Gendered experiences of health care.
OBJECTIVE
To develop a method capable of bringing to light gender specific problems in the social interaction between providers and clients, and in so doing, contribute to improving quality of care for both sexes in five primary health care centers in Argentina.


METHODS
A qualitative study using semi-structured interviews. Texts were processed in a database and analyzed using a formal method of discourse called Semiotics of Statements. Male and female clients' ideas on perceived causes of illnesses and health care needs were compared, following which providers' perceptions on the same issues were then contrasted. Problems in quality of care were suggested when: (i) differences in perceptions and/or values between providers and either male or female clients were observed; and (ii) similarities in values revealed reinforcement of traditional gender roles.


METHODS
Public sector care provided to urban poor with hypertension and diabetes mellitus type 2 in five clinics in Avellaneda, Argentina. Participants were clients identified through community organizations (n = 27), and all physicians from these clinics (n = 10), 60% of nurses (n = 6) and 80% of receptionists (n = 4) were interviewed.


RESULTS
Providers' views differed from women's in regard to: (i) the degree of individual responsibility (risky behavior) in disease causation; (ii) legitimacy of the reasons many women seek care; (iii) function of talk in the consultation; (iv) effects of chastisement; and (v) relevance of domestic violence. In addition, a series of shared values were identified that reinforce traditional gender roles, including situations detrimental to men's health.


CONCLUSIONS
The method permitted identification of subjective issues relating to social interaction that could not have been accessed with other approaches, and that had practical implications for providers, as well as managers, policy-makers, educators and patient advocates.
Pittman
P M
PM
Gender and Quality of Care Project, Women, Health and Development Program, Pan American Health Organization, Washington, DC 20037, USA. pittmanp@paho.org
D000328:Adult; D001118:Argentina; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D006973:Hypertension / Q000523:psychology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012737:Sex Factors; D014505:Urban Population