<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1137-6627</journal-id>
<journal-title><![CDATA[Anales del Sistema Sanitario de Navarra]]></journal-title>
<abbrev-journal-title><![CDATA[Anales Sis San Navarra]]></abbrev-journal-title>
<issn>1137-6627</issn>
<publisher>
<publisher-name><![CDATA[Gobierno de Navarra. Departamento de Salud]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1137-66272021000200005</article-id>
<article-id pub-id-type="doi">10.23938/assn.0945</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[La percepción local del acceso a los servicios de salud en las áreas rurales. El caso del pirineo navarro]]></article-title>
<article-title xml:lang="en"><![CDATA[Local perception of access to health services in rural areas. The case of the Navarrese Pyrenees]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sanz Tolosana]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliva Serrano]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Pública de Navarra I-COMMUNITAS. Institute for Advanced Social Research ]]></institution>
<addr-line><![CDATA[Pamplona ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2021</year>
</pub-date>
<volume>44</volume>
<numero>2</numero>
<fpage>185</fpage>
<lpage>194</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1137-66272021000200005&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1137-66272021000200005&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1137-66272021000200005&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Fundamento Mientras las inequidades en la protección de la salud son cada vez más reconocidas, la disparidad rural/urbana en el acceso a los servicios sanitarios es con frecuencia ignorada. Las regiones rurales acumulan junto a los efectos del hábitat (dispersión, tamaño poblacional), importantes desequilibrios demográficos (envejecimiento) y desventajas socioeconómicas que definen barreras para la accesibilidad. Este trabajo analiza la percepción local del acceso a los servicios sanitarios para identificar los factores que facilitan y dificultan una atención primaria continua y el seguimiento de las derivaciones.  Material y métodos Estudio cualitativo realizado en los valles de Aezkoa, Salazar y Roncal (Navarra) entre 2012 y 2016. La accesibilidad se analizó a través de siete dimensiones: disponibilidad, geografía, asequibilidad, acomodación, puntualidad, aceptabilidad y conocimiento/conciencia. Se entrevistó a 21 personas expertas (personal sanitario), informantes clave (relacionados con los cuidados y el desarrollo local) y perfiles sociológicos. La información recabada se contrastó con un marco conceptual específicamente propuesto para facilitar la evaluación de políticas de accesibilidad rural.  Resultados Los resultados muestran el peso otorgado a la geografía, la disponibilidad de servicios, así como al entorno sociológico envejecido. La accesibilidad se define en función del tiempo frente a la distancia y la disponibilidad de alternativas de movilidad.  Conclusiones  Es necesario considerar políticas inclusivas que atiendan la particularidad de las poblaciones rurales y sus territorios. El envejecimiento supone una pérdida de accesibilidad general y condiciona la demanda de servicios. En los entornos rurales y remotos dependen de la automovilidad privada como el principal recurso y estrategia para el acceso a la salud.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background While there is a growing recognition of the inequities in health protection, the rural/urban disparity in access to health services is often ignored. Rural regions accumulate not only habitat effects (dispersion, population size) but also significant demographic imbalances (ageing) and obvious socio-economic disadvantages that define barriers to accessibility. This paper analyses local perceptions of access to health services in order to identify factors that facilitate and hinder continuous primary care and follow-up of referrals.  Methods Qualitative study conducted in the valleys of Aezkoa, Salazar and Roncal (Navarre) between 2012 and 2016. Accessibility was analysed through seven dimensions: availability, geography, affordability, accommodation, timeliness, acceptability, and knowledge/awareness. A total of 21 in-depth interviews were carried out with experts (health care personnel), key informants (related to care and local development) and sociological profiles. The information collected was checked against a conceptual framework specifically designed to facilitate the evaluation of rural accessibility policies.  Results The results showed the weight given to geo-graphy, the availability of services, as well as the aging sociological environment. Accessibility was defined as a function of time versus distance and the availability of mobility alternatives.  Conclusion It is necessary to consider inclusive policies that address the particular features of rural populations and their territories. Ageing means a loss of general accessibility and influences demands for services. In rural and remote environments, people depend on private self-mobility as the main resource and strategy for access to health.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Accesibilidad]]></kwd>
<kwd lng="es"><![CDATA[Movilidad]]></kwd>
<kwd lng="es"><![CDATA[Servicios de salud]]></kwd>
<kwd lng="es"><![CDATA[Salud rural]]></kwd>
<kwd lng="es"><![CDATA[Desigualdades territoriales]]></kwd>
<kwd lng="en"><![CDATA[Accessibility]]></kwd>
<kwd lng="en"><![CDATA[Mobility]]></kwd>
<kwd lng="en"><![CDATA[Health services]]></kwd>
<kwd lng="en"><![CDATA[Rural health]]></kwd>
<kwd lng="en"><![CDATA[Territorial inequalities]]></kwd>
</kwd-group>
</article-meta>
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