[Institutional factors contributing to the utilization of breast clinical examination].
OBJECTIVE
To identify factors associated with utilization of breast clinical examination (BCE) and their relationship with institutional medical practice.


METHODS
This is a qualitative study conducted between 1996 and 1997 in medical units of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) and Secretaria de Salud (Ministry of Health). Eight focus groups were included: four groups of female users and four groups of health professionals; in total, 47 users and 29 physicians and nurses participated. Interpretations of information were based on the organizational ability to respond to the user's expectations, "ability/knowledge" within the organization and the institutional medical practice, at the light of the Grounded Theory.


RESULTS
Service demand was conditioned on the perception of poor quality of care, lack of trust in physicians, and organizational aspects. When providing care, male physicians were not interested and felt uneasy about performing the BCE. Female physicians seemed more interested and were well accepted by users.


CONCLUSIONS
Psychological, cultural, social, and institutional barriers exist in the access and utilization of BCE. Identifying these barriers and their origins could support the development of actions to improve the physician-patient relationship. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. opoblano@correo.insp.mx
Ofelia
O
Poblano-Verástegui
Juan Guillermo
JG
Figueroa-Perea
Lizbeth
L
López-Carrillo
D000328:Adult; D001940:Breast; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D012959:Socioeconomic Factors