bluuebunny/crossref_metadata_2025 huggingface dataset:
A public health approach to imprisonment
Authors: de Viggiani N
Published: November 2019

This presentation explores the contested meaning of “prison public health”. European Public Health aligns itself with legal, ethical, political and economic principles that govern human rights, the rule of law and social justice. The UN Universal Declaration of Human Rights and the WHO Commission on the Social Determinants of Health infer an egalitarian approach towards social justice that supports rights of all citizens to have their basic needs met, unnecessary threats to wellbeing minimised, and social competence maximised. In the spirit of the WHO Ottawa Charter for Health Promotion, this means operationalising agency of individuals and communities and of the broad structural determinants of health: economic, political, legal and institutional.

In contrast, the law conventionally positions criminal responsibility with the individual perpetrator who is held responsible for their ‘offending’ behaviour. In parallel, arguments surrounding responsibility for health have abounded for many decades, with the principle of collective responsibility for health forming the ethos of the Ottawa Charter. Only recently has it been acknowledged that criminogenic and pathogenic ‘determinants’ intersect, criminal risk behaviours and health risk behaviours sharing common aetiologies.

This presentation will reinforce that a public health approach towards imprisonment is fundamentally egalitarian and commitment to social justice, recognising that structure and agency intersect and that the health of the prison is as important as that of the prisoner. It will argue that it is short-sighted to attend only to prisoner behaviour if the system surrounding the prisoner is failing in its duty of care and capacity to serve society.

Most prison populations represent the most vulnerable or disadvantaged sectors of society. Governments must proactively facilitate sustainable human development and protection and empowerment of vulnerable groups including those in custody.
The longitudinal course of prisoners’ mental health problems during and after imprisonment
Authors: Dirkzwager A J E
Published: November 2019

Mental health problems are common in prison populations. Correctional institutions offer an important opportunity to improve prisoners’ health, which also benefit the wider public health agenda. At present, little is known about the longitudinal course of prisoners’ mental health problems during and after imprisonment. The aims of this presentation are: (a) to examine the longitudinal development of mental health problems in prison and after release; and (b) to identify individual and institutional factors associated with prisoners’ mental health problems.

Data are used from the Prison Project, a nationwide and longitudinal study examining 1.904 male prisoners in the Netherlands. Participants were surveyed at various intervals during detention, and 6 and 24 months after their release. Data include detailed longitudinal information on prisoners’ self-reported mental health problems, healthcare use, prison experiences (e.g. sentence length, victimisation, receiving visits, and exercise), and background characteristics (e.g. sociodemographic characteristics, financial situation, social support, and personality traits).

Prisoners reported more mental health problems in and after prison than men in the general population. Initial results demonstrate that prisoners who entered detention with pre-existing mental health problems and problematic alcohol and drug use, showed mental health improvements during detention.

The high levels of prisoners’ mental problems highlight the importance of addressing mental issues in prison and ensuring the continuity of care to support prisoners with their transition into the community.
Impact of austerity on prison health in England: a qualitative study involving national policymakers
Authors: Ismail N
Published: November 2019

Prisons offer states access to a population that is at high risk of morbidity. The UK austerity policy adopted in 2010 led to a 22% reduction (-£2.71bn) in prison spending by 2017. Whilst the number of prison officers dropped by 30%, the long-term impact of austerity on prison health in England has not been systematically contextualised. This research seeks to articulate the impact of austerity on prison health in England from the perspective of national policymakers.

Semi-structured interviews (X: 66 min) were conducted with 30 key prison policymakers. Constructivist grounded theory was used to assess the impact of austerity on prisoner health in England. Transcripts of 195,680 narrative texts were analysed using NVivo 11 until data saturation was achieved.

As a stealthy political ideology, austerity has caused societal disruption, which disproportionately affects prisons. The lack of access to services offered by the welfare state, including health-related provisions, precipitates societal unrest, increases prisoner numbers, and encourages harsher and longer sentences.

The prolonged constrained funding and the burgeoning population widen health inequalities in prisons. Healthcare provisions become increasingly limited, which unduly affects older and female prisoners who require more complex support. The degrading living conditions and lack of purposeful activities contribute to the increasing violence, self-harm and suicides in prisons, and reorient the healthcare provision from planned services to health emergencies. The excessive focus on Brexit and the perpetual changing political direction imposed on prisons reinforce the system’s instability.

Despite having the fifth largest economy in the world, England’s poorest population continues to bear the brunt of austerity. Initiating a more informed economic recovery policy and considering alternatives to imprisonment would help to ensure that England lives up to its view of itself as a progressive society.
An analysis of Croatian political parties’ pre-election manifestos and healthcare policies
Authors: Ivankovic D , Handanagic S , Dzakula A
Published: November 2019

Background

Before the regular 2015 Parliamentary elections in Croatia, we identified and analysed topics and comprehensiveness of health policies (HPs) included in political parties’ pre-election manifestos. After the loss of government confidence, we did a follow up before the 2016 preliminary elections. Here, we present a comparison of the 2015 and 2016 results.

Methods

We used the Walt-Gilson policy model for the content analysis of pre-election HPs. Five evaluators independently reviewed manifestos for HPs through four dimensions: content, actors, processes and context. HPs proposed by at least two parties were included in the final analysis and by referring to any of four dimensions for specific HP, parties scored one point (maximum of four points per HP).

Results

Seven out of the eight parties addressed healthcare topics in their manifestos, six discussed healthcare workforce and financing, while five discussed hospital systems, primary care, medical equipment and (re)organization of the healthcare. Parties earned 41% of all points for describing content, 28% for processes, 17% for actors and 14% for context of proposed HPs. Compared to the 2015 results, most comprehensively approached HPs changed to more focus on workforce and medical equipment. Topics of access to healthcare and people with disability earned significantly less points than in 2015.

Conclusions

Parties’ manifestos in both 2015 and 2016 focused on topics mostly represented in the public discourse on healthcare and daily media coverage. Financing the 2015 elections, as a consequence of a large financial restructuring effort of the hospital system at the time. Health workforce topped the 2016 elections, due to large emigration of health care professionals after legislative changes and Croatia’s accession to the EU. Parties mostly focus on the content while they less frequently address the role of processes, actors, and the context needed for successful implementation of the recommended HPs.
Introduction to the SCIROCCO online participatory tool and its evaluation
Authors: Alexandru C , Alhambra-Borrás T , Whitehouse D
Published: November 2019

This presentation will first introduce the SCIROCCO and SCIROCCO Exchange projects and the Maturity Model developed by the European Innovation Partnership on Active and Healthy Ageing. Then, a demonstration will be made of the three main functionalities of the SCIROCCO tool: assessing the maturity of healthcare systems, assessing the maturity needs of good practices, twinning and coaching with its two variants. For each piece of functionality, the methodology of using the tool will also be presented. Finally, the two main types of evaluation that were carried out for the SCIROCCO tool, and their results, will be described: Testing the validity and reliability of the SCIROCCO tool. This involved testing the content validity of the B3-Maturity Model through a literature review and Delphi survey, testing structural validity and reliability using quantitative analyses, and testing convergent validity through comparison with another tool that assesses a related concept. Results showed that the content of the wide range of dimensions and measurement scales reflects integrated care maturity, all 12 dimensions contribute to assessing integrated care maturity, the tool has good internal consistency and there is some support for convergent validity.Testing user experience with the SCIROCCO tool. This involved a qualitative approach using questionnaires and focus groups. The findings helped to improve the tool and learn about its potential future uses and wider implications.
Social cost-benefit analysis of Cognitive Behavioral Therapy for alcohol and cannabis addiction
Authors: Over E A B , van Gils P F , Suijkerbuijk A W M , Lokkerbo J , de Wit G A
Published: November 2019

Background

A considerable number of people with an alcohol or cannabis addiction currently do not receive addiction care. Some hundreds of thousands persons in the Netherlands suffer from alcohol dependency, while some tens of thousands adolescents suffer from cannabis addiction.

Methods

A (hypothetically) enhanced uptake of CBT in specialized addiction care centers was modeled using the SCBA approach. Two SCBA’s were performed: one with respect to alcohol addiction and the other regarding cannabis addiction among adolescents.

Results

Per person treated with CGT, these benefits accumulate to about 12,000 euro (range 10.000 - 14.000 euro). These profits originate from improved health and less mortality, improved quality of life and higher productivity. A decrease in the number of persons with an alcohol addiction will also lead to lower costs for police and justice following from less criminal activities. Furthermore, CGT is effective as treatment for adolescents with cannabis addiction. Per person treated with CGT, societal benefits accumulate to about 11.000 euro (range 9.700 - 13.000 euro). Here, the net benefits arise from improved health, improved quality of life, reduced early school leaving and higher incomes for those clients who have successfully participated in CGT in addiction care.

Conclusions

This study shows that society can benefit from an increase in people treated with CGT in specialized addiction care. Such an increase in number of people treated could for instance be realized by educational programs for professionals who come across people with dependency problems, such as general practitioners, professionals working in emergency care and youth care.
EVIPNet Europe – bridging the research-to-policy gap
Authors: Kuchenmueller T , Suvanbekov A
Published: November 2019

Issue/problem

Despite substantial investments into increasing the availability and accessibility of information in the WHO European Region, scientific evidence often plays a limited role in policy and practice resulting in lost opportunities to improving health systems and outcomes.

Description of the problem

The WHO Action plan and resolution to strengthen the use of evidence, information and research for policy-making, adopted in 2016, urges Member States to increase country capacity to foster the utilization of research in both policy and practice. To support and guide Member States in this effort, the World Health Organization (WHO) Regional Office for Europe launched the Evidence-informed Policy Network (EVIPNet) Europe, a capacity-building initiative that operates in line with, and in support of, Health 2020 and the 2030 Agenda for Sustainable Development. EVIPNet Europe aims to assist its member countries and catalyse sustainable change by strengthening both the evidence supply and demand sides, and building knowledge translation (KT) capacity at individual, organizational and system levels.

Results

EVIPNet Europe has been successful in enhancing the capacity of policy-makers and researchers to access, appraise, package and use evidence; strengthening organizational capacity and infrastructure; and creating institutional bridges between policy and research communities. The network’s activities have, furthermore, led to an increased conceptual and instrumental use of evidence in policy, introducing important changes in policy strategy development and legislations.

Lessons

To overcome the knowledge-to-policy gap, comprehensive capacity building strategies, operating at individual, organizational and systemic levels are required to create and sustain a culture more favourable to evidence-informed policy.
The innovative use of health information in public health policy across EU-Member States
Authors: Haneef R , Oyen H Van , Gaidelyte R , Zeynep O , Pérez-Gomez B , Haaheim H , Palmieri L , Mathis-Edenhofer S , Majek O , Gallay A
Published: November 2019

Background

Health information systems both at the national and international level play a key role in ensuring that timely and reliable evidence is used for operational and strategic decision making inside and outside the health sector. The availability of data generated from different sources is increasing with the possibility to link these data sources together. However, more efficient data generation processes are required to use data collected for different purposes initially, as well as advanced statistical techniques to generate comparable and timely health information. The main objective is to explore the innovative use of health information for better public health policy across the Member States.

Methods

As part of InfAct, we have conducted as survey among EU-MS to describe the innovative use of data sources. We are collecting inspiring examples on the innovative use of health information based on national or European data networks involved with health policy-making at national, regional or local level. We are further developing generic methods to estimate health indicators using machine learning techniques and mathematical modelling.

Results

These approaches will generate a roadmap on the innovative use of health information across Member States, enlarge the existing list of health indicators estimated from linked data and/or advanced statistical techniques, inform on the implications of these indicators in health policy with inspiring examples from Member States, and provide methodological guidelines for using linked data and advanced statistics to estimate health indicators, and composite outcome measures.

Conclusions

This work will highlight the gaps in the innovative use of data sources, and improve the comparability of health indicators and the capacity of EU-Member states to apply innovation for increased relevance and timeliness of health information for public health policy-making.
The Health-Information Impact Index: a tool to monitor the uptake of evidence in policy and practice
Authors: Delnord M , Tille F , Abboud L A , Ivanković D , Van Oyen H
Published: November 2019

Background

The optimal use of data and evidence from national health information systems is paramount in public health. However, current tools to evaluate health information systems focus on data quality and availability rather than measuring how data are used by key stakeholders. This limits capacity to monitor the impact of evidence on health care management and health policy making.

Methods

Based on an extensive literature review we developed a new model, the Health Information (HI)-Impact framework, to monitor the impact of health information in health policy and practice. We further conducted a web-based Delphi survey between February and April 2019 among European public health professionals working in health policy, health care, research, and health monitoring to develop the HI-Impact Index.

Results

In the HI-Impact framework, four domains are essential for mapping public health data availability, dissemination, and use: (1) Health Information and Evidence Quality, (2) Health Information System Responsiveness, (3) Stakeholder Engagement, and (4) Knowledge Integration. This last domain has a broader reach on the determinants of health and reflects the use of evidence by community partners and across sectors. In the DELPHI survey, 127 experts from 38 European countries selected 30 criteria to integrate in the HI-Impact Index. This tool could be used by European public health agencies to monitor the impact of their information products, and inform national strategies for evidence-based public health.

Conclusions

It is crucial for routine health information systems to create a culture of accountability in the use of evidence. Data on the determinants and consequences of ill-health as well as stakeholder engagement in leveraging evidence for intervention are explicit points to consider for a full quality assessment of national health information systems, and a sustainable impact on health outcomes.
Co-designing a virtual reality game for alcohol prevention
Authors: Stock C , Vallentin-Holbech L , Dietrich T , Majgaard G
Published: November 2019

Issue/problem

Health promotion programmes that train social competencies in situations adolescents commonly encounter are likely to minimise the social influence and social pressure to drink or use other substances. In the Virtual Reality (VR) TestLab project, an innovative VR learning tool is developed that shows a typical party situation for young people. The game user can navigate through the party making their own choices, which result in different outcomes.

Description of the problem

The Living Lab method guided the development of the VR learning tool. During the four phases of the Living Lab process three groups of 16-25-year-old students were involved, as well as two prevention practitioners, three prevention scientists, three VR game designers and one film production expert.

Results

At the initial exploration stage of the Living Lab framework a list of key concepts/scenes were co-created with all stakeholders. At the concept stage students were invited to co-create a film script for the VR game. The prototype stage involved students as actors for the scenes, which were then finally recorded in technical collaboration with game developers and the film production expert. Post production, the finalised scenes were integrated into a game engine to develop the interactive branching narrative. At the innovation stage the group was invited to examine, explore and test its usability and share their experiences, thoughts, and attitudes.

Lessons

The Living Lab framework was useful in order to structure the co-creation process into meaningful phases and to ensure that all stakeholders were consulted throughout the development of the VR game. The Living lab framework gave ‘voice’ for the end-users (young people and practitioners) to actively engage in the co-creation process.

Main message

This first Living Lab application in drug prevention contributes to a better understanding of the importance of involving users of health promotion products and services through co-creation.
Developing international inter hospital cooperation to reach the SDGs
Authors: Rossinot H , Brucker G , Veber F
Published: November 2019

Background

The current epidemiological transition creates news issues to address (NCD as oncology, cardiovascular, diabetes, road accidents...) and causes an important increase of skills transfer needs in resource-poor/intermediate countries. Hospital cooperation is an efficient way to help the partner country/city adapt and increase their quality of care.

Objectives

The aims were multiple: set up transfer skills programs, but also understand both obstacles and success factors of such projects over the long term. AP-HP’s (Greater Paris University Hospitals) Department of International Relations, has developed 3 year-long projects (financed in majority by public funders) which link one or more hospitals of our group to a southern hospital, on a precise topic. Our multidisciplinary teams then support the local professionals either by training them or assessing their current situation and proposing an action plan.

Results

Over those last 4 years, we built more than 50 cooperations, most of them being successful and still active today. 20 of our hospitals have been involved in at least one project. In 2018, we were working with more than 30 different countries. We noticed a growing interest both from our teams and new partners, over the years. In 2018, around 150 healthcare professionals from AP-HP took part in at least one mission abroad and more than 3 000 foreign professionals have been trained in various ways (from conferences to technical surgical skill transfer), including about 50 trained on site in Paris. These trainings are intended not only to physicians but also for midwives, nurses and managers.

Conclusions

Those projects have a good efficiency in a short term. Therefore, the risk of unsustainability is quite important. For the programs to be effective in the long run, there needs to be a collective involvement both from institutions and healthcare teams in the project on both sides.

Key messages

European hospitals should develop a strong international cooperation policy. AP-HP intends to intensify its work, being an efficient way of contributing to reach both SDG 3 and 9.
Burnout and quality of life among masseurs with visual impairment - Polish cross-sectional study
Authors: Binder K , Wrzesińska M , Tabała K , Lipert A , Miller E
Published: November 2019

Background

Although there are about 1.3 billion people affected by visual impairment (VI), they do not have equal access to social activities, i.e. they are very often unemployed. The authors hypothesized that being job active plays crucial role for their well-being. The aim of the study was to evaluate the level of burnout and quality of life (QoL) among Polish massage therapists with VI and to determine their relationship with sociodemographic and work-related variables.

Methods

43 participants aged 28-63, blind or poor-sighted were surveyed with sociodemographic data questionnaire and Polish versions of the Maslach Burnout Inventory-General Survey to measure burnout and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate quality of life.

Results

Low level of burnout was indicated: 6.79 ± 4.45 in the exhaustion, 7.30 ± 3.43 in cynicism and 23.3 ± 5.44 in professional efficacy. Among domains of QoL the psychological one was the highest (73.6 ± 10.0). Professional efficacy correlated with the social QOL domain (ρ = 0.306; t = 2.056; p = 0.046). Among significant socio-demographic determinants of QOL marital status and working conditions were found. The most general explanation is that job activity gives feeling of self-realization, independence and enhance social functioning which has important meaning for QOL and can be a protective factor for burnout among workers with disability (according to researches among healthy professionals they are at high risk of burnout).

Conclusions

Job activity is essential for psychosocial rehabilitation in VI. That is why we recommend education tailored to the needs and capabilities of persons with VI to prepare them for work as well as supporting employers in creating jobs opportunities for people with disabilities.

Key messages

Job opportunities for people with disabilities mean higher level of psychosocial functioning. Workers with disabilities present lower risk of burnout than professionals without impairment.
Health promoting ideas and actions generated by community engagement in an underserved Swedish area
Authors: Magnusson M , Forslund H B , Berg C , Wretlind K , Hallmyr M , Hedström C , Vaughn L M
Published: November 2019

Background

For an intervention to contribute to decreased health gaps, people living in underserved areas must participate in the research-to-action process during the development of the intervention.

Methods for increased engagement and participation have been developed within the community-based participatory research (CBPR) paradigm. Group Level Assessment (GLA) is a qualitative, participatory methodology that is designed for a large group to generate and evaluate relevant needs and priorities within a lens of action for positive social change. Influence of researchers is tuned down in favour of partnership and impact from the community. Ideally, the process results in participant-driven data and relevant action plans. The aim was to apply GLA to generate reflections on the situation in the community, aligning towards action for change.

Methods

We applied GLA together with people living in Gårdsten, an underserved Swedish suburb where obesity, caries and other illnesses are prevalent. Residents were recruited by posters and post cards at a community center and by snowball sampling. In total, 47 residents attended at least one of eight GLA sessions held over a five-month time period. The majority were women. Outcomes were reflections, suggestions and actions for change.

Results

Themes were: resident pride of the area, the importance of communication and of places to meet, a feeling of being abandoned by society, and a desire for more collaboration between schools and parents. Immediate results were a language café and inquiries from the community about information regarding teeth, food and health. When the results were presented for stakeholders in a report and an exhibition, new collaborations were founded and old were refreshed.

Conclusions

GLA helped residents identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change.

Key messages

Participatory processes that directly engage community residents can result in fruitful discussions and actions. Methodologies like GLA that support such processes may contribute to closing the health gap.
Public Health and Communication: closing the health gap depending on each other
Authors: Magnusson M , Bertolino C , Hallmyr M , Landmér R , Neselrot J
Published: November 2019

Issue

At the center of the concept “Health” is self efficacy. Communication has potential to increase or decrease individuals/groups conception of themselves as valuable beings. In communities haunted by territorial stigmatization this aspect is crucial. Respectful communication, building on a true belief that competencies and resources dwell in every human being, evoke trust which is an important aspect of public health. Angered Hospital is situated in an area with high prevalence of illness. To allow for residents to exert influence over interventions and programs, the Public Health Unit of the hospital need access to skills not only in the area of public health but also in communication design.

Description of the problem

The aim was to develop a trusting cooperation between the Public Health and Communication Units in a hospital, building on adherence to the Declaration on Human Rights and on expert knowledge. Focus is on increased health equity. Given barriers of spoken language and different perspectives, how can we set the scene for merging lay and expert knowledge on conditions for healthy habits and prerequisites for change, on individual and structural levels? How can residents be encouraged to seek help when needed? During two years, collaboration developed by intertwining theory and practice in continous discussions on planned and produced objects. Knowledge in communication design and in determinants of health equity, respectively, enriched both parties.

Changes

A trusting relationship developed, resulting in the objects “Heroes of Awngaryd”. The Heroes appear in many contexts; transfering knowledge, encouraging residents to use their competencies, inviting them to participate, and guiding to adequate care.

Lessons

Sharing of the vision of health equity, active embracing of the Declaration of Human Rights and mutual respect for each others expert knowledge form the base for a successful and transparent cooperation between Public Health and Communication.

Key messages

In this setting, expert knowledge in both communication design and public health are needed to contribute to increased health equity. Common values, trust and specific skills optimize the work.
Hospital “Outside the walls” against HIV and other Sexually Transmitted Infections (STIs) in Russia
Authors: Bouchet-Mayer C , Le Nogue D , Henry-Kagan V , Maric M , Segouin C , Shelly M
Published: November 2019

Background

Though sponsored by UNAIDS support program, Russia struggles to curb its soaring HIV epidemic. French authorities invited Russian leaders of the HIV strategy, medical institutions or civil society in December 2018, to discover the practices of their French peers. A bridging process designed by the Public Health association AREMEDIA and developed in partnership with Fernand-Widal Hospital’s testing center, to reach underserved populations, was shown. Merging associative and medical cultures, they created bonds with community associations to efficiently export free prevention, treatments and care for HIV and STIs, “outside the walls” of hospital facilities. In March 2019, they were mandated to detect dependable partners to transpose this method in the high-HIV burden Ural region.

Objectives

Selecting local political leaders, field associations and public health structures, jointly designing a project to adapt AREMEDIA’s model in Perm. Developing a training to implement locally outreach program in 2020.

Results

Contractual partnership with 4 entities in Perm and educational program. Presenting the interventional methodology at Perm University Conference on “World AIDS day”, 1st December 2019. Theoretical and field trainings of Russian stakeholders to outreach sexual health interventions towards key populations, by associative and medical staff from AREMEDIA and the testing center in Paris. Practical support to implement outreach actions in urban areas of Perm from March to December 2020. Valorization of scientific results in Saint Petersburg International Conference, July 2020.

Conclusions

Consensus found on a pilot training and research-action outreach program, approved by authorities. Advancing access to local key populations should foster switching the Russian strategy against HIV towards a comprehensive sexual health promotion paradigm, resulting among others in destigmatization.

Key messages

Support local stakeholders to promote equitable management of HIV and overall sexual health. Enhance socio-medical interface to reduce the hidden epidemic through reaching HIV key populations.
Migrants in Austria and their understanding of mental health issues
Authors: Weigl M , Gaiswinkler S , Wolf H , Haider H
Published: November 2019

Psychosocial needs are common among migrants but their use of mental health services is not. Little is known about the understanding of mental health issues by migrants and their perception of mental health services. The study aims to provide a basis for further developments of the mental health system to contribute to health equity in the long term.

Qualitative research: literature review, semi-structured interviews and focus groups. 54 migrants from Afghanistan, Somalia, arabic-speaking countries and Turkey and 16 experts were involved. Access was gained through cooperating with an institution offering various health services in different languages and well-known by migrant communities. Migrants from Turkey with long residence in Austria and linked to psychosocial services were chosen as reference group.

There are many similarities among socio-economically disadvantaged people in terms of their understanding of mental health and their willingness to seek and accept support. However, differences can also be observed which are related to country of origin or gender, but also to acculturation status, current life situation or previous experiences within the home or the receiving country. The Turkish reference group shows, that mental health issues are given higher priority in the course of time. To quicken this process, targeted measures for the promotion of health literacy are decisive, but also integration possibilities and the social climate. With a wide range of access and psychosocial support options, attitudes like openness, impartiality and flexibility among health professionals, it is possible to reach migrants with psychosocial needs.

A stronger exchange on how people with a migration background and psychosocial needs are perceived and reached is needed. But also activities to increase the diversity of support services and to carry information about mental health issues as well as the existing services into the migrant communities

Key messages

Specific activities can improve the knowledge about mental health issues within migrant communities. A wide range of access and psychosocial support services is needed to address the diversity.
Health promotion for unaccompanied minor asylum seekers – a qualitative evaluation
Authors: Kasztura M , Zumstein-Shaha M , Ninane F , Bodenmann P , Soom Ammann E
Published: November 2019

Background

We evaluated a health promotion program (HPP) for unaccompanied minor asylum seekers (UMA) in the canton of Vaud, Switzerland. UMA are particularly vulnerable to a range of health issues, due to their age and migration experiences. Effective health promotion programs are key to empower them to overcome these challenges and to improve their health.

Methods

We adopted a qualitative design with ethnographic and participatory elements to identify strengths, opportunities for improvement and appropriateness as perceived by UMA, educators and nurses responsible for UMA health care and the HPP. Data collection included observation of HPP courses, focus group discussions with UMA and interviews with educators. Analysis was based on a grounded theory in ethnography approach.

Results

Finding include three main themes: 1) UMA’s perceived low power and control, due to predominant rules and regulations and uncertainty about the future; 2) A need for health promotion in this population, due to UMA’s risk behaviours and the educators’ perceived discomfort with health-related issues and health promotion; 3) Practical feedback regarding topics, teaching methods and HPP organisation. Main recommendations include using effective adolescent health education methods to improve the appropriateness to age and context, enhancing participation of educators in health promotion and improving practical aspects of the HPP.

Conclusions

We evaluated and documented health promotion practice in the hard to reach population of UMA. Feasible changes in teaching methods and multidisciplinary collaboration may improve the HPP. However, UMA’s social environment needs to be taken into consideration to provide effective health promotion programs.

Key messages

Unaccompanied minor asylum seeker and educators perceive the health promotion program as useful and important. To address the health promotion needs of UMA, any program must be adaptive to the contextual complexity of UMA lives.
Policies for tackling health inequities in migrants in an irregular situation: learning from Italy
Authors: Sesti F , Rosano A , Ingleby D , Baglio G , Bell R , Geraci S , Marceca M
Published: November 2019

Issue

With increasing of numbers of people moving in Europe and around the world, the health of migrants has become a key global public-health issue. Migrants in an irregular situation (MIS) represent an important part of the migration phenomenon, whether they have become irregular by entering a country without authorisation or by overstaying a visa, including whose applied unsuccessfully for asylum.

Description of the problem

Overstaying of visas is not unusual in EU countries and during 2015 and 2016 in particular, many countries experienced a large number of unauthorised entrants. Health policies for MIS are increasingly a matter of concern. Using the 2015 Migrant Integration Policy Index Health strand (MIPEX HS) it is possible to conduct an analysis of health policies, focusing on access to health services by MIS.

Results

Among the 34 European countries covered by the MIPEX HS, Italy’s overall score of 65 is exceeded only by Switzerland (70) and Norway (67). Averaging the indicators of access for MIS, Italy obtains the highest score (83), followed by Denmark, France, the Netherlands, Romania, Spain, Sweden and Switzerland with 67. Its score for legal entitlements to health care is 75 (the same as Sweden), while reporting of MIS to the immigration authorities is prohibited and there are no sanctions against helping them. However, legislation introduced by the new government in 2018 has restricted some of their rights.

Lessons

Current migration to Europe requires dealing with short-term health needs as well as strengthening public health and health systems in the long term. This presentation will discuss the lessons that can be learned from the comparative analysis of health policies for MIS using the MIPEX HS.

Key messages

Affordable health care is a human right, which should not be denied to any migrant. Policy analysis plays a key role in identifying interventions for promoting health equity.
Barriers to health access for women during forced migration: An exploratory study
Authors: Durham J
Published: November 2019

Background

Mass migration is a global crisis that has a number of significant public health implications for Europe. With more than a billion migrants worldwide, Europe receives a significant proportion of those, many of whom are forced migrants, possessing particular health and social vulnerabilities. Many forced migrants transit through, or settle within Europe. Despite this, there is a dearth of literature examining the experiences and perspectives of forced migrants or the barriers they may face in accessing health services. Understanding these barriers is integral to developing an effective international response.

Methods

Using purposive sampling, 8 female key informants from displacement backgrounds were recruited for in-depth interviews from Queensland, Australia. The interview questions focused on past experiences of accessing healthcare during displacement and were formulated around the 5 dimensions of health access described by Levesque, Harris and Russell (2013). Data was analysed using qualitative content analysis.

Results

Under the five dimensions of health access (approachability, acceptability, availability, affordability and appropriateness) twelve sub-themes were identified that were specific to the displacement context. Common sub-themes included mistrust of health services, irregularity in access, focus on acute health conditions, limited healthcare capacity, self-treatment; with pharmacies often the first point of contact, and the neglected health needs of vulnerable populations, such as women.

Conclusions

The current global mass population flows, display a need to consider the long-term health effects of displacement and how these experiences shape migrants’ future health-seeking behaviours. A significant number of forced migrants transit or settle within Europe and therefore there is a demonstrable need to understand the perspectives and experiences of those individuals, if equitable health access is to be attained.

Key messages

This is the first study to the authors’ knowledge that applies a structured framework to the displacement experience, providing novel insights of an under-researched population. It is essential to understand the perceived barriers to health access of forced migrants in order to reduce morbidity, mortality, inequity and associated healthcare costs.
Health experiences of asylum seekers and refugees in Wales
Authors: Scott R , Ellis L , Khanom A , Rhydderch M , Richardson G , Russell D , Russell I , Snooks H
Published: November 2019

There are concerns that people seeking sanctuary (asylum seekers and refugees) in Wales, UK, have unmet health needs and face difficulties accessing services, but little collated evidence. This study addressed this gap to inform policy and practice in reducing health inequities. It aimed to: investigate the health, wellbeing and healthcare experiences of adults seeking sanctuary in Wales, including the views of healthcare recipients and providers; and establish what helped or hindered the healthcare experiences of those seeking sanctuary. It is the most comprehensive study of this population in Wales.

A mixed-method approach was taken, including a literature search, a cross-sectional survey of 210 adults seeking sanctuary, telephone interviews with 32 health professionals and third sector support workers, and 8 focus groups including 57 people seeking sanctuary and those supporting them.

Eight trained volunteer peer researchers, themselves asylum seekers or refugees, administered the surveys. Interviews were digitally recorded, transcribed and analysed using a standard framework.

The literature search identified 5 themes that help or hinder people seeking sanctuary to access healthcare. The survey found 79% of respondents attended an initial health assessment on arriving in Wales, with 94% currently registered with Primary healthcare. 64% reported difficulties in accessing health services. Awareness of services was mixed, with 66% having used healthcare in working hours (planned) and 28% out of hours (unplanned).

Mainstream health professionals felt they lack capacity to deliver care effectively due to time and other pressures on the healthcare system and the need for appropriate translation/interpretation services.

This study triangulates the experiences of people seeking sanctuary with those providing healthcare and general support. Peer researchers maximised sanctuary seekers’ participation. Many of its methods and findings have relevance to other countries in Europe.

Key messages

Improving health equity is key to realising Wales’ ambition to become a Nation of Sanctuary. Peer Researchers enabled participation by sanctuary seekers and revealed useful findings to steer future policy and practice.
Access to abortion of undocumented migrants seen by Médecins du Monde in the Humanitarian Hub
Authors: Ben Abdelahfidh L , Huber J , Rojas López F , Glorie C , Vanden Bussche I , Coiret C , Spoel E , Pignard A-L , Heymans S , De Bethune X
Published: November 2019

As of June 2017, the population of the Maximillian Park (an undocumented migrant camp in Brussels) is mainly Eritrean and Sudanese migrants who intend to continue their journey to the United Kingdom (Depraetere, 2017; Daher, 2018). In response to demanding needs, Médecins du Monde together with 8 organisations, created a one-stop service centre, The Humanitarian Hub, in January 2018 to offer a set of basic services to the migrants.

The Hub implemented a voluntary de-medicalized midwifery clinic. The medical team noted an under-representation of women, 40 out of 745 (5,4%), while the coordination team identified a number of complex unwanted pregnancies, many of which relating to violence. Accessing free abortion for undocumented women in Belgium requires the Urgent Medical Assistance certificate. This often takes several weeks, making it unrealistic to obtain in time for an abortion. Accordingly, the women or family planning centres cover the financial cost. The Hub’s midwifery clinic thus focused on building trust with the women, and facilitated referrals to family planning centres.

By taking steps to create a more gender-sensitive Hub, the proportion of women seeking consultations doubled. In 2018, 955 out of 8990 (10,6%) patients were women, totalling 324 midwifery consultations. 65 of these women were pregnant, and the 23 who sought abortion were referred to family planning centres. None had Urgent Medical Assistance.

It is crucial to consider the particularities of a population and their social determinants of health when implementing a holistic system. For instance, focusing on violent experiences in medical consultations can help better understand women’s situation. The coordination between The Hub and family planning centres helped in reducing barriers for migrant women. The project has seen success, thanks to the flexibility of the family planning centres in quickly receiving these pregnant women, and to the four centres who covered abortion costs.

Key messages

It is evident that the magnitude of these women’s situation is undervalued, thus it is important to increase sensitization and advocacy in order to offer them greater support. The Hub has provided a number of services for undocumented migrants, notably abortion, and removed some barriers in accessing care. However, it is a fragile solution to a structural problem.
Factors related to emigration self-efficacy among university students in Slovakia
Authors: Hajduch B , Orosová O
Published: November 2019

Background

Emigration self-efficacy (ESE) as the confidence in onés ability to successfully handle migration is an important characteristic of a migrant. We hypothesized that positive migration experience might increase ESE. We also explored whether personality factors such as extraversion, openness to experience, neuroticism, conscientiousness and agreeableness might be related to the ESE of young people (under 30 years old) in Slovakia. The moderation effect of gender in the relationship between the independent variables and ESE was also tested.

Methods

The sample consisted of 474 students from Slovakia (76.8% women, M = 22.4, SD = 2.13) all participating in the Student Life Cohort Study (SLiCE 2016) which focuses on the emigration intentions and risk behaviour of university students. The data were collected via an online survey. Standard multiple regression was used and the analysis was adjusted for gender.

Results

The model explained 23.1% of the variance in ESE. An evaluation of migration experience was found to make the largest unique contribution in explaining ESE (β = 0.317, pα<0.001). Regarding personality factors, only neuroticism was found to be significantly related to ESE (β=-0.155, pα<0.05). The main effect of gender was also significant (β=-0.179, pα<0.001) with males scoring higher in ESE although the moderation effect of gender in the relationship between the independent variables and ESE was not significant.

Conclusions

This study provides an insight into the role of personality factors and evaluation of migration experience in relation to ESE among Slovak university students. Future research may focus on a deeper exploration of the other factors affecting neuroticism, as reducing the level of neuroticism could be beneficial in experiencing healthier and safer migration and adaptation process.

Key messages

A more positive migration experience and lower level of neuroticism are related to emigration self-efficacy among university students in Slovakia. Emigration self-efficacy is an important factor of healthy migration.