https://hdl.handle.net/20.500.12412/2556 Sat, 26 Sep 2026 12:07:11 GMT 2026-09-26T12:07:11Z https://hdl.handle.net/20.500.12412/7402 Transiciones no normativas hacia la maternidad: Un análisis cualitativo desde la perspectiva de la mujer Cruz-Ramos, María Consuelo El objetivo general de la presente tesis doctoral es comprender la transición no normativa hacia la maternidad desde la perspectiva de la mujer. Para ello se han explorado tres situaciones específicas de transición hacia la maternidad no normativa: cuando esta sucede durante la adolescencia, la pandemia sanitaria de la COVID-19 y la pérdida perinatal. La tesis doctoral recoge este objetivo en cinco capítulos. En el primer capítulo, se presenta una visión general sobre las distintas teorías que recogen cómo se produce la transición hacia la maternidad. Se describe cómo el creciente interés por la salud materna da lugar a la creación de un ámbito de estudio especializado, la psicología perinatal. A través de este apartado, se expone de forma específica cómo son los procesos de embarazo, parto y posparto en la actualidad, incluyéndose cuáles son los problemas de salud mental más comunes que pueden experimentar las madres en cada etapa específica, así como los factores de riesgo asociados. Para acercar el foco al objetivo de la tesis, se aporta información relevante sobre tres situaciones específicas de transición no normativa que podrían situar a las madres en una posición de mayor vulnerabilidad durante la maternidad. El capítulo finaliza con la pregunta de investigación, el objetivo general y los objetivos específicos. El segundo capítulo recoge el marco epistemológico al que se acoge la presente tesis doctoral, así como el enfoque metodológico que se aplica para alcanzar cada uno de los objetivos propuestos. Se detallan las metodologías de revisión sistemática y de análisis temático. El capítulo finaliza con un apartado de reflexividad, criterios de calidad y consideraciones éticas. En el tercer capítulo se presentan los resultados de los diferentes estudios realizados para tratar de responder a cada objetivo específico. Concretamente, se presentan los resultados de una revisión sistemática sobre las condiciones psicológicas durante la transición hacia la maternidad en la adolescencia y los resultados de dos análisis temáticos reflexivos, uno sobre la experiencia de parto durante la pandemia de la COVID-19 y otro sobre la experiencia de posparto tras una pérdida perinatal. En el cuarto capítulo, se presentan las discusiones de los resultados obtenidos en cada estudio. Además, se realiza una discusión general de los hallazgos obtenidos en la presente tesis doctoral. Finalmente, el quinto capítulo proporciona las conclusiones, implicaciones prácticas, futuras líneas de investigación así como fortalezas y limitaciones. Los resultados de la presente tesis doctoral permiten abandonar el significado universal y reduccionista sobre la transición a la maternidad al visualizar experiencias de transición que no se ajustan a los estándares sociales preestablecidos y al tener en consideración la amplia variedad de dimensiones que influyen en la experiencia materna. Con aportaciones como la de esta investigación se podrá ayudar a los responsables políticos a diseñar programas de atención sanitaria especializada, así como estrategias de prevención, promoción e intervención en la salud mental materna, ayudando de esta manera a madres, bebés, familias y, por tanto, a la sociedad.; En abierto se puede consultar la parte no embargada de la Tesis Doctoral Tue, 01 Sep 2026 00:00:00 GMT https://hdl.handle.net/20.500.12412/7402 2026-09-01T00:00:00Z https://hdl.handle.net/20.500.12412/7392 The development of a new approach for the harmonized multi-sectoral and multi-country cost valuation of services: The PECUNIA Reference Unit Cost (RUC) Templates Mayer, Susanne; Berger, Michael; Peric, Natasâ; Fischer, Claudia; Konnopka, Alexander; Brodzsky, Valentin; Evers, Silvia M A A; Hakkart van Roijen, Leona; Ruiz Gutiérrez-Colosía, Mencía; Salvador Carulla, Luis; Park, A-La; Hollingworth, William; García Pérez, Lidia; Simon, Judit Background: Increasing healthcare costs require evidence-based resource use allocation for which assessing costs rigorously and comparably is crucial. Harmonized cross-country costing methods for evaluating interventions from a societal perspective are lacking. This study presents the development process and content of the service costing templates developed as part of the European project PECUNIA. Methods: The six developmental steps towards technological readiness of the templates included (1) a common conceptual costing framework and review of methodological costing issues, (2) harmonization strategy formulation, (3) proof-of-concept with expert feedback, (4) piloting, (5) validation, and (6) demonstration in six European countries. Results: The PECUNIA Reference Unit Cost (RUC) Templates for service costing are three new self-completion tools to be used with secondary or primary data for top-down micro-costing or top-down gross-costing approaches. Complementary data collection and unit cost aggregation/weighting templates are available. The applications leading to the final versions including (4) piloting through calculation of 15-unit costs, (5) validation within a Health Technology Assessment framework, and (6) RUC calculations mostly based on secondary data demonstrated the templates' general feasibility, with feedback for improved usability incorporated and a supplementary user guide developed. Conclusion: The validated PECUNIA RUC Templates for multi-sectoral and multi-country service costing allow for harmonized RUC development while incorporating flexibility and transparency in the choice of costing approaches, data sources and magnitude of remaining heterogeneity. The templates are expected to significantly improve the quality, comparability and availability of unit costs for economic evaluations, and promote the transferability of service cost information across Europe. Thu, 08 Aug 2024 00:00:00 GMT https://hdl.handle.net/20.500.12412/7392 2024-08-08T00:00:00Z https://hdl.handle.net/20.500.12412/7391 Validation of the PECUNIA Reference Unit Costs templates in Spain: a useful tool for multi-national economic evaluations of health technologies García Pérez, Lidia; Linertová, Renata; Hernández Yumar, Aránzazu; Valcárcel Nazco, Cristina; Perdomo Vielma, Jhoner; Serrano Aguilar, Pedro; Ruiz Gutiérrez-Colosía, Mencía; Salvador Carulla, Luis; Fernández Vega, Enrique; Mayer, Susanne; Simon, Judit Background The PECUNIA Project was funded by the H2020 programme in which 10 partners from six countries participated. The aim was to develop standardized, harmonized and validated methods and tools to calculate costs in different sectors (such as health and social care, education among others), with the purpose of facilitating comparability of economic evaluations of health technologies across European countries. In this paper we report the first validation of the developed reference unit cost templates in Spain. Methods The evaluation of the PECUNIA Reference Unit Cost (RUC) Templates involved usability, transferability and feasibility assessment. Applicability tests were performed to estimate the cost of a selection of 15 resource items by means of the RUC templates in Spain and in four Spanish regions. External validation involved comparison with existing unit costs. Results It was possible to estimate the cost of five services (dental care and general practitioner in the Canary Islands, general practitioner in Spain [tariffs], health-related day care centre and education services provided in a special education school in the Basque Country), car vandalism as an example of potential health-related consequences, and informal care in Spain. The templates were feasible although data completeness depended on the type of data needed to estimate the costs. The templates are transferable across countries although comparability depends on the services available in each jurisdiction. Conclusions The PECUNIA RUC Templates are free and feasible tools to estimate comparable reference unit costs across countries. Although more validation exercises are needed, they seem useful tools to perform robust multi-national economic evaluations and increase the transferability of cost-effectiveness studies of health technologies in Europe. However, they cannot compensate for the lack of data across jurisdictions. Wed, 18 Dec 2024 00:00:00 GMT https://hdl.handle.net/20.500.12412/7391 2024-12-18T00:00:00Z https://hdl.handle.net/20.500.12412/7390 An ecosystem approach to the evaluation and impact analysis of heterogeneous preventive and/or early interventions projects for veterans and first responders in seven countries Lukersmith, Sue; Salvador Carulla, Luis; Woods, Cindy; Niyonsenga, Theo; Ruiz Gutiérrez-Colosía, Mencía; Mohanty, Itismita; García Alonso, Carlos; Díaz Milanés, Diego; Salinas Pérez, Jose Alberto; Davey, Rachel; Aryani, Amir Background Cumulative exposure to critical incidents and life-threatening events leads to significant risk for Veterans and First Responders (VFRs) developing mental ill health and disorders. Philanthropic organisations, Movember and Distinguished Gentleman's Ride, funded 15 organisations to conduct early intervention Projects across seven countries. The Projects aim to improve the mental health and wellbeing of VFRs, their families/significant others. This paper describes the novel external evaluation and impact analysis methods to identify effective Projects having positive impact on VFRs and their families, provide return on investment and the overall Grant Program. Methods We take an ecosystem real-world approach, which recognises the context and aims to manage the complexities involved, uses a complexity and systems perspective, multi-step mixed methods and approaches. The evaluation is from three perspectives of: Projects; Project comparisons; Grant program. Embedded in the evaluation design are methods, knowledge sharing and organisational learning activities for all stakeholders. Data is collected by the Projects and evaluation team on input, throughputs, and output indicators. Analysis tools include Global Impact Analytics Framework, multi-layered statistical analysis, performance evaluation using an efficient decision support approach, Project and Grant program social return on investment, visual linking and data connection platform and assessment of gendered lens approaches. Implications The complexity and heterogeneity of Projects implemented in the real world continues to present significant evaluation challenges and limitations for project leads, stakeholders, researchers and evaluators. Our ecosystem approach and novel evaluation methodology will reduce the uncertainty around real world implementation, provide key learnings for project stakeholders and more broadly implementation researchers. Tue, 01 Apr 2025 00:00:00 GMT https://hdl.handle.net/20.500.12412/7390 2025-04-01T00:00:00Z