First Step in Planning An Intervention: Get to Know the Culture

By Molly Lopez, MPH ’12 in Population and Family Health

The first thing that struck me as I walked into the Centro Especializado de Atención de Salud Juan XXIII was the sheer number of patients lining the narrow white hallways and spilling out from the waiting rooms.

The doctor I would be working with had told me that patients arrived at the public clinic well before appointments began, but the density of the crowds still surprised me. With appointments costing just 25 pesos (less than a dollar), the clinic draws many residents of Santiago, the second largest city in the Dominican Republic.

Pressing my arms flat against my sides and turning sideways, I squeezed through the bustling throng of adults, teenagers and infants, finally reaching the Family Medicine Consult at the end of the hallway and a smiling Doctora Wendy Gomez, family and community medicine specialist.

Centro Especializado de Atención de Salud Juan XXIII

Centro Especializado de Atención de Salud Juan XXIII

My assignment for the summer was to research the nutritional knowledge, attitudes and practices of Dr. Gomez’s adult patients. With many patients suffering from obesity, hypertension and type 2 diabetes, we aimed to create educational materials that would help patients adopt healthier lifestyles. The research eventually extended to patients’ exercise habits.

Dr. Gomez also wanted to learn how common obesity was among her patients. In order to calculate prevalence, I took the height and weight of each patient that participated in the survey and calculated their body mass index (BMI). At the end of the project, we learned that 30% of the patients interviewed were pre-obese and 28% of the patients were obese.

Having spent several weeks emailing with Dr. Gomez about the project from New York, I had arrived in Santiago two days earlier with my questionnaire in-hand, written in Spanish and partially based on the World Health Organization’s STEPwise approach to surveillance. Before testing the instrument with patients – a critical step to weeding out questions that were unnecessary or confusing – I spent two hours going over the grammar with Dr. Gomez, making corrections and changing words and phrases to those most commonly used in Santiago.

Learning about the distinct culture of the Dominican Republic was essential to designing an effective questionnaire and intervention. One of the most fun and informative experiences of my practicum was a Saturday morning “tour” of the food vendors popular with the clinic’s patients. In order to recommend ways for patients to shop, cook and eat healthier, it was vital to know what options were available at the places they shop.

colmados

colmados

During our tour, Dr. Gomez and I visited colmados – the equivalent of corner stores or bodegas in the U.S., and a very common place for Dominicans to buy basic groceries – as well as a sprawling open air market and a large supermarket. We spoke with a wide range of vendors, including two young boys helping their father sell vegetables out of the bed of a pickup truck, a man selling vegetables out of a wheelbarrow, a woman selling fresh chicken meat, and a woman cooking eggs and mangu (mashed plantains) at a stand for passersby.

Next steps were putting all of this information to use.

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