Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters

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Abstract

Background

Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs—Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.

Methods

Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk’s Domains of Healthcare Access framework.

Results

Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system.

Conclusions

FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.

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Most cited references 30

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

A Tong, P SAINSBURY, J. Craig (2007)

Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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Interrater reliability: the kappa statistic

Mary L McHugh (2012)

The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.

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Codebook Development for Team-Based Qualitative Analysis

K. MacQueen, E McLellan, Sophie K. Kay … (1998)

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Author and article information

Contributors

Christopher W. Reynolds:

ORCID: http://orcid.org/0000-0001-6634-391X

chriswreynolds18@gmail.com

Leonar G. Aguiar: lgaguiar@husi.org.co

Christian Arbelaez: christian_arbelaez@brown.edu

Carlos Gómez Restrepo: cgomez@javeriana.edu.co

Andres Patiño: andresptn1@gmail.com

Heidy Carranza: heidycarranza97@gmail.com

Lindsey Pileika: lindsey_pileika@brown.edu

Andrés Duarte: aduarte@javeriana.edu.co

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 8 January 2021

Publication date PMC-release: 8 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 102

Affiliations

[1 ]GRID grid.214458.e, ISNI 0000000086837370, University of Michigan, ; 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA

[2 ]GRID grid.41312.35, ISNI 0000 0001 1033 6040, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, ; Cra. 7 #No. 40 -62, Bogotá, Colombia

[3 ]Brown Emergency Medicine, 125 Whipple St # 3rd, Providence, RI 02908 USA

[4 ]GRID grid.189967.8, ISNI 0000 0001 0941 6502, Emory University School of Medicine, ; 550 Peachtree St. NE, Atlanta, GA 30308 USA

[5 ]GRID grid.40263.33, ISNI 0000 0004 1936 9094, Warren Alpert Medical School of Brown University, ; 222 Richmond St, Providence, RI 02903 USA

Author information

Christopher W. Reynolds http://orcid.org/0000-0001-6634-391X

Article

Publisher ID: 10062

DOI: 10.1186/s12889-020-10062-3

PMC ID: 7792039

PubMed ID: 33419406

SO-VID: bf4f588d-d320-4cef-8404-dfd257927e32

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 April 2020

Date accepted : 13 December 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010629, Fulbright Association;

Funded by: Brown Emergency Medicine Innovation Grant

Custom metadata

ScienceOpen disciplines: Public health

Keywords: healthcare access barriers,farc ex-combatant,colombia,global health,armed conflict,reintegration

Data availability:

ScienceOpen disciplines: Public health

Keywords: healthcare access barriers, farc ex-combatant, colombia, global health, armed conflict, reintegration

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Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters

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Abstract

Background

Methods

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Global Health Next Generation Network

Most cited references 30

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

Interrater reliability: the kappa statistic

Codebook Development for Team-Based Qualitative Analysis

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