bluuebunny/crossref_metadata_2025 huggingface dataset:
Criteria for best practice in health promotion
Authors: Shajanian Zarneh Y
Published: October 2023

There are many interventions that take a health-promoting approach. But are they really good and do their implementation lead to results that are also a sustainable improvement for the target group in a setting? Can this improvement be scientifically evaluated and even measured or is it based on a well-intentioned perception only? The criteria for good practice from Germany, which were developed in 2003 by the Advisory Working Group of the nationwide Collaborative Network for Equity in Health of BZgA, aim in particular for professionals in community health promotion to reflect on their work and to support them in further developing and strengthening the quality of their health promotion services. The (twelve) good practice criteria, in practical language and in the form of twelve fact sheets, each contain a definition, implementation stages of the criterion, their explanation (illustrated with examples from practice) as well as further literature. The good practice criteria include conception and target group reference and take into account participation and empowerment, but also sustainability and cost-effectiveness. These criteria also serve as selection criteria for interventions to be included in the German Good Practice Portal which has a particular focus on tackling health inequalities. In a brief presentation these criteria will be presented to the participants of the workshop in order to subsequently discuss and exchange approaches from other countries.
How can public health agencies support the adoption of a population health management approach in PHC? The case of SVN
Authors: Vracko P
Published: October 2023

Slovenia has a longstanding tradition of providing accessible and comprehensive PHC services. Established in 1927, Slovenian PHC strongly emphasizes addressing health equity and reaching out to vulnerable populations in local communities to identify environmental, social and behaviour-related risk factors and diagnose disease in its early stage of development. Through a cross-sectoral cooperation based on a community based approach and a strong collaboration of public health and primary care services, Slovenia has improved health and reduced health inequality over the last decades. Registered nurses in family medicine teams conduct regular screening and follow-up for people with noncommunicable diseases to reduce family doctors’ growing burden and workload. Each family medicine practice has a list of registered patients (a capitation list), managed in defined groups of healthy individuals; those with risk factors; and those with the most common chronic diseases. Financial incentives are given for meeting target values in screening check-ups. The National Public Health Institute manages and leads the noncommunicable disease prevention and control programme at the national level.
Stakeholder engagement to assess the transferability of vaccination interventions in Greece
Authors: Karnaki P , Dalma N , Papaevgeniou N , Radaios V
Published: October 2023

Background

Due to political instability, poverty and war Greece has been witness, over the last decade, to continuous migrant and refugee flows which enter the country mainly on their way to Northern Europe. Through the RIVER-EU project in Greece we aim to identify and tailor successful interventions that can address health system barriers to MMR/HPV vaccination for this group.

Methods

RIVER-EU adopts participatory action research (PAR) in order to give voice to all involved groups. The main aim of the focus groups (FGs) and the interviews was to explore transferability. We aimed to discuss how promising interventions could be transferred to the Greek reality and discussed barriers and facilitators.

Results

FGs were conducted with migrant/refugee parents (mainly mothers), adolescents (boys and girls) and other stakeholders such as health professionals and policy makers. The main challenge in Greece is the diversity of the target group (migrants/refugees), as people who arrive to Greece come from different countries have different cultural and religious backgrounds and have fled their countries for different reasons (war, poverty, financial problems). Possible solutions were discussed such as schools as an intervention site. An additional problem identified was access to vaccination services (for HPV/MMR) and the need to create synergies with local health organizations. Finally, it was evident that adolescents as a group, although from different cultural backgrounds, share common values and norms.

Conclusions

The RIVER-EU project has implemented an innovative approach to explore barriers and facilitators of transferability and tailor the intervention to the specific circumstances of the situation in Greece. Through the PAR the target groups were able to voice their beliefs about what should be implemented in which way and able to discuss possible solutions. Agreement about the importance of HPV/MMR vaccination for migrants/refugees in Greece was established.
PAR for transferability of HPV interventions among underserved communities in the Netherlands
Authors: De Zeeuw J , van Enter B , Vervoort H , Jansen D
Published: October 2023

Background

In the Netherlands, females with a Turkish or Moroccan migration background are among underserved communities with low HPV vaccine uptake. To target health system barriers related to uptake, the RIVER-EU project will identify and adjust promising evidence-based HPV interventions in collaboration with key stakeholders.

Methods

Participatory Action Research (PAR) was applied to engage and collaborate with key stakeholders, including community members to discuss on transferability of promising evidence-based HPV vaccination interventions. Focus group discussions and semi-structured interviews were conducted for which topic guides were developed.

Results

Key stakeholders included community members (parents and daughters), non-governmental organizations, healthcare providers, and policymakers. To engage community members, we build upon the relationship we had built during the first phase of RIVER-EU, and we reached out to organizations working with the communities. To build relationships and trust intensive physical and clear communication with communities was helpful. It required time and efforts to engage with general practitioners due to work overload. We could establish successful engagement of all key stakeholders by the application of various strategies.

Conclusions

The PAR approach supported the meaningful discussion on identification of the facilitators and barriers related to the transfer and implementation of HPV interventions. All key stakeholders could provide their valuable insights needed to ensure successful understanding of the variety of perspectives needed for successful transfer.
Are evidence-based vaccination interventions transferable to Ukrainian migrants? A Polish example
Authors: Gańczak M , Kalinowski P , Kowalska M , Nyankovskyy S
Published: October 2023

Background

Ukrainian migrants (UM) are among underserved groups with limited access to use vaccination services. The RIVER-EU in Poland aims to identify and tailor the successful intervention which would address health system barriers to MMR/HPV vaccination identified during the 1st phase of the project.

Methods

Participatory action research approach (PAR) was introduced to bring Researchers, UM and other Stakeholders together to identify and discuss transferability of promising evidence-based vaccination interventions (HPV/MMR). Relevant topic guides were developed; these helped to conduct focus groups discussions and in-depth interviews aimed to assess the extent to which interventions were appropriate and identify facilitators/barriers for the transfer and implementation.

Results

UM community (mothers of adolescent children and general practitioners [GPs]), Polish GPs, policymakers, experts in vaccinology and gynecological oncology, representatives of the municipality and a non-governmental organization were identified as key stakeholders. To find and mobilize UM appeared to be the challenging task, as they are a diverse, hard-to-reach community. The lack of information about the HPV vaccine was another obstacle to mobilize this group. Engaging GPs was also difficult due to work overload, lack of time, incapacity; the lack of extra compensation negatively affected motivation to be involved. To gain the trust of stakeholders and to build relationships - consistent, transparent, inclusive communication and cooperation was needed; country coordinators played moderators’ role.

Conclusions

To achieve consensus about the type of a tailor-made intervention requires creating clear communication channels and an open space where stakeholders can voice their opinions. PAR helped to achieve more meaningful insight into the transferability of MMR/HPV vaccination interventions by leveraging the collective wisdom of the researchers, UM community and other Stakeholders.
Surveillance of the mental health of Germany's adults using monthly population-based survey data
Authors: Walther L , Junker S , Thom J , Peitz D , Mauz E
Published: October 2023

To meet new information demands in the COVID-19 pandemic, the Mental Health Surveillance at the Robert Koch Institute in Germany began using monthly survey data for high-frequency monitoring of several indicators of population mental health. Visualized time series consisting of three-month rolling estimates and smoothing curves are used to provide policymakers with regular assessments of current developments in symptoms of depression and anxiety, self-rated mental health, perceived mental health care needs, loneliness, and social support. Striking changes have taken place within the observation period - so far, particularly from mid to late 2021 and early 2022, when (further) marked declines in the mental health of adults began. For example, the percentage of the population scoring above the screening cutoff of an ultra-brief depression screener jumped from about 13 % in late 2021 to levels of 17-18 % in the first half of 2022 and then further rose to steady levels of 20 % for the second half of 2022 and the beginning of 2023. Symptoms of anxiety also increased substantially in this time, and self-rated mental health worsened. High-frequency surveillance resulted in policymakers being informed of the unfolding of these changes with relatively short delays. This presentation outlines the methods used for high-frequency monitoring within the Mental Health Surveillance and shows up-to-date results. Challenges in the interpretation of time series and in reporting will also be described. Centrally, questions about what signifies meaningful change have emerged alongside questions surrounding how the utility of high-frequency surveillance might be improved and how its utilization could be facilitated. A structured exchange with stakeholders to help address these questions is planned. A brief look at this and other next steps will wrap up the presentation.
Description of the COVID 2.0 survey in the NAKO and first results
Authors: Mikolajczyk R , Diexer S , Fricke J , Ahnert P , Pischon T , Karch A
Published: October 2023

Introduction

The COVID-19 pandemic had a huge impact on society and raised attention to the challenges related to infectious diseases. While a lot of research was initiated during the pandemic, the recruitment of participants in most instances started at the time point of infection. In contrast, the German National Cohort (NAKO Gesundheitsstudie) has the ability to study pre-existing risk factors. In order to obtain information about SARS-CoV-2 infections and the following sequelae a dedicated data collection was conducted.

Methods

An online survey was conducted in the NAKO between September 2022 and February 2023. Invitation via e-mail was followed by two reminders sent to all NAKO study participants who provided e-mail addresses. The questionnaire was implemented in LimeSurvey and included the following topics: current health status including mental health measurements, restrictions of health services during the pandemic, other collateral effects of the pandemic, reported infections with SARS-CoV-2 and symptoms of acute infection, 4-12 weeks, 12 or more weeks, and one year after infection as well as vaccination status.

Results

Of 150766 invited NAKO participants, 110362 responded to the second COVID-19 questionnaire. Respondents in 60% reported at least one SARS-CoV-2 infection, 59453 reported one, 6061 two, and 414 three or more infections. The time points of infections followed the general incidence in the German population and thus infections could be mapped to specific variants based on periods of dominance. Of those who reported an infection with SARS-CoV-2, 42% reported symptoms 4 to 12 weeks after infection (ongoing COVID-19), 35% reported symptoms 12 or more weeks after infection (Post-COVID-19), and 37% one year after infection.

Conclusions

Combined with existing biosamples and measurements prior to infection, NAKO offers an excellent opportunity to study risk factors for infection and post-infection syndromes.
How do patient and care experience data inform policy and practice? Insights from the Irish National Care Experience Programme
Authors: Hyland D , Rohde D , McGeown M , O'Flaherty K
Published: October 2023

Issue

Patient experiences are central to the delivery of quality, person-centred care and an important predictor of outcomes. Prior to 2017, there was no unified, national approach to the collection of care experience data in Ireland.

Description of the problem

The National Care Experience Programme is a partnership between a regulator, policy makers and the Irish public health service, with a suite of surveys of inpatient, maternity, nursing home and end of life care. The surveys aim to learn from people's feedback on health and social care services to identify areas of good experience and areas requiring improvement.

Results

Findings have informed national policies, including a healthcare communication programme to support staff to develop communication skills with patients and families. Survey data provide a key input to the Irish health quality indicator framework and the Health Systems Performance Assessment Framework, which assess the overall performance of the Irish health system. National Maternity Experience Survey results informed the allocation of funding for post-natal supports and new lactation consultant posts, and supported the implementation of a specialist perinatal mental health services model of care, leading to increased diagnosis and vigilance of mental health issues ante- and postnatally. National Nursing Home Experience Survey findings supported legislative amendments, including provision for the delivery of in-person advocacy awareness campaigns and the strengthening of complaints processes within nursing homes.

Lessons

In order to maximise the use of survey findings and ensure the voices of people using health and social care services are acted on, routine surveying of care experiences is required to track the impact of policy and practice initiatives. The programme is currently expanding to include people's experiences of cancer care and mental health services, in addition to exploring options for continuous, local care experience surveys.
Strategies and tactics: what have we NOT learned from decades of tobacco industry interference
Authors: Makhoul J
Published: October 2023

The tobacco industry has historically targeted vulnerable populations to increase its profits and at the expense of health. More recently, the use of Electronic Nicotine Delivery Systems (ENDS or vapes) has reached epidemic levels among vulnerable populations such as youth, globally. The vape industry uses similar tactics to advertising and market ENDS products to youth and thus contributing to increasing rates. One particularly targeted population is the youth LGBTQ+ population. In the U.S, young LGBTQ+ individuals have higher rates of ENDS use compared to heterosexuals and are also more likely to initiate ENDS use at a younger age. In this presentation, we will highlight the research to date that has documented the ENDS industry strategies and tactics with a particular focus on young LGBTQ+ populations as a vulnerable targeted population in the US, highlight similarities to the tobacco industry practices and lessons NOT learned, and propose potential prevention and policy strategies going forward.
Circle of Friends - an encouraging intervention for alleviating loneliness
Authors: Jansson A , Pitkälä K
Published: October 2023

The Finnish Association for the Welfare of Older Adults developed a group model Circle of friends (CoF) for lonely older adults. In a randomized controlled trial, it improved lonely older adults’ wellbeing, health, and cognition. It reduced the use of health services and mortality. The aim of this presentation is to describe the successful implementation and dissemination of CoF and its impact in practice, which we believe reflects the rigorous attention to the main elements, careful training of professionals as well as annual quantitative and qualitative analysis and reports of the data. CoF is a closed group of 6-8 participants suffering from loneliness. They meet with their peers 12 times, once a week, for three months. In these closed groups new participants are not added after the group has started, even if some participant(s) drop(s) out. Each group's two facilitators receive thorough training and work supervision along with the group process. From 2006 on CoF has been disseminated into Finnish communities. Altogether 1200 CoF facilitators have been trained so far and at least 12'000 older adults have participated in CoF in 100 communities in Finland. It has maintained its essential elements over the years. According to a ten-year follow-up, 90% of participants felt their loneliness had been alleviated, and over 60% of the participants had continued the meetings after the facilitated group was over. At the beginning of the COVID-19 pandemic the CoF was modified into online groups with an easy and safe electronic platform, and free of charge for the participants. During the last years it has been exported to some other countries, for example in the RECETAS project.
Social and biological factors associated with unsuccessful TB treatment outcome in Ireland 2011-2021
Authors: Jackson S , Kabir Z , Comiskey C
Published: October 2023

Background

Tuberculosis (TB) treatment success rates are crucial for TB control programme evaluations. The World Health Organisation sets targets of > 90% but Ireland remains below 70%. We analysed notifications from the Irish National TB Surveillance System from 2011-2021 to explore factors associated with successful treatment outcome in Ireland.

Methods

We selected potential predictor variables based on clinical relevance and literature review. We examined each predictor's unadjusted association with treatment success using univariable logistic regression. We used backwards elimination to remove predictors that failed to remain significant in multivariable logistic regression. Treatment success was defined as treatment completed or cured, while unsuccessful treatment was defined as treatment failed, treatment interrupted, transferred out and died from any cause. We used Stata for analysis.

Results

Between 2011-2021, 52% of cases were successfully treated, 10.7% were unsuccessfully treated and treatment outcome was not reported for 37%. Treatment outcome completeness declined significantly between 2019-2021. Univariable analysis showed successfully treated cases had higher odds of being a migrant (OR:1.9; 1.5-2.5), being linked to outbreaks (OR:1.9; 1.2-3.0), being a contact of a case (OR: 1.0-2.5;), having a normal X-ray (OR:1.7;1.1-2.6) and being an outpatient (OR:3.0;2.2-4.2). Significant predictors of unsuccessful treatment in the final model were age >70 years, unemployment, immunesuppression and any anti-TB drug resistance.

Conclusions

Surveillance data shows that Ireland fails to meet the WHO target of > 90% treatment success with high levels of missing data. Data quality improvement initiatives are needed to reverse the decline in completeness associated with the Covid-19 pandemic period so control programmes can robustly evaluate performance. Additional supports should be considered for patients who are older, unemployed, immunesuppressed or with drug resistant TB.

Key messages

• Additional patient supports should be considered for patients who are unemployed, age 70 years and older, immunesuppressed or with drug resistant forms of TB.

• Ireland fails to meet the WHO TB treatment success target with high levels of missing data. Treatment outcome completeness needs to be improved so control programmes can robustly evaluate performance.
The EC DG INTPA - World Health Organization partnership in the new global health order
Authors: Roura M , Appelt B
Published: October 2023

Issue

The 2022 EU global health strategy recognizes health as a global common good and sets twenty guiding principles, including the need to support a stronger, effective and accountable WHO as the indispensable cornerstone of the multilateral health system.

Description

Mixed-methods study using documentary, quantitative, and qualitative analyses to answer two questions: 1) Is the current EC DG INTPA-WHO partnership adequate to support the role envisaged for WHO in the new EU global health strategy)? and 2) How should the EC-DG INTPA-WHO partnership be restructured?. Documentary analysis includes review of academic literature, historical/contemporary documentation on EC-WHO collaboration agreements, monitoring reports of DG INTPA funded interventions since 2016, and selected WHO projects since 2010. Key informant in-depth interviews are conducted with 10 EC senior officials. Guided by results-oriented monitoring frameworks, we analyse interview notes/transcripts and key documents using NVIVO software. Projects are classified by geographic areas and mapped against priorities outlined in the strategy.

Results

WHO's essential role to provide global public health goods is hampered by insufficient authority and core funds to implement its constitutional mandate. As EU member states see the value of holding a common position, the EU can increase its political role in global health. The EC focusses on specific health threats while also adopting a health system strengthening approach including longstanding collaboration between WHO and the Directorate General for International Partnerships. With remarkable overall achievements, a clear pattern of strengths and weaknesses emerges with key cross cutting areas where the EU has extensive expertise to be strengthened (e.g., evaluation, visibility, inequality markers).

Lessons

Supporting the development of monitoring and evaluation frameworks could be useful to enhance the visibility and added value of the EC DG INTPA /WHO partnership.

Key messages

• As a new global health order emerges, the EU must contribute to shape it through a more strategic, coordinated, and effective cooperation with WHO.

• To enhance the EC DG INTPA/WHO partnership it is important to support the development of visibility strategies, as well as the further development of monitoring and evaluation frameworks.
Exploring the heterogeneity of obesity: A Public Health Perspective
Authors: Stranges S
Published: October 2023

Body Mass Index (BMI) has been traditionally used in the biomedical field as the main anthropometric measure to classify individuals in relation to their body weight status. High BMI levels are usually associated with an increased risk of adverse health outcomes. However, measures of obesity, including body mass index (BMI) and waist circumference (WC), do not fully capture the complexity of obesity-related health risks. In fact, obesity is a very complex condition with wide heterogeneity across individuals. The belief that weight loss is the best recommendation for all people with high BMI as the only path to health should be revisited. In fact, weight loss in some subjects does not necessarily translate in health improvements. Novel evidence support alternative approaches to weight loss in the promotion of health for high BMI individuals. This presentation will provide an overview of the complexity and heterogeneity of obesity, with a critical discussion about the current approaches used to define weight status as well as on alternative interventions to improve health independent of body weight loss.
COVID-19 vaccine and test data management – practice report from a university hospital
Authors: Bonigut M , Zhelyazkova A , Weber M , Geiser-Metz S , Geis M , Heindl B , Prueckner S
Published: October 2023

Issue

The COVID-19 pandemic generated the urgency for creating and implementing new tools, specifically for data collection, sharing. The data governance of healthcare workers (HCW) was layered on top of pre-existing digitalisation issues in health authorities as well as in health facilities.

Description of the problem

The vaccination act for the German healthcare sector adopted in December 2021, established the compulsory report of HCWs’ COVID-19 vaccination status. The LMU University Hospital management required an overview of the COVID-19 status (illness, isolation, vaccination, infection) of HCWs in order to ensure continuous clinical service. For the timely and accurate report, it was necessary to create a centralised real-time overview of data that were collected and managed by decentralised structures.

Results

We connected five in-hospital systems into one platform that was being synced three times a day. For each HCW, we created a dataset with three main categories: core personnel data, COVID-19 status and reason for absence. Two user groups were defined: strategic management (1) and operational management (2), where users of group 2 were only given access to their own unit and were required to update and verify data of their team. Overall, the platform contained data of 14,419 HCWs and had 656 users (Ngroup1 = 16, Ngroup2 = 640).

Lessons

The data merger revealed issues in interoperability and accuracy and thus expedited data standardisation. The decentralised approach facilitated the operational efficiency, digitalisation, service delivery and managerial empowerment at the hospital. The main challenges pertained to data accuracy and to the continuously changing regulatory requirements as well as privacy protection. As all data were previously hosted on different platforms, an exhaustive process of cleansing was needed prior to merging. Each HCW was assigned to an organisational unit with a respective responsible person in order to achieve data quality.

Key messages

• Dedicated digital human resources solutions in a university hospital pose a specific challenge for the balance between data privacy, availability and interoperability.

• To enable a centralised information display, data must be collected where it originates and made available through short paths. Our solution united decentralised collection and centralised management.
Evaluating achieving tobacco control targets in Belgium using modelled projections
Authors: Guariguata L , Nayani S , De Pauw R , Devleesschauwer B
Published: October 2023

Background

Tobacco use in Belgium remains a key public health concern with an estimated 15% of adults reporting daily tobacco use in 2018. In 2022, the Belgian government launched the “Interfederal Strategy 2022-2028 for a Smoke-free Generation.” The strategy outlines a number of targets for reducing daily tobacco use among adults 15+ years and young adults 15-24 years. We evaluate the feasibility of achieving these targets given current daily smoking trajectories at a national and regional level.

Methods

We modelled time trends of smoking in Belgium based on repeated cross-sectional data taken from the nationally representative Belgian Health Interview Survey. We applied a Bayesian inference model, the integrated nested Laplace approximation, to obtain a time series of daily tobacco use for adults by age, sex, and region of Belgium from 1997 to 2018. We then projected this model to 2070 using population projections from the Belgian Federal Planning bureau for population distributions. We compared trajectories with targets from the Interfederal Strategy to assess whether they are likely to be achieved.

Results

The national target of reducing daily smoking among adults 15+ years to 10% by 2028 and 5% by 2040 will not be achieved on current trajectories. Wallonia has the highest level of people smoking daily and is projected to miss the targets by the largest margin. Flanders is expected to reach the 10% threshold by 2032. The target for reduction of prevalence of daily smoking among youth 15-24 years to 6% by 2028 will not be achieved before 2040. Smoking among the youngest age group (15-24 years) is decreasing rapidly with prevalence of daily smoking in that age group projected to be < 2% in Flanders by 2059.

Conclusions

No region of Belgium is expected to achieve targets for reduction in daily smoking given current trajectories. Tobacco control policies in the country should be re-assessed, targeted and intensified.

Key messages

• The Belgian national target of 5% daily smoking prevalence in adults by 2040 will not be achieved.

• Differences in smoking trajectories in Belgium exist by age and region; tobacco control policies should be targeted.
Development and validation of an instrument to measure social capital in disadvantaged neighborhoods
Authors: Stjernqvist N W , Elsborg P , Olesen K , Tetens A , Boye M C , Tørslev M K , Nielsen A V , Bloch P
Published: October 2023

Background

Building social capital within communities is an integrated element and outcome of the Supersetting approach, but knowledge on how to measure it within a disadvantaged urban context remain scarce.

The Objective

To develop, test, and validate a questionnaire-based instrument to measure social capital among adult citizens living in a disadvantaged neighborhood. The study is done in Tingbjerg - a disadvantageous urban neighborhood.

Methods/theory

The development of the instrument is based on the social cohesion approach from within the theory of social capital and takes place in three phases. 1) Development including specification of a theoretical model of structural and cognitive social capital with indicators, development of items, and content validity of the items by experts. 2) Testing of developed items including face validity by conducting individual and focus groups interviews with Tingbjerg residents, translation into five languages and subsequent data collection among all 2567 adults living in Tingbjerg. 3) Statistical evaluation to test for dimensionality, reliability and validity. In case of suboptimal performance of the instrument, modifications may be applied, and the updated instrument re-evaluated.

Findings

Evaluations obtained from experts and residents will be analyzed and used to reduce and modify items included in the instrument. The questionnaire's dimensional structure will be explored with confirmatory factor analysis and its reliability with Cronbach alpha. Convergent validity will be tested through testing the association between social capital and a construct of social relations. Concurrent validity will be tested through testing the association between social capital and measures of self-assessed health and life quality.

Conclusions

An instrument to measure social capital in disadvantaged neighborhood will be presented at the conference. Recommendation of the instrument will depend on the evaluation of the study findings.
Analysing public debates, to support productive engagement with politicians and stakeholders
Authors: Sinclair S
Published: October 2023

Issue

UK public health debates have become highly politicised. Sean Sinclair (SCS) conducted 37 semi-structured interviews with public health professionals to understand how this affects their engagement with stakeholders. Interviewees said it has become more difficult to gain stakeholder support for public health policies. They hypothesised that politicians didn’t listen to evidence regarding health outcomes. SCS counter-hypothesised that debates are not always about facts, but sometimes about values. If a politician's main concern is, say, economic growth or personal responsibility, then evidence of health outcomes will not address their concerns.

Solution

To understand people's values, SCS analysed UK public debates about four contentious issues: vaccine passports; lockdown; healthy living advice; and Prep (the HIV prophylactic). SCS used the techniques of argument analysis used in analytic philosophy, ensuring the structure of arguments was transparent, and so amenable to assessment.

Results

From the analysis, SCS developed a conceptual toolkit to allow public health professionals to analyse what motivates politicians from different points on the political spectrum. They can then tailor their evidence to show how a policy will deliver on a politician's concerns, or tweak the policy to mitigate the features that trigger scepticism. To assess the material, SCS presented it to public health professionals in qualitative discussion groups. Feedback indicated that it will help them engage more effectively with stakeholders, eg: ‘Makes me think about what argument might be most impactful, rather than my instinctive response.’

Lessons

In any country that is politically divided over public health policy, this method can reveal new ways of arguing for policies, eg by appealing to a politician's own values.

SCS has developed the expertise to help develop similar analyses in other countries.

Key messages

• In any country that is politically divided over public health policy, it can be difficult to gain stakeholder support for policies. Analysing public debates builds understanding of people's concerns.

• This method can reveal new ways of arguing for policies. Public health professionals can tailor the evidence they present to show how a policy will deliver on each politician's concerns.
Measuring mental health literacy in children: the development of the CHILD-MHL scale
Authors: Montagni I , Philiatreau A , González-Caballero J L
Published: October 2023

Background

One child out of 5 is affected by a mental health problem before the age of 12 years. Among the determinants of children's mental health, Mental Health Literacy (MHL) is a theory including 6 dimensions: understanding mental health; help-seeking actions; supports available; influences on mental health; coping and resilience; and stigma. High levels of MHL correspond to better children's mental health. Measuring children's MHL is essential to inform the development of interventions pro-MHL, evaluate their impact and conceive related policies. We describe here the process of developing the CHILD-MHL scale.

Methods

Two public health researchers generate some MHL items in French. These are discussed by a group of 30 experts (ex. psychologists, psychiatrists), parents and teachers to verify their content and wording (Delphi study). An artist co-draw with 5 children (8-11 years old) the illustrations of the items (visual scale). Then, the scale is tested in the school setting by 30 children with feedback through qualitative interviews. Finally, the scale is administered to 500 children and undergoes psychometric analyses.

Results

Results are preliminary. We have produced 50 items telling a story based on MHL through the characters of Émile and Amélie, two children facing mental health problems. Examples of MHL items are: “Emile doesn’t say nice things about himself, he doesn’t want to spend time with his friend Amélie anymore, do you think he might be depressed?” and “Emile feels very worried and nervous, do you think he is anxious?”.

Conclusions

Developing a scale is a complex process. The CHILD-MHL scale is the first instrument measuring MHL in children in France and worldwide. It can be included in large French cohorts to obtain prevalence of MHL in representative samples of children at the national level. The scale will also be translated in 3 other languages (English, Spanish, Italian) with an international outreach and for cross-cultural comparison.
Students Health Services in Israel from the Parents’ Point of View: Mixed-Methods Study
Authors: Satran C , Bord S , Itzhaky Y , Ben-haim M , Anfinger E , Berkovich E , Madjar B
Published: October 2023

Background

Student Health Services (SHS) are provided by school nurses to 1st to 9th-grade pupils in Israel. The nurse's role is to provide early detection and prevention services. SHS is provided by the Ministry of Health (MOH) or through outsourcing.

Aim

To examine parents’ knowledge, attitudes, and satisfaction with SHS; and the differences in these measures when the services are provided by the MOH vs. outsourced organizations.

Methods

This study combines mixed methods, including a quantitative cross-sectional study among 506 parents and a qualitative study that included interviews with ten parents (upon reaching saturation). The research questionnaires were distributed via social media as well as through the National Parents’ Leadership organization. The interviewees were recruited from among the quantitative study participants.

Findings

The findings of the quantitative and qualitative studies support each other. Sixty-five percent of the parents responded that there is no school nurse or that they do not know whether or not there is one. Only 13.4% believe that the school nurse is available to answer their questions. The parents’ knowledge level regarding the school nurse's role was intermediate (an average of 4.44 on a scale of 0-9). However, their attitudes support the importance of the nurse's role. Age, socio-economic status, and trust significantly predict parents’ satisfaction. The older the parents and the higher their socio-economic status is, the lower their chance of being satisfied with the school nurse's role. In addition, the higher the parents’ level of trust in the nurse, the higher the chance they will be satisfied. No significant differences were found when comparing the MOH and outsourced organizations.

Conclusions

Many parents are unaware of the nurse's existence and are insufficiently informed regarding her role or how to contact her. However, many feel the role is essential, necessary, and should be improved.

Key messages

• It is important to promote a public participatory process of parents, pupils, school staff and healthcare professionals in order to improve SHS and the way it's provided.

• Parents-nurse-students relationship and communication must be improved in order to ensure parents’ cooperation and pupils’ health.
The added value of web listening understanding HIV risk, prevention and communication needs in Italy
Authors: Santolini G , Colucci A , Furiozzi F , Gallo P , Dalla Torre R , Maringhini G , Schwarz M , Valli R , Bertinato L , Iavicoli S
Published: October 2023

Background

Institutional communication on sexually transmitted infections (STI) and HIV requires a thorough understanding of the population's information needs and awareness on the subject.

Therefore, the National Institute of Health, in collaboration with the Ministry of Health, conducted a web listening study to set up more effective communication campaigns.

Methods

The analysis of all conversations in Italian was conducted, from October 2021 to September 2022, through Blogmeter Suite, an integrated Social Listening platform.

Data extraction was done by analyzing a database of more than 2 billion indexed documents (sources: Facebook, Twitter, Instagram, YouTube, TikTok, Twitch, forums, blogs, news sites, and app reviews such as Google Play and App Store) and containing at least one keyword among AIDS, HIV, HIV testing, STI.

Results

The term AIDS constitutes 48% of the total posts on STI, and conversations about it take place 62.7% on Facebook. TikTok and Instagram are the sources where there is the most interaction. Spikes in conversations about AIDS and HIV occurred in conjunction with news events and dedicated events. Younger generations have limited awareness of HIV risks and prevention. The barrier to HIV testing is cost, and it is found that not everyone is aware of self-testing. Stigma is related to the problem of anonymity, especially in the work environment, due to fear of career repercussions.

Conclusions

Data analysis shows that among STIs, HIV, represents the area of greatest concern. Awareness among the population is low, discussions related to seasonality and news events, and people at the time of diagnosis try to avoid their general practitioner, especially if they live in small towns and take refuge in more secretive network locations.

Key messages

• The analysis highlights how crucial evolution in institutional communication is.

• Topics such as testing, stigma and, especially for young people, HIV risks and prevention need to be explored.
Future Dutch DALYs as part of the Dutch Public health Foresight Study
Authors: Hilderink H , Plasmans M , Poos R
Published: October 2023

The Dutch Public Health Foresight Study (PHFS) provides insight into the most important societal challenges for public health and health care in the Netherlands. An important element of this study are the Burden of Disease indicators, among which the Disability-Adjusted Life Year (DALY). In the last editions of the PHFS future DALYs are also included. The methodology applied to obtain future projections varies. For around 100 diseases and health conditions, projections are obtained from demographic and epidemiological projections. For the projections of causes of death, a Poisson regression technique is used, based on historical data from 1996 onwards. These projections are made consistent with the population projections from the Nacional Statistical Office. The life tables from these population projections for the projection period till 2050 are also used to calculate the Years of Life Lost. Next, projections of a set of health determinants are used to allocate the future DALYs to the risk factors, making used of population attributable fractions. The results show an enormous increase in the burden of disease due to dementia. Where dementia ranked 10th in 2015, in the future this will be by far the major cause of the burden of disease - because of an increase in prevalence, but also because an increase as cause of death, partly due to further progress in survival from cardiovascular diseases and cancer. Arthrosis will also be gaining importance - due to the ageing of the population in combination with increasing overweight. Smoking and dietary risks will be among the main risks factors for the future burden. The projections of DALYs for the Dutch PHFS show a strong increase in disease that progress with age, such as dementia. These are partly due to successes in survival from other diseases. Policy makers should be prepared for these future development, and at the same time invest in prevention to reduce future disease burden of for example cancer and arthrosis.
The role of qualitative evaluation research in effect evaluation
Authors: Van Dale D , Rensen P , Jansen S
Published: October 2023

In the Netherlands six institutes representing prevention, health care and social welfare established an assessment system to evaluate the quality, effectiveness and feasibility of interventions. Together the institutes present in their portals 650 practices at three different assessment levels (well described, theoretically sound and effective). Ninety interventions are assessed as effective with only 15 interventions on the highest level (strong indications on effectiveness). In the assessment system the criteria for effectiveness have a strong focus on quantitative designs such as randomized-controlled trial, quasi -experimental and observational study designs. This favors ‘simple’ interventions and disadvantaged more complex intervention implemented in the domains of social welfare and health promotion. Not every intervention effect can be captured in a numerical outcome measure. To address this objection institutes decided to study the possibility to evaluate the effects of interventions also with qualitative research and to add criteria for qualitative research. To support the assessment of the validity and reliability of the qualitative evaluation studies a checklist for qualitative evaluation research and mixed methods was developed. With this checklist the external reviewer tests the extent to which methodological applications and analytical procedures have been followed. The result is a score of the validity/reliability of the relevant study to the effects of an intervention. This checklist supports the external reviewer in the decision for the effectiveness of an intervention. In this workshop we present this checklist for qualitative research and mixed methods, the addition of criteria in the assessment system of interventions and the first results of the pilot of the assessment of an intervention with a qualitative evaluation study.
Understanding excess mortality during COVID in Belgium: the influence of health and social factors
Authors: Van den Borre L , Devleesschauwer B , Gadeyne S , Vanthomme K , Willaert D
Published: October 2023

Background

This study aims to investigate how pre-existing health status and social background contribute to excess mortality during the COVID-19 crisis in Belgium.

Methods

The study population consists of 1.4 million adult members of Solidaris, the second largest health insurance fund in Belgium. Pre-existing health status was identified using health care reimbursement data, including medication use. Social characteristics included financial support, migrant background, and household composition. Excess mortality during the COVID-19 crisis was measured as the relative difference between all-cause mortality in 2020 or 2021 versus the pooled yearly estimates in 2015-2019. Yearly age- and sex-adjusted mortality rate ratios (MRR) were estimated using Poisson regression to study potential differences by health status and social factors.

Results

Compared with healthy persons, all investigated health problems were associated with increased mortality, with most notably an MRR of 8.4 (CI 8.0-8.9) for persons with cancer in 2021. Compared with 2015-2019, MRRs for persons with mental disorders (anxiety, depression) and diabetes were significantly higher than expected in 2020. Interestingly, mortality for persons with mental disorders was significantly lower than expected in 2021. Significant mortality deficits were also observed for persons with cancer and chronic respiratory conditions (COPD, asthma) in 2020 and 2021. After controlling for social characteristics, only the mortality deficits for persons with cancer and chronic respiratory conditions remained significant (p < 0.005), with respectively, 17% and 11% lower mortality in 2020, and 12% and 6% lower mortality in 2021.

Conclusions

Large mortality differences were observed by pre-existing health problem and social background during the COVID-19 crisis. A significant mortality deficit was observed for persons with cancer and chronic respiratory conditions in 2020 and in 2021.

Key messages

• Information on pre-existing health problems and social background are key to understanding excess mortality patterns.

• The already large health and social inequalities in mortality did not widen further during the COVID-19 crisis in Belgium.