHL in Bolivia. The final version, consisting of 53 items, demonstrates strong content validity and provides a solid foundation for further psychometric evaluation and broader application in Spanish-speaking and Latin American contexts.