Clinical Rheumatology

, Volume 35, Issue 5, pp 1287–1298 | Cite as

Barriers to accessing the culturally sensitive healthcare that could decrease the disabling effects of arthritis in a rural Mayan community: a qualitative inquiry

  • Adalberto Loyola-Sanchez
  • Julie Richardson
  • Seanne Wilkins
  • John N. Lavis
  • Michael G. Wilson
  • Jose Alvarez-Nemegyei
  • Ingris Pelaez-BallestasEmail author
Original Article


The impact of living with arthritis in a rural Mexican Mayan community along with the barriers encountered by people living with this chronic condition were investigated in this study. The community needs around this health issue were investigated by conducting an ethnographic study using data obtained during two time periods (August 2012–April 2013 and December 2013–December 2014). During the first period, fieldwork observations and interviews with 65 individuals, which included people with arthritis, health professionals, traditional health providers, and community leaders were undertaken. During the second period, 46 community meetings were conducted to identify the needs associated with arthritis in the municipality. Data were analyzed following a modified version of the Framework approach. The results show that arthritis reduces the health-related quality of life of the people in Chankom through a process of disablement, conditioning a need to access culturally sensitive healthcare. Availability, attainability, and acceptability barriers prevent access to this type of healthcare and result from power imbalance between indigenous and non-indigenous people. There is a need to develop culturally sensitive rehabilitation services for people living with arthritis in Chankom. Mayan people should be involved in the design and implementation of these services. Moreover, it is important to improve our understanding of the processes behind the healthcare access inequities identified in this study by attending to the historical generation of current social, economical, cultural, and political structures.


Arthritis Health policy Health services Indigenous Qualitative research 



We like to thank the group of anthropologists that participated in the data acquisition for this work: Anthropologists Gabriela Cruz, Joan Matamoros Sanin, and Daniela Flores.

We thank Mr. Diego Yeh Cen for his services as an interpreter and Mr. Carlos Castillo Kuyoc along with all participants from Chankom municipality for their time and effort to complete this work.

We like to thank Psychologist Guillermo Pérez for his hard work transcribing the extensive material used for the creation of this manuscript.

We thank the municipal authorities of Chankom and the authorities from the Jurisdicción Sanitaria No. 2, Valladolid for supporting the conduction of this research study.

An “International League Against Rheumatism (ILAR)” award primarily funded this work to promote the development of rheumatology services in Chankom municipality. In addition, the “Consejo Nacional de Ciencia y Tecnología [CONACYT]” (grant #162154) provided complementary funding for the completion of this study. ALS received funding from CONACYT’s doctoral scholarship for studying abroad (scholarship #209621) and from the Doctoral Vanier Canada Scholarships (# 268078).




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2015

Authors and Affiliations

  • Adalberto Loyola-Sanchez
    • 1
  • Julie Richardson
    • 1
  • Seanne Wilkins
    • 1
  • John N. Lavis
    • 2
    • 3
    • 4
    • 5
    • 6
  • Michael G. Wilson
    • 2
    • 3
    • 4
  • Jose Alvarez-Nemegyei
    • 7
  • Ingris Pelaez-Ballestas
    • 8
    Email author
  1. 1.School of Rehabilitation ScienceMcMaster UniversityHamiltonCanada
  2. 2.McMaster Health ForumMcMaster UniversityHamiltonCanada
  3. 3.Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonCanada
  4. 4.Department of Clinical Epidemiology and BiostatisticsMcMaster University, CanadaHamiltonCanada
  5. 5.Department of Political ScienceMcMaster University, CanadaHamiltonCanada
  6. 6.Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonUSA
  7. 7.Research UnitHospital Regional de Alta Especialidad de la Península de YucatánMéridaMexico
  8. 8.Rheumatology DepartmentHospital General de MexicoMexico CityMexico

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