bluuebunny/crossref_metadata_2025 huggingface dataset:
Digitally supported health care; evaluation approaches to a complex intervention embedded in a tria
Authors: Staines A , O'Sullivan B , Davis P , Ferrara L , White C , Degol L , Corrigan T , Musolino N , Wildiers H , Soubreyan P
Published: October 2023

Many important health care interventions do not fit the classic RCT paradigm. Drug trials have struggled with issues of non-compliance and selective withdrawal. Surgical researchers have done extensive work on incorporating operator skills and experience into trial settings. Working on innovative models of care delivery related issues arise. As part of an EU funded multi-centre stepped-wedge trial, GERONTE, of nurse-led, digitally supported, health care coordination for older people with cancer and other significant co-morbidity, we have developed and tested an outline of a novel method of evaluation, drawing on realist evaluation. There are three pieces, first the central trial outcome, quality of life, for those in the trial, analysed by intention-to-treat. Second an economic evaluation, based on care pathways, and collecting costs during the control and intervention phases in 16 centres, in 3 countries. Third, a realist evaluation of implementation, with 3 phases in each site, the first of which is underway.

1) Readiness to implement GERONTE, and documenting current practice, and identifying barriers and facilitators for change with clinical staff, technical staff and administrators;

2) Experience of implementation as the intervention is brought in over the course of the study;

3) Experience in keeping GERONTE running after the initial implementation phase.

Early results show great site to site variability, in practice and in resources, but common barriers are data handling and sharing. In each phase, guided by ideas from participatory rapid appraisal, we stress the rapid feedback to participants, of their response, and the synthesis of responses to support successful implementation. One aim is to prepare an implementation guide to support future deployments of GERONTE and similar projects, drawing on lessons from all 16 sites, and filling a gap in the literature.

GERONTE is funded by the Horizon 2020 research and innovation programme under grant agreement No 945218.

Key messages

• Innovative health care delivery, such as integrated care, requires complex assessment approaches, designed for the specific innovation.

• Site-to-site variability in the implementation of novel care pathways and approaches is the norm, and needs to be considered at design stage.
Health technology assessment of genetic and genomic applications: is it possible to standardize?
Authors: Migliara G , Baccolini V , Pitini E , Leone I , Isonne C , De Blasiis M R , Sciurti A , De Vito C , Marzuillo C , Villari P
Published: October 2023

Background

The assessment of genetic and genomic applications (GGA) has long been used ad hoc frameworks, often based on the ACCE model, while less used are more traditional health technology assessment (HTA) approaches. While ACCE frameworks are mainly focused on technical aspects, HTA ones often include economic and organizational aspects in their assessment. The aim of this study was to develop a framework able to address a comprehensive assessment of GGAs.

Methods

We analysed the most important HTA model currently used in EU, the EUnetHTA HTA Core Model, to identify any possible shortcomings in the evaluation of GGAs. The Sapienza framework, based on a previous systematic review of GGAs assessment frameworks, was used as a reference. The HTA Core Model applications were than used as a basis for an assessment framework for GGAs, classified according to ‘GGA function/Use setting’ pairs.

Results

The Sapienza framework found full correspondence in the HTA Core Model. The “Screening Technology” application was suitable for diagnostic, pre-symptomatic, predictive and carrier GGAs when used in screening settings. The “Diagnostic Technologies” application was appropriate for the pairs ‘Diagnostic/Diagnosis', ‘Pre-symptomatic/Diagnosis', ‘Prognostic/Staging’ and ‘Pharmacogenetic/Staging', although it may require additional considerations, such as the need of screening in case of germline mutations, the use of appropriate accuracy measures for prognostic GGAs, or the evaluation of the clinical utility of pharmacogenetic/prognostic GGAs.

Conclusions

The proposed methodology aims to be a flexible tool that allows the GGA assessment according to a shared and validated methodology already in use for the HTA of medical devices, considering for their technical aspect, the clinical utility, the economic value, and the delivery models. Indeed, the HTA Core Model seems to fit the needs of GGAs assessment. However, some peculiarity of GGAs should be carefully considered during the HTA.

Key messages

• The EUnetHTA Core Model can provide a comprehensive framework for the evaluation of genetic and genomic applications, allowing a standardization with the procedures usually used for medical devices.

• Some peculiar characteristics of genetic and genomic applications must be taken into consideration during their evaluation.
A theoretical framework for developing a health impact assessment implementation model in
Ireland
Authors: O'Mullane M , Purdy J , Pursell L , Archibong U , McHugh S
Published: October 2023

Background

A Health Research Board (HRB) four-year research study, which commenced in January 2023, seeks to explore the process of carrying out Health Impact Assessments (HIAs) with a view embedding the approach as normal practice in local and national policy development in Ireland.

Methods

A theoretical framework has been constructed to develop an HIA implementation model. The framework is based on the all-island Institute of Public Health Ireland's HIA guidance. The theoretical framework will examine factors affecting HIA implementation, using both the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). An action research methodological approach will be used to gather data on the experiences that participants will reflect on while doing the HIA. Participants included in the study will be the members of the two HIA Steering Groups created for each HIA (12 participants in each HIA) and policy end-users of the HIA evidence from the city council and government ministries (20 participants for each HIA).

Results

The theoretical framework will be applied to two HIAs, in order to generate data in creating the HIA implementation model. HIA 1, commencing October 2023, will be conducted on the local government Cork City Development Plan. HIA 2, commencing January 2025, will be carried out on the Irish Government's Climate Action Plan. Preliminary results on the application of the theoretical framework to HIA 1 will be presented, as well as reflections for the planned HIA 2.

Conclusions

For the first time in Ireland and beyond, a theoretical framework has been developed employing innovative methodological approaches to building a contextualised HIA implementation model. Using action research in assessing the implementation of HIA, with a view to analysing the lived experience of Steering Group members as they conduct the HIAs, and policy end-users, will ensure an enhanced HIA implementation model.

Key messages

• The development of an innovative theoretical framework for the study of HIA.

• The building of HIA capacity in Ireland using the newly revised Institute of Public Health guidance.
Cost-effectiveness analysis of child eye health interventions in India
Authors: Mannava S , Shamanna B R
Published: October 2023

Background

India has 4.8 million blind persons including 250,000 blind children, and 35 million visually impaired individuals. Prevalence of blindness is 0.36%, it was 1% two decades ago due to significant public health programs towards prevention and treatment by various stakeholders. Time is opportune for cost-effectiveness analyses of these programs. There is a lack of research evidence related to quality-of-life utility values for eye health conditions in India. This study aims to develop utility values for vision impairment and conduct cost-effectiveness analysis of eye health interventions for childhood vision impairment.

Methods

Cross-sectional questionnaire-based study. 306 Children aged 4-16 years of age with unaddressed vision impairment included. Random sampling was done at a tertiary eye hospital in central India. EQ-5D-Y-3L questionnaire along with VAS score was used to measure utility measures for each of the vision impairment levels. Vision impairment was defined based on WHO classification. Mixed methods were used to collect cost data related to interventions, sensitivity analyses were performed to account for uncertainties. The protocol was approved by institutional ethics committee of university of Hyderabad (UH/IEC/2020/222).

Results

Median utility value of mild and moderate vision impairment is 0.8 (95% CI 0.7-0.9), severe vision impairment is 0.7 (95% CI 0.65-0.75), and for blindness is 0.55 (95% CI 0.44-0.72). Willingness to pay (WTP) is USD 2,935. ICERs for mild, moderate, severe vision impairment and blindness are USD 81, USD 367, USD 44, USD 954 respectively.

Conclusions

The utility value of 0.55 for blindness correlates with existing literature. ICERs for various levels of vision impairment show the interventions to be cost-effective. There is a significant improvement in utility values post intervention. The utility measures are recommended to be used to evaluate eye health programs, and as advocacy tools for preventive eye care.

Key messages

• There is a significant improvement in utility values post-intervention and the interventions are highly cost-effective.

• Important decision-making tool for allocating scarce resources to preventive eye care services.
Work disability trajectories before and after common mental disorder among youth in private sector
Authors: Amin R , Rahman S , Björkenstam E , Helgesson M , Mittendorfer-Rutz E
Published: October 2023

Background

Little is known regarding work disability (sick leave and disability pension) among young employees in the private sector with common mental disorder (CMD) i.e. depression, anxiety and stress-related disorders. We aim to identify a) trajectory groups of work disability among young private sector employees in Sweden 3 years before and 6 years after a CMD diagnosis and b) investigate if sociodemographic, work- and health-related factors were associated with trajectory membership.

Methods

A longitudinal nationwide register-based study was conducted including all individuals aged 22-29 years, gainfully employed who had a CMD diagnosis in specialised healthcare or had prescribed antidepressant (N = 12,121) in 2014 (Y0), with follow-up from Y-3 - Y + 6. Group-based trajectory analysis was used to identify groups of individuals who followed similar trajectories of months of work disability. Multinomial logistic regression was used to determine associations between sociodemographic, work and health-related factors and trajectory membership.

Results

We identified three trajectories. Most individuals were in the ‘constant low’ trajectory with almost no work disability (57%) from Y-3 - Y + 6, followed by an ‘increasing low’ trajectory (36%) of around 1 month work disability each year and a ‘fluctuant high’ trajectory (7%) reaching 7 months of work disability in Y + 3 and declining to 5 months in Y + 6. Being women, low education and history of specialised healthcare use for musculoskeletal disorder was associated with belonging in the ‘increasing low’ and ‘fluctuant high’ trajectories. Work-related factors i.e. occupational class (non-manual/manual work) and branch (e.g. healthcare) had weak to no association with any trajectory membership.

Conclusions

Among young individuals working in the private sector, women, those with low education and those with musculoskeletal disorder require special attention regarding their return-to-work process following a CMD diagnosis.

Key messages

• Most (57%) young private sector employees had almost no work disability (WD) during 6 years after a common mental disorder (CMD) while 7% had almost 7 months of WD still 3-4 years after CMD.

• Women, those with low education and with musculoskeletal disorder require special attention regarding their return-to-work process following a CMD diagnosis among young private sector employees.
Working conditions and self-efficacy among users of psychotherapeutic consultation at work
Authors: Weber J , Hansmann M , Kohl F , Heming M , Angerer P
Published: October 2023

Introduction

Psychotherapeutic consultation at work (PT-A) aims to prevent sickness absence and to facilitate return to work by offering early intervention and treatment for employees with (subclinical) symptoms of mental disorders. PT-A specifically considers work-related aspects to increase occupational self-efficacy, which is a predictor for work ability and return to work. This study investigates which psychosocial working conditions are related with occupational self-efficacy among employees who enrolled for PT-A.

Methods

This cross-sectional analysis uses baseline data of 536 participants of a randomized controlled trial (friaa-study) investigating the effect of PT-A in Germany. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ) using the following subscales: quantitative and emotional demands, decision authority, possibilities for development, leadership quality and social support. Occupational self-efficacy was measured by the short form of the Occupational Self-Efficacy Scale. Associations between psychosocial working conditions and occupational self-efficacy are calculated by multiple linear regression.

Results

Quantitative job demands are negatively (b=-0.118, SE = 0.047, p<.05) and possibilities for development (b = 0.284, SE = 0.049, p<.001) are positively associated with occupational self-efficacy. Interactions between sex and decision authority (b = 0.228, SE = 0.097, p<.05) and social support (b=-0.273, SE = 0.101, p<.05) suggest that occupational self-efficacy is only associated with social support among male and only associated with decision authority among female participants.

Conclusions

Results suggest that psychosocial working conditions and particularly quantitative job demands, decision authority, possibilities for development and social support should be addressed during PT-A. However, longitudinal data ought to shed light on the causal relationships between working conditions and occupational self-efficacy.

Key messages

• Results suggest that adverse psychosocial working conditions are related to lower levels of occupational self-efficacy among users or PT-A.

• It might therefore be useful to address psychosocial working conditions with employees visiting PT-A.
Socioeconomic inequalities in type 2 diabetes and job demands/control/support - The Maastricht Study
Authors: Sezer B , Koster A , Albers J , Meisters R , Schram M , Eussen S , Dukers N , de Rijk A , Stehouwer CDA , Bosma H
Published: October 2023

Background

Low socioeconomic position (SEP) is an important determinant of Type 2 Diabetes Mellitus (T2DM). Adverse environments in the exposome might be involved; however, the environmental factors are under-studied compared to lifestyle. We explored low job control, high job demands, and low job support as pathways between SEP and T2DM.

Methods

Cross-sectional and longitudinal data from 8,090 participants of The Maastricht Study were used. Prevalent T2DM was measured by an oral glucose tolerance test and incident T2DM was self-reported in annual follow-up questionnaires. SEP was operationalized by baseline measures of education, occupation, and income. The work stressors were measured by questionnaires at baseline. For Cox regression, the survival time was computed by midpoint imputation. The associations of SEP, job demands, control, and support with T2DM were examined as well as the mediating role of the work stressors by using a counterfactual framework.

Results

2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP were more likely to report T2DM during the follow-up course (e.g.; education HR = 2.21, 95%CI: 1.53-3.20) and more often had prevalent T2DM. Low job control was associated with prevalent T2DM (OR = 1.44 95%CI: 1.25-1.67), but not with incident T2DM. Job control explained 7.23% of the relationship between income and prevalent T2DM. Job demand suppressed the relationship of education (3.65%) and occupation (3.72%) with prevalent T2DM.

Conclusions

Our findings provide modest evidence for environmental injustice in T2DM exposome. The substantial higher risks of diabetes in low SEP is to a small extent explained by lower control at work. Furthermore, by having lower psychosocial job demands, they are protected against T2DM.

Key messages

• Job demands and control play a role in SEP and prevalent T2DM relationship.

• Work stressors might not be a major target for tackling socioeconomic inequalities in type 2 diabetes.
Time trends in the prevalence of depressive disorder symptoms in the Danish workforce, 2012 to 2018
Authors: Dalsager L , Sørensen K , Sørensen J K , Madsen IEH , Rugulies R
Published: October 2023

Background

Over the last decade, and well-before the COVID-19 pandemic, the prevalence of mental health problems has increased in many European countries, particularly in youth, raising public health concerns. Yet, there has been little focus on the mental health status of the working population, and it is unknown if the proportion of workers with impaired mental health is growing as well. In this paper, we report change in the prevalence of depressive disorder in a large nationwide sample of the Danish workforce (N = 76,802) from 2012 to 2018.

Methods

We used data from the Work Environment and Health in Denmark study, a bi-annual nationwide survey on working conditions and health. We measured depressive symptoms using the Major Depression Inventory and defined prevalence of depressive disorder by a score ≥21, in accordance with previous clinical validation studies. Using a log-binomial regression model, we estimated change in prevalence of depressive disorders from 2012 to 2018 with 95% confidence intervals (95% CI).

Results

From 2012 to 2018, the prevalence of depressive disorder increased from 7.0% (95% CI: 6.7-7.4) to 9.4% (9.0-9.9) corresponding to an adjusted increase of 36.1% (27.4-45.4) over the 6-year period. We observed a statistically significant increase in the prevalence in every wave, from 2012 to 2014 (adjusted change in prevalence: 10.8%, 3.2-18.9), from 2014 to 2016 (8.6%, 1.3-16.4)), and from 2016 to 2018 (13.1%, 6.0-20.7)). The increase occurred in both sexes, all age groups and for all types of occupational status, but was more pronounced among women, younger workers and workers of low occupational status.

Conclusions

In a large nationwide sample of the Danish workforce, we observed an increasing prevalence of depressive disorder from 2012 to 2018. The results indicate that the general trend towards increased levels of mental health problems also encompasses the workforce and underlines the need for public health action.

Key messages

• The prevalence of depressive disorder in the Danish workforce increased considerably from 2012 to 2018.

• The increase in prevalence of depressive disorder was observed in all groups, but was particularly pronounced for women, younger workers and basic-skilled workers.
Breastfeeding initation after Postpartum Haemorrhage: Associated factors and potential implications
Authors: Gilroy J , Wall P
Published: October 2023

Background

Breastfeeding has been recognised as a significant driver of neonatal and infant outcomes, particularly in LMIC settings. Postpartum haemorrhage (PPH) is an increasingly common complication of childbirth, with multiple effects on mothers and their babies. This study aimed to explore the association between aspects of PPH care and outcomes and the rates of breastfeeding among this cohort of women.

Methods

This was a secondary analysis of data from the WOMAN trial, an international, randomised, double-blind, placebo-controlled trial, investigating the effect of tranexamic acid in women who have experienced PPH. A binary logistic regression model was developed to examine the associations between the rates of any breastfeeding during the study period and the occurrence of specific factors within the peripartum period.

Results

16,285 mothers of healthy singleton babies were included in the current study. Factors that may result in maternal-infant separation in the immediate postpartum period were significantly associated with lower rates of breastfeeding. These included: the mother requiring transfer between hospitals following PPH (Odds Ratio 0.47 [95%CI 0.41-0.54]) and the mother being admitted to ICU postpartum (OR 0.65 [95%CI 0.54-0.78]). Transfusion of any blood product was associated with a lower rate of breastfeeding (OR 0.82 [95%CI 0.73-0.93]), as was the use of Ergometrine (OR 0.69 [95%CI 0.62-0.77]). Maternal pain (OR 0.65 [95%CI 0.58-0.75]) and maternal anxiety or depression (OR 0.63 [95% CI 0.53-0.75]) were also associated with lower rates of breastfeeding.

Conclusions

Identifying women at higher risk of experiencing difficulties in initiating or sustaining breastfeeding following a PPH may allow for targeted information and support to be provided to those women. Specific prospective research should be carried out to ascertain the true implications of the identified associations.

Key messages

• Identifying women at higher risk of experiencing difficulties in initiating or sustaining breastfeeding following a PPH may allow for targeted information and support to be provided to those women.

• Certain environments, interventions and aspects associated with PPH care are associated with lower rates of breastfeeding initiation prior to hospital discharge.
Population health approach for health systems: public health organization, workforce and governance
Authors: Magalhães J P , Silvia I M , Sousa C R , Lourenço Silva R
Published: October 2023

Background

The health systems have been evolving based on solely individual care of diseases, which is no longer sustainable. A combination of a public health and individual approach is needed, although how to deliver those population health services remains a challenge. This study explores how population health outcomes are determined by the organizational model and workforce capacity of public health services at local level.

Methods

Using publicly available data on organizational, geodemographic and population health characteristics of the total 55 public health units (PHU) in mainland Portugal, a fixed effects panel regression of three models was performed. The analysis considered synergies between public health workforce (medical doctors and nurses), organizational (considering a Local Health Unit (LHU) group, that includes both primary and secondary care, and non-LHU) and infrastructure characteristics, and population health outcomes (premature standardized mortality rate and life expectancy at birth (LE)). Confidence intervals (CI) at 95% and odds ratio (OR) were calculated.

Results

A lower premature standardized mortality rate and a higher life expectancy at birth were observed when there is one public health doctor per between 22 319.4 and 24 616.7 habitants and 25 382.5 and 27 680.0 habitants, respectively. The regression models that were run showed that PHU under a LHU model or disaggregated services are associated with an increase in the premature standardized mortality rate (OR = 1.23 [CI 95% 0.21-15.24]) and a decrease in the LE (OR = 0.50 [CI 95% 0.17-1.41]).

Conclusions

Health systems must promote public health services capable of delivering the essential public health functions, particularly at local level, where they must be concentrated and integrated at the same level of governance as individual levels of care, and equipped with a public health workforce adapted to the size of the population on which they must intervene.

Key messages

• Strengthening health systems resilience require a combination of public health and individual approaches to improve population health and tackle inequalities.

• Essential public health functions require concentrated and integrated governance models and a public health workforce adapted to the size of the population.
A Qualitative Exploration of the Impact of Mutual Aid on the COVID-19 (Coronavirus) Pandemic Response
Authors: Ibrahiim K , Oghenenyerovwome Iki V , Jackson V
Published: October 2023

Background

During the COVID-19 (coronavirus) pandemic, responses of mutual aid took place at both the national and community levels. A study was conducted in the United Kingdom to investigate how grassroots community action helps people during pandemics and other types of emergency circumstances to meet their immediate health, care and social needs. In addition, the necessity for community self-organization, its success, and any challenges that developed are also evaluated.

Methods

An interpretative approach was utilised in order to gain an understanding of the points of view held by (N = 15) organisers, volunteers, and people who received support from mutual aid, who were a part of the first mutual aid group that was founded by a community in response to the COVID-19 pandemic. A purposive sampling technique was used with semi-structured interviews conducted virtually. The results of the interviews were transcribed verbatim and analyzed using thematic content analysis.

Results

The results of the interviews yielded the following themes: 1) lack of trust in government during the COVID-19 pandemic, 2) people feeling forgotten by the national government and their local council, and 3) the need to support vulnerable populations and members of the community, including those who belong to marginalized groups. It has been demonstrated how grassroots community organizing may build community cohesiveness and attempts to reinforce local and national government activities, particularly in times of emergency, that can bring communities together to assist one another.

Conclusions

This approach could be used to co-produce sustainable public health services in collaboration with communities and government, building trust and meeting population health needs by co-creating equitable services while also developing community cohesiveness.

Key messages

• This study is innovative. The community identified their needs and developed a support system.

• Working with a local council to develop a sustainable community service to meet the population health needs of the community.
Evidence on community-based intervention for tackling childhood pneumonia Project in Bangladesh
Authors: Shah M , Rana S , Mothabbir G , Islam J , Rahman L
Published: October 2023

In Bangladesh, pneumonia is a major cause of child mortality, killed 26,766 under 5 children, accounting for 24% of all under 5 child deaths in 2022. To address this issue, we implemented a community-based project in Barishal from June 2021 to December 2022. Project activities aimed to strengthen the health system for improved access and utilization of quality child health care and child immunization services, encouraged community practice and behavior for care-seeking and exclusive breastfeeding. During the project period, 22 medical doctors, 30 paramedics and 168 MoHFW employed service providers including community clinics, community-based health facility for six thousand population, received case management training, 38 health centers were equipped with necessary logistics and supplies for improved case management of sick children. We also conducted special vaccination campaigns in 13 hard-to-reach areas, deployed 11 vaccination aids for improving child vaccination coverage in remote areas and raised awareness of recommended health practices at the community level. A comparison of baseline and endline survey data showed significant improvements in children among 12-23 months of age who received all recommended basic vaccines by 12 months [77% in baseline (n = 239) vs. 92% in endline (n = 235); p < 0.01]; care-seeking from health facilities or trained health service providers for sick children with pneumonia [40% in baseline (n = 127) vs. 52% in endline (n = 225); p < 0.005]; and exclusive breastfeeding for children below 6 months [52% in baseline (n = 122) vs. 62% in endline (n = 120); p < 0.01]. These results revealed the project's success with simple but contextualized efforts to enhance the health system by developing the capacity and skills of service providers to provide high-quality child health care for sick children, improving access to equitable child immunization, and raising social awareness through partnerships with the MoHFW and community engagement initiatives.

Key messages

• Community-based intervention with minimum resources have potential to scale up with improving accessibility and utilization of health services, specially in hard to reach areas in Bangladesh.

• Contextualized and simple intervention through collaboration with local government and community engagement is critical for success of community based health system strengthening project.
Factors related to oral health behavior among primary schoolchildren in rural Armenia
Authors: Muradyan D , Atanyan A , Demirchyan A
Published: October 2023

Background

Oral health (OH) of children is very important for their physical and mental health and wellbeing. OH is known to be tightly linked to OH behavior. There is lack of studies on children's OH behavior in rural Armenia. This study aimed to measure OH behavior among primary schoolchildren in two villages of Armenia and identify factors associated with their desired OH behavior.

Methods

A cross-sectional study among schoolchildren and their primary caregivers (parents) was carried out in 2022 in Sardarapat and Mrgashat communities of Armavir province, Armenia. Overall, OH status of 400 schoolchildren was assessed by a dentist, and their parents participated in a telephone interview. The survey questionnaire included items on parent's OH knowledge, child's OH behavior and nutrition practices, and family's socio-demographic characteristics. Multiple linear regression model was fitted to identify factors associated with child's OH behavior score.

Results

The mean age of children was 8.3 years, and the mean age of their caregivers was 33.6 years. Children's mean OH behavior score was 1.8 of the maximum of 5 (i.e. 36% score); nutrition practice score was 6.0 of 14, and parental OH knowledge score was 6.9 of 9. Factors positively associated with child's OH behavior in the adjusted analysis included child's nutrition practice score (B = 0.07; p = 0.026), parent's OH knowledge score (B = 0.12; p = 0.002), higher than secondary education of parent (B = 0.22; p = 0.042), and family's higher than average living standards (B = 0.48; p = 0.051).

Conclusions

The study identified that OH behavior of primary schoolchildren in rural Armenia was poor. It could be improved through increasing the knowledge of parents on child's desired OH behavior and nutrition practices. An unexpected finding was the lack of association between children's OH behavior and objective measures of their OH - plaque index and DMFT (number of decayed, missing due to caries and filled permanent and primary teeth).

Key messages

• Rural children’s OH behavior in Armenia was mainly poor. To address this issue, parents should be educated on correct child care practices including child’s oral health and nutrition behavior.

• Further research is needed to explain the reason of the lack of association between objective measures of child’s oral health (plaque index and DMFT) and child’s OH behavior score.
Patient and public involvement in co-designing a smoking cessation pathway for people with cancer
Authors: Frazer K , Bhardwaj N , Fox P , Niranjan V , Lyons A , Mc Cann A , Quinn E , Quinn S , Johnson M , Fitzpatrick P
Published: October 2023

Background

Developing an intervention to support people who smoke and have cancer is a complex public health issue. Inclusive research development is fundamental, with public health funding agencies and research guidance emphasising the inclusion of patient and public involvement (PPI). PPI means involving ‘experts by experience’ (EBE) as partners rather than research participants. Limited evidence of PPI engagement exists in published literature. This study aimed to embed PPI across co-design phases in developing a smoking cessation (SC) pathway for people who smoke and have a cancer diagnosis.

Methods

A five-stage approach was completed [Feb 2020 - Apr 2022]. Stage 1: Dragons’ Den: PPI knowledge sought to refine the research question at a Patient Voice in Cancer Research (PVCR) and National Cancer Research Institute UK (NCRI) event. Stage 2: Study Advisory Committee (SAC) formed with membership from EBE (three former smoker cancer patients), cancer specialists and national tobacco control experts. Stage 3: Documentation review by SAC, including interview topic guides and questionnaires. Stage 4: Systematic review outputs reviewed by EBE. Stage 5: PVCR workshop held to examine systematic review evidence, survey and qualitative interview data supporting the co-design of a SC pathway.

Results

PPI was embedded across the study through research questions shaping, choice of wording and terminology used, including (i) phrasing of questions associated with treatment and quitting, (ii) piloting and sequencing of questions in surveys and interviews, including emotive questions on the nature of smoking. Members of the SAC provided unique expertise, resulting in co-authorship on published papers and abstracts. The PVCR virtual workshop facilitated collaborative discussions to inform the development of a SC pathway for cancer patients.

Conclusions

PPI partnership provided real-time confirmation of decision-making and was a key strength in co-designing a SC pathway.

Key messages

• Developing a smoking cessation pathway, including co-design methods, ensures that research questions are important for patients and use appropriate methods.

• Patient and Public Involvement in research design and development is an essential partnership.
Impact of digital health for adolescents with type 1 diabetes mellitus on health literacy
Authors: Naef A
Published: October 2023

Background

Adolescents with type 1 diabetes (T1DM) require high health literacy (HL) to prevent complications. However, little is known about the association between distal technologies (DT) use and HL, and the role of healthcare institutions in supporting DT remains unclear.

Methods

We conducted a systematic review (SR) following PRISMA guidelines to investigate the impact of DT on HL in adolescents with T1DM. Relevant studies published from 2011 to 2021 were identified through literature searches. We also conducted an exploratory study with medical doctors (n = 12) and adolescents with T1DM (n = 20) in Germany based on the SR. Interview data was analyzed using coding techniques to identify differences and similarities.

Results

Out of 981 studies, 22 were included. Findings suggest that social media interactions between healthcare providers and patients can improve HL, aligning with the ‘communication and interactions’ dimension of health literacy. In the exploratory study, medical doctors and adolescents with T1DM reported underutilization of DT due to resource and legal constraints, and a lack of structural conditions for the transition to adult healthcare. Peer support and trustworthy interactions with healthcare professionals were identified as factors that enhanced HL and patient empowerment.

Conclusions

Further investigation is needed to determine the most effective social media platform for enhancing HL among adolescents, considering communication, interaction, and peer relationships as important factors. Promoting the use of DT and improving HL may require capacity building through patient-centered and participatory approaches. The findings of this study provide valuable insights for informing practice, research, and policy recommendations.

Key messages

• Distal technologies, have the potential to improve HL among adolescents with T1DM, but further investigation is needed to identify effective platforms for enhancing HL.

• This study's findings highlight underutilization of distal technologies among adolescents with T1DM due to resource and legal constraints.
Developing tailor-made plant-based dishes with adolescents for school canteens
Authors: Kokkorou M , Dinnella C , Spinelli S , Wollgast J , Maragkoudakis P , Monteleone E
Published: October 2023

School interventions can have a significant impact on promoting plant-based (PB) diets, which can benefit both health and environmental sustainability. This co-creation and repeated exposure study was conducted in a high school and is divided into 3 parts, a) Co-creation with adolescents (aged 12-16) and chefs to develop innovative PB dishes, b) Global profile (liking, sensory properties, emotions) of the new dishes, c) Repeated exposure for 6 weeks. Using a combination of techniques, 25 adolescents and four chefs took part in iterative sessions of focus group discussions to identify ideas for new PB dishes. Interviews were conducted with 17 adolescents who tasted the five most-liked dishes, using the EmoSemio approach to define a global profile questionnaire. This was then used with 147 adolescents that were characterised for taste responsiveness and food neophobia, to study their liking, sensory/emotional responses to the dishes. The most promising dish was chosen and a 6-week exposure experiment was conducted with 60 adolescents. Results indicate that all five dishes were accepted (mean liking=54.6/100). Taste responsiveness and neophobia were significantly associated with the dish liking, with students who were less responsive to taste and more neophobic liking the dishes less (p < 0.0001). Individual differences were further explored through preference mapping combined with hierarchical clustering. Four clusters with distinct hedonic patterns were identified, with two dishes, different in terms of sensory properties, being accepted by all clusters. One of the two induced positive emotions higher in arousal and novelty and appeared the most viable for school canteen use. Liking and positive emotional responses for the selected dish remained stable during a 6-week repeated exposure experiment, unlike a control dish with a plain taste. Co-creation with adolescents and chefs was effective for developing innovative and accepted PB dishes for school canteens.

Key messages

• Co-creating with adolescents and chefs and understanding individual differences are promising strategies for developing innovative and well-received PB dishes for sustainable school meals.

• Segmenting for psychological traits and taste responsiveness and evaluating the Global Profile of healthy PB dishes in terms of sensory/emotional profile is essential in developing tailor-made dishes.
Can a mindful movement-based program contribute to health? Results of a pre-post intervention study
Authors: de Waure C , Chiavarini M , Buratta L , Carestia R , Gobetti C , Lupi C , Sorci G , Mazzeschi C , Biscarini A , Spaccapanico Proietti S
Published: October 2023

Background

Mindful movement integrates interoceptive, proprioceptive, kinesthetic, tactile, spatial, emotional, psychological, and relational aspects ‘through’ and ‘into’ movement and is expected to contribute to individuals’ health. The objective of this study is to assess the impact of a mindful movement-based program (named Movimento Biologico, MB) on participants’ psychological well-being (PWB), positive mental health (PMH), sense of coherence (SOC), and interoceptive awareness.

Methods

We set up a training program based on MB for students attending the Degree in Exercise and Sport Science at the University of Perugia, Italy. The program included one session per week for a total of 8 weeks and 48 hours. Participants were requested to fill in four questionnaires before and after the MB program: 1) 18-item PWB scale; 2) 9-item PMH scale; 3) 13-item SOC scale; 4) 32-item scale for Multidimensional Assessment of Interoceptive Awareness (MAIA). Wilcoxon signed-rank test was performed to determine whether the MB program produced a significant difference in post-intervention scores. A p-value of less than 0.05 was deemed statistically significant.

Results

38 students (mean age 21.2 years; range 20-25; 60.5% males) attended the MB program. The majority of the MAIA subscales, including noticing (p = 0.003), attention management (p = 0,002), emotional awareness (p = 0.007), self-regulation (p = 0.001), body listening (p = 0.001), and trusting (p = 0.001), improved significantly after the MB program. A significant increase also occurred in the PMH score (p = 0.015) whereas SOC and PWB improved, but not significantly.

Conclusions

The MB program significantly enhanced participants’ psychological well-being and interoceptive awareness. This can be due to the positive physiological sensation recognition and management, a deeper connection between physical sensations and emotional states, and a greater perception of one's own body's reliability.

Key messages

• Mindful movement is a practice based on the integration of more physical aspects with emotional, psychological, and relational ones and can contribute to individuals’ health.

• This study showed that a mindful movement-based training program for university students in significantly improved participants’ psychological well-being and interoceptive awareness.
The relationships of chronotype with BMI and cognitive performance among university students
Authors: Fukukawa Y , Takikawa R
Published: October 2023

Background

Chronotype is a sleep-wake cycle that reflects individuals’ daily activity patterns. It has been suggested that evening-type individuals have increased risk of adverse outcomes. However, chronotype also relates to their innate characteristics. The purpose of this study was to investigate whether those characteristics mediate the relationships of chronotype with physical and mental outcomes.

Methods

A total of 146 Japanese university students participated in a web survey in October 2022. The data of 131 respondents (44 males and 87 females: aged from 18 to 27 years) were eligible for analysis. The following information was assessed: 1) Munich Chrono Type Questionnaire (MCTQ: Roenneberg et al., 2003), 2) Body mass index (BMI: calculated from self-report height and weight), and 3) Cognitive reflection test (CRT: Frederick, 2005). We hypothesized that BMI would be higher in evening-type students compared to morning-type students. We also hypothesized that subjects’ CRT score would be better when they took the test at a proper action time, i.e., a time that is matched to their own chronotype.

Results

The percentage of students in morning-type was significantly higher for females (49.4 %) than males (31.8 %). Analysis of variance (ANOVA) indicated that morning-type males had significantly higher BMI compared to evening-type males. On the other hand, morning-type females had significantly lower BMI compared to evening-type females. Another ANOVA indicated that males who took the CRT at the time matched to their chronotype had significantly less errors. Such a difference, however, was not found in females.

Conclusions

As predicted, while chronotype was associated with BMI and CRT score, the relationships were moderated by gender and the task execution time. The implication of the study was that researchers would be required to consider those moderating factors when investigating the effect of chronotype on physical and mental health.

Key messages

• A web survey was conducted for 146 Japanese university students to examine the relationships of chronotype with body mass index and cognitive performance.

• The analysis indicated that gender and the task execution time moderate the effect of chronotype on physical and mental health.
Behavior integration for a sustainable COVID-19 vaccination in Serbia, North Macedonia, and Moldova
Authors: Mandić-Rajčević S , Cvjetković S , Oot L , Tasevski D , Meghani A , Costache A , Cotelnic T , Popović D , Cullen-Balogun T , Cogswell L
Published: October 2023

Issue/Problem

In Serbia, North Macedonia, and Moldova, USAID's MOMENTUM Routine Immunization Transformation and Equity project is using a behavioral integration approach to increase COVID-19 vaccine uptake in priority populations. This approach is aimed at changing provider and community behaviors to embrace COVID-19 vaccination as part of a healthy lifestyle. This approach may be applicable and replicable in countries around the world.

Description

In an effort to implement a sustainable model for COVID-19 integration into the primary healthcare system, the project applied a behavioural integration approach to understand barriers and motivators to COVID-19 vaccination. In all three countries, we collected qualitative data through interviews with public health decision-makers, immunization health professionals, and other key partners, and focus group discussions with members of the priority populations.

Results

The project created profiles for each priority behaviour, detailing barriers and motivators to adopt it, and supporting people and their actions. We conducted participatory workshops with relevant immunization stakeholders that validated and prioritized key behaviors, and conceptualized integrating COVID-19 vaccination into a healthy lifestyles’ framework. We identified effective messages to promote vaccine uptake, and a course curriculum focused on healthy lifestyles, life-course immunization, and person-centred care.

Lessons

Behavioural insights and the behavioural integration approach helped identify and prioritize critical COVID-related behaviours to increase vaccine uptake amongst key priority populations. For the first time in the region, we proposed the integration of COVID-19 vaccination into a primary healthcare platform, focused on healthy lifestyles and life course immunization, as well as person-centered care, which aligned well with both governments’ and populations’ priorities.

Key messages

• Behavioral insights and behavioral integration helped identify priority populations and behaviors, and better align the respective priorities of populations and governments for COVID-19 vaccination.

• Participatory workshops with relevant stakeholders, together with evidence from qualitative and quantitative research, allowed us to design and adapt public health interventions.