bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing use of natural environments among immigrant women in Norway
Authors: Lorentzen C , Viken B
Published: November 2019

Background

Due to a high burden of health challenges among immigrants in Norway, and the documented health benefits of interaction with nature, Norwegian authorities have prioritized the promotion of outdoor recreation among immigrants. Success in this part of public health work presupposes knowledge about factors influencing immigrants` use of nature, which to date is scarce. The present study explores these conditions in a group of immigrant women in Norway.

Methods

We performed individual interviews with 14 first generation immigrant women aged 27-70 years from Iran (2), Poland (2), Palestine, Afghanistan, Congo, Kenya, Thailand, Russia, Portugal, Latvia, Colombia and Bulgaria. Data were analyzed by qualitative content analysis.

Results

Multiple and interrelated factors at the individual, relational, cultural/religious, and structural level influenced the interviewees` use of nature. Individual-level conditions included the interviewees` attitudes towards nature and their perceived control over making use of nature. Previous experiences with nature and role model influences shaped attitudes, and knowledge about outdoor life opportunities and appropriate clothing/equipment, and perceived security shaped perceived control. A major relational level barrier was the lack of access to companions for nature outings. A barrier at the cultural/religious level included the discomfort of wearing hijab/all-covering dresses in nature. Main structural level premises for use of nature included available time and economy and access to natural sites.

Conclusions

This study highlights multiple conditions influencing immigrant women in Norway`s use of nature. Public health actors should be aware of and take into account this knowledge.

Key messages

Factors influencing immigrant women in Norway`s use of nature are to be found at different levels of influence. Strategies for increasing immigrants` use of nature should be based on existing knowledge about influencing factors.
Advocating migrant and minority health in Bulgaria through an innovative education subject
Authors: Kamburova M
Published: November 2019

Introduction

Migrants and ethnic minorities often face serious inequities concerning their access to good quality health services. The Statement by the European Public Health Association on migration, ethnicity and health addresses the need of supporting public health policy makers by providing education courses.

The objectives of the teaching course “Migrant and minority health”, established in Medical University-Pleven in Bulgaria as optional additional subject, is to extend the specific knowledge of students (bachelors and masters of public health) and to develop competencies and skills of future public health practitioners and policy makers.

Results

The unique for Bulgaria course consists of 15 academic hours of the curriculum and ends with an electronically based test. Teaching methods include lectures, seminars and individual practical assignment and stresses on practice rather than theory. The training advocates migrant and minority health by presenting: the most important migrant’s social and health problems; impact of migrants’ health status on public health; the organization of healthcare in the recipient countries of migrants. The lecture course provides information for the main challenges facing healthcare professionals and the health system regarding the health of the migrants and main minorities groups, in particular the Roma as a predominantly ethnic minority in Bulgaria and Europe. The result of exam until now is good in 42.8% of students, very good in 14.2% and excellent in 42.8%. The curse enable public health professionals to acquire knowledge regarding to the international situation, critical assessment skills and the ability to implement appropriate strategies to address specific health problems.

Conclusions

The training meets the needs of in-depth knowledge of public health specialists in relation to the medical and social problems of migrants and minorities in Bulgaria. The positive experience gives ground to include it as part of basic curricula.

Key messages

The subject “Migrant and minority health” enhances student’s competencies as public health practitioners. Knowledge and skills are relevant to the EUPHA Statement on migration, ethnicity and health. By the subject “Migrant and minority health” public health practitioners may work to establish friendly health system with good quality of health services for migrants and Roma population in Bulgaria.
Adequate utilisation of emergency services in Germany: a differential by migration background?
Authors: Sauzet O , David M , Naghavi B , Borde T , Sehouli J , Razum O
Published: November 2019

Background

The role of emergency services (ES) is to provide a round-the-clock acute care. In recent years, inadequate use of emergency services has been internationally thematised because of overcrowding and the cost associated. There is only limited evidence regarding the pattern of utilisation of ES by populations with a migration background.

Methods

Consecutive patients visiting three ES in Berlin from July 2017 to July 2018, and who fulfilled inclusion criteria such as being conscious, were recruited into the study. A questionnaire covered medical conditions, reasons to visit the ES, and socio-economic factors. A criterion for the adequacy of utilisation was developed using a sub-sample of patients with information provided by physicians. Differences between migrants (1st generation), their offspring (2nd generation), and non-migrants were evaluated using logistic regression.

Results

2 327 patients were included, 901 had a migration background. The utilisation was adequate if the patient was admitted to hospital and/or if all three following criterion were fulfilled: reported to have been advised by a physician to visit the ES; reported strong pain; and reported a high perceived urgency (both ≥7 on a scale from 0 to 10). Adjusting for gender, age, condition and number of recent visits to ES, 1st generation migrants had a significantly higher chance than non-migrants to have an inadequate utilisation of services (OR 1.30; 95% CI [1.01; 1.68]). For 2nd generation persons, this was not statistically significant.

Conclusions

First generation migrants have a higher chance of inadequate ES use compared to non-migrants. A similar study 20 years ago had similar findings. This implies that existing information leaflets on ES addressing specific population groups are not sufficient to improve adequacy of use. Structural changes in the healthcare system as well as improved methods of communication respecting the needs of diverse subgroups of patients need to be considered.

Key messages

Existing information leaflets on emergency services addressing specific population groups are not sufficient to improve adequacy of use. Structural changes in the healthcare system as well as improved methods of communication respecting the needs of diverse subgroups of patients need to be considered.
Non-communicable diseases among refugees claimants in Greek refugee camps—are their care needs met?
Authors: Jervelund S S , Nordheim O , Stathopoulou T , Eikemo T A
Published: November 2019

Background

Little is known about the prevalence of non-communicable diseases (NCDs) among newly arrived refugees in Europe and whether their medical needs are met. The objective of this study was to investigate patterns of NCDs as refugee claimants migrate, whether refugee claimants experience unmet healthcare needs before, during and after flight when living in Greek refugee camps and to elucidate sociodemographic determinants for unmet medical care needs in the Greek refugee camps.

Methods

Survey data collected in 2016 among 267 newly arrived adult asylum-seekers staying at six refugee camps in Greece was used. The survey was available in English, Arabic and Farsi. We inspected frequency distributions of NCDs and unmet medical care needs, and using multiple logistic regression analysis, we estimated determinants for unmet medical needs in Greece.

Results

The majority had a good or fair self-reported health; yet, 17.1% suffered from 1 NCD, while 42.1% suffered from 2 or more NCDs. The most prevalent reported NCDs in Greece were: back or neck pain (26.6%) and severe headache (24.7%). The prevalence of most NCDs in the migration phases followed a U- or J-shaped pattern: decreased during migration and increased after migration to Greece. Unmet medical care needs were reported by 41.3% with one NCD after arrival in Greece. Compared with young adults, adults aged 51+ years were in increased risk of reporting unmet medical needs in Greece [odds ratio = 7.59; p = 0.015].

Conclusions

The high number of persons who report NCDs underscore the need for availability of diagnostic tools and agents to ensure that the refugee claimants receive the right healthcare assistance. Tools and guidelines to provide continuity of NCD care when people migrate are likewise important. Many European countries that receive this group of refugees should take the disease patterns, including multi-morbidity, into consideration when planning for health reception and the organization of healthcare.

Key messages

The prevalence of NCDs among refugee claimants decreased during migration and increased after migration to Greece. Unmet medical care needs were reported by 41.3% with one NCD after arrival in Greece.
Access to health care among people with foreign background and the general population in Finland
Authors: Kuusio H , Seppänen A , Lilja E , Vehko T , Jokela S , Koponen P
Published: November 2019

Background

Prior studies suggest that people with foreign background (PFB) often face problems in access to health care, although access to care may vary between the different PFB groups. This study explores 1) the potential differences in perceived access to care between different PFB groups and the general population, and 2) if marital status, education, employment, self-perceived health, long-term illness, length of stay, age moved to Finland or language skills are associated with access to care among PFB.

Methods

The data were gathered from the cross-sectional survey on well-being among the PFB (FinMONIK), conducted in Finland 2018. Its random sample consisted of 12 877 persons, aged 18-64 years and the response rate was 53%. Three items were used to assess perceived access to care: I was able to contact the place of care smoothly, I was able to make an appointment without undue delay and I was examined without undue delay (e.g. laboratory tests, X-ray, ultrasound). Logistic regression was used to test which factors were associated with accesses to care, adjusted for age, sex and region.

Results

After controlling for age, sex and region, the results showed significant differences in access to care among different migrant groups and the general population (p < 0.001). Of those of Estonian background 37% felt that access to care was smooth while only 17% of those coming from Middle-East, and 26% of the general population. Employed persons, persons who had good self-perceived health, and people with no long-term illness, and those who had lived in Finland less than five years, had better access to health care. Marital status, education, language skills and age moved to Finland, were not associated with access to care.

Conclusions

Large inequities in access to care were identified among people with foreign background. Access to services seems to be better for employed persons and those who have good self-perceived health.

Key messages

Special attention should be given to improve access to care among non-employed migrants. Migrants should not be considered as a uniform group when planning services.
Mental health treatment gap in adults of Russian, Somali, and Kurdish origin in Finland
Authors: Cilenti K , Rask S , Kuusio H , Castaneda A
Published: November 2019

Background

Migration affects migrating persons’ health in many levels. Populations of migrant origin, and in particular refugees, are known to have an increased risk of mental ill health. Previous research from Finland has shown that the prevalence of mental health symptoms is significantly higher among Russian origin women and Kurdish origin men and women than in the general population. Building on prior research, we explore the prevalence of perceived need for mental healthcare among Russian, Somali, and Kurdish origin populations and compare this to the general population in Finland. Additionally, we present prevalence of mental health treatment gap in these groups.

Methods

We used data from the Finnish Migrant Health and Wellbeing Study (n = 1404) and the Health 2011 Survey (n = 1459). Prevalence was calculated using predicted margins (95% confidence level). P-value of less than 0.05 was considered significant. Mental health treatment gap was examined by constructing a combined variable of perceived need for mental health services and prevalence of service use.

Results

The perceived need for mental health services was higher in Kurdish origin persons (16%) and lower in Somali origin persons (<1%) than in the general population (8%). Both Kurdish origin men (11%) and women (20%) expressed more need for mental health services than men (4%) and women (11%) in the general population. The mental health treatment gap was highest in Russian origin women (10%) and Kurdish origin women (10%) and men (8%). For the general population, the treatment gap was only 1% (men 2 %, women <1%).

Conclusions

Untreated mental health problems are unjust, problematic and can be a source of great human suffering. Evidence from Finland shows that especially persons of Kurdish origin experience a mental health treatment gap. To expand coverage and reduce inequalities in health services, national development projects (e.g. PALOMA) have been launched to improve mental healthcare.

Key messages

Perceived need for mental health services is more common among certain foreign-born populations than the general population in Finland; this is in line with prior research on mental health symptoms. Untreated mental health problems are unjust, problematic and can be a source of great human suffering; evidence of mental health treatment gap should lead to improved access to mental health services.
Health among immigrants in Norway, results from the Living Condition Survey among immigrants 2016
Authors: Kjøllesdal M K , Straiton M L , Øien-Ødegaard C , Aambø A , Holmboe O , Johansen R , Grewal N K , Indseth T
Published: November 2019

Introduction

To manage immigrants` health needs is an important challenge for the society. This report gives knowledge about the status of immigrant health in Norway, which can be used in planning of health services.

Methods

Statistics Norway carried out a Living Condition Survey among immigrants in 2016. We report the prevalence of health outcomes (self-reported health, cardiovascular diseases, hypertension, diabetes, back- and neck problems, impaired functioning, mental health problems, problems with sleeping, overweight) and lifestyle (alcohol, smoking, physical activity) by country of origin and assess associations between health and sociodemographic (age, education, income) and migration related (age at immigration, duration of residence, Norwegian proficiency) variables, as well as discrimination and employment. Immigrants from twelve countries were interviewed. The questionnaire was translated into the main languages in the twelve countries and English. In this report, 4399 participants aged 16-66 years were included.

Results

There were large variations in health according to country of origin and gender. Immigrants experienced a deterioration in health at younger age than non-immigrants did. The educational gradient in health was less pronounced among immigrants than among others. Perceived discrimination was related to mental health problems. Some immigrant groups had a high proportion of smokers. In most groups a considerable proportion was drinking alcohol and a low proportion were physically active.

Conclusions

Future research should take into account differences in health according to country of origin and gender. The importance of physical and social circumstances for immigrant health emphasizes the need for structural population-based initiatives to promote health.

Key messages

Immigrant health varies by country of origin and gender. Physical and social environment is important for immigrant health.
Empowering minor migrants: peer support program Nantes
Authors: Combes S , Kardiana D , Le Grand E , Moreau D , Quinette M , Sauzède S
Published: November 2019

Background

Under-aged migrants (UAMs) may see their legal minority unrecognised by the French state. If they confront this decision at court, they stand in a legal void. They can benefit from a direct access to State Medical Aid and are not submitted to a minimum period of 3 months of staying in France unlike adults. Moreover, when accessing care, unrecognised UAMs are in an unclear situation as they are minors without legal representation. This research is based on a newly created program ran by Doctors of the World (MDM) in Nantes, aiming to enhance UAMs access to health care and rights through peer-support. Peer-support is intended to develop the empowerment the UAM and help them to be able to be the authors of their life thus develop their own abilities (Le Grand, 2018). The role of empowerment in health access is established (Wallerstein, 2006). The research aims at identifying the obstacles and levers in the implementation of the program, the modifications it can cause in the program.

Methods

The research is based on 3 months ethnographical observations, 9 formal interviews with UAM, 5 with professionals, and informal interviews.

Results

We identify that volunteers share a different perception of what is empowerment. Some would leave quite a large autonomy to UAMs while others find it difficult to alter the organisation to give space to UAMs. Finally, self-help mainly develops abilities of those UAMs who were more resourceful.

Conclusions

The analysis shows that a successful program of empowerment rely on shared views of its meaning. Moreover it shows that empowerment may help mainly those resourceful thus exacerbate some inequalities in ressources.

Key messages

The notions of empowerment and peer-support need to be well understood by all. Empowerment, as a side effect first exacerbates some inequalities of resources among UAMs.
Training development in the ORAMMA (Operational Refugee and Migrant Maternal Approach) project
Authors: Petelos E , Vivilaki V , Papadakaki M , Sioti E , Triantafyllou E
Published: November 2019

Background

ORAMMA is a European capacity-building project (GR, NL, UK) for pregnant migrant, asylum-seeking and refugee (MAR) women to improve maternal and newborn outcomes. ORAMMA is an operational and strategic approach for mother-centred, community-oriented, gender-sensitive, interdisciplinary and compassionate care, to meet the needs of MAR women in Europe.

Objectives

ORAMMA developed training for midwives and other primary health and social care (PC) professionals to meet the needs of MAR women. Methodology comprised three phases: evidence synthesis and needs assessment, training material development, and community enablement through locally recruited women in the innovative role of Maternal Peer Supporters (MPSs).

Results

Needs assessment highlighted the need to train ORAMMA’s teams of midwives and other PC professionals to care for women who suffered undue hardship, oftentimes leading to PTSD, i.e., victims of trafficking, rape, underage women, sufferers of acute or chronic conditions, and sole family carers. The experiences encountered informed curriculum development for midwives and other PC professionals. Interprofessional training for integrated perinatal care delivery was developed for and delivered in three phases, i.e., detection of pregnancy (GP coordination), care during pregnancy (midwive coordination), and support after birth (social worker coordination), with special modules developed in a participatory manner on: migration status and policies, maternity care for MAR women, and communication and culturally sensitive practices.

Conclusions

Training midwives and other PC professionals along with members of MAR communities in the MPS role was identified to be a key element to efficiently support women and their families, to propagate key perinatal and public health messages, and to advocate for the rights of MAR women to ensure access equity to quality care in a highly responsive manner. ORAMMA’s tools are available in easily accessible platform online.

Key messages

ORAMMA developed multilingual material to meet the needs of PC professionals and of MAR women, in an innovative manner and with high relevance for cross-border knowledge transfer. ORAMMA addressed key aspects in delivery and access, focusing on cultural awareness and communication; its relevance extends well beyond perinatal care to improved family outcomes and public health.
Ethnic differences in participation in diabetes education programmes
Authors: Juul A , Glümer C , Jervelund S S , Hempler N F
Published: November 2019

Background

Immigrants from non-Western countries have a higher prevalence of type 2 diabetes. In addition, immigrants have an increased risk of developing diabetes complications, compared with the general population. Diabetes education programmes facilitate essential knowledge and skills that enable people to manage their condition in daily life. However, fewer immigrants attend and complete diabetes education compared with the general population. The aim of this study is to explore what characterises those who decline and accept participation in diabetes education in relation to ethnicity, household composition and diabetes burden in the family.

Methods

The study population consisted of adults with type 2 diabetes referred to a municipal diabetes centre (n = 1819). Individual medical record data was linked to national registry data. Descriptive statistics and logistic regression models were applied.

Results

Preliminary results showed that 23% of individuals from the study population participated in diabetes education. We found no overall differences in participation rates between the general population and non-Western immigrants (24% vs. 18%, P = 0.12). However, when examining the immigrant groups by language (Arabic, Urdu and Turkish), the results indicated a non-significant tendency: Urdu speaking groups’ participation was similar to the general population (24%), whereas Arabic and Turkish speaking groups had lower participation rates (17% and 11%, P = 0.25/0.40).

Conclusions

The results suggest that there are differences in participation between some immigrant groups and the general population. Increased knowledge about which mechanisms affecting participation in diabetes education programme is required to ensure equal access. Further studies and analyses will explore how immigrants’ social relations enable and/or hamper participation in diabetes education and investigate which factors can be changed to improve participation rates.

Key messages

There are differences in participation in diabetes education programmes across different ethnic groups, which suggests a need for in-depth analysis into which mechanisms that affect participation. The results will be used to give input for future practices that can increase immigrant’s participation and retention in diabetes education programmes.
Maternal country of birth and in-hospital exclusive breastfeeding: results from a Portuguese study
Authors: Lisi C , Freitas C , Barros H
Published: November 2019

Background

Breastfeeding provides benefits for children, mothers, society and the environment. The promotion of optimal breastfeeding, from an early stage in life is, therefore, a public health priority. Infant feeding can be influenced by maternal country of birth. However, studies carried out in European settings point to inconsistent findings. This study aims to compare first day in-hospital exclusive breastfeeding among migrant and native women in Portugal.

Methods

This study is based on a national project on perinatal health among migrants and natives in Portugal (baMBINO). Out of 39 public maternity units in mainland Portugal, 32 were enrolled. Women aged 18 years old or older with a live birth were recruited. The final sample included 5109 participants (2431 natives and 2678 migrants). Logistic regression was used to assess the association between maternal country of birth and in-hospital exclusive breastfeeding.

Results

Migrant participants included women from Portuguese-speaking African countries (PSAC) (49,7%), Brazil (18%), Eastern Europe (10.2%), other European countries (9.6%), Asia (5.5%) and other countries (7.0%). No differences were found between migrants and natives, with the exception of women from PSAC who were more likely to exclusively breastfeed during the first day of hospital stay (aOR 1.34 CI95% 1.05-1.72), irrespective of maternal age, education, parity, type of pregnancy, reproductive assistance, tobacco use, gestational age, newborn birth weight, mode of delivery and antenatal care.

Conclusions

In Portugal, women from PSAC are more likely to exclusively breastfeed their babies during the first day of hospital stay when compared to native women. Strategies to maintain healthy breastfeeding practices in this population are fundamental.

Key messages

Women from PSAC are more likely to breastfeed exclusively in the first day after delivery than Portuguese natives. They should be supported in the maintenance of optimal breastfeeding practices.
Illness behaviour and health needs in migrants characterised by low satisfaction with healthcare
Authors: Reime B , Tufan M , Tkachenko E , Sahbaz M , Warth P , Weidmann C
Published: November 2019

Background

Previous research shows inequalities in access to and quality of health care for migrants. We aimed to explore in what way individuals with a migrant background, who report different levels of satisfaction with healthcare, differ in terms of illness behaviour, health needs and sociodemographic characteristics.

Methods

In the rural Southwest of Germany, we conducted a survey with individuals who have a Turkish (n = 217) or Russian (n = 101) background and whom we could contact via cultural centres. Data were analysed using SPSS.

Results

In the total sample, 47,5% (Turks 53%, Russians 37%) reported always being satisfied with healthcare, 46,9% were sometimes and 5,7% never satisfied. Turks who were not always satisfied with healthcare significantly more often did not have a regular GP, and rarely visited GPs and consultants. They more often reported the need for culture sensitive print material, assistance in applying for ambulant care and culture sensitive treatment in matters such as intimacy and death and dying. Also, they more often demanded accessibility to healthcare providers with the same cultural background compared to Turks who reported more satisfaction with healthcare. Among Russians, not always being satisfied with healthcare was associated with demanding culture sensitive information on ambulant nursing care and demanding more cultural competence in providers regarding the treatment of particular diseases. Gender was not related to satisfaction with healthcare in either group.

Conclusions

In this sample of migrants from a rural area culture sensitive treatment was reported to be lacking especially in ambulant nursing care and end of life treatment. In view of the increasing heterogenization of society, it is necessary to address the socio-cultural needs of migrants in a home as well as in a hospital context. Therefore, culture-sensitive materials and workshops for health professionals may be useful to complement their own expertise.

Key messages

A low level of satisfaction with healthcare may be related to low levels of utilization. In this underserved rural area concerns regarding culture sensitive care need to be addressed.
Patient information ownership in the age of digital health and big data
Authors: Mirchev M
Published: November 2019

Background

In the context of digital health and the increasing capabilities to derive, store and use information, Big data, and data analytics provide an exceptional perspective towards the evolution of medicine and public health. We collect patient data at unimaginable scale thanks to technological improvements such as wearables, sensors, smart and mobile devices. We are digitizing health on our way to improve cares. The other side of the coin reveals specific issues: it is all about personal information. The risks we face in regard to privacy, autonomy and ultimately justice are worth debating.

Aim

To consider whether ownership of patient data in the context of digital health and Big data is a good way to guarantee both privacy and the social interest in the field of public health.

Methods

Historical, documental, ethical research.

Results

The abilities to collect and store zettabytes of health-related information is spectacular, but learning how to structure and optimize the use of this information is pivotal for the future of public health. People are sensitive in terms of “ownership”, rights and privacy, although the idea for actual ownership of health information is not quite popular. Given the fact, that it is personal data, a lot of concerns are related to ensuring privacy. One way to do it is by recognizing patient ownership over their data. The major issue with this, is that it might limit, or even prevent public interest, and so the public benefits. Having in mind the huge commercial interest in health data, that concern looks relevant. When applied in healthcare Big data has the potential to provide important data analytics, which means that we can move to next step in healthcare development - improving disease prevention and health promotion, which are vastly ignored in favor of clinical care. In this specific environment, it is highly questionable whether patient`s ownership would bring more benefit, than harms in the shared goal of improving healthcare.

Key messages

What people might do if their health data is their property, might reflect in a bad way the common goal to structure and use it for health improving. Patient data ownership might not be reasonable in the long run, even though from an ethical standpoint and with regard to patient`s autonomy looks fair.
Infographic as a form of communication in public health
Authors: Machala Poplašen L , Draušnik Ž , Vočanec D , Brborović H
Published: November 2019

Background

Infographics are a communication tool used in the digital environment that can present information, data or knowledge in an easy and understandable way to a wider audience. The aim of this study was to analyze if, and in which areas of public health, infographics are used as a form of communication in Croatia in relation to the world.

Methods

The research analyses available infographics of leading institutions in public health in relation to Croatia and the world.

Results

Visualization of key information is an accustomed concept in public health with infographics being a recognizable form of communication and an important part of digital health. However, only a small number of infographics in public health in Croatia are used. Infographics published in Croatia were mainly about exercise, cancer, ageing and stress. In the European Union, the topics found were aging, risk assessment, harassment/violence in the workplace and work-related stress. Infographics from the world addressed child labour, youth employment, gender equality, better work, dialogue promotion, migrant workforce, migration, domestic workers and safety at work. Moreover, International Labour Organisation made interactive media containing infographics - infostories - with topics: young workers, gender gap, migrants, non-standard employment, disability inclusion, forced labour and collective bargaining.

Conclusions

We suggest to include more public health topics and to raise awareness among Croatian public health experts on the importance of infographics as a form of communication.

Key messages

Visualization of key statistical data in the style of infographics enables public health professionals to educate their employees and the public. Infographics are excellent tools for communicating important topics and are more likely to drive action and change behavior.
Use of social media in public and private hospitals in Italy: preliminary results
Authors: Gelatti U , De Bernardis A , Covolo L
Published: November 2019

Background

In 2010, the Italian Ministry of Health set out recommendations for the use of Web 2.0, inviting organizations within the Italian National Health Service (INHS) to implement these tools. In 2014, a study carried out by the National Institute of Health showed a low presence of Local Health Authorities and Italian public hospitals on social media. Considering the constant increase of the use of social media in the population, the aim of the study is to understand if and how healthcare context is moving towards this direction.

Methods

The list of all public and private hospitals in Italy were retrieved by the official website of INHS. The websites of all the hospitals (n = 1054) will be visited to look for the presence of social media. Engagement level and use of social media will be evaluated.

Results

A preliminary analysis focused one 97 hospitals, of which 64 public and 33 private. Social media are present in 38 (39%) of them, particularly Facebook, Twitter and You Tube (92%). Only Twitter or YouTube are present in three hospitals. Social media are present more in hospitals in the North of Italy (58%) compared to Center (29%) and South (13%) (p = 0.002). Furthermore social media are present more in private hospitals than public (55% vs 44%, p < 0.001).

Conclusions

Preliminary results show a low presence of hospitals on social media, with some differences between geographical areas and type of hospitals. Adherence to Ministry of Health’s recommendations seems still low.

Key messages

Public health communication need to implement new strategies to increase public participation and provide reliable information using the information channels most used by the population. Considering the spread of health information through social media, an active presence of healthcare organizations on these channels could be an opportunity to engage people in health interventions.
Addressing equity in eHealth interventions for healthcare system users & patients, literature review
Authors: Ramel V
Published: November 2019

Objective

eHealth has great potential to improve access to health information and care but important barriers to equity still exist and a real digital divide threatens its use. It is therefore necessary to build a conceptual framework on digital health interventions aiming at promoting equity and to analyse the strategies and recommendations that arise through the literature. Such a conceptual framework has not been identified in the literature yet.

Methods

We carried out a scoping literature review of the scientific literature since 2000 in Western countries, in Scopus, PubMed, PsycArticles, SocIndex and PBSC.

Results

Strategies that take into account equity in eHealth for healthcare system users and patients can be presented in light of the five key action areas of the Ottawa Charter for Health Promotion. They deal with the policy level, the individual one, aim at creating supportive environments, at using the community level for eHealth promotion and focus on health services. Individuals-oriented interventions are the most reported, thus revealing a lack of systematic thinking and certainly a lack of understanding of the whole spectrum of health determinants.

Conclusions

Following Gibbons’ expression of “compunetics” (Information and Communication Technologies & ethics), interventions that truly consider the unintended consequences of eHealth on social and geographic health inequalities are absolutely necessary. The conceptual model analysing the whole literature on this interaction makes it easy to understand the types of interventions that are or could be carried out to tackle equity issues in digital health interventions. Its recommendations become easy to implement in the field and can be extremely helpful for decision-making.

Key messages

Strategies that take into account equity in eHealth for healthcare system users and patients can be presented in light of the five key action areas of the Ottawa Charter for Health Promotion. The conceptual model we elaborated makes it easy to understand the types of interventions that could be carried out to tackle equity issues in digital health interventions.
Women political empowerment and child health: an empirical analysis, 1990-2016
Authors: Besnier E
Published: November 2019

Empowering women has been presented as a key strategy to improve child health. Yet, the literature on the subject is mixed, with strong variations in measures or according to context. Additionally, most of the research focuses on social or economic empowerment at the individual level rather than on structural factors or political empowerment. In this study, we explore whether women political empowerment is associated with improved health for children under 5 years old, in comparison to socio-economic empowerment or structural factors from the sustainable development agenda.

We use the V-Dem project’s Women’s Political Empowerment Index and its components, combined with selected indicators of child health from the World Bank’s World Development Indicators for 166 countries, between 1990 and 2016. We estimate random- and fixed-effects regressions for the index as a whole and its individual components against child mortality, stunting and immunization coverage, controlling for structural and socio-economic indicators.

The association between women political empowerment and child health outcomes tends to weaken once country heterogeneity is accounted for. Looking at individual components of women empowerment, factors or markers of socio-economic empowerment tend to have a stronger positive effect on child health compared to more political ones, for which we found either no correlations or even detrimental links to child health outcomes.

Our results demonstrate the complexity of the relations linking women empowerment and child health. Presenting women political empowerment as a whole as the solution to improved child health appears misguided. However, selected individual freedoms and markers of women socio-economic empowerment are associated with positive effects on specific child health outcomes. This calls for a more context-specific yet multi-dimensional approach to women empowerment and child health in order to provide cohesive evidence to achieve the related SDGs.

Key messages

The relations between different dimensions of women empowerment and child health are complex. Women socio-economic empowerment may offer better leverages than political empowerment to improve child health.
Is the French Emergency Medical Service System duplicable in developing countries?
Authors: Rossinot H , Lapandry C , Adnet F , Carli P , Lecarpentier E , Baer M , Veber F
Published: November 2019

Issue

The management of pre-hospital emergencies is a growing issue in developing countries, particularly because of the increase of both road accidents and cardio-vascular diseases.

Description of the problem

Numerous countries have tried or are currently trying to develop emergency response systems like the French SAMU but the outcome of those actions show a lot of difficulties. It is however proved that efficient care of serious pre-hospital medical emergencies significantly improves both patients’ mortality and morbidity.

Results

AP-HP, Greater Paris University Hospitals, has a strong experience of supporting the development of this model of care in countries with limited resources. Most of last 30 years’ experiments have been reviewed to understand what the essential prerequisites to succeed in setting up an emergency response system such as SAMU are. The analysis (5 criteria evaluation: efficiency, sustainability, effectiveness, impact, relevance) of past and present experiments in 28 countries showed that main issues are political (what are the priorities?), financial and societal (what does the population expect?). The question of medical resources is also crucial as the French model introduces medical regulation at all levels. Moreover, in France, such a system is built as a health care pathway with a predetermined orientation towards the appropriate and operational structure, which unfortunately is not the case in a lot of countries. Aside from those realized in China or in some Southern American countries, most of the projects so far don’t match all the evaluation criteria, particularly sustainability, as it is based both on stable funding and a strong reactivity of local hospitals.

Lessons

Future projects will have to fit with the local context. Strong commitments from partner countries must be made on the long term to have a real impact.

Key messages

There is no universal system easily duplicable. Some major prerequisites must be identified and implemented to succeed in the set-up of an efficient and sustainable EMSS.
From deliberative dialogue to impact: envisioning kmowledge translation
Authors: Hobden O , Borst R A J , Al-Metleq A , Kok M O
Published: November 2019

Background

The previous decades of research have contributed tremendously to the improvement of health. Nonetheless, problems remain regarding the use and relevance of public health research. Knowledge translation methods, such as deliberative dialogues, are believed to increase the use and relevance of such research. However, little is known about how they increase the impact of public health research. This study sought to trace the impact of deliberative dialogues through an actor-scenario approach. Actor-scenario mapping asks key actors to describe how and by whom research findings may potentially be used. This allows for constructing more concrete action plans.

Methods

This study used a qualitative case-study design with semi-structured interviews, participant observation, and a survey. The study focused on a Jordanian deliberative dialogue organised in April 2019. Interviews were conducted with 15 key stakeholders before and after the dialogue. Observations and surveys were collected during the dialogue. An abductive approach to thematic analysis was used to arrive at key themes for the report.

Results

The results show that dialogue participants found it difficult to propose concrete scenarios for action. They described that the sensitive nature of some research topics impairs action. Additionally, participants proposed that research funding should be earmarked for concrete actions. Overall, their scenarios proposed that high-level decision makers maintain involved in the knowledge to action process. Some participants mentioned that the articulation of scenarios for action contributes to research impact, since researchers usually do not engage with potential users.

Conclusions

Actor-scenario mapping is an innovative way of understanding how deliberative dialogues increase the impact of public health research. This scenario approach can inform the organisation of deliberative dialogues by actors such as EVIPNet.

Key messages

Actor-scenario mapping can trace the impact of deliberative dialogues. The scenario approach can better align the dialogues with policy and practice.
Strategies and measurement for global health governance assessment: a 5-years mixed review
Authors: Damiani G , Pettinicchio V , Markovic R , Rosi L
Published: November 2019

Global health governance is defined as the use of institutions, rules and processes “to deal with challenges to health that require cross-border collective action to be addressed effectively”. Several studies on this have been published, but there is no consensus about the measure of its various aspects. The aim of this study was to search for strategies used by healthcare systems to evaluate their care in global settings and for shared indicators to assess global health governance worldwide.

This systematic analysis of qualitative and quantitative studies was conducted according to the Population-Intervention-COntext model and the Population-Intervention-Comparison-Outcome models, using search string “global health and governance and assessment”, from 2014 to 2018 (in biennium 2013-14 WHO and others identified health governance as a global priority). Articles that reported quantitative and/or qualitative evaluation on global health governance were included.

Outcomes were screened by title and abstract, and then by full texts in order to assess eligibility.

From a total of 98, six studies met inclusion criteria. 4 main strategies of global health governance were identified: intersectoral policies (demographic factors, sanitation practices, housing characteristics and social behaviors); food and nutrition, caring to strengthen country-owned governance capacity (high levels of governance are associated with signing up initiatives for undernutrition prevention, OR = 30); disability and rehabilitation, crucial for realization of the right to health; risk factors control and non-communicable disease prevention (tobacco control).

Two set of indicators were found: an expert-informed framework for assessing rehabilitation and a set of primary data sources to evaluate nutrition in fragile countries. Although lots of evidence in literature about globalization, only few areas are adequately measured. Literature about this topic should pay attention to assessment.

Key messages

In literature, four local areas were identified having perspective of global health governance: intersectoral policies, nutrition, rehabilitation and non-communicable disease prevention. For two of these areas, nutrition and rehabilitation, shared patterns of indicators were found, from primary data sources and expert consensus.