bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic inequalities in self-reported dental and general health in a Norwegian county study
Authors: Lyshol H , Sen A , Natland Fagerhaug T , Jullumstrø Feuerhern A , Jakhelln G , Grøtvedt L
Published: October 2020

Background

Studies have shown socioeconomic gradients in both dental health and general health, with poorer health in lower-socioeconomic status (SES) groups than in their higher-SES counterparts. We wanted to see if these gradients were present in our study population according to educational differences, and whether age or gender would have effect.

Methods

In 2015-16 a cross-sectional interview survey was carried out in three of Norway's then 19 counties. Questions about dental and general health were included. The respondents' educational level was available from linkages to the national education registry. 4551 men and 5141 women responded; a response rate of 42.7%. We included respondents aged 25-79. We compared the percentages reporting good/very good dental and general health by degree of education according to ISCED classification (0-2, 3-4 and 5-6) across the age groups 25-44, 45-66 and 67-79; by gender and county, in a regression with general linear models in STATA 15

Results

Clear educational gradients were found for both general and dental health. Stratifying by gender and county, we found more consistent age gradients for general health than for dental health, and consistent educational gradients for both. Both general and dental health were expected to deteriorate with age, and age was weakly associated with dental health. In regression analyses, general health was (negatively) associated with age (RR 1.04, CI 1.02-1.07) and (positively) associated with education (RR 0.92, CI 0.89-0.94), but not with gender. Dental health was not associated with age, but with education (RR 0.93, CI 0.91-0.96).

Conclusions

Self-reported dental health varied more by education than by age, and showed clear gradients only by education. There were county variations, but the oldest people with the highest education reported better health, both dental and general, than the youngest people with the lowest education. This may be connected to other socio-economic differences.

Key messages

There is often a gradient for age within each educational group regarding general health, but more rarely so regarding dental health. Education has a stronger influence on both dental health and general health than age.
Intersectorial educational incentive and youth leadership program: promoting opportunities
Authors: Vieira A M M , Secundino R C C B , Ortiz M S P , Castro V D S , Amaral M I B , Santos A C C
Published: October 2020

The Poupança Escola Program, created by municipal law and part of the Prevention Axis of the Niterói Pact Against Violence, aims to encourage young people from low-income communities and members of Bolsa Família Program, to study and complete high school. To receive the financial incentive in addition to the annual approval, the student must participate in mandatory extracurricular activities offered by the Municipality, such as courses and workshops on financial education, health education, entrepreneurship, among others. Its implementation results from a collective construction, wich had the participation of Niterói Pact Against Violence's secretariats and the Program Supervision Commission, in order to stimulate the agreement and shared management. In 2019, of 281 eligible students, 231 pre-registered on the program's website and of this total, 72.29% students opened their savings account in a public bank. After analyzing the 2019's monitoring informations of Niterói's public schools, students who met all requirements were identified and the first financial incentives was paid, totaling R$ 41.400,00 (about $ 10,000). For that, it was necessary an intense work of intra-municipal articulation and partnerships: the Government of Rio de Janeiro and federal schools, strengthening the reduction of school dropout. In 2020, the challenge will be to expand the availability of extracurricular activities, through public partnerships and non-governmental institutions, with the aim of improving the professional and citizen training of young people, encouraging their autonomy and protagonism over their future and contributing to the reduction of inequities. It is important to highlight the potential for replicability of the experience in other units of the federation and also for other countries.

Key messages

As a public policy, Poupança Escola encourages low-income youth to develop professional and citizen training, contributing to the reduction of risk factors that influence youth violence rates. Extracurricular activities expand opportunities for generating skills and abilities, contributing to the reduction of inequalities in access for low-income youth.
Social determinants of self-rated health in women
Authors: Mijatovic Jovanovic V , Milijasevic D , Cankovic S , Susnjevic S , Harhaji S , Tomasevic T
Published: October 2020

Background

Social determinants of health determine the extent to which a person possesses the physical, social and personal resources to stay healthy and achieve personal aspirations, satisfy needs, and cope with the environment.

Methods

Data from a cross-sectional study - The 2013 National Health Survey in Serbia was used. The study involved 1840 women aged 20 years and over in the Province of Vojvodina. The research instrument was a specially designed questionnaire. Multivariate logistic regression was implemented to assess the association between self-rated health as a dependent variable and social-demographic characteristics of women as independent variables (age, type of settlement, marital status, material status - DHS Wealth Index (WI), level of education, employment status, social support (Oslo-3 Social Support Scale), smoking and alcohol consumption.

Results

Out of a total 38.8% of women had a low level of education, according to WI 49.3% were poor, 21.9% were unemployed and 11.5% had poor social support. Every third woman was a smoker (31.9%) and 21.3% self-rated their health as poor. The number of women with poor health increased significantly with the decrease in social support, level of education and WI (from 14.3% among women with strong social support to 36.0% with poor social support, from 8.5% among highly educated to 31,4% among the low educated, from 11.1% among the rich to 24.4% among the poor). Multivariate logistic regression indicated that poor social support (OR = 3.96; 95%CI=2.34-6.70), low level of education (OR = 2.87; 95%CI=1.47-5.58), WI category of poor (OR = 1.77; 95%CI=1.10-2.84), ex smoking (OR = 2.49; 95%CI=1.51-4.08) and smoking (OR = 2.16; 95%CI=1.42-3.29) were significantly associated with poor self-rated health.

Conclusions

The research shows that there is a strong association between social determinants and self-rated health, which demands multi-disciplinary strategies to improve health and reduce health inequalities.

Key messages

Protecting the health of women is not only a basic human right, it is also crucial for health and economic development. Social determinants of health are leading causes of the health inequalities and demand an adequate health policy development at local, as well as at the national level.
Self-reported prevalence and risk factors for NCD in a Roma community in Romania
Authors: Mangaloiu D , Bratu E C , Mardare I , Brinduse L A , Minca D G
Published: October 2020

Background

Most of Romanian Roma communities are considered a vulnerable group, but there are limited data regarding the exposure and the prevalence of NCD specific for these communities. The research aims to assess the self-reported NCD prevalence and NCD risk factors among members of a rural Roma community.

Methods

A cross-sectional survey was carried out among a sample of 116 adults aged 18-85 years (52 male and 64 female), from a rural community with 800 Roma members. The study tools included questions to record NCD risk factors (WHO STEPwise approach) and self-reported data about the presence of chronic conditions. Descriptive statistics methods were used to analyse the data.

Results

Unhealthy diets (25% -95%CI, 17,7: 37,4), tobacco use (35,3% -95%CI, 27,0: 44,3), obesity and physical inactivity have been identified as the top NCD risk factors, with higher prevalence than ones reported for Romanian general population. Overall, the self-reported prevalence of chronic diseases in the sample was 56,8%, (95%CI, 47.8:95.9), no significant difference between men and women. 62% (95%CI, 50.4:73,8) of respondents with self-reported disease have declared co-morbidities. The most prevalent disease reported was hypertension (37.0% - CI95%, 28.2: 45.8), followed by dyslipidaemia (23,2% -CI95%,15,5:30.9), diabetes type 2, gastritis and ischemic heart disease (IHD). One quarter of respondents with HTA are daily smokers and more than half have obesity and dyslipidaemia.

Conclusions

This analysis provides information that NCD risk factors and self-reported NCD prevalence in a typical rural Roma community are higher than in the majority population of Romania. Both prevalences should be known in order to increase access to prevention, diagnostic and treatment programs.

Key messages

The health system should monitor NCDs and risk factors and implement equitable public health policies to address health inequities and meet the needs of Roma population groups. The high prevalence of risk factors for NCD in this rural Roma community indicates the likelihood of a high future burden of illness.
Equitable Access of Naloxone Programs in Durham Region, Ontario, Canada
Authors: Martignetti L , Sun W
Published: October 2020

Background

In 2019 there were over 1500 opioid-related deaths in the province of Ontario, Canada. While the opioid crisis is affecting many socioeconomic groups and communities across Canada not all are being affected equally despite the presence of naloxone distribution programs in Ontario. This qualitative exploratory study seeks to understand facilitators and barriers that influence equitable access of naloxone programs in Durham Region, Ontario, Canada.

Methods

An environmental scan will be conducted to examine the availability and distribution of naloxone across community pharmacies and organizations in Durham Region. A qualitative descriptive phenomenology will be the methodological approach where key informant interviews will explore experiences of users and providers of naloxone programs. Key informants will include service providers and clients of both Ontario Naloxone Program and Ontario Naloxone Program for Pharmacies in Durham Region. The harm reduction framework will be used to guide data analysis where thematic analysis will be conducted to generate overarching themes about the phenomenon.

Results

The environmental scan will result in the creation of a map outlining availability and distribution of naloxone programs to examine possible gaps that exist in Durham Region. It is expected that key informant interview findings will help understand where inequity exists in accessing Ontario's naloxone programs in Durham Region by highlighting its barriers and facilitators.

Conclusions

Findings generated will be used for larger scale studies in the future examining equitable access of naloxone distribution programs in Canada. This study will have implications to provide recommendations to policymakers for developing new policies to facilitate timely access of naloxone to mitigate risk of opioid-related harms.

Key messages

This research will help to better understand the inequities that exist in Ontario's naloxone distribution programs. This research will help to inform recommendations to improve policies surrounding Ontario's naloxone distribution programs.
Early assessment of health impact of the population-based tobacco control interventions in Vietnam
Authors: Nguyen T D , Oh J K , Hoang V M
Published: October 2020

Background

Through the period from 2013 until now, Vietnam has achieved progress in tobacco control following the implementation of MPOWER in 2008 and the enactment of the comprehensive Law on Prevention and Control of Tobacco Harms in 2012. This study aimed to assess the cost-effectiveness of 6 population-based interventions including health promotion & education program; smoke-free models; cessation program; graphic health warning on cigarette package; bans on advertising/ promotion/ sponsoring; raising tobacco tax.

Methods

An Excel-based Markov model was adopted based on the previous studies of HV Minh et al 2018 and Ngalesoni et al 2017. We estimated the potential health gain on Vietnamese population by using the empirical data on tobacco epidemic in Vietnam together with the reviewed intervention effects from the literature. Due to the rapid decline of risk of cardiovascular disease after the smoking behavior changed, the short-run heath impacts were mainly estimated based on the change of smoking-related health burden of cardiovascular diseases.

Results

All six population-based interventions on tobacco control that have implemented were considered to be highly cost-effective ranged from 1,405 VND - 135,560 VND per DALYs averted compared to the WHO recommended threshold at 1 GDP per capita. Raising tobacco tax was projected to the most cost-effective intervention due to its significant health gains and potential to work on in the long run. Besides, smoke-free model, as the best intervention on individual behavior change, should be continue invested together with campaigns on raising awareness.

Conclusions

The study results shown the potential health impact in tobacco control in Vietnam after 10 years' implementation of MPOWER. Also, the findings provided a strong message that more attention should be paid to developing the national tobacco control strategy in the next phase to make the best use of available resources.

Key messages

Adequate attention should be equally paid for both political interventions and individual behavior – aimed interventions (communication, cessation…) in the fight against tobacco harms. Aside from raising tobacco tax, further investigations and investments on cessation services as well as smoking bans in public places are needed in Vietnam to achieve the best compliance on MPOWER.
Knowledge translation: a case study in a public health network in Manguinhos, Brazil
Authors: da Silva Miranda E , Figueiró A C , Potvin L
Published: October 2020

Background

This paper presents a post hoc analysis of knowledge translation (KT) actions and strategies implemented by three projects in a sociotechnical network, in Rio de Janeiro, Brazil. In order to assess the actions and practices of knowledge producers (mostly researchers) and knowledge users (residents of Manguinhos) we applied the KT model developed by the Québec Public Health Institute.

Methods

This case study relied mainly on document analysis (texts produced by the network coordination, meeting minutes and reports, management reports and promotional material), interviews with knowledge producers (N = 10), and focus group with knowledge users (4 participants). Framework analysis was applied to provide clear steps to follow and structured outputs of summarized data. A content analysis of this material used categories such as: project development; KT products elaboration; and interaction between knowledge producers and users. Data were coded based on the KT model to understand whether and how the eight dimensions were implemented.

Results

The findings reveal that, albeit there were differences among the three cases, the KT dimensions related to the co-construction of knowledge, what to be translated, and how to translate were more extensively implemented. Even though KT was a new concept for most knowledge producers, all three cases had previous practical experience on how to disseminate knowledge in the Territory of Manguinhos. However, dimensions related to KT evaluation and resources were less frequently implemented.

Conclusions

More attention must be paid to the dimensions involving the feasibility, resources and evaluation of projects. Creating research organizations working together in the KT process with support, infrastructure, theoretical and methodological competences about KT may facilitate the integration of these dimensions.

Key messages

Through our study, we provide more evidence and progress about how the KT process can be improved in low- and middle-income countries, such as Brazil. We display an overview of the challenges that public health researchers in Brazil have in applying KT strategies to improve the public health care.
Safer prescribing for older patients: Preliminary findings from a large project in Canada
Authors: Greiver M , Wang J , O'Brien P
Published: October 2020

Background

Polypharmacy is common and deleterious for elders. We devised a QI-research collaboration, Structured Process Informed by Data, Evidence and Research (SPIDER) aimed at improving medication appropriateness for complex older patients.

Methods

Single-arm mixed methods feasibility study followed by a 2-arm (Intervention vs Usual Care) pragmatic cluster randomized controlled trial. Setting: seven Practice-Based Research Networks across Canada. Participants: Seven practices (each with two physicians) per arm per region will be recruited. patients 65+ years taking 10+ different medications identified by participating physicians' EMR. Intervention: three key elements: 1) Practice teams participating in QI Learning Collaboratives; 2) Support of coaching/practice facilitation; and 3) validated EMR data for feedback. Main Outcome Measures: Reduction of potentially inappropriate prescriptions (PIPs) measured using EMR data.

Results

Thirty-three physicians from ten family health teams/practices and one nurse practitioner and three family physicians from a community health centre in Toronto were recruited. All teams have accessed coaching support, reflecting high engagement. Teams were given flexibility in developing deprescription strategies and action plans that fit for the local context. Review and validation of patient cohort identified by the EMR were time-consuming for some, depending on the size of the cohort and the patterns practices have been using to capture medication information in their EMR. Engaging pharmacists in the medication review and deprescription process greatly alleviated the burdens on the physicians.

Conclusions

SPIDER appeared to be feasible and has the potential to enhance safer prescription for complex older patients. A flexible and contextually adaptable design helped with increased uptake. Having access to embedded QI and data support and working with collaborating pharmacists may enhance the sustainability of the approach.

Key messages

A QI-Research collaboration to improve care for complex elders is feasible. If the RCT shows improvement, this may provide an argument for QI support in primary care.
Community-based health agents practices in Burkina Faso
Authors: Lapierre J , Aboulhouda I , Gaudreault-Belley M , Ramdé J , Coté A , Bationo F , Dabal M , Beogo I , Traore L
Published: October 2020

Background

It is estimated that around 25% of the world's infant mortality is in West Africa where undernutrition accounts for more than 50% of the underlying causes of under-5 mortality. Malnutrition rates have decreased slightly, especially compared to the targets set for 2025. Since Alma-Ata's declaration in 1978, community participation in primary health care has been one way of reducing health inequalities. WHO recommended the integration of community health workers (CHW) into the health system and their inclusion in the human resources planning strategy. We observed a decline of programs involving CHW in the 1990s, then a definite revaluation since the 1990s and specifically, since 2012. They provide health education, as well as referral for a range of services, and provide support and assistance to communities and families through preventive health, easier access to curative health services as well as social services. The specific objectives of this project include: to describe the roles and functions of CHW in Burkina Faso, to identify the workers' needs, to explore the changes in the system and to identify the conditions related to their deployment.

Methods

A qualitative case study allowed to describe the processes and also facilitated the discovery of key elements related to the experiences of community agents, considering the elements of complexity and context.

Results

Our results include activities in promotional services, preventive services, curative services and health data management. In addition, we will shed light on their feelings and experiences related to integration into the system, on the strategies they use, on the advantages that bring their role as community workers, their concerns and finally, we will share their perception of their impact. Some recommendations are proposed in regards to training and supervision.

Key messages

CHW are major players in health systems by creating a bridge between health and social service providers and communities with reduced access. CHW contributes to social justice by facilitating access, promoting recognition and creating empowering processes through increased participation.
Health Promotion Strategies in Georgia
Authors: Antia N , Tabidze D , Gabunia L
Published: October 2020

Background

The main burden of global morbidity comes from non-communicable diseases (NCDs). As recent data shows, almost 97% of mortality is caused by NCDs in Georgia. According to the WHO, Georgia has one of the highest smoking prevalence in Europe. Effective health promotion strategies are crucial to prevent chronic diseases and to improve health education. The main aim of this scoping review was to analyse the literature on health promotion strategies in Georgia, as well as to provide an overview of current initiatives and activities.

Methods

Medline and PubMed databases, as well as official government documents and grey literature where used to identify relevant literature. We finalised search by September 2019.

Results

Our study showed that the Formation of Health Care sector started in 1995 and since then, health promotion has been an important component of Public Health in the country. Moreover, four out of eight main goals of the 'Millennium Development Goals in Georgia' address health issues. Implementation of state programs and public health measures in the field of public health remains a main priority for the 'National Center for Disease Control and Public Health' (NCDC). Working areas of the center include development of health promotion, disease prevention strategies and programs. Currently, the NCDC is implementing nine state programs with this regard. However, our analyses showed that improvement of population's health is a complex process and requires coordinated actions by involving the following sectors: government, health, social and economic, NGOs, local municipalities, media and industrial sectors, health researchers and civil society.

Conclusions

Our study clearly demonstrates that health promotion strategies are essential for the improvement of nation's general health and welfare. However, increasing tendency of NCDs in the country requires the strengthening of existing programs as well as developing and implementing new strategies.

Key messages

The health promotion strategy, with its multi-component and multilateral nature, has the greatest potential to improve public health in Georgia. Strategies are particularly effective when it is strengthened by other actions, including partnership, community and intersectional involvement in decision-making.
Reliability and Validity of Healthy Lifestyle Behaviours Scale in Children
Authors: Öcal E E , Önsüz M F
Published: October 2020

Background

Improving healthy behaviour from childhood could be beneficial both children and families and communities. The aim of the study was to develop the Healthy Lifestyle Behaviours Scale (HLBS) to determine the healthy lifestyle behaviours of primary school students.

Methods

This methodological study carried out in 521 primary school 4th grade students in two eco-schools in the 2019-2020 academic year. By using literature 120 questions was collected including nutrition, physical activity, hygiene, sleep, environmental cleaning, health responsibility and addiction sub-dimensions. After taking expert opinions, a scale that consists of 54 questions and scored as I agree:3, undecided:2, I disagree:1 and was created named HLBS. In order to evaluate the reliability of the scale, item total score correlation and internal consistency (Cronbach's alpha) analyzes and exploratory and confirmatory factor analysis were used for construct validity.

Results

Of the 52.8% students were male and their age ranges from 8-11, the mean was 9.5±0.5. After the scale development study, the scale consisted of 53 items and 7 sub-dimensions. The Cronbach's alpha coefficient of nutrition, physical activity, hygiene, sleep, environmental cleaning, health responsibility and addiction sub-dimensions were 0.87, 0.68, 0.85, 0.52, 0.76, 0.85 and 0.76, respectively. The variances of sub-dimensions in the scale ranged from 30.17% to 67.87%. The fit of scale and the fit index were found to be acceptable after confirmatory factor analysis. In the last form of the scale, the score that can be taken from scale range 53-159. It was accepted that by increasing of the score, healthy lifetsyles behaviours were increased. The mean score of the students was 141.39±16.21 and the median was 145.0.

Conclusions

HLBS was found to be a valid-reliable tool for assesing healthy lifestyle behaviours in primary school students.

Key messages

Health promotion is an issue that needs to be addressed from school age for developing healthy lifestyle behaviours. In the literature, HLBS seems the first scale about healthy lifestyle behaviours for children and needs to be tested in large groups of children.
Sub-national structures matter when evaluating physical activity promotion: Lessons from Germany
Authors: Forberger S , Gelius P , Messing S , Volf K , Kelly L , Taylor S , Zukowska J , Lakerveld J , Woods C
Published: October 2020

Background

Public policies are increasingly acknowledged as important part of promoting physical activity (PA). However, especially in states with sub-national administrative structures such as Germany, national and sub-national approaches differ considerably. In Germany, sport for all (SfA) promotion is mostly organized at sub-national level, which is usually not covered in national evaluations. Knowledge of these structures helps to understand national outcomes, enables comparisons and learning within and between countries, and assists in identifying support structures for effective PA promotion.

Methods

Data were collected in the PEN Policy Evaluation Network project. In addition to the WHO HEPA PAT, a questionnaire was sent to the sports representatives of the 16 federal states. Responses of 11 state representatives were included and overarching issues were identified using inductive thematic analysis.

Results

PA promotion in Germany is organized in three areas: SfA, professional sports and school sports. SfA promotion at sub-national level is assigned to different administrative bodies (ministries, senate administration, state chancellery) and policy areas: culture, health and care, home affairs with various aspects, education, social affairs and family. The priorities of the federal states are more diverse and specific compared to the national level. There is an overlap in the topics: urban planning, cycling, health prevention and targeting children. Cooperation mechanisms and partners vary between federal states, but some partners are active at sub-national and national level.

Conclusions

The results provide an insight into the complexity of PA and especially SfA promotion at sub-national level in Germany. Our results suggest that a broader range of approaches is used in the 16 German states than national overviews would suggest. These particularities must be taken into account when assessing and comparing the results from different countries.

Key messages

The promotion of SfA at German sub-national level is much more diverse than represented at national level evaluations. Knowledge of sub-national structures enables the understanding of national outcomes, the promotion of cross-national learning and the identification of supportive structures for effective PA promotion.
Falling short of a culture of health: Planning alcohol-permitted events at a U.S. university
Authors: Nieri T , Webb M , Goodwin D , Yoo M
Published: October 2020

The Healthy Campus movement in the United States aims to infuse health promotion into higher education operations. We examined the extent to which event planners employ a culture-of-health approach related to alcohol consumption when planning alcohol-permitted events in a large, public university in California. We interviewed 31 event planners to assess their strategies for ensuring health and safety at the events and accommodating people in recovery from substance use disorders. We focused on events that involved faculty, staff, and graduate students. Event planners were most concerned about avoiding legal liabilities at the events, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers at the events. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax), drinkers (e.g., only undergraduate students engage in risky consumption), and people in recovery (e.g., they lack self-control). Planners over-relied on informal control to shape attendees' behavior, failing to acknowledge how contextual factors can shape individual behavior. Planners need to be educated about how to shape the event context to promote healthy behaviors, avoid exclusively focusing on preventing unhealthy behaviors and informal control, and promote better inclusion of people who don't drink.

Key messages

There is fertile ground for infusing a culture of health into events in higher education. Event planners need expanded perspectives that consider context, inclusivity, and health promotion.
Barriers and facilitators to implement community outreach work and collaboration with partners
Authors: Roy M , Lavoie-Trudeau É , Benlkhalti M , Couturier Y , Lane J , Clapperton I , Roy M A , Bibeau L , Ouellette M , Camden C
Published: October 2020

Background

Community outreach workers support individuals to access health and community services through various form of proximity approaches. Even though community outreach work is present in the province of Quebec (Canada) since the past 40 years, it is still difficult to implement and sustained, especially with families with young children. The aim of this study was to document barriers and facilitators to implement community outreach work, and to describe how such workers collaborate with sectoral (e.g. healthcare) and intersectoral (e.g. municipality, community organizations, schools) partners.

Methods

A content analysis was performed on 55 scientific and grey literature documents, and on the transcriptions of 24 individual interviews and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners.

Results

This study reveals four categories of barriers and facilitators acting on the implementation of community outreach work: factors related to organizational factors, to the nature of community outreach work, to the intervention with families, and external/uncontrollable factors. With regards to collaboration, community outreach workers collaborate with many partners. Good interprofessional collaboration is achieved with a positive interaction and communication, shared or co-constructed activities for the families, co-intervention with the families, and strategies to be known and intersectoral meetings.

Conclusions

Results highlighted that many factors interact and can either influence positively or negatively the opportunity to implement community outreach work. The collaborative practices identified might help maximizing facilitators and overcoming barriers. Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers' flexibility are needed to sustain this practice.

Key messages

Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers’ flexibility are needed to sustain this practice. Community outreach workers help to reduce inequalities in health.
A multidimensional approach to improve migrants’ health in the new context of living
Authors: Banzola S , Clemente G , Frignani P , Bisceglia G , Ferrara R , Nunez I , Buci B , Taila K , Bandello M A , Berghenti F
Published: October 2020

Background

Quantitative data analysis performed by the multidisciplinary team in a Primary Care setting, addressing migrants' health in Parma, showed poor adherence and lower completion rate of Latent Tuberculosis Infection (LTBI) treatment among 2701 refugees and asylum seekers, registered from 2013 to 2018. Soon afterwards, qualitative data analysis revealed that health operators, intercultural mediators and operators working for no-profit-organizations (NGOs) did not share the same approach towards LTBI care cascade. Different knowledge about patient engagement, Health Literacy (HL) interventions, disagreement about the objectives and motivation to screening and treatment of LTBI, could be the consequence of an ineffective communication and not well-structured cooperation between health operators, private sectors and other stakeholders.

Objectives

In order to enhance migrants' capability for self-care management of LTBI, the multidisciplinary team plans seven meetings with intercultural mediators and operators working for NGOs, from March to June, within the I.C.A.R.E European Project. The interactive meetings aim at improving knowledge about Tuberculosis (TB) and LTBI, awareness about the relationship between self-decision making and health outcomes, motivation to patient engagement and finally at identifying culturally competent and HL oriented strategies.

Results

It is expected a structured, evidence-based approach, according to national guidelines, enabling newly arrived immigrants to improve self-care management of health and LTBI. Indicators, outcomes, challenges managed within the participatory meetings will be presented at the conference.

Conclusions

A co-construction of a multidimensional approach, supporting individual capacity building to improve self-care management of LTBI among newly arrived immigrants, could be an effective strategy for patient engagement and health promotion.

Key messages

Newly arrived immigrants’ health is not only a matter of individual capability but also of a multifactorial approach, actively involving stakeholders from the public, private and no-profit sectors. This multidimensional cooperation to improve migrants’ health considers HL as a fundamental factor, supporting individual engagement and decreasing in fear about TB.
Continuing Education in Health: interprofessional practices in the field of Collective Health
Authors: Fornereto A P N , Ogata M N , Santos T A , Franceschini A B C , Pinto MCRLR , Silva M V , Souza R , Souza V , Malvezzi E
Published: October 2020

Family Health Support Centres (NASFs, in Portuguese) aim to develop interprofessional practices anchored in the assumptions of Primary Health Care, guided by the criteria of shared care specific professional interventions, management processes, interdisciplinarity, intersectoriality, Continuing Education in Health and health promotion. This health management methodology (Matrix Support) still represents a challenge to workers and managers, as it switches the logic of clinical thought from individual-centred, ambulatory and disciplinary care to collective, territory and interdisciplinary care. This study might illustrate and allow sharing of experiences about a work management format for multidisciplinary teams in Primary Health Care. A partnership between the University and the state health department was established in order to elaborate a collaborative, educational and supportive action. We formed a group of workers in the target area (24 municipalities and 18 teams) who had a focus on Continuing Education in Health using Institutional Analysis as theoretical reference. The main goal of the action was to provide spaces to share experiences and learning in the perspective of Continuing Education in Health. How does Continuing Education in Health support interprofessional practices in the field of Collective Health? Among the main results, we list: reflection about organisation practices of multiprofessional work, reflection about care practices and clinic management in the technical-assistance and pedagogic perspectives of Matrix Support; encouragement to improve the services offered in this level of care and their relationship with other points of the network. This experience showed us the importance of three main aspects: Continuing Education in Health, as a strategy of critical analysis about work and workers; the partnership and integration between teaching and service; and interprofessional formation processes (necessary to NASF and Collective Health).

Key messages

Continuing Education in Health is a strategy to deal with challenges and possibilities of interprofessional practices in the field of Collective Health. Enabling experiences and providing spaces for health professionals to share experience and learning.
Get to know to prevent: the Local Health Authority of Cuneo takes care of visual disability
Authors: Dalmasso M , Falcone U , Gallo F , Blengio C , Di Pasquale A , Allocco N , Costa G , Puglisi M T
Published: October 2020

Visual impairment has an important economic weight on our society; in addition to this considerable cost, loss of vision imposes physical, financial and quality of life limitations. Preventing visual impairment is not only a social duty but also an economically convenient activity for the national health system.

On the basis of this concept, a visual impairment disability campaign was carried out in the ASL CN1 (Southern Piedmont Region) taking into account the guidelines recommended by the WHO (1968 screening guidelines but still applicable) in the most disadvantaged territories of the cross-border and rural area, where people have more difficulties to reach territorial services or hospital.

Patients who tested positive for the screening were taken over by the local network for a second-level visit and subsequent follow-up based on the pathology found. In this frame, visual screening represents a promising health policy as it can identify visual disability at an early stage. Through the health information systems (hospital discharge, access to the emergency department and exemptions for pathology), the geographical distribution and demographic characteristics of the subjects with visual disability were described in the ASL CN1 area. The level of detail has reached granularity at the single municipality and single age level.

For the year 2018 among 416.000 residents in ASL CN1, about 4.000 visual impaired subjects were identified (3.188 on the basis of the presence of an exemption for glaucoma, 542 from hospital discharge and 535 at the emergency department). Assessing mortality in this subgroup, the mean age at death is slightly higher than that of general population (82,42 vs 81,39 years respectively). This can be suggestive of an efficient handling the local population with visual disability. The developed indicators can be extended to other periods and new areas.

Key messages

Visual screening represents a promising health policy as it can identify visual disability. Through the health information systems, the geographical distribution and demographic characteristics of the subjects with visual disability were described.
Cancer control implementation experience: The case of Health in All Policy Approach
Authors: Bakker L , Kiasuwa Mbengi R
Published: October 2020

Health and health equity are important prerequisites to achieve most societal goals. However, governments still struggle facing lobbying and establishing a coherent policy approach to ensure health and health equity. Therefore, the WHO Health in All Policies (HiAP) Framework for Country Action has been developed to support the avoidance of harmful policies.

In the framework of the JA iPAAC, semi-structured interviews with health administrators in 28 EU countries were conducted from September 2018 until January 2020. The objective was to gather experience and examples of cancer control policies implementation, including health promotion actions. We deductively coded the interview reports based on the WHO HiAP Framework core components to see how EU MS engaged efforts on these core components.

Actions that relate to the 5 HiAP core components were found in all countries which discussed health promotion. Needs and priorities identification are reported through international commitments and risk monitoring. Frames for planned actions are mainly non-disease specific, but often risk-specific. Reported supporting structures and processes are bans, price regulation and inter-ministerial committees. To facilitate assessment and engagement of different actors, efforts were found in involving scientific communities, industry, health professionals and NGO's. Insuring policy monitoring, evaluation and reporting is experienced as challenging. Capacity building has been identified in the provision of guidance; training of policy makers, health care professionals and teachers; structural monitoring; and increase health literacy and empowerment.

The frequency of efforts identified, importantly varies among the core components. While issue specific inter-sectoral platforms are frequently reported, impact assessments and sub-national capacity building were experienced as challenging. Other challenges concern industry interference and cultural and institutional resistance to change.

Key messages

Although most core components of HiAP are reflected in health promotion policies, more engagements are required into impact assessment and insurance of equity among sub-national levels. By sharing innovative examples applying a HiAP, EU countries can learn from each other on how to ensure population health and health equity.
The evolution of an asset-based community led alcohol harm intervention in the North West England
Authors: Cook P A , Ure C , Hargreaves S C , Burns E , Coffey M , Audrey S
Published: October 2020

Background

Communities in Charge of Alcohol (CICA) is an Asset Based Community Development (ABCD) place-based approach to reducing alcohol harm. Local volunteers, from areas with multiple indicators of deprivation, train to become accredited 'Alcohol Health Champions' (AHCs). AHCs, supported by a local co-ordinator, provide brief opportunistic advice at an individual level and mobilise action on alcohol availability through influencing licensing decisions at a community level. CICA is the first programme we are aware of globally that has attempted to build local AHC capacity. Here we explore lessons learned from four case study areas (of the original ten) that persisted with the intervention for more than 12 months.

Methods

A case study approach to investigate the context, acceptability, facilitators and barriers to maintaining CICA. Descriptive analysis of ongoing recruitment of champions, numbers of training events and activity of champions (as reported by area coordinators). Framework analysis of interviews with AHCs and stakeholders.

Results

CICA has increased public health capacity by training 123 AHCs in its first year. The four areas that continued with CICA have trained a further 34. The different approaches in the four areas include: embedding champions in wider health champion/volunteering projects; innovative use of new technology (portable fibroscan); expansion into different geographical areas. AHCs and coordinators report significant social value from participation in CICA.

Conclusions

The likelihood of embedding CICA into a local area's activities appeared to be dependent on the energy and enthusiasm of the local area's co-ordinator, and may be dependent on that individual remaining in post. ABCD programmes may be more likely to be sustainable if capacity building is supported. CICA might be more sustainable if it was embedded in a wider programme of ABCD, since health issues are interrelated and AHCs often wish to broaden their portfolio.

Key messages

A volunteer alcohol health champions programme increased public health capacity in areas of social deprivation by utilising the assets (skills) of local people. Embedding a community alcohol health champions programme in a wider programme of asset based community development is more sustainable and allows champions to broaden their volunteering portfolio.
User involvement in developing community-based public health services: a scoping review of methods
Authors: Petersen K S , Pedersen J F , Egilstroed B , Overgaard C
Published: October 2020

Background

User involvement in developing community-based public health services has been on the agenda for decades. User involvement refers to the variety of ways in which service users or public citizens participate in the development of health services: from proving information on their needs to actively being involved in decisions about future services. Former studies found that user involvement is meaningful to the people involved and could have a favorable impact on the quality of services. Thus, it is timely to systematically identify and provide a comprehensive overview of user involvement methods used in public health studies. The aim of this scoping review is to provide an overview of the current body of empirical research where user involvement methods have been used to develop community public health services and identify its possible impact on the individual as well as services.

Methods

A systematic scoping review of user involvement methods aiming to develop public health services followed Arksey and O'Malley, 2005 framework. Six databases: CINAHL, Cochrane Library, Embase, PsycINFO. PubMed, Scopus and ProQuest, were searched from October till November, 2019. Search terms were: user involvement, methods and health care with corresponding synonym. All hits were double screened.

Results

6.044 studies were identified of which 38 studies lived up to the criteria. Preliminary findings from coding and synthesizing studies have identified a variety of user involvement

Methods

19 of the studies used complex, multi-facetted packages of methods aiming to identify needs, prioritize and formulate recommendations for future services. 19 studies used different kinds of group meetings and some used certain techniques to facilitate the process. Many reported the impact, and 13 evaluated the methods. The impact of using the methods varied from impact on individual, group, or service/political level. Final results will be presented at the conference.

Key messages

Studies on user involvement methods in developing community public health services and its impact are sparse. User involvement is privotal in developing sustainable public health community services.