Health Education Research Articles

10.F. Skills building seminar: How public health professionals can use the right to health to advance climate action and justice

Abstract The climate crisis is the single biggest threat to global health, peace and security, a crisis multiplier, and a significant driver of health inequalities. In many areas of public health policy, legal action and litigation have delivered significant and long-lasting impacts. In April 2024, the European Court of Human Rights concluded that Switzerland had violated the right to health of older women in Switzerland by failing to meet its past greenhouse gas (GHG) emissions reduction targets and set future GHG targets. State-of-the-art public health evidence provided by the Intergovernmental Panel on Climate Change and Lancet Countdown on Health and Climate Change were vital to the Court’s decision, which has implications for all Council of Europe member states, and globally. Rigorous scientific evidence of health harms, including but not limited to heat stress, can inform other climate litigation grounded in the right to health. Public health researchers and practitioners are essential to this litigation. In recognition of this emerging role, in November 2023 the Faculty of Public Health (UK) and the Aletta Jacobs School of Public Health launched ‘From analysis to action: climate change litigation. A guide for public health professionals’ at the 16th European Public Health Conference. The guide was also endorsed by ASPHER, ASPPH, EUPHA, Global Consortium on Climate and Health Education, Global Network for Academic Public Health, Lancet Countdown, Public Health Ethics and Law Global Network, and WFPHA. This workshop will familiarise participants with recent rights-based climate litigation and explore the role of public health professionals in identifying, collecting, storing, assessing and presenting this evidence in a form that is accessible to court officials without medical training. First, there will be short presentations on 1) the role of the law in climate action and the role of scientific evidence of health harms in human rights litigation, and 2) How to collect and use scientific evidence of health harms in climate litigation (15 minutes). Small group discussions will follow, addressing questions such as: The health harm of climate change-related heat stress was a major factor in the 2024 decision of the European Court of Human Rights in KlimaSeniorinnen v. Switzerland: What other health harms could support future cases? In what population groups? What opportunities do you see today for public health researchers and practitioners to compile such evidence to make the most compelling case? How can public health researchers and practitioners work more closely with legal experts and affected communities to bring this evidence to court? (20 minutes) The workshop will conclude with a plenary discussion of these questions and the small group responses. (25 minutes) As a result of the workshop, participants will be better prepared to identify opportunities to contribute compelling evidence of health harms in climate litigation. Key messages • Rigorous scientific evidence of climate change-related health harms is proving central to success in rights-based climate litigation. • Public health professionals have a key role in identifying and presenting compelling evidence of health harms in climate litigation. Speakers/Panelists David Patterson University of Groningen, Groningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards Heath, UK

9.B. Scientific session: Promoting health in the digital age: a room to improve health literacy and digital health literacy?

Abstract The workshop aims to explore innovative approaches to promoting health literacy and digital health literacy and their impact on individual and community health outcomes at different stages of life. This initiative is driven by the recognition that digital platforms and tools offer unprecedented opportunities to improve population health through health education and behavior change. The workshop will feature a dynamic and interactive format starting from plenary sessions in which speakers will provide insights into digital health promotion best practices and their outcomes, offering diverse perspectives. The added value of organizing this workshop lies in its comprehensive approach to integrating digital tools into health prevention strategies, particularly for addressing childhood smoking. By examining innovative digital interventions, the workshop provides a platform for sharing insights and strategies that leverage technology to promote healthier lifestyles among youth. This is increasingly pertinent as digital platforms become central in the daily interactions of young people. The coherence between the presentations revolves around the theme of enhancing digital health literacy as a preventive measure against health issues. The first presentation sets the stage by exploring digital tools that educate and engage young people about the dangers of smoking. The subsequent session builds on this by assessing the current state of digital health education and literacy, emphasizing the need for curriculum integration and better training for educators to support these initiatives effectively. Finally, the meta-analysis presentation ties everything together by evaluating the effectiveness of these digital interventions across various demographics, offering evidence-based recommendations for tailoring health literacy programs to diverse needs. Together, these presentations form a cohesive narrative on the critical role of digital literacy in health prevention, illustrating a clear pathway from educational content to educational infrastructure, and culminating in broad-based intervention strategies that can be adapted to different settings and populations. This coherence enhances the workshop’s impact, providing attendees with a well-rounded understanding of how digital tools can be harnessed to foster long-term health improvements from an early age. Live Q&A sessions will encourage dialogue between speakers and attendees, enhancing the learning experience. By combining expert knowledge with interactive discussions, the workshop aims to share insights needed to implement effective digital health promotion strategies. Key messages • The role of health literacy and digital health literacy in improving health outcomes demands that the efficacy of the most effective strategies be evaluated. • Digital tools offer opportunities for innovative health promotion approaches and tools.

The Longlasting Program Keluarga Harapan as Conditional Cash Transfer in Indonesia: The Existing Problems and the Policy Recommendations

Program Keluarga Harapan (PKH) is a conditional cash transfer program in Indonesia that requires beneficiaries to meet certain requirements such as school attendance and health checks. Adopted from similar models in Latin America, PKH aims to reduce short-term poverty and invest in the health and education of future generations. Since its launch in 2007, PKH has operated in various regions with different poverty and infrastructure issues. PKH faces several challenges, including mistargeting of beneficiaries and burdensome bureaucracy for the poor. To address this, improvements to the targeting system and simplification of document procedures are recommended. The program has also contributed to reducing stunting through improved nutrition and health education, although health facilities need to be improved. In the education sector, PKH has succeeded in increasing school enrollment and attendance, but has not significantly reduced child labor. In terms of livelihoods, PKH encourages beneficiaries to shift to non-agricultural jobs, although often only casual labor. This study uses descriptive and explanatory designs to describe and explain the evolution of the PKH policy from 2007. Descriptive design is used to describe policy changes that occurred during the period, while explanatory design is used to explain the factors that influence policy changes and their impact on program effectiveness. The results found that there were problems with PKH facilitators including insufficient numbers, high workloads, and low salaries, which affected their effectiveness. To improve the performance of facilitators, new recruitment, regular training, and increased salaries and working conditions are recommended.

Integrating SDGs, One Health and transdisciplinarity into AMR Education Strategies

Abstract Introduction The increasing prevalence of Antimicrobial Resistance (AMR) threatens modern medicine, undermines food security, and impedes environmental sustainability. The complexity of AMR requires various stakeholders to contribute to mitigate this challenge. We discuss the critical need for integrating the One Health framework, transdisciplinarity, and Sustainable Development Goals (SDGs) within AMR education; and demonstrate how these integrations enhance the effectiveness of educational strategies against AMR. Methods Through a review of existing literature and analysis of multiple interventions, we synthesize findings from instances where One Health strategies have been applied. We assess their effectiveness in fostering cross-sector collaboration and enhancing health outcomes, thereby providing a grounded framework for developing integrated educational strategies. Results Our analysis reveals that AMR education programs incorporating the SDGs and One Health principles are more likely to foster interprofessional collaboration and a deeper understanding of AMR. Case studies demonstrate that such educational approaches significantly improve the preparedness of health professionals in managing AMR through innovative and cooperative approaches. Despite the significant potential of One Health education in impacting global health positively, current interventions lack specific SDG indicators directly related to AMR, suggesting a gap in policy and global health prioritization. Conclusions By aligning AMR education with SDGs and One Health, there is an opportunity to enhance global health security. We call for a paradigm shift in educational strategies to effectively combat AMR, advocating for policy reforms and curriculum adjustments to incorporate these integrated approaches. The findings are crucial for educators, policymakers, and healthcare professionals aiming to redesign AMR education to be more comprehensive and globally oriented. Key messages • AMR education integrated with SDGs and One Health enhances interprofessional collaboration and understanding, improving health professionals’ preparedness to manage AMR effectively. • Current AMR educational strategies lack specific SDG indicators; aligning education with SDGs and One Health can significantly boost global health security.

1.Y.1. Navigating choppy water for global health competencies, education and innovation in Europe

Abstract Global health is rapidly evolving against a backdrop of increasingly complicated, intersecting challenges and crises across health, socio-economic and ecological systems. Interconnected social justice movements call for greater acknowledgement, accountability and qualified responses to address inequities and their structural drivers. The field of global health is going through a period of reckoning and debate about how colonial legacies and structural inequities pervade the sector and how activities of global health professionals across research, policy and practice are complicit in and perpetuating them. Simultaneously, global health education (GHE) is growing, with new speciality degrees and core or elective courses integrated into degrees in medicine, health and other disciplines. Thus, GHE holds great potential as a space to train future professionals with competencies and aptitudes to confront inequalities through innovative, evidence-informed and sensitive approaches. Yet it is also a space in which inequalities may be reproduced through material and epistemic injustices. To address these paradoxical tensions, transformation in GHE is needed in terms of what is taught, how it is taught and who is involved in teaching. This Pecha Kucha workshop will contribute to this discourse by exploring perspectives on issues including: i) What key competencies and content should be included in GHE across different disciplines and Bachelor, Master or Doctoral level?; ii) How can we better practice and develop in educators and students critical perspectives and capacities to be equipped for and responsive to inequities and social injustice?; and iii) How can we ensure meaningful engagement and partnership in education with countries across varied contexts and communities with direct lived experience of marginalisation and deprivation? Four panellists with diverse backgrounds and perspectives will provide insights on their initiatives to tackles such issues within their own institutions and European alliances, followed by a short discussion with the audience. The presentations will emphasise the need to progressively build affective, practical and cognitive competencies to critically engage with historical, geopolitical and structural inequities and injustices, including how they manifest in local contexts. Panellists will highlight examples of innovative methods and approaches to build these capacities, including through co-design in education that fosters self-reflexivity in students and builds alliances and partnerships with non-academic stakeholders, such as civil society and people with lived experience. The Pecha Kucha workshop aims to inspire exchange across institutions and countries, and with the audience, about how we can collaboratively set our compasses and our sails to navigate the choppy waters of tackling pervasive colonial legacies and sailing towards an equitable, inclusive and effective future for education and action in global health. Key messages • Transformation is urgently needed to ensure that global health education builds curricula and competencies that are sensitive and responsive to historical injustice and structural inequities. • Equitable partnerships across institutions and with diverse stakeholders, and innovative educational approaches such as gamification and co-design, can address tensions in global health education. Speakers/Panelists Henrique Barros ASPHER, Porto, Portugal Victoria Saint Bielefeld University, Bielefeld, Germany Francisco Mboufana Department of Community Health, School of Medicine, Eduardo Mondlane University, Executive Secretary, Maputo, Mozambique Mariam Sbaiti Faculty of Medicine, School of Public Health, Imperial College London, London, UK

From the first European Climate Risk Assessment to action in policy and practice

Abstract The first European Climate Risk Assessment (EUCRA), produced by the European Environment Agency in March 2024, engaging nearly 100 authors across Europe, highlights health among the most at-risk sectors. According to the structured risk assessment that was conducted to support the transparent identification of priorities for policy action, more and urgent action is needed to reduce health risks from heat indoors and outdoors; from wildfires and outbreaks of vector- and water-borne diseases. The responsibility for managing risks lies both with the EU and Member States, and the policy readiness varies depending on the risk. The European Climate and Health Observatory, set up to better understand, anticipate and prevent climate risks to human health in Europe, in the most recent report ‘Responding to climate change impacts on human health in Europe: focus on floods, droughts and water quality’ provides in-depth analyses of some climate-related risks to health and presents examples of responses to them in both policy and practice. Both assessments emphasise that without fast and systemic action to increase societal resilience, the health impacts of the changing climate will worsen, affecting already disadvantaged or vulnerable groups the most. Health and health-determining sectors have the opportunity to address the health impacts of climate change by, among others, increasing the climate resilience of health systems; developing, updating and implementing national health adaptation plans; and supporting the education and training of public health and healthcare professionals on climate change threats. At the same time, addressing health impacts from climate extremes requires responses across sectors, actors and spatial scales.

Targeted initiatives to tackle health inequalities, integrating the Leeds Health and Care Workforce

Abstract Deprivation and poor health are significant challenges in Leeds, with the poverty gap growing in parts of the city. The Leeds One Workforce approach to narrowing inequalities (NI) was co-designed in 2021 building on the innovative partnership approach already visible in the city. Its phased approach has seen interventions put in place to boost the opportunities for people from marginalised communities to develop their skills and remove barriers to careers in health and care and has global relevance for other localities experiencing high deprivation. The overall NI approach is supported by a long-term and wide-reaching evaluation plan which mobilises our partner organisations and intends to amplify best practice in getting people into careers and supporting this group to develop within the health and care workforce. We will present findings from embedded evaluations of initiatives across the city, and individual case studies, from those who have accessed NI interventions in Leeds. These will explore the relationships and contributions of partnership organisations and presence of any unexpected barriers or facilitators to these interventions. Linking with third-sector organisations and creating accessible pre-employment opportunities to develop core working skills is a vital part of the Leeds approach to recruiting people from priority wards. Additionally, supporting people into careers in health and care which suit their values, interests and personal circumstances, in addition to employing organisations with flexibility and openness towards their employees at their core is a strong factor in recruiting and retaining from areas of deprivation. Partnership working is essential to tackling health inequalities in places of high deprivation to address individual and systemic barriers to securing employment, ensure the best chance of success for community outreach programmes, and maximise efficiencies by combining the efforts of local organisations. Key messages • Leeds, UK is transforming approaches to narrowing health inequalities through partnership working across health and social care education and employment. • Current and future best practice will be explored to demonstrate transferable NI approaches.

3.F. Round table: Legal action & capacity building: essential for climate action to protect and promote public health

Abstract The climate crisis is the single biggest threat to global health, peace and security, a crisis multiplier, and a significant driver of health inequalities within and between countries. In many areas of public health policy, legal action and litigation have delivered significant and long-lasting impacts. Court action is a strong domain of legal policy and practice to address climate change and related air pollution in many countries, and increasingly in international courts and tribunals. Examples include the 2021 landmark UK Coroners Report on the asthma-related death of Ella Kissi-Debrah, the 2023 UN General Assembly Request for an Advisory Opinion from the International Court of Justice on states’ obligations to address climate change, and the 2024 European Court of Human Rights decision in Klimanseniorinnen v. Switzerland. Climate litigation also creates opportunities for public scrutiny and debate by raising awareness of inaction or harm caused by governments or private sector polluters, generating wider community mobilisation for action. Since 2021, the EUPHA Law and Public Health Section, Faculty of Public Health (UK), Aletta Jacobs School of Public Health, Global Network for Academic Public Health, ASPHER and other partners have collaborated to build ethicolegal competence and capacity of public health professionals for climate action. Initiatives have also included research, advocacy, and resource development, and exploring opportunities for legal action and litigation, including at the International Conference on Strategic Litigation and Public Health (Liverpool, 2023). The roundtable will present key findings from an evaluation of the course on climate change organised by the ASPHER and the Global Consortium on Health and Climate Education (GCHCE), and learnings and feedback from the publication ‘From analysis to action: climate change litigation. A guide for public health professionals’, which was launched at the 16th European Public Health Conference. The expert panel will also reflect on whether the nature of current educational materials, means and methods in curriculum and training initiatives are effective, appropriate, adequate, and sufficient. Should climate change be part of One Health and Planetary Health programmes rather than a distinct entity? What is the role of, and what are the opportunities for, public health professionals to be engaged in climate litigation? What are the gaps and opportunities through strategic networking with environmental and legal experts, and affected communities? The roundtable will be interactive and invite input and insights from the participants to explore opportunities to further advance the agenda. Key messages • Public health professionals have a key and increasing role in climate law and litigation: interdisciplinary collaboration is essential. • Public health professionals have multiple avenues for capacity building on opportunities to address climate and environmental impacts on public health through law. Speakers/Panelists David Patterson University of Groningen, Groningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards heath, UK Liz Green Public Health Wales, Wrexham, UK Ana-Catarina Pinho-Gomes University College London, London, UK

Barriers to the application of simulation technologies in the education of health care students

Abstract Simulation technologies (ST) in health and medical education are undergoing rapid development due to the undoubted advantages of the methods and forms of simulation used - high quality, significant efficiency, economy, reliability and safety for the patient. At the same time, the application of ST is still underrepresented in the education of health care students. The main aim of this study was to identify the barriers and perspectives for the application of ST in the education of health professional students in Bulgaria from the perspective of the respondents’ expertise. A qualitative study of the expert (n = 17) opinion of those directly involved in the introduction, application, and evaluation of the use of ST in the education of healthcare students was conducted in 2023 in Varna. The questionnaire regarding the barriers and perspectives in the use of ST in the education of undergraduate and postgraduate students in health specialties students was used. The main barriers to the widespread use of ST in the training of students were identified as follows: the lack of adapted curricula that combine traditional practical sessions with patients and those on simulators; the lack of a sufficient number of trained and motivated trainers; the reluctance of trainers to introduce or more widely use ST; lack of or insufficient space to locate a simulation centre or equipment in relevant core units; the high cost of purchasing and maintaining ST and limited financial resources, as well as the large number of students in the groups. According to one of the experts, ‘there are no barriers to the use of ST, but real patient contact and a personalized approach to the patient is impossible to replicate through technology,’ highlighting the importance in combining traditional training with real patients and modern with the use of technology. Ethical issues in training healthcare professionals with simulators appear to be a new aspect of medical education with the application of ST. Key messages • In the effort for widespread implementation of ST in the training of health professions students, it is important to achieve a balance with traditional training experienced with real patients. • Identifying and overcoming barriers is an important prerequisite for the rapid and widespread application of ST in the training of health care students.

Digital Health in Croatia: Key stakeholders’ perspective of societal and institutional readiness

Abstract Background According to the literature, digital health brings an innovative approach to healthcare and an inevitable transformation and disruption. The potential of digital technologies is far-reaching, from preventive medicine to addressing public health challenges. However, the implementation also significantly depends on the social & cultural context. Methods To research Croatia’s expectations, challenges, and readiness for implementing digital health, interviews were conducted with physicians, patients, hospital managers, policymakers, jurists, and engineers (n = 75). Following identifying key themes, a survey was conducted among Croatian medical students (n = 775) at the end of 2022. Results Key stakeholders believe implementation preparedness is demonstrated through institutional and societal readiness. Prominent characteristics of societal readiness include appropriate infrastructure and legal and financial frameworks. Societal readiness is assessed through digital and health literacy and existing social practices within Croatian society. Only 4.6% of medical students believe Croatia’s healthcare system is ready to implement digital technologies. They perceive the highest readiness regarding digital education (63.7%) and the digital literacy of physicians (60.9%) while negatively evaluating healthcare infrastructure, financial resources, and patient literacy. The results highlight numerous aspects that must be addressed for successful implementation, many of which have been neglected in previous periods. Conclusions The research identifies critical aspects of the social context and presents valuable implications for the digital health transformation. Key stakeholders assess that institutional and societal readiness is not at the level required for the sustainable implementation of digital health, thus necessitating specific actions, ranging from governmental bodies and international organisations to the health system, education system, and media. Key messages • It’s crucial to align digital health implementation with the social & cultural context and capabilities. • The prerequisites for successful implementation necessitate engagement across various societal domains beyond the healthcare system.

Empirically exploring the association of health literacy with schoolchildren’s health behaviours

Abstract Background Health literacy (HL) is a modifiable factor contributing to the promotion and maintenance of health and well-being throughout an individual’s life. Identified as a priority in Wales, UK in 2010, progress has since stalled despite health and education as national policy priorities and international policy growth. There is a gap in understanding of children in Wales’ HL needs, particularly below adolescent age ( < =11 years). Methods This study aimed to scope a measure of children’s HL to be integrated into the existing HAPPEN Cohort Study survey, which collects self-reported health behaviours of children aged 8-11. A review identified the Health Literacy of School-Aged Children (HLSAC) tool which conceptualises health literacy as a learning outcome. A convenience sample of n = 15 primary schools were recruited in April 2023 through HAPPEN and n = 669 school children n = 669 completed the online survey between May-June 2023. Results Preliminary data using sum HLSAC scores show a proportion of children with low (20.5%), moderate (52.8%) and high HL (26.8%). Independent samples t-tests comparing mean HLSAC scores with binary self-reported health behaviours show higher HL scores for weekly behaviours (p < 0.05); feeling less tired (0-4 days: 15.1+-4.1, > =5 days 14.5+-3.4), can concentrate (0-4 days: 14.3+-3.6, > =5 days: 15.5+-4.0) and consume less fizzy drinks (0-4 days: 15.0+-3.9, > =5 days: 14.0+-3.8). Further, for can ride a bike (no: 14.3+-4.0, yes: 15.0+-3.9), can swim 25m (no: 14.6+-3.7, yes: 15.1+-4.0), someone active in the household (no: 14.3+-3.8, yes: 15.2+-4.0) and higher health well-being (<7/10: 13.9+-3.5, > =7/10: 15.3+-3.9). This preliminary data will be strengthened with further analyses including regression. Conclusions Associations appear between various important health behaviours spanning physical activity, nutrition, cognition and wellbeing. Capturing children’s HL and health behaviour needs enables targeted health promotion and education activities.

Using PPI and UDL principles to design a gastrointestinal endoscopy patient information video series

Abstract Introduction Patients undergoing GI endoscopy often experience anxiety and due to limited health literacy. Traditional paper-based information leaflets are often not sufficient to accommodate for the diverse way in which people consume information. Public and patient involvement (PPI) and universal design for learning are two well-described pedagogical principles. We wanted to use these principles to design more effective patient education materials. Objectives Given the heterogeneity of resources available to patients, the authors wanted to develop a high-quality and trustable video resources for patients that would be available on our hospital website. These videos would be co-designed by patients and ancillary staff, through the formation of a key stakeholder panel. Results Using PPI principles, we were able to improve the relevance and quality of our content, through the use of storyboards and the expertise of the stakeholder panel. Through the three key UDL principles of multiple means of representation, engagement and action and expression, we were able to ensure that our videos were accessible and appropriate for all of our patients. Initial feedback from stakeholders and patients provided valuable insights, prompting necessary adjustments for accuracy and patient understanding. This comprehensive approach underscores the commitment to enhancing healthcare delivery. Our project is the first guide in combining both pedagogical principles in the development of patient information and education materials. Conclusions The meticulous steps taken, from stakeholder engagement to video production, reflect a commitment to inclusivity and patient-centred care. Ongoing evaluation and feedback mechanisms ensure continuous improvement, contributing to the overall success and sustainability of the digital service. Key messages • This is the first research/patient education piece designed using both PPI and UDL principles. • The importance of patient-centred educational design is key to improving health literacy and education in our patients.

Enhancing Interprofessional Skills with SKY Campus: A Pilot Study on Mental Well-being at UCD

Abstract Background Public health professionals and students face increasing mental health challenges. Sudarshan Kriya Yoga (SKY), known for its mental health benefits such as stress reduction and improved emotional regulation, offers a promising strategy for enhancing well-being in public health education. Objectives To evaluate the immediate effects of a three-day participatory SKY workshop on mental well-being of Master of Public Health students at University College Dublin, Ireland. Methods A non-randomized, controlled pilot study will involve MPH students at UCD. Participants, aged 18 and above, enrolled in the MPH programme, will provide informed consent to attend a three-day SKY workshop in September 2024. The workshop, delivered by certified trainers, includes three sessions of three hours each. Standardised and validated Patient-Reported Outcome Measures (PROMs) such as the Perceived Stress Scale (PSS-10) and WHO-Five Well-being Index (WHO-5) will be used to assess perceived stress and mental wellbeing at baseline and immediately after the workshop. Results Based on previous literature, it is hypothesized that participants will show a significant reduction in perceived stress and improvement in mental wellbeing scores. Data will be analysed using descriptive statistics and Wilcoxon signed-rank tests to evaluate changes in PROM scores. Conclusions This pilot study aims to provide preliminary evidence on the effectiveness of SKY in improving mental wellbeing among public health students. Successful outcomes could support integrating SKY into the public health curriculum, promoting its adoption across other institutions, and enhancing the professional skills development of future public health professionals. This component is proposed in the ASPHER core curriculum programme for public health as an important cross curricular subject area Key messages • Integrating SKY Campus workshops into public health education enhances interprofessional skills and mental well-being, offering a holistic approach to professional development in global health. • This study uses standard PROMs to assess the SKY workshop’s impact, aiming for significant improvements in stress and mental well-being to shape global public health curricula.

Enhancing literacy among the elderly on sexually transmitted infections: an educational intervention

Abstract Issue Sexually transmitted infections (STIs) pose significant public health concerns across different settings and countries, especially in elderly populations, in which recent increases have been noted. This project aimed to target STIs literacy among the elderly, addressing a crucial gap in public health education. Description of the problem This project focused on improving STIs literacy among elderly residents in a municipality in Northern Portugal. Using innovative methods such as tailored materials and interactive sessions, the intervention aimed to evaluate their effectiveness through pre-, post-, and one-month follow-up STD-KQ questionnaire assessments (composite score of total correct calculated as average, ranged from 0 to 27). Statistical analysis used SPSS IBM for Mac OS® v29. Descriptive statistics: mean ± standard deviation for continuous, proportions (%) for categorical variables. Analysis included only individuals with complete data. ANOVA with Bonferroni post hoc tested intervention impact on STD-KQ scores. Results Fifty-one individuals participated in this study, with an average age of 70,89 ± 5,10 years old, and 64,7% female. The average STD-KQ score increased by 151.54% immediately after, 11.39 ± 5.66 (p < 0,01), and by 122.54% after one month, 10.08 ± 5.35 (p < 0,01), compared to pre-intervention, 4.53 ± 3.96 (p < 0.01). The score at one month follow-up remained similar to post-intervention (p = 0.39), presenting a significant improvement in STIs knowledge. Lessons This pioneering project, to the best of our knowledge the first of its kind, demonstrates the effectiveness of tailored educational interventions in improving STIs literacy among the elderly, with sustained effects after one month. This innovative approach can be adapted and scaled up for broader use in different settings and countries. Key messages • Tailored educational interventions can be a powerful public health strategy to effectively enhance long-term STI literacy among elderly populations. • Assessing knowledge about STIs can be a crucial initial step for physicians to provide or refer for comprehensive education on safe sexual practices in this age group.

Immigrants and nurses’ perspectives on the barriers in using health promotion services in Finland

Abstract Background The incidence of chronic diseases and health disparities is high among immigrants. Lack of access to health promotion services targeting the needs of the immigrant population was reported. This study aimed to explore the perspectives of immigrants and nurses on the barriers to using health promotion services in Finland. Methods A qualitative study with 12 focus group interviews was conducted in various cities across Finland. A total of 69 participants, including 46 adult immigrants and 23 registered nurses, were selected through purposive sampling. A semi-structured interview was used. Interviews were transcribed verbatim and analyzed using content analysis. Results The analysis generated four themes: insufficient individual factors (i.e., knowledge, skills), restraining cultural norms (i.e., unhealthy cultural habits, gender disparities), inadequate health promotion services (i.e., lack of resources, structural limitations), and negative environmental impacts on health behavior (i.e., sweet foods and beverages, cold weather). Conclusions The findings suggest reinforcing health promotion services to prevent chronic diseases among the immigrant community. Providing health education resources that are culturally tailored helps improve immigrants’ knowledge to make healthier decisions in their own lives after migration. Moreover, it is recommended to introduce the health care system of the host country and healthy habits during the integration process, along with language training. Key messages • Improving equity in using health promotion services for immigrants requires reforms. • More strategies are needed to prevent chronic diseases among immigrants in Finland.

The influence of education on antenatal care and nutrition of newborns in Croatia

Abstract Background Previous studies indicate differences in the nutrition of newborns. Great efforts are invests in public health education of expectant mothers in order to improve the health of their offspring. Methods An analytical study of data on the influence of social factors and the level of education of mothers on the nutrition of newborns, habits of pregnant women and antenatal care in the City of Zagreb was conduct in 2022. The paper shows analytical results expressed in percentages of the prevalence and 95% confidence interval (CI). Results The survey covered 6,358 women giving birth in the City of Zagreb in 2022. Most mothers fed their newborns in the hospital with breast milk (48.6%) or a combination of breast milk and artificial nutrition (45.8%), and only 1.4% with artificial nutrition. The share of mothers who fed their newborns exclusively with breast milk is slightly higher among highly educated women (52.4%). The majority of women had their newborn’s first feeding within one hour (81.4%), also more often in highly educated women. The first breastfeeding is most often ten (10.1%) or 15 minutes after birth (8.2%). Only 1.1% of pregnant women smoked during pregnancy, of which the largest share was women with a high school diploma (62.1%). With the increase in education, the share of women with 5 or less antenatal checks decreases (completed college 3.3%, higher school 4.6%, secondary school 6.6%, primary school 12.7%). The largest share of pregnant women who had their first antenatal examination only after 10 weeks of pregnancy is among women with a high school diploma (11.3%). Conclusions The education of pregnant women influenced their adoption of positive lifestyle habits, the need for timely and regular antenatal care and the benefits of feeding newborns with breast milk. Additional education through public health campaigns aimed at pregnant women and future parents as well as breastfeeding support groups need to be continuously implement. Key messages • The education of pregnant women influenced their adoption of positive lifestyle habits, the need for timely and regular antenatal care and the benefits of feeding newborns with breast milk. • Additional education through public health campaigns aimed at pregnant women and future parents as well as breastfeeding support groups need to be continuously implement.

Training of women in the methodology of Gamification for the promotion of healthy habits in children

Abstract Background It has been evidenced that gamification has scope in the change of people behavior and in the acquisition of knowledge, therefore this methodology contributes to the promotion of health and adapts to the needs of children from the language of play, which increases their motivation in health literacy processes, so it is necessary to encourage the acquisition of new methodologies for community mothers and women caregivers, who are configured as promoters of healthy habits with their children. Objectives To train 150 women in the methodology of Gamification for the promotion of healthy habits in children; for which 20 sessions were developed addressing the following modules: a) Empowerment of women b) Gamification methodology c) Healthy habits and lifestyles d) Healthy eating e) Physical activity. Results The training of women evidenced a) the empowerment and recognition as health promoters for their life and that of their community b) the identification of the methodology of gamification and its application in processes of promotion of healthy habits c) a high adherence in the participation and learning through gamification methodology, training 150 women through sessions mediated by Information and Communication Technologies (ICTs), Learning and Knowledge Technologies (TACs) and Technologies of Empowerment and Participation (TEP) enabling the participation of women from urban and rural territories, which accounts for an inclusive process and democratization of health knowledge, impacting both women and their families, communities and children under their care, an average of 5 members per woman, benefiting 750 people in health promotion actions. Conclusions 150 women were certified, who from the application of the gamification methodology promote healthy habits in children, in their families and their communities, starting from the recognition of the experience of these in themselves to be health promoters in their territories. Key messages • Training women in gamification methodologies to promote healthy habits in children strengthens the health system by empowering them in their role as health literacy teachers in their territories. • ICT, TAC and TEP enable access to health education from an inclusive process that democratizes knowledge so that communities are active agents in health promotion activities.

Awareness of personal cardiovascular risk among the adults with an elevated body mass index in a very high-risk country

Abstract Background An elevated body mass index (BMI) is a risk factor for cardiovascular diseases (CVD). The awareness of personal cardiovascular risk (pCVR) may vary in different populations, thus influencing health behaviours and cardiovascular prevention. Purpose To analyse the awareness of pCVR among the adults with an elevated BMI, along with sociodemographic characteristics and cardiovascular risk factors (CRF) possibly associated with the lack of pCVR awareness in a very high-risk country. Methods The pilot study included a convenient sample of 1054 adults. Those with an elevated BMI (≥25 kg/m2) were divided into two groups depending on their awareness of pCVR. The groups were compared according to the sociodemographic characteristics (age, gender, and education) and CRF (BMI, hypertension, dyslipidaemia, diabetes mellitus, smoking, physical inactivity, feeling of frequent exposure to stress, previous myocardial infarction (MI), and family history for CVD). The data were collected by voluntary filling out a survey with multiple-choice questions from April 1st to June 30th, 2022. Results Out of the total number, about half of the participants had an elevated BMI (N=549, 52%). Most of them were aware of their pCVR (69% vs 31%, p<0.01). Those unaware of pCVR were younger (44±13 vs 51±14, p<0.05), mostly females (56% vs 47%, p<0.05), with high education (61% vs 51% with more than high school, p<0.05). The groups had similar average BMI (28±3 kg/m2 vs 29±3 kg/m2, p>0.05), but the participants unaware of pCVR were more frequently overweight than obese (82% vs 64% with BMI ≥25 kg/m2 and <30 kg/m2, p<0.01). They had significantly lower frequencies of hypertension (15% vs 53%, p<0.01), dyslipidaemia (23% vs 46%, p<0.01), diabetes mellitus (2% vs 14%, p<0.01), smoking (50% vs 59%, p<0.05), previous MI (3% vs 26%, p<0.01), and family history for CVD (62% vs 82%, p<0.01). However, the majority in both groups reported physical inactivity (60% vs 64%, p>0.05) and a feeling of frequent stress exposure (70% vs 71%, p>0.05). The participants unaware of pCVR less frequently had over three modifiable CRF (12% vs 37%, p<0.01). Conclusion Most of the adults with an elevated BMI in a very high-risk country are aware of pCVR, usually because of obesity, multiple additional modifiable CRF, previous MI, or family history of CVD. Still, a notable proportion of the adults with an elevated BMI in a very high-risk country is unaware of pCVR, which is associated with younger age, female gender, high education, overweight, fewer additional modifiable CRF, and the absence of previous MI or family history for CVD. This subpopulation should be considered as a target for timely health education to raise the awareness of pCVR. Increasing physical activity through motivational campaigns and developing programmes for stress relief would be important for CVD prevention among the adults with an elevated BMI, independently of pCVR awareness.

‘HepGenç’: A youth festival to promote health and well-being via films, photography, music, and arts

Abstract Background The ‘Lifelong Health’ framework of WHO emphasizes that investing in health during young ages fosters better health and higher quality of life in later years. When working with and for youth, using innovative and participatory approaches have become more important for effective health communication, especially in an era of increased environmental stimuli, digitalization, and decreased attention span for many young people, who are less attracted with traditional/ didactic health education and communication methods. Objectives This paper aims to share practical experiences of a multidisciplinary team of professionals with backgrounds in public health, psychiatry, communication, music, and arts, in collaboration with young people to organize a series of youth health festivals in different cities of Turkiye to promote youth health literacy and access to health care, with a special focus on mental health and well-being. Results HepGenc (ForeverYoung) Festivals are organized by academics and youth from different universities in Turkiye, in collaboration with NGOs and local municipalities of cities, where the events take place. These events encourage young people to think about health and well-being, including social and environmental determinants of health via short films, photography, music, and arts. The series of festivals use creative workshops to introduce different health and well-being topics to youth, who may not always find these issues ‘attractive.’ Social and mental health, including resilience and ability to adapt are also addressed, which help young participants to build a holistic and comprehensive look on health and its determinants. Conclusions Organizing health-focused festivals using films, photography, music, and arts encourages young people to be creative and productive, while raising their awareness on healthy lifestyles and healthy cities, and how they can be agents of positive change. Key messages • Using films, music, and arts help with greater engagement of young people and facilitates their learning, as well as their creativity and productivity. • Collaboration of health, communication, and arts professionals strengthens health communication/ education programs, with additional beneficial outcomes for all disciplines including shared learning.

A Training-of-Trainers program for health facilitators fighting malaria in a vulnerable community

Abstract Background When Public Health is challenged by issues related to migrant and vulnerable populations, health facilitators’ profiles are crucial to accessing communities and increasing intervention effectiveness and acceptability. The French overseas region, French Guiana, is concerned with a migrant population living in vulnerable conditions far from healthcare and being a major reservoir of malaria. Curema is an intervention implemented to fight malaria in this population by distributing RDTs, and treatments after an appropriate training of participants. Facilitators from the community are employed to provide health education and enroll participants. Objectives An intensive theoretical-practical training program was realized to enable facilitators to master procedures related to the intervention. The training was designed using the CDC Training-of-Trainers (ToT) framework and adult learning principles. It was composed of initial and on-the-field training, both based on bidirectional, participative, and dynamic working spaces. A mixed-method evaluation was carried out to assess training effectiveness and quality. Results Group dynamics and adaptations driven by facilitators’ needs were key elements of a high-quality training program. Satisfaction was elevated for training format and learning results. Statistically significant improvements in knowledge level demonstrated good effectiveness. During the initial training, difficulties persisted regarding some tasks to be performed during the intervention: further on-the-job training addressed them, improving facilitators’ practices in the field. Conclusions High-quality, effective, and appropriate training programs are required for intervention involving facilitators’ profiles. Training design is crucial to achieve it. ToT model has been shown to allow high satisfaction, learning results, and good implementation in the field. Initial and on-the-job training are an indispensable continuum to sustain good practices and motivation. Key messages • If health facilitators from the community are actors in public health interventions, appropriate training is necessary to ensure good implementation. • ToT seems an optimal model for training health facilitators.