Health Professionals Research Articles

How much digital public health is taught in German public health programs? A qualitative analysis

Abstract Background Digital public health (DiPH) professionals are crucial for a successful digital transformation in social and health care. However, the extent to which academic professionals are taught DiPH-related content in their public health studies in Germany remains unclear. Methods We used a systematic module handbook analysis to assess accredited full-time public health-oriented degree programs at German Universities for DiPH-related modules. Programs were identified through the Hochschulkompass platform and among the German Public Health Association member programs. We used MAXQDA for the content analysis of the included module handbooks. Results We identified 79 public health programs. Of these, 10 Bachelor’s and 6 Master’s offered at least one DiPH module, all being highly heterogeneous in their overall addressed public health subfields. Regarding DiPH, 6 programs lectured on the ethics of digitalizing health and data protection, 5 programs each offered modules on DiPH in health policy, on data science in healthcare and software used for eHealth, or on the digital determinants of health. 4 programs each included modules on digital health promotion and alternative evaluation methods. 3 programs each addressed digital science communication and health technology assessment. Finally, 2 programs had modules on digital epidemiology. We found differences between the common understanding of DiPH in academia and the content in the module handbooks. The content identified in the analysis focused mainly on technical areas. Social and health science content was only marginally present. Conclusions The diverse DiPH study programs allow academic public health specialists in Germany to develop specific profiles. There is a need for further development of modules with relevance to the respective degree program to achieve comprehensive competencies in DiPH. We encourage the uptake of our analysis to develop a core curriculum in DiPH among European public health programs. Key messages • Digitalization affects all areas of life, including healthcare systems and public health. Preparing the future workforce already during their training is crucial to enable them to lead the change. • German public health programs are not fit to prepare students for their professions. Developing DiPH curricula with pre-defined and updated competencies will strengthen programs in Germany and beyond.

How advanced is your digital public health system? A qualitative analysis of suitable indicators

Abstract Background Revealing the full potential of digital public health (DiPH) systems necessitates a wide-ranging tool to assess their maturity. Essential domains that need to be considered include the literacy and interest in DiPH tool application by society and the workforce and the legal and ICT maturity of DiPH systems. No review has investigated indicators on these national DiPH system maturity (DiPHSM) domains yet. Our narrative review and qualitative analysis aimed to map the landscape of indicators related to DiPHSM measurement and rank them based on their importance for such assessments. Methods As original indicators were not published in scientific databases but as grey literature, we used DuckDuckGo to apply a pre-defined search strategy for 11 countries from all continents classified as having reached level 4 of 5 in the Global Digital Health Monitor. Of the 1484 identified references, 137 were included which named 15806 indicators. Consensus on importance was defined as at least 3 or 4 authors rating an indicator as important. Results We recognized 180 indicators on different constructs with importance for DiPHSM analysis, including the availability and use of Smartphones, computers, the Internet or the DiPH intervention, the existence of skilled workforce, infrastructure (investment), and interoperability between interventions, the secondary use of health data, a DiPH strategy and controlling agency, or the application of big data and artificial intelligence for health data collection, analysis, and sharing. Conclusions Our study holds the potential to develop more comprehensive tools for DiPHSM assessments. Further examination is required to analyze the suitability and applicability of all identified indicators for diverse healthcare settings. By working towards a uniform evaluation of DiPHSM, we foster informed decision-making among healthcare planners and practitioners, improve resource distribution, and continue to drive innovation in healthcare delivery. Key messages • Maturity assessment tools need to consider the complexity of DiPH systems. Thereby, DiPH system evaluations need to be accompanied by analyses of the legal, ICT, and literacy perspective maturities. • New methods are needed to systematically assess and use multidisciplinary grey literature for research.

Vaccine literacy and cultural competence training of Professional FOR health to improve the vaccination offer

Abstract Background It is essential that healthcare institutions have a high level of organizational vaccine literacy so that they can support Newly Arrived Migrants (NAM) to navigate, understand and make informed decisions on vaccinations in an effort to make uptake equitable. Developing training material for Professional-FOR-health (PfH) working with NAM, i.e. health and non-health workers, can improve the vaccination offer for NAM. Objectives A holistic training framework for PfH was designed to increase capacity building skills and cultural sensitivity of the healthcare system in promoting active immunization of NAMs. The blended training should cover four topics: “Vaccine Literacy”, “Cultural awareness/migrant sensitivity”, “Health promotion tools with community-based approach” and “Entitlement to vaccination for NAMs/NAMs profile”. As learners cannot be seen as mere recipients of notions, their needs, motivations, and experiences should be put right at the center of the training process. Therefore, a training guide and materials were shared to Consortium Countries to be adapted and implemented in their context. Training sessions were conducted in the summer of 2023. Results A total of 180 participants showed an average increase of 8.2% in correct answers from pre- to post-raining. Notably, 112 participants experienced more than a 10% increase in correct answers. Significant increases were observed across all topics, particularly in Vaccine Literacy (A1) and NAM Profile (A4), with increases of 52% and 74%. The training was evaluated positively with an overall index of 4.2 out of 5. All items analyzed from the satisfaction questionnaire yielded positive evaluations, with an average rating of 4 out of 5. Conclusions The evaluation underscores the effectiveness of training in meeting educational needs of participants. This type of training can be the groundwork for the changes needed to make the NAMs vaccination process more guaranteed and inclusive.

3.L. Round table: Outcomes from a public debate on the future health priorities of the European Union

Abstract Objective and background In the run up to the European elections, the European Observatory on Health Systems and Policies facilitated a public debate on the future health priorities of the European Union. The purpose of the debate was to provide insights to the European Commission on the views of stakeholders and the public health community with regards to the future of the European Health Union (EHU). The EHU was established as a comprehensive health systems and public health response to the COVID-19 pandemic, featuring enhanced budgets, expanded mandates for existing bodies, and the introduction of new entities like the Health Emergency Response Authority (HERA) alongside new strategies. Methods The methodology for this comprehensive debate included workshops and plenary sessions at various conferences like the 2023 EUPHA conference in Dublin, an interactive webinar series, and a detailed stakeholder survey featuring both closed and open-ended questions. Data was collected and analyzed using diverse qualitative and quantitative tools, including AI-driven analysis of survey responses. Preliminary outcomes Preliminary analysis shows that participants actively engaged in the debate, and mostly expressed support for the EHU’s achievements to date. There was a consensus on the significant value added by the EHU, with many advocating for stronger EU action on a range of discussion topics. Stakeholders and the public health community could also relate to the discussion framework designed to guide the public debate, which included nine topics: enhancing health security; addressing the determinants of health through Health in All Policies and Health for All Policies; supporting health system transformation; enhancing the labour market for health and care workers; achieving universal health coverage; implementing digital solutions and AI; improving the performance and resilience of health systems; addressing long-term challenges, such as population ageing or climate change; and strengthening the EU’s global voice and leadership. The importance placed on these topics varied among different groups. Young participants prioritized climate-related actions, the public health community emphasized addressing the determinants of health, and policymakers concentrated on issues related to health system resilience, universal coverage, and transformation. Digital solutions and AI were recognized as crucial, but they were typically considered integral and transversal to broader issues rather than standalone priorities. The debate also surfaced priorities not initially included in the discussion framework, such as health promotion, prevention, and equity within health systems, which were repeatedly highlighted. Key messages • The debate on the EU’s future health priorities demonstrates that stakeholders and the public health community acknowledge the value of the EHU and would like to see further action to build on it. • Stakeholders and the public health community have formulated concrete action to take the EHU further. Speakers/Panelists Giada Scarpetti TU Berlin, Berlin, Germany Caroline Costongs EuroHealthNet, Brussels, Belgium Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg

3.B. Scientific session: Why do we need clear understanding of digital public health interventions?

Abstract The rapid proliferation of digital technologies in health and public health has led to various terms and concepts, often used interchangeably or inconsistently. This ambiguity hampers communication, complicates research efforts, and undermines the effectiveness and adaptation of interventions. Without a clear understanding of such concepts, stakeholders face difficulties using, evaluating, and regulating digital public health (DiPH) initiatives. Thus, there is an urgent need to establish a common language - across academic disciplines and in the science-to-practice/policy transfer - to foster collaboration, ensure accountability, and maximize the impact of DiPH interventions globally. This workshop highlights the need for a cross-sectoral understanding of terms and concepts related to DiPH interventions. For this, we identify effective strategies for engaging diverse populations in DiPH interventions, considering accessibility, usability, and cultural sensitivity. Additionally, we present how a more precise understanding of these concepts will impact positive population-health outcomes of DiPH interventions. Finally, we discuss DiPH terminology enhancement regarding data protection, highlighting the boundaries of digital interventions within and outside health policies and public health systems, given the diversity of the legal frameworks applicable in either case. We aim to facilitate interdisciplinary collaboration and knowledge exchange, fostering a shared understanding of terminology and best practices. This will advance DiPH by promoting clarity, rigor, and transparency in research and practice. Shared understandings of key concepts will eventually enhance the design, implementation, and evaluation of DiPH interventions, leading to improved population health outcomes and informing evidence-based policymaking and regulatory frameworks. The workshop consists of four presentations and a 20-minute panel discussion on increasing understanding dissemination. The first talk highlights multi-stakeholder perspectives (including researchers, technicians, health and medical practitioners, and the general public) on the ever-changing terminology of DiPH concepts. The second presentation showcases how these varying perceptions influence the academic representation of DiPH interventions and that interventions - although summarized under the same terminology - drastically vary concerning their use case and characteristics. The third speaker will discuss why a clearer understanding of these terms is needed to increase engagement with DiPH interventions for positive population health outcomes and identify effective DiPH interventions based on evidence. The last talk explains why unclear terminology or standards threaten populations and result in over- or under-regulation of DiPH interventions. Overall, this workshop catalyzes advancing the DiPH agenda in Europe, empowering stakeholders to harness the full potential of technology for promoting population health. Key messages • When we create technical terms, it is our professional approach, characterized by our academic background. It does not necessarily transfer to other domains or the general population. • Digital Public Health can transform global healthcare. However clear & harmonized terminologies are crucial for comparing evolving technologies & paving the way for transformative digital healthcare.

Environmental and health databases used together for boosting a One Health approach

Abstract Publicly available European environment data, and specifically those collected and published by the European Environment Agency represent a great asset for environment and health researchers and practitioners. This presentation will summarize the use of such data for various environment and health projects and assessments at the National School of Public Health of NOVA University in Lisbon, Portugal.

Fast lane for decision making: The PHIRI Rapid Exchange Forum

Abstract Issue & Problem The COVID-19 pandemic demanded swift, yet structured exchange of knowledge, data and good practices between experts and institutions supporting national governments in decision making for crisis response. Thus, in March 2020 population health experts from several European countries started to meet online, complementing the more formal EU Health Security Committee meetings. The European Commission understood the high need of Member States for evidence-based, and structured cross-country exchange and supported it as part of the Population Health Research Infrastructure (www.PHIRI.eu) project. Since then, the PHIRI Rapid Exchange Forum (REF) is a knowledge-sharing platform that brings together public health researchers, practitioners, policymakers, and other stakeholders to share information, experiences, and best practices in public health implementation research even if the EU co-funded PHIRI project has ended. The forum aims to promote collaboration and networking, facilitate the dissemination of research findings, and accelerate the translation of evidence into policy and practice. Lessons Through the PHIRI REF, participants can engage in interactive discussions, workshops, and presentations on various public health topics, including infectious diseases, digitalisation, health emergency simulations, health systems strengthening, and community health interventions. The platform is designed to be user-friendly and accessible to all, with a particular focus on European countries. By May 2024, the REF-Secretariat at the Austrian National Public Health Institute GÖG had organised 60 REF meetings, with in average 20 attendees from 12-15 countries. The monthly 1-hour online meetings cover in a moderated, structured format pre-agreed topics that are proposed by the participating countries. All findings and topics are documented and publicly available at the EU Health Information Portal (https://www.healthinformationportal.eu/rapid-exchange-forum). Key messages • The success of the Rapid Exchange Forum highlights the importance of collaboration and information exchange between population health experts in addressing global health challenges. • Having a pre-established information exchange network on urgent public health issues is of utmost importance as it enables rapid and trustworthy communication among relevant stakeholders.

Participative development of a culture-sensitive instrument to measure substance use in Syrian refugees

Abstract Background Rarely assessment instruments have been developed with end users such as refugees or those suffering from mental health conditions. Refugees’ experiences pre-, during, and post-flight are associated with various mental health problems including substance use disorders. Systematic reviews on the prevalence of substance use disorders in refugees worldwide show heterogeneous results. To address possible misclassification due to the lack of refugee-sensitive instruments we aimed to develop a refugee-sensitive instrument. Methods We applied a three-step triangulation study design. First, we conducted a three-stage delphi-process in 2019 and 2020. We recruited Syrian medical doctors for the study. Second, we conducted six focus group discussions with Syrian refugees and medical doctors. Third, we conducted expert checks with medical doctors and professionals providing psycho-social services for refugees. For all focus group discussions, audio recordings were translated and transcribed. Computer-assisted thematic analysis was performed applying a deductive approach with semantic coding. Results The refugee-sensitive instrument consists of seven domains of substance use: lifetime use of relevant types of substances, frequency, intensity, self-perception of, and situations posing a risk for substance use, ability to perform, craving, tolerance, and intentions to reduce or quit substance use. Discussion The instrument has been developed qualitatively, however, a limitation is that it could not be validated in a quantitative large sample of refugees. In spite of this limitation, this is - to the best of our knowledge - the first instrument that has been developed in a participatory approach together with end-users. Outlook The study suggests that developing assessment instruments in a participatory approach is feasible. Participatory development of assessment instruments is in line with the new paradigm of co-creation of mental health conditions management.

The meaning of organizational culture and structure for interprofessional collaboration

Abstract In Germany, early neurological rehabilitation (ENR) acts as a link between acute inpatient care and rehabilitation, aiming to restore patients’ ability to rehabilitate amid their complex clinical conditions. Interprofessional cooperation (IPC) is crucial for harmonized treatment due to patients’ vulnerability. An interprofessional team comprising medical, nursing, and various therapy professionals is essential for this purpose. To explore the meaning of organizational culture and structure to IPC, 15 group discussions in 5 clinics were conducted with n = 76 participants. 1. Weekly team meetings are used to coordinate treatment goals and outcomes, but their implementation varies from clinic to clinic. Two types of meetings were identified: those that focus primarily on billing compliance and others that address patients’ long-term perspectives. However, both require additional social service involvement and are not sufficient to adequately address daily tasks, requiring additional IPC coordination. Some clinics have therefore introduced daily meetings to improve the coordination of IPC tasks. 2. Therapy planning and therapist assignment shape IPC and task fulfillment. Three therapy planning methods were observed: centralized, block-based, and flexible, each with different therapist allocation strategies. Centralized planning with flexible allocation leads to appointment pressure and interprofessional communication challenges. Block therapy reduces therapist turnover and promotes better interprofessional coordination in patient care. Flexible therapy planning is conducted through daily interprofessional meetings with shared task allocation and planning leads to a shared understanding. Initial analysis underscores the meaning of organizational structure on interprofessional task fulfillment in ENR, emphasizing the importance of enhancing different cooperation formats which can balance stability and flexibility and integrate social services effectively in patientcare. Key messages • Morning interprofessional meetings on the ward facilitate flexible responses to daily changes in patients’ health conditions and promote interprofessional collaboration. • The consideration of occupational group-specific processes in ward organization is a necessary structural prerequisite for successful interprofessional collaboration.

Missed opportunities of method information index plus (MII+) counseling among current modern contraceptive users. multi-level analysis from the Ethiopian PMA 2021 data set

IntroductionIn Ethiopia, there is a decrease in percentage of women who receive method information index counseling service from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally, and less than 40% of these services provided are high quality. Therefore, the aim of this study was to identify modern contraceptive users-related factors at individual level and community level associated with missed opportunities of method information index plus counseling.MethodsThis study used the datasets from the 2019 Performance Monitoring for Action Ethiopia Survey, which comprised a total of 8,365 households (98.9%) and 7,988 women (98.8%). The data analysis was done with Stata version 14. Using multilevel mixed effect logistics regression, both individual and community-level factors were found to be associated with missed opportunities of method information index plus counseling. a P-value of less than 0.05 was used to declare statistical significance. The association was presented using an adjusted odds ratio with a 95% confidence interval.ResultsThe study shows that the prevalence of missed opportunity MII + family planning counseling among current modern contraceptive users was 81% (79.15, 82.66) and factors significantly associated with missed opportunities of method information index plus counselling are educational status, low level of media exposure, religion, receiving the service in health centers and health posts, never heard of any other methods, number of children at first contraceptive use and region.ConclusionsIn Ethiopia 81% of women had a missed opportunities of MII + counseling service. In order to address this, we recommend policy makers to focus on training of health care workers and pharmacists about MII + counseling, and establishing ways to improve access to media exposure.

Pager Explosion in Beirut: An Unprecedented Event.

On September 17, 2024, at 15:30 local time, thousands of pagers used by members of a specific party group detonated across Lebanon. As a result of the explosions, 2800 were wounded and 12 lost their lives. Almost two-thirds of the injuries were in the face, eyes, or hands. The Lebanese American University Medical Center received 38 injured and admitted 36 patients, 13 of them to the Intensive care unit. A total of 33 patients needed surgeries. All medical and nursing staff were deployed. The health care workers faced major challenges that night: the severity of the injuries and the unprecedented types of injuries with the same pattern, and the urgent need for ophthalmology and orthopedics within the hospital and across the country. Learning from the Pager Explosion, each hospital should perform assessments of their disaster response plan, develop trainings, and conduct regular exercises in preparation for future disasters.

Forecasting the future demand on health workforce – the Austrian model

Abstract Background An aging population and upcoming retirements of health care professionals pose new challenges to the Austrian health care system. On the one hand the health care and nursing needs will increase while at the same time a shortage on health care personnel threatens adequate supply. We as the Austrian Public Health Institute estimate the risk of an undersupply with model-based health workforce forecasting and are therefore able to advise the federal states and the ministry of health on early measures. Methods We developed a forecasting model to estimate the future supply and demand. The main influencing factors are the demographic development as well as the upcoming retirements and graduates. Different environments and needs in different federal states (e.g. changing future skill mix) are considered and can be implemented as additional influencing factors. Usually a baseline scenario as a forward projection of the status quo is developed for defined professions and workplace settings. Then depending on the stakeholder needs additional scenarios are calculated and discussed. A usual forecast horizon is 10 to 15 years. Results Model output are time series of yearly workforce personnel numbers (heads and full-time equivalents) and demand in the defined settings. An analysis of possible gaps shows the need for action. Conclusions The Austrian health workforce model is a flexible tool to estimate future needs on health workforce based on different assumptions. But as assumptions and influencing factors must be represented as data, the data collection can be quite laborious. Comprehensive data is the basis for a comprehensive health workforce planning. Further work is needed to develop practical and evidence-based nursing-sensitive indicators for nursing workfoce reportings on a country level. In Austria the health professionals register forms the basis for the description of the nursing workforce structure, but that there is a need for data sources on care effectiveness. Key messages • Comprehensive data is the basis for a comprehensive health workforce planning. • An aging population and upcoming retirements of health care professionals pose new challenges to the Austrian health care system.

The 2023 Terror Attack on Southern Israel: Well-Being and Burnout Among Health Care Personnel Treating Traumatized Evacuees

The 2023 Terror Attack on Southern Israel: Well-Being and Burnout Among Health Care Personnel Treating Traumatized Evacuees

In development intervention, professionals aim to enhance working practices and interaction

Abstract Background The social services and healthcare professions are experiencing a global labor shortage. Enhancing the appeal and retention requires the development of work and processes through community-level interventions that reduce workload and bolster resources. Further research into such interventions is necessary. This study focuses on a systematic community-based practice development model (Breakthrough Collaboratives) to evaluate the change in alignment with the development intervention’s objectives and the prerequisites for change. The evaluation will utilize the process evaluation model for well-being at work projects and health promotion interventions. Methods This qualitative process evaluation employs a multi-case study approach to depict the changes occurring during the development intervention. It assesses the development processes of fifteen workplaces across Finland. The research material includes recorded group discussions from the initial workshop, where professionals establish goals and development targets for their work. The qualitative data are analyzed using content analysis. The analysis is guided by questions such as: What goals and development objectives do participants set for their work? What workplace-specific characteristics inform these objectives? Results Preliminary findings indicate that the work units’ development objectives concentrate on updating the unit’s common rules, enhancing the induction process for new employees, improving work behavior, and refining meeting practices. Workplace-specific characteristics differ based on the work unit’s sector, the level of trust among professionals, and their willingness to critically evaluate management. Additionally, competence and professionalism emerge as prominent themes in group discussions. Conclusions In a workplace development intervention, professionals aim to enhance common working practices and interaction, with the goal of improving well-being at work. Key messages • Enhancing operational practices and promoting positive interpersonal conduct among colleagues constitutes a pivotal goal in advancing social and health care work units. • The Community based intervention provides workplaces with concrete models to support co-creation and permanent changes in working practices.

TB Care in Ukraine: Understanding Access Barriers at the Primary Healthcare Level

Abstract Background In the WHO European Region, Ukraine is a high-priority country for TB control, being one of nine globally with high rates of multidrug-resistant TB. The WHO emphasizes patient-centered TB care, prioritizing patients as key figures in the care continuum. Thus, our aim was to explore barriers impacting the accessibility of TB services for patients at the primary healthcare level (PHC) in Ukraine. Methods During December 2022-June 2023, a qualitative study was conducted across eight PHC facilities in the Kyiv, Odesa, Mykolayiv, and Volyn regions. The study comprised: 4 focus groups involving 27 family doctors, 16 in-depth interviews with managers and health authorities from regional and national levels, as well as 25 interviews with TB patients. All data was transcribed, manually coded and deductively analyzed. Results All participants highlighted the benefits for patients of providing TB care continuum at the PHC level, yet the program lacks clear requirements for training of family doctors and nurses. Overall family doctors perceived positively various TB training they received; but despite this, they expressed doubts and reported a lack of practical skills, affecting the quality of care provided. Patients highlighted several barriers in interacting with healthcare providers, including stigma and cases of dismissive behavior of healthcare workers, communication challenges, and breaches of patientś data confidentiality. Patients also mentioned self-stigma, and perceptions of family doctors as poorly trained in TB. Still, patients who received healthcare services from the same family doctor “during long time” positively described their experience with TB services too. Conclusions Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine. To achieve this, a comprehensive TB training program tailored for PHC family doctors and nurses should be developed and implemented. Key messages • Expanding TB healthcare services to primary healthcare levels in Ukraine can be beneficial for patients. Training primary healthcare staff can enhance TB care quality. • Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine.

Exploring Stakeholder Perspectives on the Implementation of WHO iSupport for Dementia Program: A Qualitative Study.

To explore the stakeholders' perspectives and develop a conceptual framework for promotion strategies to implement the iSupport-based intervention for family caregivers of people with dementia. A descriptive qualitative design was adopted. Semi-structured interviews were conducted with 49 stakeholders of people with dementia from July to December 2023. The Consolidated Framework for Implementation Research was applied to guide the development of the interview guide, data collection and analysis. Directed content analysis was employed to identify facilitators and barriers, with data analysed based on the framework and the established its codebook. These findings were then summarised into a conceptual framework of critical components. The identified 16 barriers and 28 facilitators were distributed across all Consolidated Framework for Implementation Research domains. All facilitators and barriers were integrated into a conceptual framework guiding the implementation of iSupport. This four-tier, eight-component conceptual framework guides the global promotion of the web-based dementia care model, covering state, society, hospitals, individuals and strategies. The components included comprehensive and balanced national medical guidelines, a friendly social culture, adequate hospital collaboration, cooperative healthcare workers, responsible family caregivers, a comprehensive intervention system, appropriate learning content and digital health support. The 'iSupport for Dementia' program is seen positively for its potential to improve dementia care by providing mental and technical support to family caregivers. Successful implementation requires addressing barriers, enhancing facilitators and adapting to China's conditions and policies. Mobilising local healthcare resources and gaining stakeholder recognition is crucial. This approach may help develop a localised version of iSupport that suits the needs and habits of Chinese family caregivers, with the potential for broader dissemination. The 'iSupport for Dementia' program could greatly improve dementia care in China by addressing barriers and utilising facilitators. This study offers critical insights for future policy development and effective implementation strategies. Adherence to the COREQ guidelines for reporting qualitative research was maintained. No patient or public contribution.

Primary eye care service provision ability of mid-level healthcare providers in southern Ethiopia

Background: The provision of eye care services by trained and well-capacitated primary care providers in the rural community will contribute significantly to the reduction of avoidable blindness.Aim: This study aimed to investigate mid-level healthcare providers’ knowledge and skills capacity to provide primary eye care services.Setting: The study was conducted in four districts of southern Ethiopia.Methods: An institution-based descriptive cross-sectional study was conducted among randomly selected mid-level healthcare providers from August to October 2023. A self-administered questionnaire was used to collect data. Data entry and analysis were performed using Epi info version 6 and SPSS version 28 software. Descriptive statistics and logistic regression models were used in the analysis.Results: A total of 103 mid-level healthcare providers were involved in the evaluation with a response rate of 99%. Of the study respondents, less than half (48.5%) were found to have intermediate-level ability to provide primary eye care services. Serving more patients per month (p 0.001), receiving additional training (p 0.005) and having a first degree (p 0.001) were found to have a statistically significant association with the ability to provide primary eye care services.Conclusion: Most primary eye care service providers had a significant knowledge and skill gap. Capacity-building training aimed at enhancing the ability of primary eye care service providers need the appropriate attention.Contribution: This study presents the ability of mid-level healthcare workers to provide primary eye care services to support the elimination of avoidable blindness, resulting in improved quality of life.

An integrated approach to enhance vaccine uptake in chronic patients – the VacciNetwork project

Abstract Issue/problem Individuals with chronic illnesses are at a higher risk of infections and their complications. Vaccinations are crucial in reducing this risk and their integration in chronic care pathways can enhance vaccine uptake, but it requires a collaborative approach and increased awareness in care personnel, caregivers and patients. Description of the problem The Local Health Authority of Rome 2 (ASL Roma 2, with approx. 1.3 million residents) initiated an active promotion plan for recommended vaccinations in chronic patients in January 2023, and a Clinical Vaccinology Workbook was produced to guide healthcare workers in promoting vaccinations across various care settings. The plan aims to establish collaborative agreements with hospitals and territorial structures that manage these patients, integrating vaccination plans with clinical and healthcare pathways for a more holistic approach to chronic disease management, a model that could benefit similar populations globally. Results Data was extracted from administrative databases regarding vaccinations performed in 2022 and 2023 on fragile subjects, i.e., those with a marked ‘risk condition’, aged ≥18 years. The results showed that vaccine uptake was more than doubled (6675 vs. 2041; +227%). Notably, vaccinations rose among those with oncological-hematological diseases (+212%), asplenia (+185%), chronic kidney failure or on dialysis (+190%) and those with an HIV infection (+160%). Increases were also significant in other immunocompromised conditions (+194%). Lessons The practice underlines the importance of targeted vaccination programs within chronic care management. Collaborative healthcare frameworks can significantly improve vaccination rates, reducing the burden of infectious diseases in high-risk populations. These results underscore the potential applicability of such a model in other regions and countries, highlighting the universal relevance of integrated healthcare solutions. Key messages • Collaborative, integrated frameworks between clinical and vaccination services can represent a model for increasing vaccine uptake in chronic disease patients. • Strategic partnerships and education in healthcare settings can improve vaccination rates and contribute to more holistic chronic disease management.

Cohort retention in a pandemic response study: Lessons from the SIREN study

Abstract Background Cohort studies represent an important research-tool, yet participant retention is difficult. SIREN followed a cohort of healthcare workers across 135 NHS sites in the UK during a pandemic. We designed an evolving retention programme, underpinned by our Participant Involvement Panel (PIP). We aimed to evaluate cohort retention over time and identify learnings. Methods Mixed method evaluation of our evolving retention programme in the 12 and 24-month cohort. We described cohort retention by demographics and site, using odds ratios from logistic regression. Withdrawal reasons were collected by survey. We collected participant feedback via cross-sectional survey using a behavioural science approach. We conducted focus groups with research teams and conducted thematic analysis. Results 37,275 (84.7%) participants at 135 sites completed 12-months of follow-up. 12,635 (85.5%) participants at 87 sites completed 24-months. Retention increased with age (24-months: >65 vs < 25 years OR = 2.92; 95%CI: 1.78-4.88; p < 0.001) and was highest in the Asian and Black ethnic groups (24-months OR = 1.78; 95%CI: 1.42-2.25; p < 0.001, and OR = 2.12; 95%CI: 1.41-3.35; p < 0.001, respectively, Ref=white). SIREN scored highly in participant feedback. Lessons for future studies include the need to monitor changing participant motivation; using inclusive and comprehensive communication; acknowledging the contributions of participants and investing in the skillset of research teams. Conclusions Despite challenges to running a large multicentre cohort study in an evolving pandemic, retention in SIREN has remained very high. Some factors impacting retention were outside of study control, including the altruistic motivation of participants. Participant feedback was positive, suggesting SIREN methodology will provide useful learning for future retention programmes. Site feedback provided learning for future multicentre research studies, offering insights into key facilitators and common challenges. Key messages • Cohort retention is difficult. Mixed methods evaluation shows SIREN achieved high retention while following a cohort of healthcare workers across 135 NHS sites in four UK nations during a pandemic. • Lessons learned include the need to monitor changing participant motivation; using inclusive communication; acknowledging participants contributions and investing in the research team skillset.

A new digital model for Italian Integrated Home Care: strengths, barriers, and future implications

Abstract Issue/Problem After the COVID-19 pandemic, Italy’s National Health Service (NHS) is transforming by adopting telemedicine through its National Recovery and Resilience Plan, aiming to modernize healthcare delivery and ensure equity. In this plan Territorial Coordination Centers (COT) were designed to improve patient access and continuity of care. However, regulatory challenges hinder the widespread adoption of telemedicine. Our work describes the technical, structural, and operational aspects of the new Italian Integrated Home Care (IHC) digital model, addressing strengths, barriers, and future implications. Description of the problem The implementation of the IHC digital model faces multiple challenges. Italy’s poor technical infrastructure, especially in rural areas, hampers access to critical services. Resistance to change among rural systems and the elderly, coupled with low digital literacy, inhibits telemedicine adoption. Fragmentation in the NHS leads to resource disparities, particularly disadvantaging southern regions. Italy also grapples with a severe shortage of healthcare professionals, posing a threat to the model’s sustainability. Results The National Digital Health Agency enacts the IHC model by overseeing telemedicine services through a cloud-based protocol. Each Region provides “Basic Telemedicine Services”: healthcare professionals’ and patient teleconsultation, telemonitoring, teleassistance. Communication between services, infrastructures, and local health authorities is facilitated by a modular interoperability layer, ensuring data standards and quality. A national telemedicine dissemination portal will contain data on all telemedicine solutions provided. Lessons Clear communication is essential for telemedicine acceptance. COTs enhance coordination and management. Bridging the technology gap for disadvantaged groups, supporting frontline employees and addressing adoption factors is vital to overcome the challenges faced. Key messages • The National Digital Health Agency drives telemedicine services under the IHC model. Each region offers Basic Telemedicine Services, ensuring data standards, quality and interoperability of data. • Italy’s telemedicine adoption faces poor infrastructure, resistance and workforce shortages. Focusing on equity, healthcare workers support and bridging the technology gap will be key.