How can a local government boost prevention and inclusive primary care for its citizens?

Abstract

Introduction: A retirement wave in healthcare professionals has put severe pressure on healthcare provision in the municipality of Vorselaar in Belgium and forced residents to look for alternatives in the wider region or postpone essential care. The local government wants to reinforce community healthcare in a future-oriented and innovative way and has set up a collaboration with LiCalab Living and Care lab to gain insight into the healthcare needs and expectations of their citizens to guide this process.
 Aims & methods: The municipality wants to create an accessible, interdisciplinary healthcare hub, putting the focus on health prevention rather than cure. Additionally, in collaboration with King Baudouin Foundation, they aim to investigate ways to promote health literacy in primary healthcare practice. Consequently, living lab activities were designed to provide insight into user needs for primary healthcare practice and preventative initiatives as well as the health literacy of the population. Firstly, a survey study aimed to include a large and representative local sample by lowering participation thresholds through e.g., sending personal invitations and providing support in completing the online or pen-and-paper questionnaire. In a second phase, co-creation sessions with citizens, (care) professionals, and individuals with low health literacy are currently being conducted to get more in-depth information about these topics and to solicit concrete actions to realize preventative health goals. 
 Key findings: A total of 1078 adult individuals from varying ages and social backgrounds participated in the survey (16,49% of the population). Physical and mental health were generally satisfactory. Health literacy skills varied in the population and lower literacy was associated with loneliness, increased age, lower education, and financial difficulties. Dentists, nurses, and psychologists were deemed important additional professions for primary care practice. Participants also had several practical recommendations for such a practice (e.g., regarding opening hours, online and telephone booking, and accessibility). In terms of health promotion, citizens believe that the local government has a role to play and find healthy eating habits, physical activity, mental health and sleep relevant factors of interest. The citizens are to some extent willing to use digital means for prevention although about half of participants of 80 years and above are very reluctant to use such technology. Finally, Vorselaar’s residents are motivated partners in the co-creation process to further shape the health landscape of their municipality.
 
 Conclusions: A collaboration between Vorselaar and LiCalab, with the endorsement of King Baudouin Foundation supporting projects committed to a better society, informed on local healthcare needs through selected living lab activities and the inclusion of a large representative sample. These citizens proved motivated partners in designing futureproof and inclusive primary healthcare.
 Implications: A population-based survey and co-creation sessions with multiple stakeholders can support data-driven actions towards promoting health literacy (which has important health benefits), designing primary care as a flexible and interdisciplinary endeavor, and investing in preventative activities (that are preferably not solely offered digitally). Potential future avenues to be explored consist of conducting implementation research into health promotion interventions, with special attention for the inclusion of vulnerable citizens.