bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges to Implementation of a CHW-led COPD Screening and Referral in rural Uganda
Authors: Ingenhoff R , Robertson N , Bodnar B , Kalyesubula R , Munana R , Knauf F , Siddharthan T
Published: October 2023

Chronic obstructive pulmonary disease (COPD) ranks as the third leading cause of global mortality. In rural areas of low- and middle-income countries (LMICs), COPD screening and diagnostic services remain often inaccessible. This study seeks to comprehend the implementation challenges of a Community Health Worker (CHW)-led program for COPD in Nakaseke, rural Uganda. During September and October 2022, this qualitative study explored the perceptions of Community Members, CHWs, and Healthcare Providers (HCPs) on challenges associated with CHW-delivered COPD screening and referral. In-depth interviews were conducted with eight CHWs and ten HCPs, along with six focus group discussions including 34 Community Members. Research assistants recorded and transcripted interviews verbatim. The thematic analysis was guided by the conceptual framework for implementation outcomes research. The acceptability of the implementation was hindered a lack of awareness about COPD, skepticism regarding the usefulness of COPD screening, and the presence of stigma surrounding the diagnostic process. Additionally, limited adoption was attributed to difficulties in accessibility and the willingness of Community Members to participate in the COPD referral process. The high patient volume, coupled with the complexity and time-consuming nature of the diagnostic and referral procedures, posed significant barriers to successful implementation. To ensure program sustainability, participants recommended increased support for CHWs, the decentralization of COPD care, and the expansion of follow-up services provided by CHWs. CHW-led interventions have great potential to deliver health care services that overcome barriers to treatment and self-management, particularly in settings with limited access to healthcare. However, prior to implementation, baseline assessments are needed to identify potential implementation obstacles and strategies that consider evidence-based approaches tailored to local contexts.

Key messages

• CHW-led interventions are a useful tool to alleviate barriers to COPD treatment and self-management in rural areas of LMICs where access to care is limited.

• Formative assessments of the potential challenges prior to an intervention are required to address and minimize barriers to implementation and sustainability.
Development and implementation of information management standards to contribute to safer better care
Authors: Ryan M , Foley B , Flynn R
Published: October 2023

Issue

Good data and information is the foundation to a high-quality healthcare. It is also important for planning and managing services, policy-making and research.

Description

Information management includes the collection, storage, management and maintenance of information at any stage of the data and information cycle. Advances in eHealth have the potential to improve care by providing information when, and where, needed. Ongoing developments, including the establishment of a European Health Data Space, emphasise the need for good information management practices. It is imperative that organisations have the appropriate structures, systems, policies and procedures, according to evidence-based standards, to ensure data collected is of the highest quality and used to its full potential to promote safer better care, improved outcomes and overall wellbeing.

Results

In 2017, ‘Information Management Standards for National Health and Social Care Data Collections’ and a review programme to assess compliance against these standards was initiated by HIQA. To date, compliance with the information management standards has been reviewed in five major national data collections. A common finding was that a system-wide approach to information management was required. In 2022, HIQA began revising the standards given the learning from the review programme. The revision of the standards involves broadening the scope of the standards to include all services and organisations that process health and social care information.

Lessons

It is important that everyone working within health and social care services is aware of their responsibilities in terms of information management. Good information management is critical as eHealth plans progress and large volumes of personal data are processed in Ireland. Information management standards will be key to promoting high quality care, and enhanced planning and management of services, policy making, public health and research.

Key messages

• Good information management is critical to promote safer better care, improved outcomes and overall wellbeing.

• Organisations need appropriate structures, systems, policies and procedures according to evidence-based standards to ensure data collected is of the highest quality and used to its full potential.
Theories used for Social Prescribing in studies - a scoping review
Authors: Evers S , Husk K , Napierala H , Klose L , Gerhardus A
Published: October 2023

Background

General practitioners increasingly engage with patients who have social problems. Social Prescribing (SP) is a pathway for them to connect these patients with appropriate social support and activities in their community. However, there is a lack of adequate evidence for the effectiveness of SP. For the design of high-quality studies for complex interventions, theory-guided development of the intervention and evaluation is essential. Nevertheless, there are differences in the conceptualization and intended mechanisms of SP. Therefore, the question is how theories are used in studies for the development and evaluation of SP.

Methods

A scoping review was conducted according to the JBI manual. Nine databases were searched without date limits. The extracted publications were independently screened by two reviewers. The inclusion criterion was the description of the use of a theory for a specific SP intervention.

Results

The search lead to 4,240 hits, of which 18 full-texts with 11 theories were included. The theories explain how SP works as an intervention (e.g., the Social Cure), inequalities in its effects (e.g., based on Bourdieu), or the implementation process (e.g., Normalization Process Theory). Similar endpoints are explained with different mechanisms by the theories. For example, the aim to improve a person's health is explained in the Social Cure theory through identification with social groups, while the Self-Determination theory describes how increasing intrinsic motivation through SP leads to behaviour change. All studies describe the use of theories for evaluation.

Conclusions

Few studies describe theories for SP interventions. The included theories differ significantly in their explanation of interrelations. The development of theory-guided intervention models for SP should be promoted to improve the evidence base through high-quality studies and to address social problems in general practice as effectively as possible.

Key messages

• The chosen theory for a complex intervention has an integral influence on endpoints and outcomes.

• Despite a proliferation of SP evaluation and research, little is described regarding the use of theory.
Preterm birth and stillbirth rates during COVID-19 pandemic: differences by socioeconomic status
Authors: Zeitlin J , Philibert M , Rihs T A , Draušnik Z , Gatt M , Engiom H M , Racape J , Szamotulska K , Barros H , Gissler M
Published: October 2023

Background

At the onset of the COVID-19 pandemic, there were concerns about maternal and newborn health because of increased stress, economic difficulties and restrictions to healthcare. However, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth (SB) rates remained stable or were slightly elevated. Hypotheses for the PTB result include positive consequences of lockdowns (more rest, less pollution, less exposure to infection) or restricted healthcare, leading to fewer indicated preterm births. These effects have not been examined on a population-level by socioeconomic (SES) group.

Methods

The Euro-Peristat network developed a Common Data Model and R scripts to produce aggregated data tables from vital statistics and birth registers. This analysis uses data from 2015 to 2020 on singleton PTB rates and SB rates as well as on mother's educational level (preferred) or area level deprivation/occupation of mother (if education unavailable). SES measures were harmonised into 3 groups (low, medium, high). We computed observed versus expected risks of the outcomes for the year 2020, given linear trends from 2015 to 2019, overall and by SES group; these estimates were pooled using random effects meta-analysis.

Results

19 countries provided data on perinatal outcomes by SES group. The overall pooled mixed effect measure for PTB was -0.04 (95%CI of -0.06 to -0.02), corresponding to a 4% decline in 2020 over expected levels. This estimate was the same in low and high SES groups (-0.04 (-0.07 to 0.02) versus -0.04 (-0.06 to -0.02)). For stillbirth, the overall pooled measure was 0.02 (-0.03 to 0.07), corresponding to an increase of 2%, with higher estimates in the low SES group 0.05 (-0.02 to 0.11) versus 0.2 (-0.3 to 0.7) in the high group, although confidence limits overlapped.

Conclusions

A small decrease in PTB was observed in all SES groups, while results are suggestive of increases in SB rates among women in lower SES groups.

Key messages

• Previous results in some countries of decreased preterm birth rates in the general population in 2020 were confirmed in this European study, with similar associations in all socioeconomic groups.

• Stillbirth rates were not increased in the overall population, but a 5% increase was observed in lower SES groups.
Stroke Pathway impact on healthcare processes and outcomes: a retrospective observational study
Authors: Di Pilla A , Camporesi J , Strumia S , Paolucci M , Cacciuttolo M G , Orsini D , Assorgi C , Specchia M L
Published: October 2023

Background and Aim

The Stroke Pathway performance assessment is a key quality improvement element in healthcare. The aim of this study was to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Northern Italy and the possible impact of the COVID-19 pandemic.

Methods

A retrospective observational study was carried out analysing data from 1/01/2010 to 31/12/2020. Data considered were: case volume and characteristics of patients undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3m-mRS) and NIHSS score 24 hours after the ischemic event onset (24h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one following it (March-December 2020).

Results

During the considered 10 years range, 418 patients underwent pharmacological thrombolysis. Treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher baseline disability level (from 0.22 to 1.22; p = 0.000). A statistically significant reduction was found for DTN (from 90 to 61 minutes average value; p = 0.000), so that in 2019 more than 50% and in 2020 more than 60% of patients were treated within 60 minutes (golden hour). Comparing pre- and COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS=1.18 vs 0.72, p = 0.048). The OTD increased from 88.13 to 118.48 minutes, although without a statistically significant difference (p = 0.197).

Conclusions

The study highlighted the Stroke Pathway positive impact, even during the COVID-19 pandemic, both on healthcare processes and patients’ outcomes. Nevertheless, both of them could be further improved through specific changes of the Pathway hospital phase and health communication actions.

Key messages

• Stroke Pathway hospital phase (DTN score) could be improved by starting thrombolysis in the diagnostic imaging department to further align with the international guidelines standards.

• Communication actions should be promoted to improve the Stroke Pathway pre-hospital phase (OTD score) providing the public with essential information to timely recognize stroke signs and symptoms.
Use of dyadic longitudinal interviews in health services research: a case example
Authors: Nielsen H S , Schmidt L
Published: October 2023

Introduction/background

Pregnancy loss (PL) is common (∼25% of pregnancies). PL has a negative psychological impact on women and growing evidence that partners are impacted too. Thus PL is a unique public health issue - a “couple” problem that affects both partners. With millions of pregnancies each year, a significant number of pregnant women and their partners will have experienced prior PL and may be vulnerable in pregnancy given their reproductive history. But are their needs met by the standard pregnancy care? This study used dyadic, longitudinal interviews to examine: what are couples’ perceptions of the health care and support provided in a subsequent pregnancy after PL and do their needs change across a pregnancy? The combination of dyadic and longitudinal methods is rarely used in health services research, but seems especially well-placed to examine how needs for health care change across the pregnancy and the perception of both partners.

Methods

Semi-structured dyadic interviews were conducted with 15 couples over four time periods across a new pregnancy after PL (after pregnancy test and once in each trimester). Couples were recruited from a national cohort of couples with PL. Interviews were held in person or via Zoom in Denmark. Qualitative dyadic and longitudinal interview data were analyzed using thematic analysis with a focus on identification of common themes within and across couples and trimesters.

Results and analysis

Dyadic data showed that both partners experienced anxiety and worry about the safety of the fetus and possibility of miscarrying. Longitudinal data revealed that couples believed that standard pregnancy care in the first trimester of pregnancy was insufficient for their needs. They wished for ongoing access to regular scans and close monitoring to provide reassurance and detect problems early. They reported that their needs for care were met through antenatal care provided in the later stages of pregnancy.

Key messages

• Dyadic longitudinal interviews generate nuanced data about a shared experience of receiving health care across a pregnancy.

• A better understanding of needs can inform development and provision of effective health care and support to fill identified gaps and promote overall family, maternal and infant health.
Cost-efficient child vaccination project results from hard-to-reach rural communities in Kenya
Authors: Shah M , Hasan M , Afeworki A
Published: October 2023

Child immunization is a cost-effective public health measure for reducing child morbidity and mortality. Child immunization coverage in Kenya has improved in recent years, with coverage rates for most vaccines exceeding 80%. However, there are still pockets of low coverage, particularly in remote or hard-to-reach areas. We implemented a community-based project to improve access and equity in child immunization services in three Kenyan counties (Nairobi, Wajir and Mandera). We trained health workers, promoted community acceptance, and provided logistical support to Ministry of Health (MoH) for child immunization services through community outreach centers. During the project period (January 2020 to February 2023), our project facilitated full immunization coverage for 93,879 children and we reached 200,554 community members whom we communicated relevant messages for recommended practice about health, nutrition and child vaccination. Our project achieved a 26 percentage-point increase (increased from 62% at baseline in 2020 to 88% at endline in 2022) in age-appropriate child vaccinations by end of the project. We also conducted a cost-efficiency analysis by taking the actual costs incurred and project achievements into account. The key results from the cost-efficiency analysis revealed approximate cost for a fully immunized child as 21 US dollar, while per capita cost for communicating health messages to community members and health care worker training was 10 US dollar. UNICEF estimated approximately 32 US$ as vaccine delivery cost (=total cost - cost of vaccine and supply) per fully vaccinated child with standard schedule for children < 24 months which is higher than the cost for ensuring a fully immunized child in our project. These data clearly indicate the efficiency and success of community-based approach for strengthening MoH child immunization services in Kenyan rural and hard-to-reach communities.

Key messages

• Strong collaboration with Ministry of Health and community participation are critical key aspects for implementing child vaccination program successfully and cost-efficiently in rural communities.

• Facilitating Ministry of Health for health system strengthening focus yields sustainable impact as footprint after end of a short-term of a community based project in developing country settings.
Health behaviors and cancer screening in family caregivers vs. general population
Authors: Hwang I , Kim K , Kim M , Lee S , Shin J , Cho B , Cho W , Kim H , Yoo S
Published: October 2023

Purpose

This study aimed to compare health behaviors and healthcare utilization between family caregivers of advanced cancer patient and general population.

Methods

Data of 158 family caregivers were obtained from one oncologic clinic and from 3,775 Korean adults aged 40 years or older who participated in the Eighth Korea National Health and Nutrition Examination Survey. Propensity-score matching was employed to match family caregivers with general population (1:1). We assessed health behaviors and healthcare visit, cancer screening, and influenza vaccination among two groups. Further, we performed subgroup analysis to explore factors associated with health behaviors and healthcare utilization of family caregivers.

Results

After propensity-score matching, the proportion of individuals performing moderate to high-intensity physical activity (MVPA) of 500 METs or more was higher in the caregiver group (p = 0.004). Also, the proportion of cancer screenings over a two-year period was significantly lower in the family caregiver group compared to the non-caregiver group (62.1% versus 73.1%, p = 0.045). In subgroup analysis, family caregivers with higher HADS depression scores were less likely to engage in MVPA, while those with higher HADS anxiety scores showed a significant decrease in healthcare visits. Family caregivers who received social care/economic support had an increased aOR in healthcare visits for own health (aOR 0.18 95% CI 0.04-0.91). Moreover, caregivers who had high competency and rewards were more likely to engage in MVPA.

Conclusions

The caregiver's has vulnerable aspects of and healthcare utilization, affected by their depression or anxiety. Social care/economic support was associated with improved health behavior and utilization of caregivers. Further studies for multi-dimensional support for caregivers’ health is needed.

Key messages

• Family caregivers, especially those with higher levels of depression or anxiety, face challenges in terms of their health and healthcare utilization.

• Social care/economic support is crucial in improving their health behaviors and healthcare access.
Food and Beverage Placement in Child Focused YouTube Channels: A Content Analysis Study
Authors: Almutairi L , Alqahtani A , AlHusseini N
Published: October 2023

Background

High exposure to food content encourages unhealthy dietary practices among children. Nowadays, children are exposed to many food products through social media, which influence their eating behaviors. Due to the growing social media use, the number of food advertisements via YouTube has increased. Therefore, regulatory agencies worldwide are investigating social media content to implement appropriate restrictions on unhealthy food marketing.

Methods

This quantitative content analysis descriptive study aimed to analyze all food content in the child-centric channels of Arabic speakers’ vloggers on YouTube in Saudi Arabia. The authors measured the food presentation, promotional techniques, and food product/type by quantifying the appearances of each variable in each video. The variables were analyzed as frequencies and percentages.

Results

Four of the top subscribed channels in Saudi Arabia were selected; 96 videos were analyzed by watching 17 hours. Food placements appeared in 65 videos (67.7%), with a cumulative duration of 304 minutes. Among videos that featured food and beverages, 87.7% of the vloggers consumed the food that appeared. The most commonly employed persuasive marketing techniques were emotional and taste appeals, with a percentage of 90%. Unhealthy foods comprised 66.8% of the total number of products that appeared in the analyzed videos.

Conclusions

This study highlights the high prevalence of low-nutrient food products on child-centric YouTube channels in Saudi Arabia, which may negatively impact children's food choices and eating habits. To protect children from harmful content on social media, it is recommended to develop comprehensive policies that consider the different challenges of regulating media content. Parents and caregivers should also actively monitor children's social media use and educate them on making healthy food choices.

Key messages

• Children might get exposed to a high prevalence of unhealthy food products through social media, which might have a negative impact on their food preferences.

• Comprehensive policies are needed to regulate food marketing on social media in order to protect children from harmful content and promote healthy eating habits.
Anti-Vaccination movement as a supracultural phenomenon
Authors: Vučurović M , Jovanovic V , Krcmar O
Published: October 2023

Background

Despite efforts by public health officials to counter the spread of anti-vaccine ideology, the movement continues to thrive in various countries and cultures. This study aims to answer the question of whether the anti-vaccine movement is a supracultural phenomenon that transcends national and cultural boundaries by identifying the anti-vaccine narratives in Serbia and comparing them to anti-vaccination narratives present in Germany, Brazil, India, United States of America, Australia, Canada, Nigeria and Japan. Answering this question can inform the development of targeted interventions and communication strategies to mitigate the negative impact of the anti-vaccine movement on public health.

Methods

For identification and understanding of the anti-vaccine narratives, qualitative research is conducted using thematic analysis via the folk model on 12 Serbian social groups on the internet chosen by the criteria of an existing anti-vaccine narrative. Systematic analysis of the topic-related literature from PubMed and Google Scholar and news articles and broadcasts provided information on present narratives in other countries.

Results

Comparative analysis of the acquired data has confirmed that two narratives are present in all countries. Distrust in the vaccine composition and benevolence of its components being one and another being the malevolent political agenda behind the vaccination.

Conclusions

This study has proved that the anti-vaccine movement is a supracultural phenomenon based on the recurring narratives in countries worldwide. The importance of this discovery for public health lies in the implication that only the unified international initiative to counter the anti-vaccine movements can hope to yield lasting results because, if confronted locally, movements can be bolstered from outside sources.

Key messages

• The anti-vaccine movement is a supracultural phenomenon.

• The anti-vaccine movement cannot be countered locally.
Efficacy of a lifestyle intervention for elderly in long-term care: a randomized controlled trial
Authors: Conti A , Concina D , Opizzi A , Zeppegno P , Gramaglia C M , Grossini E , Panella M
Published: October 2023

Background

Long term care (LTC) services represent an important element of worldwide health systems, providing medical care and social services to thousands of elderlies. In this setting inadequate food consumption and lack of physical exercise represent major causes of mortality and morbidity due to malnutrition, sarcopenia, osteoporosis, and dehydration. While it has been acknowledged that these conditions are potentially reversible with proper lifestyle medicine interventions, the latter are rarely implemented and evaluated in LTC owing to their intrinsic complexity.

Methods

A randomized controlled trial was conducted to assess the effectiveness of a three-months combined food-physical exercise lifestyle intervention in elderlies living in an Italian LTC facility. The diet was designed to provide high levels of energy, proteins, leucine, and calcium. The physical exercise treatment was delivered two times per week, with a moderate to high effort requested to subjects. At baseline and at the end of the intervention subjects were evaluated using the Barthel Index, Activities of Daily Living, and Tinetti scales.

Results

54 participants took part to the trial. At the end of the study the intervention group showed a significant improvement in all the scales. They burned 287 Kcal/week, significantly more than the control group. In contrast to the study protocol, they introduced 11% less calories than the control group.

Conclusions

This intervention has been proved effective in increasing functionality, with the beneficial effect that might be primarily attributed to the physical exercise, considering the low adherence to diet in the intervention group. This evidence supports the hypothesis that these interventions, despite the effectiveness, are complex to be powerfully implemented. While our results encourage the efficacy of lifestyle interventions in LTC, more studies are needed to deeply understand barriers and facilitators for an effective implementation.

Key messages

• This lifestyle intervention proved effective in improving functionality in institutionalized elderlies.

• The low adherence to diet highlights challenges and complexities of lifestyle interventions in LTC.
Belgian general practitioners’ perception and use of physical activity on prescription
Authors: Bensemmane S , De Pauw R , Keune H , De Schreye R
Published: October 2023

Background

Physical activity (PA) reduces 19.5% of the attributable burden of chronic diseases (CDs), i.e. healthy life years lost due to morbidity and mortality. In addition, 29.5% of Belgians self-declared having at least one chronic disease. Moreover, almost 30% of the population above 15 years old is at health risk due to physical inactivity. Evidence shows physical activity on prescription (PAP) has a positive impact on PA level and metabolic health. General Practitioners (GPs) can use PAP as a prevention intervention. In Belgium, overall 94,1% of citizens have a referring General Practitioner (GP) or are affiliated with a general practice. There is no national policy on PAP, only a regional policy in Flanders. Therefore, the aim of the study is to investigate the perception and the (potential) provision of PAP by Belgian GPs.

Methods

A cross-sectional survey was conducted in Belgian GPs between January and end of March 2023. The survey has 41 (ordinal or multiple choice) questions. Descriptive statistics were performed.

Results

134 GPs completed the survey of which 56% were female. 66.4% work in Flanders, 19.4% in Wallonia and 14.2% in Brussels-Capital region. Among respondents, 44% only discuss the benefits of PA with patients with a CD. Interestingly, less than 2% never discuss PA. 86.8% (would) prescribe if patients’ health status would be remedied by increasing PA, while 35.8% (would) use PAP if patients are inactive, regardless of their health status. About 75% identified chronic disease and exercise initiation as incentives for PAP. 41% would refer to PA (motivational) coaches, 55.2% to (adapted) PA courses. Lack of training (12.7%), time (49.3%), and knowledge of local PA offer (74%) were cited as barriers to using PAP.

Conclusions

The majority of responding GPs linked PAP with CD. Although there is no national implementation and regulation of PAP, GPs used (were ready to use) PAP in their practice. However, several barriers still hinder the use of PAP.

Key messages

• PAP is identified by Belgian GPs as a non-medical therapeutic strategy to counter health risks due to inactivity.

• There is a need to harmonise and facilitate PAP in Belgian primary care.
Planning engagement with web resources to improve health habits among home-working employees
Authors: Tognon G , Holfored D , Gladwell V , Murray K , Nicoll M , Knox A , McCloy R , Loaiza V
Published: October 2023

Background and objectives

The increasing popularity of remote work makes the implementation of health promotion initiatives at the workplace challenging, particularly in bridging the gap between employees’ intentions to adopt healthier habits and their actual actions. Previous evidence suggests that action planning can foster the adoption of healthier behaviors. Therefore, we investigated action planning in the context of reducing sedentary behaviour and improving dietary quality for remote workers.

Methods

A mixed-methods investigation of a web-based self-help intervention featured a randomized planning trial, quantitative engagement measurements, and follow-up qualitative interviews with a participant subset. For one work week, participants received access to 2-minute workout videos to reduce sedentary time and a balanced meal approach with recipe cards for weekly lunches and dinners. The intervention group was given a motion plan and a meal plan to execute these actions, while the control group only obtained access to the resources.

Results

Having a motion plan proved more effective in increasing engagement with online resources compared to the condition with no plan. In the follow-up interviews, participants noted that the plan served as a reminder to engage with the resources and simplified adherence to the exercise and meal recommendations. Ease of use and the ability to incorporate exercises and meals around work tasks were crucial factors in promoting resource adoption, while time constraints and concerns about colleagues’ perceptions of taking breaks to utilize the resources hindered adoption. Participants’ self-efficacy correlated with overall resource use but not with plan adherence.

Conclusions

Incorporating plans (motion and meals) into online self-help resources could boost their adoption and improve lifestyles among remote workers.

Key messages

• Incorporating plans (motion and meals) into online self-help resources could boost their adoption and improve lifestyles among remote workers.

• Ease of use and the ability to incorporate exercises and meals around work tasks were found to be facilitators of adoption.
Factor’s influencing primary teacher practices in health education, life skills, health literacy
Authors: Simar C , Genton M , Regnier V , Jourdan D , Chauvin F , Cury P , Pironom J
Published: October 2023

Background

A health-promoting school (HPS) approach was introduced over 25 years ago and has been promoted globally since; however, the aspiration of a fully embedded, sustainable HPS system has not yet been achieved, and very few countries have implemented and sustained the approach at scale. The Alliance for health aims to enact and assess the impact of a comprehensive approach to health promotion at the school and community levels. This is an intersectoral project involving regional education authorities, regional public health agency, local policy makers, researchers, and local health promotion operators. The question arises as to how to identify factors influencing teachers’ activity in wellness (WB), health education (HE), life skills (LS) and health literacy (HL)?

Methods

This project involves 101 French primary schools and 97 associated municipalities in the AURA region randomly selected in an intervention and control groups. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Each year, a questionnaire is distributed to teachers in order to monitor the development of their activity in the areas of WB, HE, LS and HL. 243 questionnaires are analyzed, collected from october 19 to March 20, 12 opening questions were analyzed (1591 items) in order to characterize their practices in the areas aboved. Based on this classification, factors contributing to activities were seeked by doing univariate, multivariate and exploratory factor analysis. Results:

The descriptive analysis showed that factors are linked to institutional, contextual, individual and collective dimensions. The results are preliminary and the complex analysis are actually in process.

Key messages

• A better understanding linked to their practices in health education, health literacy, like skills and well-being is needed to develop appropriate training and support.

• To develop adequate training and support in health promoting school, it's necessary to identify factors most linked to primary teacher practices in health education, like skills and health literacy.
Reducing loneliness in the community. More Together – a complex intervention in Denmark
Authors: Lasgaard M , Bo A F , Nielsen L A , Swane C E , Qualter P , Christiansen J
Published: October 2023

The mounting evidence that loneliness is a determinant of poor health and wellbeing underpins the need for effective interventions and community action. A public health approach to loneliness involving both targeted individual interventions and community-level interventions has been highlighted as a promising avenue. However, there is limited knowledge on how to effectively develop and implement such interventions. ‘More Together (‘Flere i Fællesskaber')’ is a large-scale, complex, multi-component and multi-level intervention for community change that addresses loneliness among young people and older adults in Silkeborg Municipality, Denmark. The intervention is inspired by the Collective Impact framework, it is practice driven and rooted in an extensive cross-sector partnership including institutions, organisations, and companies. The intervention, which is currently underway, is implemented in the course of a four-year period, and the overall effect will be assessed in a large impact evaluation. This presentation outlines (1) the organisation of the cross-sector partnership, (2) the structure of the intervention programme, (3) key components and activities of the programme and, (4) describes the intervention setting and target population. More Together aims to create new ways to develop, implement and evaluate loneliness interventions. Lessons that are directly supported by the project hold the potential to transform our understanding of loneliness interventions and may inform and guide future community-based interventions.

Key messages

• ‘More Together’ aims to reduce loneliness in Silkeborg Municipality, Denmark through a large-scale, multi-component and practice-driven intervention.

• The project has the potential to inform and guide future community-based interventions for loneliness and improve social health in the community.
Workplace health promotion embedded in medical surveillance
Authors: Magnavita N
Published: October 2023

The Total Worker Health© strategy is an advantageous and effective way of integrating prevention and health promotion in the workplace. The main critical points are the correct balance between prevention and promotion efforts and the extension of the projects to small companies. For several years now, in Italy, the Occupational Health Unit of the Catholic University proposed a model named Workplace Health Promotion Embedded in Medical Surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. The design of the project, the development of the investigative tools and the operating procedures are carried out by the University. The doctors in charge of the health surveillance of the workers in the various companies can join and receive the results free of charge. The data analysis is conducted by the University. Despite its apparent simplicity, the strategy required many years to develop, refine and validate the promotion methods. In recent years projects have dealt with: Eating behavior disorders; Post-COVID syndrome; Syncope and presyncope; Headache; Musculoskeletal disorders; Work engagement; Sleep health promotion; Aging and ability to work; Violence at work; Work organization; Indoor air quality; Mediterranean Diet. More than 30,000 workers participated and over 1,000 of them were invited to undergo diagnostic tests or treatments. The participatory character of the projects, their simplicity and cost-effectiveness, the integration between occupational medicine and basic medicine demonstrate that WHPEMS projects are economical, sustainable, and effective.

Key messages

• Workplace Health Promotion Embedded in Medical Surveillance Projects are economical, sustainable, and effective.

• The creation of a network of occupational physicians who are involved in WHPEMS projects respects corporate and professional independence and improves the work culture, health, and safety of workers.
Culturally-Relevant Physical Activity over the Lifecourse and Association with Chronic Disease
Authors: Sentell T , Mika Thompson M , Rodericks R , Schmid S , Pirkle C , Ching L , Look M , Wu Y Y , Finn J , Phillips M
Published: October 2023

Background

Culturally-relevant physical activity (PA) such as traditional dance shows significant promise in health promotion. Besides the value of the PA itself, these practices can also include important connections to culture, history, community, family, and the outdoors, promoting health and wellbeing. The primary study goals were to: (1) illuminate trajectories in lifetime participation in four culturally-relevant PA (surfing, outrigger canoe paddling, spearfishing, and hula) and (2) explore factors associated with engagement in these activities over the lifecourse, including gender, race/ethnicity, and chronic disease.

Methods

English-speaking residents in Hawai'i, USA (n = 1066) were recruited from an existing research panel to complete a questionnaire delivered online or by phone. Weighted quasi-Poisson and logistic regression models predicted engagement and self-reported chronic disease, adjusting for race/ethnicity, age, gender, and education. Significance was p<.05.

Results

Respondents were 50% female and 50% male. Over their lifetime, 64% of respondents participated in at least one of the four culturally-relevant PAs. Variation in participation was seen by type of culturally-relevant PA and over the lifespan. Engagement was highest during earlier periods of life and tended to decrease over age, but trends varied notably by race/ethnicity, gender, generation, and by the four PA types. For chronic disease, there was a general pattern of lifetime engagement in the four activities being related to lower likelihood of hypertension (with models for paddling and surfing showing significance). Lifetime engagement in surfing was significantly related to lower likelihood of diabetes.

Conclusions

Engagement in culturally-relevant PA was associated with lower likelihood for chronic disease. Trends varied notably by factors relevant for health promotion, planning, and policy to achieve health equity.

Key messages

• Engagement in culturally-relevant PA over the lifespan was associated with lower likelihood of chronic disease. Culturally relevant PA, including traditional dance, is relevant in Europe and beyond.

• Culturally-relevant PA can engage culture, history, community, family, and the outdoors supporting holistic health and wellbeing. This is an important area of future research and health promotion.
The use of social marketing approach in adolescent sexual health promotion
Authors: Putkonen H , Kallio H , Kylmä J , Rissanen T , Sormunen M
Published: October 2023

Background

To tackle adolescent sexual health challenges, sexual health promotion must be versatile and originate from adolescents’ needs. Social marketing, an audience-centered approach that aims at changing people's behavior, can be used in adolescent sexual health promotion. This scoping review researched the content and delivery methods of social marketing interventions in adolescent sexual health. To our knowledge, these objects have not been previously reviewed.

Methods

Six databases were searched to capture the peer-reviewed quantitative, qualitative, and mixed methods articles without time restrictions that provided evidence of sexual health-related social marketing interventions targeting adolescents aged 11-25. An inductive-deductive content analysis was performed. Nineteen studies were included in the data.

Results

The content of interventions included sexual risks, risk prevention, morals of sexual relationships, and changes in the body. Risks and risk prevention dominated the data, and they focused on sexually transmitted diseases, unwanted pregnancies, and sexual violence. Morals of sexual relationships included values such as fidelity toward one's partner, whereas changes in the body were observed from a reproductive perspective. Delivery of interventions occurred through various media channels, events, and activities.

Conclusions

The interventions were mostly preventive and concentrated on the risks, whereas the delivery methods were diverse and creative, combining modern and already well-established channels. Sexuality should be seen comprehensively, and interventions should respond to the full range of adolescents’ needs in a way that also positive aspects, such as love and relationships, respect, and equality are included.

Key messages

• The study improves public understanding of the phenomena by summarizing the existing knowledge.

• The results are beneficial in planning social marketing interventions and other sexual health programs.
Cervical cancer screening behavior of reproductive women in Rajavithi Hospital
Authors: Treesinchai S , Manmee C
Published: October 2023

Background

Cervical cancer is one of a public health problem and is the fourth most commonly occurring cancer in women worldwide. Cells change in women's cervix was a cause of Cervical cancer. In early stage, no signs or symptoms but it can be detected with pelvic examination for decrease severity of disease. This study aimed to determine cervical cancer screening and factors associated with cervical cancer screening in reproductive women.

Materials and Methods

This cross-sectional study was performed among 620 healthcare worker women in Rajavithi Hospital, Bangkok Thailand. Logistic regression was performed to identify factors associated with screening.

Results

Of the 598 (96.5%) questionnaires were returned; the mean age was 35.79±11.36 years, Body Mass Index (BMI) was 22.99±4.74 kg/m2, and most were single 64.5%. Most of participants were multidisciplinary personnel 45.0%. Cervical cancer knowledge was at high level (74.4%) while the attitude regarding cervical cancer screening was at a moderate level. The prevalence of cervical cancer screening was 37.5%; the three most reasons for not being screened was the absence of symptoms was (83.2%), followed by single status (24.6%) and no time for screening (19.0%). Factors associated with the screening included age (aOR=1.11, 95%CI 1.08-1.14, p < 0.001), marital status (aOR=2.74, 95%CI 1.55-4.86, p = 0.001), contraception use (aOR=4.27, 95%CI 2.42-7.53, p < 0.001), gynaecological disease history (aOR=2.93, 95%CI 1.58-5.62, p = 0.001), and sexual relation (aOR=1.83, 95%CI 1.01-3.32, p = 0.048).

Conclusions

The prevalence of cervical cancer screening was low. Demographic and gynaecological factors were involved. The organization should have a yearly campaign to increase cervical cancer screening behavior to prevent severity of the disease.

Key messages

• Cervical cancer is one of a public health problem in women worldwide, therefore cervical cancer screening is one of a significant prevention method to decrease severity of disease.

• Most healthcare workers have a good knowledge about severity of cervical cancer, while the prevalence of screening was low.
Risk of depression and distress in people aged 70+ in a rural area in Germany
Authors: Arndt S , Sisenop F , Lindert J
Published: October 2023

Background

Mental health of people living in rural areas is largely unknown. We aim to evaluate mental health of individuals aged 70+ in a German rural region.

Methods

We conducted a cross-sectional study (2018-2019). Participants were a representative sample living in a rural area. Main outcomes for this study were depression and general health (assessed with the PHQ-9 and the GHQ-28, respectively). As independent variables we assessed socio-demographics and access to care.

Results

Of the 460 participants, 140 (30.4%) were 70+ years old and 320 were between 18-69 (69.6%). The older age group was predominantly male (63.6%) and did not have university degrees (71.9%). 2.2% were employed. 2.1% reported depression symptoms (younger groups: 7.8%, p = 0.019) and 11.0% distress symptoms (younger groups: 28.0%, p < 0.001). Depression and distress were inversely associated with financial worries (p < 0.001). Higher education status was positively associated with depression (p = 0.051). Discussion: Older age was associated with less depression and distress. Results suggest that financial worries in old age contribute significantly to mental health conditions in old age. Interventions to reduce financial stress in old age are needed. Furthermore, longitudinal research is needed to evaluate how depression risk develops in rural areas in different groups.