bluuebunny/crossref_metadata_2025 huggingface dataset:
18.H. Workshop: Bringing evidence during public health emergencies: addressing the challenge through HTA
Authors:   Organised by: EUPHA Infectious diseases control section, EUPHA Health technology assessment section,   Chair persons: Elena Petelos - Greece, Carlo Favaretti - EUPHA-HTA
Published: October 2020

Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking.

The process of including evidence in public health decision-making and for evidence-informed policy, in preparation, and during public health emergencies, is not systematic and is complicated by many barriers as the absences of shared tools and approaches for evidence-based preparedness and response planning. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability and to implement coordinated evidence-based response plans. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. As a multidisciplinary, standardized and evidence-based decision-making tool, Health Technology Assessment (HTA) represents and approach that can inform public health emergency preparedness and response planning processes; it can also provide meaningful insights on existing preparedness structures, working as bridge between scientists and decision-makers, easing knowledge transition and translation to ensure that evidence is effectively integrated into decision-making contexts. HTA can address the link between scientific evidence and decision-making in public health emergencies, and overcome the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines. It may allow a 360° perspective, providing a comprehensive view to decision-making in preparation and during public health emergencies. The objective of the workshop is to explore and present how HTA can be used as a shared and systematic evidence-based tool for Public Health Emergency Preparedness and Response, in order to enable stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent.

Key messages

There are many barriers and no shared mechanisms to bring evidence in decision-making during public health emergencies. HTA can represent the tool to bring evidence-informed actions in public health emergency preparedness and response.
18.I. Workshop: Opportunities for EU funding in health
Authors:   Organised by: EUPHA, CHAFEA, EC,   Chair persons: Anne-Marie Yazbeck - CHAFEA
Published: October 2020

The session will outline the new stand-alone EU4Health Programme for 2021-27. The programme that will fill the gaps revealed by the COVID-19 crisis and ensure that EU's health systems are resilient enough to face future health threats through: more coordination between Member States,more capacity at EU level to prepare for and to fight health crises,more investment in health systems to face future challenges.

Links to other important areas of EU funding will be included, such as: social inclusionregional developmentresearch and innovation.

Presenters are European Commission staff covering areas: EU4 Health Programme, DG Health and Food SafetyEuropean Social Fund+; DG Employment, Social Affairs and InclusionHealth Research in Horizon Europe; DG Research and InnovationDigital Health in Horizon Europe; DG Communications Networks, Content and TechnologyEuropean Regional Development Fund; DG Regional and Urban Policy.

Key messages

Building on the lessons learned from COVID-19, EU4Health is an ambitious and dedicated funding programme for 2021-2027 to build resilient health systems in the EU to be better equip us for the future. Other important areas of EU funding for health include social inclusion, regional development, research and innovation.
Burden of foodborne disease in the Netherlands: from science to policy
Authors: Mughini Gras L
Published: October 2020

In the Netherlands, the Ministry of Health mandates the National Institute for Public Health and the Environment (RIVM) to provide annual updates of the number of illnesses, disease burden and cost-of-illness caused by an agreed-upon standard panel of 14 enteric pathogens. These pathogens are mainly transmitted by food, but also via direct contact with animals, environment-mediated and human-to-human transmission routes. The disease burden is expressed in DALYs (Disability Adjusted Life Years), a metric integrating morbidity and mortality into one unit. Furthermore, the cost-of-illness (COI) related to these 14 pathogens is estimated and expressed in euros. The COI estimates include healthcare costs, the costs for the patient and/or his family, such as travel expenses, as well as costs in other sectors, for example due to productivity losses. Moreover, using different approaches to source attribution, the estimated DALYs and associated COI estimates are attributed to five major transmission pathways (i.e. food, environment, direct animal contact, human-human transmission, and travel) and 11 food groups within the foodborne pathway itself. The most recent DALY and COI estimates referring to the year 2018 show that the 14 pathogens in question are cumulatively responsible for about 11,000 DALYs and €426 million costs for the Dutch population in 2018, with a share for foodborne transmission being estimated at 4,300 DALYs and €171 million costs, which is comparable to previous years. These estimates have been providing vital insights for policy making as to guide public health interventions and resource allocation for over two decades in the Netherlands. Herewith, the approach and outcomes of the burden of disease and COI estimates in the Netherlands will be presented, with a focus on how these estimates enable policy-makers and the scientific community to monitor trends, generate scientific hypotheses, and undertake public health actions.
Mental health policy issues and development in Lithuania
Authors: Rubikas I R
Published: October 2020

Background

Lithuanian has experienced rapid and relatively successful transition to capitalism and transatlantic-Western values and practices in recent decades. Suicide and legal alcohol consumption rates remain the highest in the EU and OECD, and Lithuania's Positive emotions index score has been consistently amongst the 10 lowest in the world in recent years. Emigration rate is the highest in the EU and OECD, social inequality is amongst the highest in the same groups. Despite a relatively strong economy these changes are not automatically transferred to better social and emotional well-being.

Methods

This unconventional situation calls for strong and unconventional policy responses in the area of mental health, amongst others. Health impact assessment using theory-based approach and desk research.

Results

Recent attempts include strategic reorientation towards social and emotional well-being, stronger focus on prevention and promotion and primary care, intensifying efforts to reduce suicide rates, and implementation of strong regulatory measures to reduce alcohol use. Suicide rates have been declining since 2013 but remain high. Effort is made to implement best practices in media reporting, recognition and providing appropriate help for those in suicide crisis, expanding prevention efforts.

Conclusions

Finally, WHOs “best buys” in alcohol control were implemented since 2017, including steep increases in excise taxes, ban on alcohol advertisement, increase of allowed age, reducing alcohol trading hours and others. This resulted in the steepest decline of legal alcohol consumption in decades. The chosen policy route may be called iterative policy-making, whereby improvements are made along the way, which allows for quicker policy decisions and results.

Key messages

Mental health policies need to be based on the socio-political context of the specific country. Smaller countries such as Lithuania might benefit form flexible approaches to mental health policies.
Opportunities and current challenges for the use of polygenic risk scores in risk prediction and prevention
Authors: Kroese M
Published: October 2020

The panellist Mark Kroese will discuss about the opportunities and current challenges for the use of polygenic risk scores in risk prediction and the prevention of common adult onset conditions. Considerable progress has been made in the scientific development of polygenic risk scores for use in estimating the risk of common chronic conditions. However, key challenges remain in developing practical applications for their use in the clinic and establishing the evidence of their clinical utility. Questions remain about how such approaches will improve current risk prediction tools and methods. In addition, there is much debate about the nature of the possible benefits of using such scores for clinical advice and decision making as well as the likely impact on individual behaviour and future outcomes. Do we need a different approach in developing future risk prediction tools?
Homo Salus: the master mind behind health tourism
Authors: Saboga-Nunes L
Published: October 2020

Background

Health tourism (HT) (e.g. wellness tourism, thermalism & spa, medical tourism based in the delocalization of disease curative segments) is pervasive today in different formats. Hubs of high tech and nature spots are the basis for this increment of services. HT although present in the course of human history, has conquered a new social dimension today. Mobility and easy access to travel, are ingredients that fueled this segment, while a culture of health promotion (of all human dimensions - physical, psyche, spiritual and social) diversified the marked offers and services. The focus on health (salus, in latin) is the basis for the HT industry, contributing to a new ethos: the homo salus. Implications of HT need to be dissected and basic concepts integrated, as a glossary of terms and references and a charter of HT, from the public health perspective, are introduced to participants.

Methods

Document and stakeholder analysis help explore the Health Impact Assessment (HIA) of HT towards a knowledgeable civic society.

Results

In the EU28, HT contributes 0.3% to the economy (2017). HT has hindrances but represent also a set of benefits since it may contribute to health (per see) and moreover decrease pharmaceutical consumption and reduce health costs through disease prevention. For this to take place a set of (competences) health literacy needs to empower the health tourist so that the benefits of HT become sustainable. Therefore, the concept of health needs to be clarified since the commonly used idea of WHO (1948) of what health is, do not fit into the overall social representation of HT.

Conclusions

The advent of the Homo Salus as a Prosumer, is aiming at the creation of health (salus+genesis) i.e. the quest is to become in a better condition moving towards the health end of the dis-ease continuum. Salutogenesis as a framework can contribute to better understand the public health dimension of HT going beyond the traditional curative dimension.
Does management integration improve cross-level clinical coordination? Experience of Catalonia
Authors: Esteve-Matalí L , Vargas I , Cots F , Ramon I , Sánchez E , Coderch J , Plaja P , Vázquez for Gaia M L
Published: October 2020

Background

Cross-level clinical coordination is a priority for health systems. Evidence suggests that management integration may improve clinical coordination. This study aims to evaluate clinical coordination according to the type of management integration of the area in the Catalan health system.

Methods

Cross-sectional study based on the online questionnaire COORDENA-CAT (October-December 2017). Study population: primary and secondary care (acute and long term) doctors of the public Catalan health system. Sample: 3.308 doctors. Outcome variables: experience and perception of clinical coordination across care levels, knowledge and use of coordination mechanisms and related factors. Explanatory variables: area according to type of management (integrated, semi-integrated and non-integrated), demographic, employment characteristics and attitude towards work. Descriptive and multivariate analysis by robust Poisson regression.

Results

Better clinical coordination was observed in integrated areas compared to those semi-integrated, mostly in information transfer (PR 0.80 (95%CI 0.74-0.87)) and adequate follow-up of the patient (PR 0.89 (95%IC 0.82-0.97)). No differences were observed between integrated and non-integrated areas. General perception of coordination was higher in integrated areas than in semi-integrated and non-integrated areas (PR 0.73 (95%CI 0.63-0.84) and PR 0.85 (95%CI 0.75-0.97) respectively). Some organizational and interactional factors and the knowledge and use of coordination mechanisms showed also better results in integrated areas. There were common fields for improvement like accessibility between care levels.

Conclusions

No differences between integrated and non-integrated areas reveal that management integration is not enough condition to improve clinical coordination. Differences with semi-integrated areas suggest that coordination efforts should be equitable among all the providers of the territory to avoid inequalities in quality of care.

Key messages

Management integration does not determine clinical coordination. Cooperation formulas are needed between all territory providers that allow to fix common strategies to improve clinical coordination.
Evaluating small conditional cash transfers to improve vaccine coverage and timeliness in Pakistan
Authors: Abdullah S , Siddiqi D A , Shah M T , Glennerster R , Khan A J , Chandir S
Published: October 2020

Background

Low immunization coverage rates have prompted the need to design effective demand-side interventions to improve uptake. Simple SMS reminders and large (≥USD 100) incentives have been demonstrated to effectively increase immunization coverage. However, research on small incentives (≤USD 15) for immunization is sparse and there is uncertainty regarding the optimal structure of incentives in terms of size, schedule, and design.

Methods

A 12-arm randomized controlled trial is being conducted in Karachi, Pakistan with 10 incentive arms of varying size (amount), schedules (progressivity) and design (certainty of payment), an exclusive SMS arm and control arm. The incentives are provided through two mechanisms: mobile air time and mobile-money through a mobile-money provider. Children were enrolled when they presented to the study sites for either BCG, Penta-1, or Penta-2 vaccine.

Results

A total of 11,197 children were enrolled between Nov 2017 and Oct 2018 with approximately 800 children in each incentive arm and 1600 and 1599 in SMS and Control arm, respectively. As of Jan 09, 2020, Penta-3 and Measles-1 coverage are lowest in the control arm (71% and 60% respectively) and highest in the high-flat-lottery arm (78% and 69% respectively) with uniformly progressing incentive amounts along the immunization schedule.

Discussion

Interim results suggest that small mobile-based incentives coupled with SMS reminders can significantly improve immunization coverage in children. The final analysis will provide robust evidence of this impact and provide policy implications for the most optimal incentive structure that can build caregiver demand for effectively increasing child immunization in an LMIC setting.

Key messages

Small incentives (USD<15) coupled with simple SMS reminders can improve immunization coverage and timeliness in low resource settings in an inexpensive, logistically simple way. The study will provide experimental evidence on optimal incentive design, structure, and size of small incentives for a cost-effective approach to increase immunization coverage and timeliness.
Understanding the drivers of m-Mental Health uptake among emerging adults
Authors: Hasa M
Published: October 2020

Background

In the age of the ever-increasing prevalence of depressive symptoms and suicidal rates among young people, aiding this population to foster healthy mental well-being poses a key public health challenge. Since emerging adults generally tend to avoid offline help-seeking in case of mental health troubles, this population might especially benefit from m-Mental Health. The present study aimed to identify the determinants of the use of m-Mental Health apps among emerging adults and investigate the role of privacy and safety concerns of potential users in the highly confidential area of mental health.

Methods

A mixed design comprising an online survey and manipulation tested the new model among 229 adults aged 18-29 from 27 different countries.

Results

The SEM analysis indicated good model fit. Significant strong associations were found between Health Technology Efficacy, Health Technology Self-Efficacy, attitude toward mobile mental health and intention to use m-Mental Health. Health Technology Social Acceptance had a significant positive relationship with Health Technology Efficacy. Confidence in Health Technology negatively moderated the way Health Technology Efficacy shaped the attitude toward m-Mental Health.

Conclusions

When emerging adults are to decide whether or not to use an app to enhance their mental well-being, several factors come into play: Perceived efficacy of the app, positively linked with one's self-efficacy and social influence, predicts behavioural intention through the attitude toward m-Mental Health, while health technology self-efficacy is also directly related to the intention to use such an app. Moreover, the variable Confidence in Health Technology manifested its indispensable role within the model. Finally, the study disconfirmed the assumption that young people would be less confident in the app if they were confronted with signs of its profit-driven origin.

Key messages

The perspectives-bridging, variables-contextualizing approach is a promising avenue for investigating the drivers of e-Health uptake in various health domains, technologies, and populations. Young adults who believed in m-Mental Health apps in terms of safety and privacy were less influenced by the perceived efficacy of such apps with regard to their attitude and intention to use.
Digital health in a social health insurance system: new emergent market powers in Germany
Authors: Posselt J , Kuhlmann E
Published: October 2020

Background

This presentation analyses the dynamics of digital health from a governance perspective. It aims to explore the driving forces for the implementation of digital health in Germany. Germany is chosen as a case study of a social health insurance system, which is based on joint self-governance of sickness funds and providers, and strong corporatist power of the medical profession.

Methods

A qualitative explorative approach is applied, drawing on document analysis and other secondary sources. The research is based on a governance approach adapted from Glassman and Buse's model of public health policy reform.

Results

The WHO Global Strategy for Digital Health 2020-2024 serves as a key international policy framework. However, the analysis reveals firstly that implementation is shaped by national healthcare systems and may create different results; secondly, the global strategy provides only a weak guidance on the national level. In Germany, strong corporatism and weak state intervention is supporting market forces and private actors. Poorly developed digital health governance has opened a window of opportunity for market powers as driving forces for digital health, thus creating new risks of social inequalities. There is an urgent need for public health to step up advocacy for health literacy to improve the accessibility to digital health for all citizens.

Conclusions

National healthcare systems strongly shape the implementation of international digital health frameworks, which makes digital health an issue of governance. Stronger public health orientation and a people-centred approach are needed to counteract new emergent social inequalities created by market power.

Key messages

Market power and private actors are important drivers of digital health in the German healthcare system. Social health insurance systems may be vulnerable to market powers and new digital health inequalities.
An app-based quick assessment tool for childcare PA environments and practices
Authors: Müller C , Kaiser V , Hassel H
Published: October 2020

Background

Childcare centers are settings with a huge impact on children's health and health behavior and should therefore be encouraged to implement policies and practices to promote physical activity (PA). The project “QueB 2 - developing quality with and through physical activity” aims at exploring how stakeholders can be involved to identify childcare centers with need for action. For this purpose, an app-based quick assessment tool is developed.

Methods

We conducted two group discussions with stakeholders working with childcare centers (consultants, supervisors) about requirements in terms of applicability and criteria that are important and easily verifiable. Based on the results of the discussions and building on scientific evidence and existing frameworks, a quick assessment checklist was created and developed as a web app. The tool is tested by stakeholders and evaluated in further group discussions.

Results

Stakeholders require a simple assessment tool that can be used in counseling with small expenditure and is combined with information material. The developed app-based assessment tool consists of 20 items in 7 categories (indoor space, outdoor space, play equipment, activities, childcare center culture, professional development, network). It incorporates a simple scoring system with a total score ranging from 0 to 126. Based on the score, the tool shows a feedback window stating whether there is little, some or much need for action and providing additional information.

Conclusions

Stakeholders can be involved to sensitize childcare centers to the issue of physical activity environments and practices with the help of an app-based quick assessment tool. This is an important step before possible interventions can be implemented in childcare centers.

Key messages

An app-based assessment tool for childcare physical activity environments and practices is developed. It will enable stakeholders to identify childcare centers with need for action and offer support.
AcademicMind - The mindfulness app for academics
Authors: Guedes R , Valois R , Costa A , Delineau V
Published: October 2020

Support better mental health is a long-term investment. Stressful life events and chronic adversity have a substantial impact on brain functions and may result in mental health problems. Stress during academic life was already established as a problem, and university students have a high-stress rate. Create and improve strategies to lower those levels can increase student wellbeing. Smartphones connect individuals across the world, and its software applications may have the ability to facilitate behavior change. Mindfulness-based interventions bring positive results for physical and mental health and are recommended to reduce stress. We offered a Mindfulness-based program for stress reduction for eight weeks on a progressive web application (app) for higher education students. The main objective of the project is to increase wellbeing by reducing stress levels in university students, providing them with tools and knowledge through a digital intervention program. Individuals completed the Warwick - Edinburgh Mental Well-being Scale before the 1st, in the 5th week, and the 8th week of intervention. The pilot study counted with 15 participants from 4 countries, from undergrad to postdoc. Preliminary results showed that participants are mostly female (69%) from a master (52%) in health sciences (45%) and located in Brazil (50%). The access was usually via mobile (67%), and the first month had six times more visits and 1.3 times more meditations listened than the second. Participants improved their test score considering before (M = 43.20, 5.26) and after (M = 49.80, SE = 6.90), t(4)= -3.404, p = 0.027, demonstrating an increase of wellbeing after the program. Our lessons were: To maintain adhesion rate to the program constant. Provide access to professional help if needed. Turn the progressive web app into a native IOS and Android app. Integrate the smartphone application into university health programs with the possibility of referrals to mental health professionals.

Key messages

An intervention program as a progressive web app designed for academic students to improve wellbeing can offer good cost-benefit, ample reach, and early detection of cases that need specialized help. Provide a readily available and understandable program that permits the improvement of stress levels and wellbeing may be a possibility to decrease academic abandon and improve academic achievements.
Process modelling of organized screening programs – breast cancer
Authors: Terras Marques I , Santos C , Santos V
Published: October 2020

Breast cancer is the most frequent cancer among women and one of the principal causes of cancer related death in women worldwide, being a public health problem. Oncology screenings allow its early detection and reduce its mortality. Business process management (BPM) is a management field that leads an organization into continuously improvement with increase of efficiency. The processes of the healthcare system are complex what makes the application of BPM techniques harder, however their usage has been increasing in this sector.

The main objective of this study is the identification and modelling of BPM processes for the Portuguese breast cancer screening.

The current processes and the entities (actors, systems and documents) involved in the Breast Cancer Organized Screening performed by the Portuguese League Against Cancer were identified through interviews to the employees. With the information retrieved and using Bizagi the related As-Is diagrams were developed.

In this work 5 processes within the Breast Cancer Organized Screening were identified: Process “Patients' invitation”; Process “Screening”; Process “Reading of the exam”; Process “Check-up Consultation” and Process “Sending Results”. Through the analysis of the As-Is diagrams and of the available information, a critical analysis was made. As for example, in the process “Patients' invitation” an invitation letter is sent 15 days earlier to the patient but no telephone contact is done before the screening. An improvement could be sending a message in the day before the screening, remembering the appointment, avoiding forgetfulness absences.

With this work the mainly processes of the breast cancer organized screening were modelled as “As-Is” diagrams and, in a macroscopic way, some of the problems were identified and improvement suggestions were made in order to achieve the main objective of the process, the early detection of breast cancer, while optimizing the process.

Key messages

This work represents an important contribution to the Breast Cancer Organized Screening since, through the use of BPM, a set of actions is proposed with an impact on its effectiveness and efficiency. This work represents an example of what the BPM techniques can do to help in the optimization of all the processes of the healthcare sector, from screening to diagnosis and treatment.
Digital and innovation skills in health care professionals in Europe
Authors: Fornes-Romero G , Doñate-Martinez A , Garces-Ferrer J , Fredskild T U , Hansen H , Traver-Salcedo V , Martinez-Piqueras M , Gil-Granados A , Gimenez-Campos S
Published: October 2020

Background

Rising life expectancy and ageing population are current phenomena that European society is facing and these are challenges for the European healthcare systems. To face them, several e-health solutions are already designed to optimize resources of the healthcare provider system. However, most of them are not being implemented or deployed. Some of the reasons are the lack of digital skills and innovation readiness in staff, and existing barriers to changing organizational practices.

Objectives

The DISH project (601008-EPP-1-2018-1-DK-EPPKA2-SSA) will develop 3 concepts to improve the digitalization of healthcare staff to help them in the use of e-health solutions already developed: 1)Learning Innovation Units, where healthcare staff, SMEs and educational institutions work together for improving the e-health solutions development and implementation; 2)On the job training, where healthcare staff will be trained in e-health and digital competences; 3)Assessment, where competences accomplished by healthcare staff will be recognized. All these concepts will be tested in 6 EU countries.

Results

The development of the 3 concepts is based on a needs analysis on present and future competences required to support the implementation of e-health solutions in Denmark, Norway, UK, Germany, Spain and Poland. Also, each country will test the 3 concepts and train 100 healthcare staff in the use of an e-solution/innovation already developed but not being fully implemented. An evaluation of the achieved skills/competences by the staff will be also conducted.

Conclusions

Healthcare workers and SMEs show willingness and motivation in contributing to the digitalization but there is a clear lack of digital skills (although this is different from country to country) to make easier the adoption in daily practice of such solutions. The project looks for promoting close collaboration between the interested parties to work together in overcoming the stated deficiency.

Key messages

The DISH concepts will facilitate a training framework for healthcare professionals in the use of digital solutions. The DISH project will promote the use of several innovations already available in the market.
Using personalised avatars in a weight loss management programme: participants’ perspectives
Authors: Horne M , Hill A , Ugail H , Murrells T , Hardy M
Published: October 2020

Background

Obesity interventions rely predominantly on managing dietary intake and/or increasing physical activity but sustained adherence to behavioural regimens is often poor. Avatar technology is well established within the computer gaming industry and evidence suggests that virtual representations of self may impact real-world behaviour, acting as a catalyst for sustained weight loss behaviour modification. We explore patient's experiences of using an avatar as an adjunct to a weight management programme.

Methods

Exploratory, qualitative research design with a sub sample of participants to explore uncertainties and develop intervention optimisation and conduct of a future trial. Semi-structured interviews, with a purposive sub sample of obese and overweight patients a undergoing weight management programme (n = 12) from two settings in West Yorkshire, England (November-March 2020). Ethical approval was granted. Data were analysed using framework approach of verbatim transcripts.

Results

Three main themes emerged through data analysis (i) avatar appearance (ii) added benefits and (iii) areas of development. Visual perception of the personalised avatar could positively or negatively influence current and future realities. Patients generally found that using a personalised avatar provided added motivation to continue with the weight management programme and increased their confidence in their ability to work towards a healthy lifestyle to reduce weight loss. Several areas of development were identified for both the weight loss programme and the personalised avatar in relation to accessing psychological support and ways of developing and strengthening their own personal resilience.

Conclusions

The findings suggest that using personalised avatars could be a useful technique to increase engagement, motivation and adherence to weight loss management programmes among individuals who are obese or overweight.

Key messages

There appears to be some added motivational benefits to using personalised avatars. Virtual representations of self may impact real-world behaviour, acting as a catalyst for sustained weight loss behaviour.
An evaluation matrix for self-instructional courses of Continuing and Online Education in Health
Authors: Gasque K C S , Guizardi F L , Coomans de Brachene SMDBTC , Fernandes K , Dutra E B , Lemos A S P , Passos M F D
Published: October 2020

Background

In 2003, the National Policy for Continuing Education in Health (PNEPS) was created as a strategy to train and update workers of the Unified Health System. To be effectively instituted, the Open University of the Brazilian Unified Public Health System was conceived to offer free online courses. But, it was observed that the online educational modules developed were not structural and pedagogically homogeneous.

Objective

Propose a matrix of criteria and guidelines to support the improvement of the design of instructional modules, investigating three main areas: ergonomics, education and health.

Methodology

Anasynthesis was the approach to build the evaluation matrix.

Results

The matrix consists of 29 criteria (Accessibility, Progression Activities, Updating Practices, Self-Analysis and Self-Management, Assessment, Cognitive Load, Student-Centered, Collaboration, Compatibility and Interoperability, Consistency, Knowledge Building, Student Control, Documentation and Help, Aesthetics, Feedback, Flexibility, Error Management, Interactivity, Maintenance, Clear Instructional Goals and Objectives, Motivation, Personalization, Problem Practicing, Critical Reflection, Relevance, Renewable, Safety, Use of Different Paths, Valorization of Knowledge) with 132 guidelines that allows to check if the online self-instructional module meets minimum quality criteria. Five courses produced by the UNA-SUS system were tested and compared with the perception of users of these courses, obtained by the polls for opening and closing the courses. There was an approximation between the evaluations using the matrix and the responses of the surveys of the courses, answered by the users. Results from these surveys were transferred to a user matrix. The Interactivity and Collaboration criteria were considered non-mandatory for self-instructional courses without tutors.

Conclusions

The matrix is an adequate evaluation tool for self-instructional courses developed for Continuing Education.

Key messages

The evaluation matrix is adequate to evaluate online self-instructional courses developed for Health professionals qualification. Self-instructed courses could be a good tool for Continuing Education in health, according to students’ perceptions.
Are persons with a limited health literacy less satisfied with the German health care system?
Authors: Achstetter K , Köppen J , Blümel M , Busse R
Published: October 2020

Background

Health literacy (HL) is the ability to find, understand, appraise and apply health information with the aim of using this information to make decisions affecting the own health. Previous studies showed limited HL in around 50% of the German population. The assessment of the German health care system from the perspective of persons with limited HL is subject of this study.

Methods

In 2018, a survey was conducted among 20,000 persons with private health insurance in Germany. Survey items were based on the intermediate and final goals of the WHO Health Systems Framework. Questions comprised, for example, satisfaction with the health care system, responsiveness (e.g. perceived discrimination), access (e.g. off-hour care), and safety (e.g. medical errors). HL was assessed with the HLS-EU-Q16 questionnaire. Descriptive statistics and Chi-square test were used to analyze the data and group differences.

Results

Overall, 3,601 participants (18.0%) completed the survey (58.6 years ± 14.6; 64.6% male). Limited HL was seen with 44.6% (8.5% inadequate & 36.1% problematic), whereas 55.4% did not report limited HL (43.4% sufficient & 12.0% excellent). Very satisfied with the German health care system were 6.5% of the persons with limited HL (vs. 14.3%). Perceived discrimination within the last 12 months was reported by 11.0% of the persons with limited HL (vs. 5.1%). To get medical care on weekends, holidays or evenings outside hospitals was rated as “very hard” by 34.6% of the persons with limited HL (vs. 23.6%). The feeling that they experienced medical errors was reported by 18.7% with limited HL (vs. 11.5%) and 5.9% were unsure (vs. 2.2%). All results were statistically significant (p < 0.001).

Conclusions

Persons with limited HL were less satisfied with the overall German health care system in comparison to persons with not limited HL and reported more often perceived discrimination. Strengthening HL could help to improve satisfaction with the health care system.

Key messages

Limited HL among persons with private health insurance in Germany was found in 44.6% of the survey’s participants. Persons with limited HL indicated to be less satisfied with the German health care system and perceived more often discrimination in their health care.
howtostayfocused.org Addressing attention-related health problems in higher education with an eTool
Authors: Van Der Heijde CM , Arts D L , Vonk P
Published: October 2020

Background

20 to 30% of university students consistently report attention-related health problems (studenthealthcheck), such as depression, a less healthy lifestyle (e.g. alcohol/ drugs, sleep, etc.) or adhd. Students are healthcare avoiders and as such ideal candidates for eHealth. To sort out their attention problems, increase their knowledge and guide them to solutions, howtostayfocused.org/ has to be scientifically evaluated.

Methods

A qualitative study was conducted in 2019 at the Student Health Service of the UvA. A prototype eTool and interview guide were developed in accordance with CeHRes, contextual background and value specifications for attention-related issues. Semi-structured cognitive interviews were administered to students before, during and after completion of the Etool (i.e. think aloud method) (N = 9; 5 female; mean age 23.5) concerning its' system, content and service quality. (audio recorded, transcribed verbatim and thematically analyzed).

Results

They were triggered to conduct the test and appreciated the personal advice that advanced the acceptance and confirmation of their complaints. the system: User-friendliness, lay out and abundance of information were appreciated. Improvements included technical errors, too much text provision, low visualizations, unclear navigation.the content: Although appreciative of the content, improvements included experience stories, study tips, information clarity.the service quality: Self-sufficiency has added value. (perceived usefulness) Soon after the launch of the eTool, it was used about 1000 times.

Conclusions

An eTool to address, clarify and analyze attention-related health problems among university students is considered of added value to meet their self-sufficient ways. They appreciated the personal advice from the test for the acceptance and confirmation of their attentional complaints. These results are of value for the development of other health-related web-based innovations for students.

Key messages

eHealth is a suitable way to address (attention-related) health problems that are common in university students, who are typically healthcare avoiding. The eTool contributes to prevention in the sense that university students may identify their attention-related health problems at an earlier stage and prevent aggravation of their complaints.
To arouse interest in health advice: a qualitative inquiry on popular health books in Turkey
Authors: Kucukali H , Yapalak AN Balci
Published: October 2020

Background

While some of the health advice is arousing interest in large audiences, others are neglected. It is known that the presentation of health contents affects their adoption. However, there are not enough studies on popular health books as a medium. The aim of the study is to find out how popular health books are presented to arouse interest in health advice.

Methods

Promotional descriptions of books may reveal the prominent characteristics of the presentation of health advice and sales of the books may be a proxy of public interest. Public data of 5320 books that are listed in the health category collected from the most popular online bookstore in Turkey (Alexa rank=109) via a web mining program which is developed for this study. A qualitative coding scheme is created after familiarisation with data. Two researchers independently coded promotional descriptions of best selling 95 books that appeared to constitute the 50.1% of all 780,617 sales in health category by February 2020.

Results

The 95 best selling health books have been written by 61 different authors. They were found to be mostly about advice on nutrition/ diet (33.7%), weight loss (16.8%) and traditional medicine (14.9%) with a substantial intercoder agreement (κ = 0.756). A common narrative discovered in data which usually contains the number of following components: a claim of a paradigm shift, a saviour, a path to salvation, the evil, believers and non-believers and their aftermath, a single responsible for most health problems and an easy single solution for them.

Conclusions

Best selling health books are presented in a way that its health advice were ideologies or some kind of belief systems. Even it is arguable to recommend this approach for practice, our findings may help to address contemporary challenges in health communication such as epidemics of disinformation. Further studies may consider to analyze the data from a variety of sources and also compare books from different categories.

Key messages

How the health books are presented may affect how much interest their advice can arouse. Best selling health books found to be using a narrative that present health advice like they were ideologies.
Polypharmacy in elderly migrants: perspectives of chronically ill migrants on E-Health-Applications
Authors: Tezcan-Güntekin H , Özer-Erdogdu I
Published: October 2020

Background

Polypharmacy occurs frequently among the elderly and is associated with an increased risk of falls and medication-related adverse events. Especially people with migration backgrounds may receive inappropriate medication due to language barriers or experiences of discrimination in healthcare. This study aimed to assess barriers to drug therapy in elderly migrants and to generate user experience data for the development of an e-health application.

Methods

10 interviews, respectively, with chronically ill individuals of Turkish descent and with family caregivers. The 20 interviews were analyzed qualitatively by means of structuring content analysis.

Results

Medication is connected to uncertainty for respondents and most are affected by polypharmacy. Medication is not always taken regularly, especially among respondents living transnationally. Adherence depends on trust and the quality of doctor-patient relationships. The number of medications required and their side effects are a source of dissatisfaction, but elderly migrants develop a variety of coping strategies. Smartphone use is common among respondents and they are open to using an application for medication prescription and intake management.

Conclusions

Interprofessional care teams are needed in order to reduce uncertainty regarding medication management, to improve health literacy and to strengthen alliances between stakeholders. Additionally, collaboration between diversity-sensitive nursing care specialists and physicians is needed to provide accessible information, thus improving continuity of intake and adherence. E-health applications have the potential to improve medication management and information exchange between all stakeholders, thus facilitating correct medication use.

Key messages

Diversity-sensitive care can improve drug therapy for elderly migrants by removing language, information and trust barriers. Elderly migrants are open to web-applications for medication management.
Assessing the Quality of skin Healthcare Mobile Apps: a systematic review and scoring using the MARS
Authors: Woo H , Kim G h , Kim Y w
Published: October 2020

Background

With the number of skin healthcare-related apps users increasing, the selection of high-quality apps is not a simple task. The aim of this study was to (1)describe the content of available skin healthcare apps, (2)evaluate their objective quality regarding engagement, functionality, aesthetics, information and subjective quality.

Methods

The App Store and Google Play store were systematically searched to identify skin healthcare mobile apps for general population use. Eligible apps were downloaded and independently evaluated for quality by 4 reviewers using the Mobile App Rating Scale(MARS). The MARS is the only currently available tool that provides a comprehensive, multidimensional evaluation of app quality. MARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. In addition, the correlation between MARS score and user score was analyzed.

Results

The overall 37 apps obtained a mean quality score of 2.77(SD.62). 'Trove skin(Android: 4.13)' received the highest score, while 'Complete Beauty Guides(Android: 1.8)' received the lowest score. User scores were found to have no significant correlation between overall quality scores through MARS and content scores(r= .240, p= .153)(r= .290, p= .081), the overall quality score through MARS and the Content Score were significant static correlation(r= .487, p= .002).

Conclusions

As the use, and introduction, of mobile apps continue to grow, it will become increasingly important for consumers to adopt high-quality apps. Understanding the effectiveness of high-quality apps compared with low-quality apps can make it easier and more accurate for consumers decisions about using related to skin healthcare apps. Furthermore, qualities of apps that ranked higher could be used to improve existing apps or help with the development of new ones.

Key messages

Consumers refer to the User Score when selecting skin healthcare-related apps. However, User Score was not correlated with MARS content quality assessment scores evaluated by experts. This study is a significant help that enables consumers to select good-quality skin healthcare apps by high-quality content information through MARS.