Skip to main content

Improving Maternal Health Status in Indigenous Communities of Panama: Community-Based Participatory Research and Interventions Among the Ngäbe-Buglé People of Panama

  • 1121 Accesses

Part of the Global Maternal and Child Health book series (GMCH)

Abstract

This chapter describes participatory processes among an indigenous group in Panama, the Ngäbe-Buglé people, to develop appropriate health education and promotion interventions and increase the acceptability and positive impact of educational interventions. We illustrate how the application of formative research—focus groups, community visits, and meetings with institutional stakeholders and community key leaders—provides necessary information to develop a health education intervention responding to the Ngäbe-Buglé health-related learning needs, including prenatal care, working with lay midwives, and detection of high-risk pregnancies. Community participants identified the main health priorities—hygiene, nutrition, healthy environments, prenatal care, the role of the lay midwife in the community, and domestic violence. Most of these are relevant to reduce disease burden and mortality rates, mainly pregnancy issues in poor rural settings. Responding to the Ngäbe-Buglé needs, the material included community pictures with local residents and trained 78 health promoters at a centralized location in the Comarca. During the active phase of the project, community health promoters reached over 8000 people at their remote communities, ten times higher than anticipated! Community involvement and participation resulted in community empowerment and adoption of the project. The Ngäbe-Buglé community has continued to implement the intervention, and 6 months after its conclusion, they reported reaching over 11,000 people in their communities. We conclude that inclusion of community members, community participation to develop appropriate educational material, and reinforcement of empowerment is an effective manner to reach indigenous communities with health-related messages, including pregnancy, prenatal care, and the role of the midwife.

Keywords

  • Maternal morbidity
  • Maternal mortality
  • Indigenous women
  • Maternal health
  • Prevention
  • Community participation
  • Pregnancy
  • Central America
  • Prenatal care
  • Panama
  • Comarca
  • Health training
  • Health promoters
  • Midwife
  • Education
  • Pregnancy education
  • Ngäbe-Buglé
  • Guaymí

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-71538-4_36
  • Chapter length: 13 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-3-319-71538-4
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.99
Price excludes VAT (USA)
Hardcover Book
USD   279.99
Price excludes VAT (USA)
Fig. 36.1
Fig. 36.2
Fig. 36.3
Fig. 36.4
Fig. 36.5
Fig. 36.6
Fig. 36.7
Fig. 36.8
Fig. 36.9
Fig. 36.10

Notes

  1. 1.

    Hesperian is a nonprofit organization that works on health education since the 1970s. Since then, the organization has published more than 50 books in 20 different languages on health training, health education, community empowerment, international health, and women’s health. For more information visit http://hesperian.org.

References

  • Bryan, V., Brye, W., Hudson, K., Dubose, L., Hansberry, S., & Arrieta, M. (2014). Investigating health disparities through community-based participatory research: Lessons learned from a process evaluation. Social Work in Public Health, 29(4), 318–334. https://doi.org/10.1080/19371918.2013.821356

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Calvo, A. E., Hess-Holtz, M., Rebollón Guardado, A., Alguero, L., & Vega, S. (2014). Participatory processes applied to developing culturally appropriate educational material among the Ngäbe-Buglé women of Panama for domestic violence prevention. Journal of Cognitive Psychotherapy: An International Quarterly, 28(3), 238–248.

    CrossRef  Google Scholar 

  • Caniza, M. A., Maron, G., Moore, E. J., Quintana, Y., & Liu, T. (2007). Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador. Journal of Hospital Infection, 65(1), 58–64. https://doi.org/10.1016/j.jhin.2006.08.011

    CrossRef  PubMed  CAS  Google Scholar 

  • Chi, D. L., Ko, A., & Kim, J. Y. (2014). Bilingual flipcharts help improve oral health-related knowledge and self-efficacy of Korean-American caregivers of preschoolers. Journal of Public Health Dentistry, 74(4), 261–265. https://doi.org/10.1111/jphd.12073

    CrossRef  PubMed  Google Scholar 

  • Conant, J., & Fadem, P. (2008). A community guide to environmental health. Berkeley: Hesperian.

    Google Scholar 

  • Contraloria Nacional de la República. (2000). Censo Nacional. Panama: Contraloria Nacional de la República.

    Google Scholar 

  • Crawford, S., & Garrard, J. (2013). A combined impact-process evaluation of a program promoting active transport to school: Understanding the factors that shaped program effectiveness. Journal of Environmental and Public Health, 2013, 816961. Retrieved from https://www.hindawi.com/journals/jeph/2013/816961/.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  • Index Mundi. (2016). Panama total fertility rate. Retrieved from http://www.indexmundi.com/panama/total_fertility_rate.html.

  • Kaur, B., Roberton, D. M., & Glasgow, N. J. (2013). Evidence-based medical workforce planning and education: the MSOD project. Medical Journal of Australia, 198(10), 518–519.

    CrossRef  PubMed  Google Scholar 

  • Keyonzo, N., Nyachae, P., Kagwe, P., Kilonzo, M., Mumba, F., Owino, K., et al. (2015). From project to program: Tupange’s experience with scaling up family planning interventions in urban Kenya. Reproductive Health Matters, 23(45), 103–113. https://doi.org/10.1016/j.rhm.2015.06.010

    CrossRef  PubMed  Google Scholar 

  • Klein, S., Miller, S., & Thomson, F. (2013). Un libro para parteras. Atención del embarazo, el parto y la salud de la mujer. Berkeley: Hesperian.

    Google Scholar 

  • Lefebvre, R. C., & Rochlin, L. (1997). Social marketing. In K. Glanz (Ed.), Health behavior and health education. San Francisco: Josey-Bass Inc. Publishers.

    Google Scholar 

  • McKay, C. C., Chang, A. B., Versteegh, L. A., & McCallum, G. B. (2015). Culturally appropriate flipcharts improve the knowledge of common respiratory conditions among Northern Territory Indigenous families. Health Promotion Journal of Australia, 26(2), 150–153. https://doi.org/10.1071/HE14100.

    CrossRef  PubMed  Google Scholar 

  • Ministerio de Economía y Finanzas. (2003). Economía, Nivel de Vida (D. d. P. Sociales, Trans.). Panama: Dirección de Políticas Sociales. Ministerio de Economía y Finanzas.

    Google Scholar 

  • Mintjes, J., Boldewijn, W., Aerts, G., & Sparnaay, M. (2001). Train the trainers course on infection control and hospital hygiene in Bangladesh. Tropical Doctor, 31(1), 36–37.

    CrossRef  CAS  PubMed  Google Scholar 

  • Murphy, M. A., Neequaye, S., Kreckler, S., & Hands, L. J. (2008). Should we train the trainers? Results of a randomized trial. Journal of the American College of Surgery, 207(2), 185–190. https://doi.org/10.1016/j.jamcollsurg.2008.02.032

    CrossRef  Google Scholar 

  • Pearce, J., Mann, M. K., Jones, C., van Buschbach, S., Olff, M., & Bisson, J. I. (2012). The most effective way of delivering a train-the-trainers program: a systematic review. The Journal of Continuing Education in the Health Professions, 32(3), 215–226.

    CrossRef  PubMed  Google Scholar 

  • Rawat, R., Nguyen, P. H., Ali, D., Saha, K., Alayon, S., Kim, S. S., et al. (2013). Learning how programs achieve their impact: embedding theory-driven process evaluation and other program learning mechanisms in alive & thrive. Food and Nutrition Bulletin, 34(3 Suppl), S212–S225.

    CrossRef  PubMed  Google Scholar 

  • Reed, H., Langley, J., Stanton, A., Heron, N., Clarke, Z., Judge, S., et al. (2014). Head-Up; An interdisciplinary, participatory and co-design process informing the development of a novel head and neck support for people living with progressive neck muscle weakness. Journal of Medical Engineering & Technology, 39(7), 404–410. https://doi.org/10.3109/03091902.2015.1088092

    CrossRef  Google Scholar 

  • Revere, D., Dixon, B. E., Hills, R., Williams, J. L., & Grannis, S. J. (2014). Leveraging health information exchange to improve population health reporting processes: lessons in using a collaborative-participatory design process. EGEMS (Washington DC), 2(3), 1082. https://doi.org/10.13063/2327-9214.1082.

    CrossRef  Google Scholar 

  • Rosenstock, A., Mukandi, B., Zwi, A. B., & Hill, P. S. (2013). Closing the gaps: competing estimates of indigenous Australian life expectancy in the scientific literature. Australian and New Zealand Journal of Public Health, 37(4), 356–364. https://doi.org/10.1111/1753-6405.12084

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Sarli, L. (2016). The need to train trainers. Acta Biomédica, 87(Suppl 2), 5–6.

    PubMed  Google Scholar 

  • Waqa, G., Moodie, M., Schultz, J., & Swinburn, B. (2013). Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji. Global Health Promotion, 20(4), 23–34. https://doi.org/10.1177/1757975913501909

    CrossRef  PubMed  Google Scholar 

  • Werner, D., & Bower, B. (2010). Aprendiendo a promover la salud. Berkeley: Hesperian.

    Google Scholar 

  • Werner, D., Thurman, C., & Maxwell, J. (2010). Where there is no doctor. A villa health care handbook. Berkeley, CA: The Hesperian Foundation.

    Google Scholar 

  • Wright, M. T., Killian, H., Block, M., von Unger, H., Brandes, S., Ziesemer, M., et al. (2015). Participatory quality development: Engaging Community members in all phases of project planning and implementation. Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes (Germany), 77(Suppl 1), S141–S142. https://doi.org/10.1055/s-0033-1,347,268

    CrossRef  Google Scholar 

  • Zhao, Y., Wright, J., Begg, S., & Guthridge, S. (2013). Decomposing indigenous life expectancy gap by risk factors: a life table analysis. Population Health Metrics, 11(1), 1. https://doi.org/10.1186/1478-7954-11-1

    CrossRef  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arlene Calvo Ph.D., M.P.H. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Calvo, A., Rebollón, A. (2018). Improving Maternal Health Status in Indigenous Communities of Panama: Community-Based Participatory Research and Interventions Among the Ngäbe-Buglé People of Panama. In: Schwartz, D. (eds) Maternal Death and Pregnancy-Related Morbidity Among Indigenous Women of Mexico and Central America. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-71538-4_36

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71538-4_36

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71537-7

  • Online ISBN: 978-3-319-71538-4

  • eBook Packages: MedicineMedicine (R0)