Papers by Maria Amalia Pesantes
The accuracy of the Content should not be relied upon and should be independently verified with p... more The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden.
Frontiers in Clinical Diabetes and Healthcare
IntroductionLiving with a chronic condition is a challenging experience, as it can disrupt your c... more IntroductionLiving with a chronic condition is a challenging experience, as it can disrupt your capacity to function and fulfill social roles such as being a father. Fatherhood constitutes an important component of masculinity that has not received significant attention in studies aimed at understanding the role of gender norms in health-related behaviors. Fatherhood refers to the set of social expectations placed on men to provide, protect, and care for those considered his children. Our paper aims to show the importance of understanding men’s perspectives around fatherhood and its relevance for staying healthy.MethodsIn-depth semi-structured interviews with men living with Type 2 diabetes in Peru to explore their experiences with diabetes management.ResultsEighteen Peruvian men, diagnosed with Type 2 diabetes for at least one year and with ages between 27 and 59 years old were interviewed. They had an average of three children each and were all insured under the national insurance...
Human Organization, Mar 1, 2019
This study analyzes the experiences of low-income people living with type 2 diabetes in Lima, Per... more This study analyzes the experiences of low-income people living with type 2 diabetes in Lima, Peru. We use a syndemic approach to describe and discuss their challenges in following physicians' recommendations around medication adherence and dietary changes. We use the concept of "burden of treatment" to analyze patients' stories and to understand the complexity of medication adherence and dietary changes in a middle-income country where the health system is still unprepared to provide chronic care. Analysis demonstrates that emotional, socioeconomic, and structural components play a role in patients' capabilities for following the prescribed recommendations. We show that patient's illness experiences are intimately linked to the capacity of the local health system to attend to their needs but are not always acknowledged when promoting self-management behaviors. Our study shows the relevance of a syndemics approach for understanding the interaction between individual and structural factors to make suggestions for improving the management of diabetes and the overall experience of chronicity.
Global Health Action, May 14, 2020
Background: Co-creation is the process of involving stakeholders in the development of interventi... more Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce. Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru. Methods: Observational study to describe the use of the COHESION manual 'Moving from Research to Interventions: The COHESION Model' developed for a multi-country project in low-and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru. Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process. Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.
Wellcome open research, Feb 5, 2019
Incentives play a role in introducing health-related benefits, but Background: no interventions u... more Incentives play a role in introducing health-related benefits, but Background: no interventions using mixed incentives, i.e. a combination of individual and group incentives, have been tested in individuals with type 2 diabetes mellitus (T2DM). We evaluated the feasibility of implementing individual-and mixed-incentives, with and without a supportive partner, on glycated haemoglobin (HbA1c) control and weight loss among patients with T2DM. This is a feasibility, sex-stratified, single-blinded, randomized Methods: controlled study in individuals with T2DM. All participants received diabetes education and tailored goal setting for weight and glycated haemoglobin (HbA1c). Participants were randomly assigned into three arms: individual incentives (Arm 1), mixed incentives-altruism (Arm 2), and mixed incentives-cooperation (Arm 3). Participants were accompanied by a diabetes educator every other week to monitor targets, and the intervention period lasted 3 months. The primary outcome was the change in HbA1c at 3 months from baseline. Weight and change body mass index (BMI) were considered as secondary outcomes. Out of 783 patients screened, a total of 54 participants, 18 per study Results: arm, were enrolled and 44 (82%) completed the 3-month follow-up. Mean baseline HbA1c values were 8.5%, 7.9% and 8.2% in Arm 1, Arm 2, and Arm 3, respectively. At 3 months, participants in all three study arms showed reductions in HbA1c ranging from-0.9% in Arm 2 to-1.4% in Arm 1. Weight and BMI also showed reductions. Individual and mixed cash incentives show important reductions Conclusions: in HbA1c, weight and BMI in patients with type 2 diabetes mellitus after 3 months. Recruitment and uptake of the intervention were successfully accomplished demonstrating feasibility to conduct larger effectiveness studies to test individual and mixed economic incentives for diabetes management.
Nutrients, Oct 23, 2018
Peru is undergoing a nutrition transition and, at the country level, it faces a double burden of ... more Peru is undergoing a nutrition transition and, at the country level, it faces a double burden of disease where several different conditions require dietary changes to maintain a healthy life and prevent complications. Through semistructured interviews in rural Peru with people affected by three infectious and noninfectious chronic conditions (type 2 diabetes, hypertension, and neurocysticercosis), their relatives, and focus group discussions with community members, we analyzed their perspectives on the value of food and the challenges of dietary changes due to medical diagnosis. The findings show the various ways in which people from rural northern Peru conceptualize good (buena alimentación) and bad (mala alimentación) food, and that food choices are based on lifelong learning, experience, exposure, and availability. In the context of poverty, required changes are not only related to what people recognize as healthy food, such as fruits and vegetables, but also of work, family, trust, taste, as well as affordability and accessibility of foods. In this paper we discuss the complexity of introducing dietary changes in poor rural communities whose perspectives on food are poorly understood and rarely taken into consideration by health professionals when promoting behavior change.
Qualitative Health Research, Aug 1, 2018
Family support is crucial for managing chronic conditions but it is often overlooked when designi... more Family support is crucial for managing chronic conditions but it is often overlooked when designing behavioral interventions in type 2 diabetes mellitus (T2DM). As part of the formative phase of a feasibility randomized control trial (RCT), we conducted 20 semistructured interviews with people with T2DM from Lima, Peru. Based on such results, we describe the support people with T2DM receive from their families and the role that such support has in their efforts to implement diabetes management practices. We learned that participants receive support from family members, but mostly from their spouses and children. Their relatives encourage them and motivate them to fight for their health, they also provide instrumental support by preparing healthy meals, reminding them to take medications, and sharing physical activity. Participants also reported controlling actions which were not always "well received." Thus, any intervention supporting self-management practices need to work with key family members. We support the literature that suggests that interventions should target family members to ensure improved T2DM self-management practices.
eNeurologicalSci, Dec 1, 2016
The evaluation of cognitive impairment in adulthood merits attention in societies in transition a... more The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT). Methods: A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools. Results: We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%. Conclusions: Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools.
Pontificia Universidad Católica del Perú, 2004
Revista Peruana de Medicina Experimental y Salud Pública, Sep 30, 2022
d antropóloga, Ph.D. en Antropología Médica; e médico cirujano, magíster en Epidemiología. RESUME... more d antropóloga, Ph.D. en Antropología Médica; e médico cirujano, magíster en Epidemiología. RESUMEN Objetivos. Explorar los factores que predisponen la aceptabilidad o reticencia a la vacunación contra la COVID-19 utilizando métodos cualitativos. Materiales y métodos. Estudio cualitativo descriptivo realizado entre abril y junio del 2021. Se utilizó una guía de entrevista semiestructurada que exploró las percepciones de los participantes de diferentes regiones del Perú con relación a la aplicación de la vacuna para la COVID-19, tomando como marco teórico el modelo de creencias en salud, cuyas dimensiones son: susceptibilidad, severidad, beneficios, barreras y estímulos asociados para ejecutar la acción. Resultados. Se entrevistó a treinta personas, en su mayoría mujeres. Para los participantes la eficacia de las vacunas se relaciona con el país de procedencia, además, consideran que es importante conocer los efectos a largo plazo en la salud luego de la aplicación de la vacuna. La información recibida por las autoridades gubernamentales y sanitarias puede ser un factor decisivo para la aplicación de la vacuna. Las personas con la intención de no vacunarse sienten que las estrategias de promoción de la vacunación vulneran sus derechos humanos. Conclusiones. Existe un grupo de personas indecisas o inseguras de recibir las vacunas contra la COVID-19 en quienes es necesario fomentar estímulos de acuerdo con sus preocupaciones y necesidades. Las autoridades gubernamentales y sanitarias deben trabajar conjuntamente para mejorar la confianza de la población y brindar mensajes que despejen las principales dudas sobre la eficacia y las reacciones adversas de las vacunas.
Wellcome open research, Jun 25, 2021
Background: Financial incentives may improve the initiation and engagement of behaviour change th... more Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery. We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 (CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of Open Peer Review Reviewer Status
Wellcome Open Research, 2018
Background:Incentives play a role in introducing health-related benefits, but no interventions us... more Background:Incentives play a role in introducing health-related benefits, but no interventions using mixed incentives, i.e. a combination of individual and group incentives, have been tested in individuals with type 2 diabetes mellitus (T2DM). We evaluated the feasibility of implementing individual- and mixed-incentives, with and without a supportive partner, on glycated haemoglobin (HbA1c) control and weight loss among patients with T2DM.Methods:This is a feasibility, sex-stratified, single-blinded, randomized controlled study in individuals with T2DM. All participants received diabetes education and tailored goal setting for weight and glycated haemoglobin (HbA1c). Participants were randomly assigned into three arms: individual incentives (Arm 1), mixed incentives-altruism (Arm 2), and mixed incentives-cooperation (Arm 3). Participants were accompanied by a diabetes educator every other week to monitor targets, and the intervention period lasted 3 months. The primary outcome was t...
International Journal of Migration, Health and Social Care, 2017
Purpose The purpose of this paper is to describe and discuss the limitations of strategies that m... more Purpose The purpose of this paper is to describe and discuss the limitations of strategies that mothers of undocumented Latino children use in an emerging community to address the health needs of their children. Design/methodology/approach In-depth interviews with low-income immigrant mothers of undocumented Latino children (n=10) and social service providers (n=6). Interviews were transcribed, coded using Atlas-ti and analyzed to identify common perspectives on the strategies used to secure healthcare for uninsured undocumented children. Findings Mothers of undocumented Latino children struggle to secure healthcare for their children. Based on the principles of familismo and personalismo, they rely on social support networks such as friends, relatives and fellow churchgoers to secure information about available healthcare options. Despite the willingness of social and health service providers to help them access healthcare, options are limited and depend on the actions of individua...
Nutrients, Jan 5, 2017
Interventions to promote behaviors to reduce sodium intake require messages tailored to local und... more Interventions to promote behaviors to reduce sodium intake require messages tailored to local understandings of the relationship between what we eat and our health. We studied local explanations about hypertension, the relationship between local diet, salt intake, and health status, and participants' opinions about changing food habits. This study provided inputs for a social marketing campaign in Peru promoting the use of a salt substitute containing less sodium than regular salt. Qualitative methods (focus groups and in-depth interviews) were utilized with local populations, people with hypertension, and health personnel in six rural villages. Participants were 18-65 years old, 41% men. Participants established a direct relationship between emotions and hypertension, regardless of age, gender, and hypertension status. Those without hypertension established a connection between eating too much/eating fried food and health status but not between salt consumption and hypertension...
eNeurologicalSci, 2017
Understanding local complexities and challenges of stroke-related caregiving are essential to dev... more Understanding local complexities and challenges of stroke-related caregiving are essential to develop appropriate interventions. Our study aimed to characterize the impact of post-stroke care among informal caregivers in a setting of transitioning economy. Materials and methods: Qualitative study based on in-depth interviews with primary caregivers of stroke survivors in Lima, Peru. Transcribed data was organized around the following themes: emotional impact of caregiving, main stress factors and coping mechanisms to deal with the caregiving role, as well as the unmet needs of caregivers. Results: We interviewed twelve caregivers, mean age 52.5 years. Eight were females, who were either the spouse or child of the stroke survivor. Stroke patients had a median age of 70 years, range 53-85 years. All participants reported having experienced emotional stress and depressive symptoms as a result of caregiving. Although most had family support, reduced social activities and added unanticipated financial burdens increased caregiver's stress. None of the caregivers had received training in post-stroke care tasks after the patient's discharge and only a few had received some psychological support. Almost all expressed the need to see a professional to improve their mental health. Keeping a positive attitude towards their relative's physical post-stroke condition was a key coping mechanism. Conclusions: In the absence of structured institutional responses, family members are responsible of providing care for stroke survivors, a task escorted by major emotional, financial, and social strains. This burden could be prevented or curtailed if caregivers were to be targeted by interventions providing psychological and financial support, together with basic training on post-stroke care.
Globalization and health, Jun 2, 2016
Human capital requires opportunities to develop and capacity to overcome challenges, together wit... more Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality…
Global Heart, 2015
The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Here... more The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the United States National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognised Centre of Excellence conducting quality and innovative research and generating high-impact evidence for health. The Centre's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity building strategies. The CRONICAS Centre of Excellence is not a risk-averse organisation: it benefits from past experiences, including past mistakes, and improves upon them, and thus challenges traditional research approaches. This ethos and environment is key to fostering innovation in research. A CENTRE OF EXCELLENCE IN PERU Established in Peru, the CRONICAS Centre of Excellence in Chronic Diseases is based at Universidad Peruana Cayetano Heredia and was founded to close the research and capacity building gap in relation to non-communicable diseases (NCDs) in Peru. In Peru, the field of Miranda et al.
Journal of Immigrant and Minority Health, 2013
International Journal for Equity in Health, 2019
Background: In 2014 the World Health Organization (WHO) launched the "End TB Strategy", setting n... more Background: In 2014 the World Health Organization (WHO) launched the "End TB Strategy", setting new ambitious goals for elimination of tuberculosis (TB). In contrast with previous efforts to control TB, the new strategy adopted the protection and promotion of human rights in TB prevention and care as a core pillar. This mandated the development of national programmes that are sensitive to the characteristics of populations and responsive to structural factors that put people at increased risk of exposure to TB, limit access to good quality health services and make people more vulnerable to TB infection. Indigenous people living in the Peruvian Amazon have been identified as a TB vulnerable group by Peruvian health authorities. This article examines the barriers faced by indigenous people and rural settlers from the Peruvian Amazon in obtaining a TB diagnosis and appropriate TB treatment, through the principles of the human rights based approach of accessibility, availability, affordability, adaptability and quality, and thus provides evidence of the utility of such approach in Peru. Methods: This is a qualitative study. We combined information from policy documents and legal regulations and in-depth interviews with health workers and health authorities. We used Atlas-ti to conduct a thematic analysis and identify interviewees responses to pre-defined topics. Results: Despite having a strong legal framework to protect the right to health of indigenous people and people affected by TB, there are underlying structural factors contributing to delays in detection, diagnosis and TB treatment, which are mostly related to having a health system poorly prepared to provide care for people living in dispersed rural communities. This article shows the limited level of integration of the "End TB Strategy" principles in the Peruvian National TB Programme and identifies the weakness of the health system to improve health care provision for indigenous people and rural settlers from the Peruvian Amazon. Conclusions: Our study shows the need to go beyond developing a strong legal framework to ensure vulnerable populations such as indigenous people are able to realize their right to health. Governments need to allocate funds, improve training and adapt healthcare provision to the cultural, geographical, and social context of indigenous people.
Health Policy and Planning, Mar 4, 2022
Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action ... more Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016–19) in 16 countries. This study aimed to analyse the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on ‘diffusion of innovation’ and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analysed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident ‘diffusion networks’ included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries’ taxes, particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy-making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.
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Papers by Maria Amalia Pesantes