bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring methodologies and frameworks for best practice transfer at the primary care level
Authors: Petelos E , Vafeiadi M , Papadakis S , Anastasaki M , Marketou M , Tornero Patricio S , Carriazo A M , Angelaki A , Maganaraki A , Lionis C 
Published: October 2024

Abstract

Background
In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings.

Methods
The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review.

Results
From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all.

Conclusions
Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring.

Key messages
• Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer.
• This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.
Improving the healthcare response to migrants landing in Lampedusa through a multimodal strategy.
Authors: Sisti L G , Canzone G , Scorsino F , Napoli C , Camponi C 
Published: October 2024

Abstract

Issue
Lampedusa island is a crucial Italian entry point for migrants and the only health facility is the outpatient clinic that relies on the helicopter transfer to the mainland for urgencies. When the influx of migrants -and of tourists- increases, the health demand burden rises. Moreover, the plurality of the actors involved in migrants’ reception and assistance makes healthcare organization complex. In 2023, 115.000 arrivals were recorded with an increase of pregnant migrants transferred by helicopter; moreover, the lack of an EMTs-equipped ambulance and coordination gaps between actors were raised.

Description of the practice
Also paving on law 50/2023, in 2023 INMP and other institutions promoted a multimodal strategy to support healthcare in Lampedusa. A needs assessment grounded on settings and processes field observation and key stakeholders’ structured interviews was designed. Hence, an equipped ambulance service was set in September 2023 and an obstetric triage (ObT) procedure for pregnant migrants was tested. Further, operational protocols for migrants’ health have been drafted and enclosed in a MoU signed between key institutions, and a dedicated Committee monitoring protocol implementation was also set.

Results
Until now the ambulance has carried out 242 operations, mostly in response to community requests and ObT has led to using helicopter solely for real Ob urgencies. Also, the MoU has improved the coordination between actors, and the monitoring Committee-just settled-has already identified new priorities such as of defining a procedure for pregnant migrants requesting pregnancy termination.

Lessons
A multimodal strategy based on field assessment, enhancing coordination between actors and rolling-out of shared procedures has improved the effectiveness, efficiency and appropriateness of healthcare in Lampedusa, requiring a slight increase in resources. Remarkably, the healthcare reinforcing results in beneficial also for the general population.

Key messages
• Massive influx of migrants in Lampedusa has required strengthening health services on the island.
• Evidence-based interventions based on needs assessment have improved healthcare for both migrants and the general population.
Life course prevention - challenges for public health lying ahead
Authors: Albreht T 
Published: October 2024

Abstract

Issue/problem
Demographic and epidemiological transitions have now shifted the focus from vulnerable population groups onto the active population, in particular young adults. At the same time lessons from the covid-19 pandemic taught us about missing actions on the elderly. While the latter have shown compliance and have followed most preventative activities, we observe scepticism and reluctance in the young adults.

Description of the problem
The covid-19 pandemic showed that young to middle-aged adults were the most reluctant group to adhere to preventative measures but in complying to the recommendations concerning vaccination. Since European activities are now focusing on addressing determinants of NCDs and are hoping to mobilise all population strata, including young and middle-aged adults, it would be important to explore how this mindset might affect the overall attitude to prevention.

Results
Health policy should explore specifically the needs of young to middle-aged adults (e.g. ages 30 to 44) to list their specific needs, expectations from preventative activities. On the other hand, it would be necessary to find out about the concerns, reluctance, and objections. The interplay of these will play a significant role in acceptance of present and future preventative activities. Exploration on these topics presents the following challenges: 1. Multiple sources of information on given health problems; 2. Lack of structured accessible and well-understandable explanations of advantages and benefits; 3. Inappropriate communication by health professionals or agencies on their behalf; 4. Complexity of the problem, which is then translated into complex and not easily understood messages.

Lessons
Learning about the specific needs of young adults, their expectations from the health systems in terms of prevention and health care as these will shape their overall attitude to prevention and have an impact on their families, particularly children.

Key messages
• Knowledge about expectations, needs, concerns, and reserves with respect to prevention is essential for the future activities on prevention.
• Involving young and middle-aged adults in the preparation of the future preventative activities for their population groups is essential.
Utilization patterns and preferences of telemedicine services in the post-Covid-19 era in Israel
Authors: Samuel H , Norman T , Myers V , Ziv A , Wilf-Miron R 
Published: October 2024

Abstract

Background
While telemedicine can streamline healthcare delivery, suboptimal use may compromise care quality and access. Given the increased adoption of these services during and after the Covid-19 pandemic, understanding best practices through examination of utilization patterns and patient preferences is crucial. This study estimated utilization rates, patient preferences and perceptions of response received for different physician-encounter channels for common clinical and administrative scenarios.

Methods
Cross-sectional telephone survey in Hebrew or Arabic of 519 Israelis who contacted a doctor in the past year for clinical or administrative needs. Data collected during April-June 2023, focused on chosen contact channel, reasons for choice, perceived response adequacy, and hypothetical future preferences.

Findings
78% of encounters with family physician for clinical need were in-person, with lower rates for phone (16%) or messaging (6%); in-person dominated with encounters with specialists (94%). Conversely, for administrative needs, more used phone (15%) or messaging (48%), though 37% still preferred in-person encounter. Video usage was negligible (&lt;1%). Main reasons for in-person choice were perceived need for physical exam, habit, or negative perception of remote service quality. Convenience/exam-free needs drove phone/messaging use. While most patients were satisfied with their chosen channels, phone consultations had lower future preference rates.

Conclusions
Matching channel to need is crucial. Physical exams require in-person visits, though they are not always required and many stick with in-person out of habit; remote options like messaging can streamline administrative tasks. Patient education could address habits and help familiarize patients with new options. Optimizing phone visits and promoting video options could enhance adoption due to their benefits.

Key messages
• In-person visits are preferred for clinical needs, while messaging/phone are underutilized for administrative tasks, highlighting missed opportunities for convenient telemedicine options.
• Addressing patient habits and perceptions around remote healthcare channels is crucial for optimizing telemedicine adoption and streamlining care delivery.
The evaluation of an eHealth tool to prevent and alleviate migraine complaints in adults
Authors: Van Der Heijde C M , Jurgens F , Tempelman D , Altink-van den Berg WMM , Vonk P 
Published: October 2024

Abstract

Background
Migraines attacks cause great suffering in individual patients. There is great unfulfilled potential to increase patients’ knowledge about various personal triggers and subsequent treatments. The objective of this study is to pilot test an e-Health tool that aims to increase migraine patients’ knowledge. It takes into account personal preferences and contributes to informed decision-making in choosing the appropriate method. Considering the shortage of primary care physicians and other health care providers, such an e-Health tool could be of great value.

Methods
lessmigraine.nl consists of a website with information plus an electronic decision aid. It was evaluated on its content, development process and effectiveness, and its contribution to the patients’ empowerment process. A first round of usability testing was done using semi-structured interviews and thematic analysis with 12 patients from a Dutch General Practice until data saturation. After minor improvements to the e-tool, in a first implementation step subsequently 85 patients used the e-tool.

Results
Patients’ expectations were exceeded in terms of the content of the e-Health tool, as all patients discovered new potential migraine triggers. Most patients found the tool effective in the sense that it provided enough information to decide on an appropriate treatment. The implementation was successful in the sense that all 85 participants completed the e-tool. Most important triggers were stress, sleeping problems, changes in weather and flickering or bright light.

Conclusions
The majority of the migraine patients were satisfied with the e-Health tool. It enlarged their knowledge of prevention and treatment options and therefore empowered them in their decision-making process and communication with their GP. Other aspects of implementation need to be studied. This study needs to be repeated in other clinical settings.

Key messages
• Migraines cause great suffering in individual patients: Considering the shortage of primary care physicians and other health care providers, an e-Health tool could be of great value.
• The e-Health tool increases patients’ knowledge about migraine, including personal triggers and subsequent treatments.
How can we support the development of health literacy in young people?
Authors: Smith C , Belton S , Meegan S , Behan S , Goss H R 
Published: October 2024

Abstract

Over the past two decades, there has been an increased interest in Health literacy (HL) to improve health behaviours and health outcomes. Due to its potential impact, HL is considered one of the major issues in public health and is increasingly being recognised in recent policies and initiatives. Although, the research justifying the importance of HL continues to grow, there is a lack of research focusing on strategies to improve HL and challenges that are faced when supporting HL, particularly in young people. Thus, this study aimed to explore, from the point of view of international academics and community-based practitioners, (i) key considerations when supporting young people’s HL; (ii) major challenges to supporting young people’s HL; and (iii) possible solutions to overcome such challenges. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part of in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that: the participants feel the use of participatory approaches is essential when designing a HL-focused program; the importance of embedding HL education and awareness into schools; the value in using interactive style learning; and the importance of targeting those ‘hardly reached’ populations. The participants highlighted that accessibility to schools; difficulty in engaging young people; and ensuring programs are sustainable as major challenges. Solutions to overcome which challenges were posited, including professional development for teachers; the development of engaging and context specific programs that target the young person’s physical and social environment; and importance of influencing national policies to value HL. These findings can be used to inform interventions and policies to target the HL of young people.

Key messages
• The importance of adopting participatory approaches when developing health literacy interventions.
• The importance of developing feasible, context specific and engaging health literacy curricula within schools.
A lifestyle program for socially vulnerable community-dwelling elderly
Authors: Lambers S , Verschelden P , Es E , Vanderlinden J 
Published: October 2024

Abstract

Problem
Socially vulnerable older adults often face lower health literacy and limited access to health care.

Description of the problem
Current lifestyle programs are often insufficiently adapted to this socially vulnerable target group. As a result, these older adults are underrepresented in lifestyle programs. From a public health perspective, lifestyle programs that improve the poorer physical and mental health of these older adults, should be made more accessible by involving the expertise, participation and needs of this group. The aim of this study was to develop and implement a lifestyle program adapted to the expectations and needs of socially vulnerable older adults.

Results
Both the target group and the local community (health) centers were involved during the co-creative phase of development. A neighborhood analysis was used to identify and reach out to the target group. Motivators and barriers for a healthy lifestyle were identified through focus groups. The developed program consisted of 10 weekly group sessions. Various health aspects were integrated, including exercise, nutrition, stress, sleep, positive psychology, meaningful living, and motivation. Nine centers for community dwelling older adults in Flanders and Brussels were included. In total, 93 older adults were recruited out of which 76 completed the full program. In the final phase, the program was evaluated by means of objective and subjective measuring methods. Finally, the local community (health) centers are currently involved in the program’s sustainability through a trainers’ program.

Lessons
The belongingness, the catering, the empowering attitude of the trainer and the ‘fun’ factor turned out to be success factors for the adherence to the program. The participating centres experienced an increase in numbers of older adults that were attracted to their activities that are focused on healthy lifestyle behaviors. The continuity of the program is currently being examined.

Key messages
• A neighbourhood analysis in collaboration with local partners helped to reach the target group.
• The program was made attractive by the involvement of the older adults, the fun-factor and the small groups.
Development of the health literacy responsiveness (HLR) evaluation framework for HLR interventions
Authors: Meldgaard M , Aaby A , Østergaard L S , Heuck I R 
Published: October 2024

Abstract

Background
Health literacy responsiveness (HLR) interventions include actions at different levels of an organization to provoke change and improve environments ensuring equitable access to and use of information and services (1). However, generic instruments measuring the effect of HLR at intervention level are inconsistent, making evidence on HLR intervention effects difficult to compare (2). The objective of this study was to develop an evaluation framework based on core outcome domains of HLR to facilitate higher consistency in future evaluations of HLR interventions.

Methods
HLR outcomes were identified through a narrative literature review and categorized into domains through a content mapping process. Expert consensus on core outcome domains was reached through a Delphi process. Experts within the field of HLR were invited to participate and answer three questionnaires designed to rank and clarify potential core outcome domains. Quantitative and qualitative analysis was performed to select and complete the final core outcome domains in the HLR evaluation framework (HLR-EF).

Results
The literature search resulted in identification of nine reviews. A total of 383 outcomes were identified from these reviews and included in the content mapping process, which resulted in a total of 26 core outcome domains. Experts (n = 15) participated in the three-round Delphi process, which resulted in consensus on 15 core outcome domains in HLR-EF allocated under five headings.

Conclusions
The study has successfully managed to identify a set of core outcome domains applicable in future evaluations of HLR interventions based on systematic methodologies and expert consensus. Context-sensitive manuals for the use of the HLR-EF is under development and the instrument is ready to be applied in future evaluation of HLR interventions, potentially making future measuring, reporting and comparison of results significantly easier.

Key messages
• Instruments facilitating evaluation of HLR interventions are non-generic and inconsistent.
• HLR-EF has been developed using a narrative literature review, content mapping, and a Delphi process, and defines 15 core outcome domains for evaluation of HLR interventions.
A process evaluation of a LifeLab Dublin; an interactive health literacy intervention
Authors: Smith C , Belton S , Issartel J , Meegan S , Goss H R 
Published: October 2024

Abstract

The argument for targeting adolescent health has been made strongly, with poor lifestyle behaviours often emerging during this life stage. Furthermore, there is consistent evidence of a widening socioeconomic gap in health indicators. Developing health literacy (HL) in youth populations to improve lifelong health behaviours has garnered increased interest in recent years. This process evaluation examines the acceptability, fidelity and dose delivered of the pilot of LifeLab Dublin: a nine-week, school-based HL intervention for low socioeconomic adolescents. The intervention, which comprised of two out-of-school, interactive HL experiences in conjunction with seven school-based lessons, took place between September and December in 2021 and involved students aged 11 - 13. The health issues targeted were previously identified by the teachers and students of the target population, and the learning activities within the out-of-school experiences were co-designed by adolescents of a similar demographic. Overall, the intervention was perceived positively by the students and teachers, particularly the two interactive out-of-school experiences. The teachers, however, highlighted issues with the volume and content of the school-based lessons, resulting in a reduced number of lessons being delivered. The fidelity of the two LifeLab experiences was high, demonstrating that the students engaged well with the learning activities and that the experience aligned with LifeLab’s core principles and underpinning theoretical constructs. The findings from this study highlight the value in implementing experiential style learning in school-based HL education and the benefit of involving participants in the design of intervention. The evaluation provided valuable insight into the refinements required to enhance the efficacy of the intervention, as well as providing an evidence-base to inform future school-based HL interventions for low socioeconomic adolescents.

Key messages
• The benefit of adopting experiential style health literacy education with young people.
• The benefit of including young people in the design of a health literacy intervention.
An update on the concept and importance of health literacy in young people
Authors: Smith C , Belton S , Meegan S , Behan S , Goss H R 
Published: October 2024

Abstract

The burden of non-communicable diseases is a growing public health crisis that requires immediate action. As health literacy (HL) has been strongly linked with health behaviours and health outcomes, it has many potential implications for health care and health education. Although recent research has emphasised the importance of developing HL early in life, much of the research has focused on understanding and improving HL in adult populations. As young people socialise in different contexts and are exposed to different health-related situations, they require different HL competencies. As part of a wider project, this study aims to gather the perceptions of international academics and community-based practitioners on the concept and importance of HL in and for young people. Specifically, the study aims to (i) explore current understandings of the concept of HL in young people; (ii) examine the importance of HL for young people; (iii) identify those at risk of having low levels of HL; and (iv) determine the specific health behaviours that young people are currently struggling with. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that HL is a very broad yet individualised concept that is critical to develop at an early age given the difficulty young people face in adopting healthy behaviours in their social and physical environment. Furthermore, the participants highlighted that minority groups, such as members of the travelling community and refugees, and those from low socioeconomic populations, are at greatest risk of low HL. Finally, the health issues that appeared to be of most concern in young people were vaping, social media use and poor mental health. These findings can be used to inform appropriate interventions and policies to target the HL of young people.

Key messages
• Health literacy is a very, yet individualised, concept that is critical to develop given the difficulty young people face in adopting healthy behaviours in their social and physical environment.
• Minority groups, such as members of the travelling community, refugees, and those from low socioeconomic populations are at greatest risk of low levels of health literacy.