The value of grounded theory for disentangling inequalities in maternal-child healthcare in contexts of diversity : a psycho-sociopolitical approach

摘要

Adopting a psycho-sociopolitical approach, the present paper describes the results of a community-basedparticipatory needs assessment focusing on the perceived needs of women of reproductive age as users ofprimary healthcare in contexts of migration-driven diversity and socioeconomic vulnerability in theMetropolitan Area of Lisbon. The investigation comprised 64 in-depth interviews with women, includingnatives and immigrants to Portugal from the main origin countries in the context under study (Brazil, CapeVerde, and other Portuguese- speaking African countries) and a survey of 125 women, again natives andimmigrants from these countries. The central role of qualitative methodology and grounded theory, in theframework of a multi-method research, allowed understanding the needs of women as embedded incontexts characterized by asymmetrical power relations, in terms of unequal opportunities and resources,at multiple interrelated ecological levels (personal, relational, organizational, community, socioeconomic,health system/policy, cultural/migration). The priority perceived needs of women were primarily related tosocioeconomic disadvantage, severely aggravated in the current contexts of crisis; and factors at the healthsystem level, mainly unequal access to family doctors, excessive waiting lists, and increases in the directcosts of healthcare. Results allow questioning the adequacy of cultural competence approaches for thereduction of inequalities in maternal-child healthcare in the context under study, showing the critical andinnovative value of qualitative methodology and grounded theory in research on social justice and healthin contexts of diversity characterized by unequal power dynamics.