bluuebunny/crossref_metadata_2025_split huggingface dataset:
9.I. Workshop: Health systems performance – making the links between what we do and what we want to achieve
Authors:   Organised by: WHO, UHC2030, European Observatory,   Chair persons: Dheepa Rajan (Switzerland), Marina Karanikolos (UK)
Published: October 2021

Abstract

In this session, WHO together with the UHC2030 Technical Working Group on Health System Assessment and the European Observatory on Health Systems and Policies discuss the main elements of their joint approach to HSPA. The workshop intends to propose a common and practical framework that links descriptive health system analysis with evaluation, focussing on health system outcomes. The framework's approach to uncovering health system challenges and bottlenecks and the sources of variation will be discussed - showcasing how Health System Performance Assessment can be used as a means to uncover sources of health system inefficiencies and inequities. The workshop intends to identify the links between intermediate and ultimate goals and relate these to specific actions and actors within a health system, thus providing policy makers with an actionable tool to assess performance. The session is structured into two parts. In the first part the process of developing the HSPA framework and the framework itself will be introduced. The presentation will provide insights into the joint framework based on health system functions and emphasise the links to the intermediate and final goals of the HSPA framework. This will be followed by four short case studies pertaining to the four functions - governance, financing, resource generation and service delivery - and linking specific assessment areas to intermediate and final goals. The second part is an interactive discussion, to be kicked off by the input of Kanitsorn Sumriddetchkajorn and moderated by Josep Figueras, to jointly identify the strengths and weaknesses in performance of a given health system.

Key messages
Health Systems Performance Assessments should focus on what health systems do and how well, rather than on what they are. Health System Performance Assessment should focus on performance and use their evaluative angle to get to the root causes of not achieving final health system goals.
Patient safety attitudes in the next generation of healthcare providers. A review of the literature
Authors: Tocco Tussardi I , Benoni R , Moretti F , Tardivo S , Poli A , Wu AW , Rimondini M , Busch IM 
Published: October 2021

Abstract

Background
A comprehensive understanding of the attitudes towards patient safety of the new generation of healthcare workers is fundamental not only for ensuring safe, high-quality care in the present but also for creating a safer healthcare setting in the future. This study aimed to systematically review the literature on patient safety attitudes of health professional students, new graduates, newly registered health professionals, and resident trainees, and to examine potential differences in this population with respect to year of study, specialty, and gender.

Methods
We searched four databases (i.e., PubMed, Web of Science, Scopus, and PsycInfo) up to 20/02/2020 and screened also additional sources, including weekly, automatic e-mailed search alerts up to 18/10/2020. Two reviewers independently performed all methodological steps (i.e., search, study selection, quality appraisal, data extraction and formal narrative synthesis), including a third reviewer in case of disagreement.

Results
We identified 6606 records, assessed 188 full-texts, and included 31 articles. Across studies, healthcare students and young professionals reported more positive patient safety attitudes in certain domains (e.g., teamwork climate, error inevitability, received patient safety training) but showed more negative attitudes in other areas (e.g., management support, safety climate, disclosure responsibility). Women and persons with more years of study and training demonstrated more positive attitudes towards patient safety.

Conclusions
Healthcare students should receive early curricular education in patient safety to build a solid foundation for the development of a strong and healthy safety culture. Understanding the differences in attitudes between aspiring healthcare providers from different areas is important to tailor teaching and training to the specific needs of certain populations.

Key messages
According to the reviewed literature, young healthcare students and professionals’ attitudes towards patient safety differed across domains. Institutions should increase education and training on patient safety for aspiring healthcare professionals, tailor them to the specific needs of this population, and monitor attitudes over time.
Respite service for informal caregivers: evaluation of simulation-training based education program
Authors: Loeffler K , Jerusalem A , Goldgruber J , Weidinger L 
Published: October 2021

Abstract

Background
Currently, the care for elderly people is provided mainly on an informal basis by relatives. This is often associated with psychological and physical stress. Caregiving relatives usually take over the role unprepared and they lack both knowledge and skills to fulfil the tasks. Therefore, arrangements must be made to provide respite for family carers. Simulation training is a validated experiential learning tool traditionally incorporated in health professional education but has not been commonly used in the hands-on training of informal caregivers. This study tried to measure whether participation in a special simulation training affects the trust in one's own ability to care, the quality of life and the stress perception of caring relatives.

Methods
98 caring relatives participated in the prospective, controlled (non-randomized) intervention study. The intervention involved an eight-month educational program in a simulation-training center in Graz (Austria). The program is either Manikin-based or Standardized Patient simulation trainings and take place in a show apartment. The impact on the caregiving competence, the quality of life and the burden-of-care was measured at the beginning (T1), after four months (T2) and after eight months (T3) using validated questionnaires (Self-Efficacy Scale, EQ-5D-5L and HPS).

Results
The results show a significant influence of the education program on self-efficacy (p 0.0018) and the increase in knowledge (p 0.04) of the participants. With regard to the subjective quality of life and the perception of stress no significant effects were shown.

Conclusions
The results show that the participation of family carers at the education program has different influence on the defined parameters. Not only the stable quality of life of the intervention group but also the short-term significant reduction in subjective stress perception directly after the training can be emphasized as positive indicators for the program.

Key messages
The results show that informal caregivers benefit from simulation training, since they can apply at home what they have learned during the training. Simulation training for informal caregivers significant influence their self-efficacy and the increase in knowledge.
Capacity building primary care responses to domestic violence in Brazil: designing a training model
Authors: Lucchesi V , Signorelli M , Priotto E , Hooker L , Taft A , Hegarty K 
Published: October 2021

Abstract

Background
Violence against women (VAW) is a public health challenge in Brazil. The country ranks 6th globally for femicide, with a high prevalence of domestic violence, amplified by the pandemic. Primary healthcare (PHC) workers can play a significant role caring for survivors, but their training on how to identify and respond to survivors is a major gap. This study aimed to investigate frontline PHC workers' needs and concerns in the care of VAW survivors, aiming to co-design a participatory model of capacity building to be implemented in the Brazilian PHC.

Methods
This study is based on participatory action-research (PAR) through participant observation and in-depth interviews with an interdisciplinary team of 13 PHC workers from Paranaguá, South of Brazil. Data were collected between Aug/2020-Jan/2021, transcribed, coded and synthetized through thematic analysis.

Results
Major needs and concerns were: 1) unanimous need of capacity building for all PHC workers and managers; 2) training ideally should be face-to-face, and more than one day, based in practical cases (not just in theory); 3) clarifying the role of the cross-sectoral network and referral options; 4) contents needs to address confidentiality, qualified listening, empathy and respect, with practical guidance on how to approach survivors. Other issues included: integrating VAW approaches with violence against children and adolescents; ensuring PHC units have a private room to care for survivors; and electing a key professional in each unit, with more specialized knowledge, to support survivors and staff.

Conclusions
This PAR revealed key issues to collaboratively design a capacity building model for PHC in Brazil, tailored to local needs. The next step will be applying for funding to implement a pilot training.

Key messages
Frontline PHC workers routinely attend cases of VAW, therefore their insights are essential to design capacity building to care for survivors in PHC settings. Training healthcare workers to care for survivors of violence needs to address local concerns, targeting knowledge, skills and competences.
Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey
Authors: Villani L , Pastorino R , Molinari E , Anelli F , Ricciardi W , Graffigna G , Boccia S 
Published: October 2021

Abstract

Background
Italy was the first European country to implement a national lockdown because of the COVID-19 pandemic. Worldwide, this pandemic had a huge impact on the mental health of people in many countries causing similar reaction in terms of emotions and concerns at the population level. Our study investigated the impact of the COVID-19 pandemic on psychological well-being in a cohort of Italian university students.

Methods
We conducted a cross-sectional survey in the period immediately after the first lockdown through the administration of a questionnaire on the personal websites of students attending their undergraduate courses at the Università Cattolica del Sacro Cuore. We used the Patient-Health-Engagement-Scale, Self-Rating-Anxiety-Scale, and Self-Rating-Depression-Scale to assess engagement, anxiety symptoms, and depression symptoms of our sample.

Results
The sample size was 501 subjects, of which 35.33% were classified as anxious and 72.93% as depressed. Over 90% of respondents had good understanding of the preventive measures despite over 70% suffered from the impossibility of physically seeing friends and partners. Around 55% of students would have been willing to contribute much more to face the pandemic. An increase in the occurrences of anxiety was associated with being female, being student of the Rome campus, suffering from the impossibility of attending university, being distant from colleagues, and being unable of physically seeing one's partner. Performing physical activity reduced this likelihood.

Conclusions
University students are at risk of psychological distress in the case of traumatic events. The evolution of the pandemic is uncertain and may have long-term effects on mental health. Therefore, it is crucial to study the most effective interventions to identify vulnerable subgroups and to plan for acute and long-term psychological services to control and reduce the burden of psychological problems.
Acculturation strategies and their impact on the mental health of migrant populations
Authors: Choy B , Arunachalam K , Gupta S , Taylor M , Lee A 
Published: October 2021

Abstract

Objectives
This systematic review examined the correlation between the different types of migrant acculturation strategies according to Berry's model of acculturation (integration, assimilation, separation, marginalisation) and their effects on mental health.

Methods
Three databases (PubMed, Ovid and Ebsco) were searched using different combinations of terms to identify relevant articles. Search terms included relevant synonyms for “migrants”, “mental health” and “integration”. The list of article titles from these searches were filtered using inclusion and exclusion criteria. Common mental health conditions including suicide/self-harm, depressive disorders, psychosis, as well as substance misuse were analysed.

Results
21 primary studies were examined, which assessed 61,885 migrants in total. Of these, 7 were cohort studies and 14 were cross-sectional studies. Most studies showed that marginalisation was associated with worse depression symptoms, compared to integration, assimilation and separation, while integration was associated with the least depressive symptoms. Marginalisation triples the likelihood of anxiety-related symptoms compared to integration. Similarly, separation increased the likelihood of anxiety-related symptoms nearly six-fold. Our study has also identified 16 factors that negatively impact level of migrant acculturation, 19 factors that adversely impact general mental health of migrants, and 22 factors that increases risks of depressive symptoms in migrants.

Conclusions
Our review found out that marginalisation had the worst effects on migrant mental health while integration had the most positive effects. The study also established multiple factors associated with low levels of acculturation and poor mental health in migrants. Given the problem of limited public resources, governments can identify at-risk individuals using factors highlighted and channel these scarce resources to develop targeted mental health interventions for them.

Key messages
Our review found out that marginalisation had the worst effects on migrant mental health while integration had the most positive effects. The study identified factors associated with low levels of acculturation and poor mental health in migrants. Governments can develop targeted mental health interventions for these at-risk individuals.
Improving refugees’ health literacy: An assessment of the Swedish ‘teach-back’ method at group level
Authors: Wångdahl J , Drebold H 
Published: October 2021

Abstract

Background
Refugees report lower levels of self-assessed health and underutilize healthcare services compared to host populations. In Sweden, a course in civic orientation is offered to all refugees to facilitate their establishment and help them make informed health choices. However, an evaluation of the civic orientation indicates that refugees with lower health literacy levels do not benefit from the orientation to the same extent. To address this, the ‘teach-back' method has been taught to about 200 cultural mediators participating in the EU project ‘MILSA training platform for civic and health communication'. This study investigated perceptions of the communicators in implementing a Swedish version of the ‘teach-back' method at group level for improved health information recall called Förstå Mig Rätt (FMR).

Methods
The data was collected through semi-structured interviews and analyzed by content analysis. Deriving from a holistic view of health, Sørensen's integrated model for health literacy guided the discussion in examining how FMR contributed to health literacy.

Results
Three themes emerged: (i) Appreciating the impact of FMR; (ii) valuing the role of a communicator and; (iii) practical challenges of implementing FMR. The findings demonstrated an overall appreciation for FMR as it empowered the communicators with the ability to discover misunderstandings easier. Nevertheless, it was sometimes perceived as challenging to ask the refugees to retell information and some refugees even expressed feelings of insult. Lack of time and struggle to adapt the information to fit all also generated concerns.

Conclusions
FMR makes its largest contribution to health literacy improvements in the second competence outlined by Sørensen's model (understanding). However, for optimal utilization, groups should be adjusted for participant educational level while further clarification on when the second and third phase of the teach-back concept should transpire, is recommended.

Key messages
FMR (a Swedish version of the method ‘teach-back’) can be used for health communication on group level. The use of FMR makes it easier to detect misunderstandings when communicating.
Reliability and Validity of the Perception of Stigma due to COVID-19 in Physicians
Authors: Oktar D , Aydogan Gedik S , Sungur S , Onsuz MF , Metintas S , Kosger F , Altinoz AE 
Published: October 2021

Abstract

Background
Thinking that they are being stigmatized can negatively affect the mental health of healthcare workers, whose workload has already increased during the epidemic. The aim of the study was to develop the ‘Perception of Stigma due to COVID-19 in Physicians' (PSCP) and to conduct a validity and reliability study.

Methods
A 5-point Likert-type 23-item question pool was created. In order to evaluate the content validity, CGI and CGO were calculated by taking expert opinions and 18 items were selected. It was tested with 303 physicians in Turkey to determine the psychometric properties. In order to evaluate the reliability of the scale, internal consistency (Cronbach's alpha) analyzes, item analysis and test-retest reliability analysis were performed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for construct validity.

Results
Of the participants 59.1% were female. After analysis, the scale consisted of 10 items and 2 sub-dimensions. The Cronbach's alpha coefficient was 0.87 for the environmental stigmatization sub-dimension, 0.76 for the perception of personal stigmatization, and 0.88 for the whole scale. Scale items explained 61.56% of the total variance and factor loads varied between 0.66 and 0.85. Scale fit and fit index were found to be acceptable as a result of CFA. Pearson correlation coefficient calculated for test-retest reliability was 0.63, and intraclass correlation coefficient was 0.70 (95% CI 0.38-0.86, p: 0.001). In the final, the total score that can be taken from the scale was between 0-50. The mean total score obtained from the scale was 24.3 ± 7.9. Of the physicians 46.9% scored above the average. It was accepted that as the score obtained from the scale increased, the level of perception of stigma caused by COVID-19 increased in physicians.

Conclusions
PSCP is a valid and reliable tool for assessing perception of COVID-19-induced stigma in healthcare workers.

Key messages
The scale developed is a tool that can be used in studies aimed at evaluating the stigma perceptions caused by COVID-19 in physicians. During the COVID-19 pandemic, physicians' level of stigma perception obtained with the PSCP scale was high.
Psychological Resilience Training Effectiveness in Emergency Healthcare Workers in Pandemics
Authors: Caliskan Pala S , Metintas S , Ozakın E , Pala VG 
Published: October 2021

Abstract

Background
In the struggle with COVID-19 pandemic, Pre-Hospital Emergency Healthcare Workers(PHE-HCW) are faced with a lot of problems. It is known that people with good psychological resilience(PR) levels could successfully cope with the problems. The study was aimed to evaluate the effectiveness of the psychological resilience training program in PHE-HCW.

Objectives
This intervention study conducted on PHE-HCW. In the study, when type 1 error(α) was taken as 5% and type 2 error(1-β) was taken as 95% and the effect size was accepted as 0.5, it was calculated that there should be at least 47 HCW in the groups.To minimizing the differences between groups, two groups were selected as intervention(n = 51) and control(n = 49) by applying propensity score matching analysis, taking into age, gender, occupation and working time. The questionnaire included questions of sociodemographic characteristics and the PR Scale(PRS).The questionnaire was applied to the both groups before the program and after four weeks of follow-up. The PRS consists of six subdimensions(structural style, future perception, family cohesion, personal strenghts, social competence, social resources), and it was accepted that psychological resilience increased as the score increased. The intervention group received video training on PR(self-awareness, hopefulness, optimism, etc.) whereas online classical training was applied to the control group.

Results
There was no difference in PR score between the intervention and control groups before the intervention(p &gt; 0.05).The mean PR score±SD increased in both groups, for the intervention group from (67.2±18.2) to (80.3±12.4) and for the control group from (64.2±19.3) to (77.7±9.5).After the follow-up, positive changes were found in all subdimensions in the intervention group and in subdimensions except structural style and social competence in the control group(p &lt; 0.05).

Conclusions
Psychological resilience training is effective in PHE-HCW during the pandemic period.

Key messages
Pre-hospital emergency healthcare workers need psychological resilience training during the pandemic process and this training program provides a positive change in healthcare workers. Psychological resilience training programs should be developed according to the needs of healthcare workers and added to in-service training.
Trends in uptake of Pap test in Estonia: results from cross-sectional studies in 2004–2020
Authors: Suurna M , Pärna K 
Published: October 2021

Abstract

Background
In 2006, Estonia started organized nationwide cervical cancer (CC) screening program, but in 2020 incidence of CC in was still second highest in Europe. An estimated 80% of women have done Pap tests outside the organized screening program. The aim of this study was (1) to describe the trend in lifetime uptake of Pap test and (2) to explore trends in lifetime uptake of Pap test by age group, nationality and education among 25-64-years-old women in Estonia based on data from 2004 to 2020.

Methods
Data of 6685 women aged 25-64 years who participated in population-based cross-sectional surveys of Health Behavior among Estonian Adult Population in 2004-2020 was analyzed. Uptake of Pap test was determined by asking women whether they have ever had a Pap test. The proportion of women who reported taking a Pap test was calculated for each study year. Chi-square test for trend was used to evaluate statistically significant changes (p &lt; 0.05) in the uptake of Pap test over the study period. Join point regression analysis was used to estimate annual percentage changes for the Pap test uptake trends.

Results
Proportion of women who reported ever having a Pap test increased from 51.1% in 2004 to 86.8% in 2020 (p &lt; 0.001). Annual percentage change was 2.8% per year (95% CI 0.5 to 5.1%). Uptake of Pap test increased significantly in all age groups, among Estonians as well non-Estonians and across all education levels (p &lt; 0.001).

Conclusions
Although self-reported uptake of Pap test has increased significantly during 2004-2020, particular attention should be paid to determinants of Pap test uptake to better target CC prevention activities and improve effectiveness of interventions with the further aim to reduce prevalence and mortality of CC in Estonia.

Key messages
Uptake of Pap test has increased significantly in Estonia according to data from 2004–2020. More research is needed to explore why prevalence of CC is increasing despite of high uptake of Pap test.