Health Promotion In Primary Care Research Articles

THE CARE SCENARIO IN PRIMARY HEALTH CARE FOR THE BLACK POPULATION

This research aims to analyze inequalities in access to health care for the black population in Primary Health Care (PHC) in Brazil, highlighting the impact of structural and institutional racism on care practices. The overall objective is to analyze the current scenario of care and health promotion in primary care for the black population. The research methodology was a qualitative and descriptive literature review. The research shows that PHC, although it is the gateway to the Unified Health System (SUS), often fails to equitably meet the needs of the black population, resulting in worse health and quality of life indicators. The conclusion points out that it is urgent to implement inclusive public policies and anti-racist practices, in addition to promoting the continued training of health professionals with a focus on the specificities of the health of the black population. The active participation of this population in the formulation of policies and the encouragement of research on their health conditions are essential to promote comprehensive and equitable health.

Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil.

Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC. To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil. The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups. Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy. Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.

Prevalence, distribution, and hepatic fibrosis burden of the different subtypes of steatotic liver disease in primary care settings.

In relation to the new umbrella terminology for steatotic liver disease (SLD), we aimed to elucidate the prevalence, distribution, and clinical characteristics of the SLD subgroups in the primary care setting. We retrospectively collected data from 2535 individuals who underwent magnetic resonance elastography and MRI proton density fat fraction during health checkups in 5 primary care health promotion clinics. We evaluated the presence of cardiometabolic risk factors according to predefined criteria and divided all the participants according to the new SLD classification. The prevalence of SLD was 39.13% in the total cohort, and 95.77% of the SLD cases had metabolic dysfunction (one or more cardiometabolic risk factors). The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) was 29.51%, with those of metabolic dysfunction and alcohol associated steatotic liver disease (MetALD) and alcohol-associated liver disease (ALD) at 7.89% and 0.39%, respectively. According to the old criteria, the prevalence of NAFLD was 29.11%, and 95.80% of the NAFLD cases fulfilled the new criteria for MASLD. The distribution of SLD subtypes was highest for MASLD, at 75.40%, followed by MetALD at 20.06%, cryptogenic SLD at 3.33%, and ALD at 1.01%. The MetALD group had a significantly higher mean magnetic resonance elastography than the MASLD or ALD group. Almost all the patients with NAFLD met the new criteria for MASLD. The fibrosis burden of the MetALD group was higher than those of the MASLD and ALD groups.

Can Waist-to-Height Ratio and Health Literacy Be Used in Primary Care for Prioritizing Further Assessment of People at T2DM Risk?

To identify people at risk of type 2 diabetes. Primary health care needs efficient and noninvasive screening tools to detect individuals in need of follow-up to promote health and well-being. Previous research has shown people with lower levels of health literacy and/or well-being scores are vulnerable but may benefit from intervention and follow-up care. This cross-sectional study, aimed to identify people at risk for type 2 diabetes by comparing the Finnish Diabetes Risk instrument with the waist-to-height ratio. Further, the difference was examined in health literacy and well-being scale scores in the countryside versus town areas, respectively. In total, 220, aged 18-75 years, participated. Thereof, 13.2% displayed biomarkers at prediabetes level of HbA1c (39-47 mmol/mol); none had undiagnosed diabetes. Of the participants, 73% were overweight or obese. Waist-to-height ratio demonstrated 93.1% of the prediabetes group at moderate to high health risk and 64.4% of the normal group, with an area under the curve of 0.759, sensitivity of 93.3%, and specificity of 63.1%. Residency did not influence prediabetes prevalence, health literacy, or well-being. Waist-to-height ratio and the Finnish Diabetes Risk instrument may be suitable for identifying who need further tests and follow-up care for health promotion in primary care.

Development, Pre-Testing and Feasibility Testing of Multi-Component Interventions, Critical for Mental Health Promotion in Primary Care among Mexican-American Adolescents Living in Rural America.

Rural America is often viewed as bereft of social problems facing urban America. Rural families, however, experience stressors due to low employment rates, fewer educational opportunities, a relatively increased incidence of poverty and limited access to mental health care. These families are at increased risk for substance use, violence and associated psychological distress that occurs when failing to cope with stress. Rural children, experiencing these stressors and affected by barriers of culture, poverty and remote access to mental health care, are at higher risk for these negative health outcomes. The need for culturally appropriate intervention tailored to the target population, rural Mexican-American adolescent women, is consistently supported by evidence. A one-size-fits-all approach most likely will not effectively impact behavior and health outcomes. The fact that few studies evaluated effects of mental health interventions on multiple outcomes including substance use, violence, unintended pregnancy and STI is problematic given previously noted associations. Evidence is needed to evaluate associations between mental health interventions and these outcomes. This manuscript presents results of preliminary studies, conducted using a multi-method research approach for development, pre-testing and feasibility testing of interventions for rural primary care settings. This methodology is appropriate when dealing with the complexity of social phenomena. It provides a look at an issue from all angles and thereby the cultural context and perspective informing intervention development. These multi-component interventions are critical for mental health promotion among Mexican-American adolescent women living in rural America.

Rural Health Workers and Primary Health Care Promotion in Southeast Nigeria: Challenges and Their Implication to Community and Sustainable Development

Rural Health Workers and Primary Health Care Promotion in Southeast Nigeria: Challenges and Their Implication to Community and Sustainable Development

Health promotion in primary care: effects and limitations in conservative neoliberalism.

This article aims to understand and analyze the effects and limitations of Health Promotion in Primary Health Care (PHC). We conducted genealogical, qualitative research with 23 PHC workers. The analysis originated the following datasets: effects of Health Promotion practices performed in PHC and difficulties and limitations in conducting the practices. The results show that the main impact of Health Promotion is reducing medicalization and adopting Expanded Clinic elements in the care provided. The main difficulties arise from the poor public policies due to the fiscal austerity measures adopted in recent years. Strengthening the collective nature of health demands and their responses is a possibility of resisting in the face of the authoritarian neoliberal rationality currently prevailing in the Brazilian State.

Scandinavian entry points to social medicine and postcolonial health: Karl Evang and Halfdan Mahler in India.

Our contributions examine the Norwegian Karl Evang's (1901-1981) and the Dane Halfdan Mahler's (1923-2016) participation in international health co-operation facilitated by the World Health Organization (WHO) in India in the 1950s. While Evang's was a hectic, but relatively short visit as part of a WHO visiting team of medical scientists in 1953, Mahler's spanned the entire decade on assignments as WHO medical officer to tuberculosis control projects. Mahler's name should be familiar to researchers of international health as the Director-General of the WHO 1973-88, and for his promotion of primary health care through the 1978 Alma-Ata Declaration. Evang, Norway's Director of Health 1938-72, was also a key figure in international health in the mid-twentieth century as one of the original instigators of the WHO, and a participant in much of its early work.A core theme is the place of social medicine, both in Evang's and Mahler's work, and within the WHO and its navigation of complex postcolonial settings in the 1950s. Investigating cross-regional encounters and circulations of social medicine ideas between Evang and Mahler and their Indian interlocutors as well as international WHO staff members, we ask what the role of social medicine was in international health in the early post-war period. Researchers have found that social medicine had its heyday during the 1930s and 1940s, and that a technology-focused, vertical approach became dominant soon after the war. In contrast, we suggest that continued circulation of social medical ideas points towards a more complicated picture.

Health promotion: the essence of primary healthcare

Background: Health promotion is well known for its role in disease prevention and non-pharmacological treatment, and how it has helped improve disease prognosis. It is also one of the most important functions of a well-qualified primary care physician.Current Concepts: The four main areas of health promotion in primary care are smoking cessation, nutrition, physical activity, and weight control. There is strong evidence to suggest that quitting smoking can prevent a variety of tobacco-related cancers. A well-balanced diet along with the right amount of exercise and resulting weight control are just as important as pharmacologic treatments for comorbidities related to obesity and cardiovascular diseases. As can be deduced from the leading causes of deaths in Korea in 2021, the majority of them are caused by diseases on which health promotion can prove to be a useful remedy. The potentially significant impact of health promotion is emphasized here.Discussion and Conclusion: Although it may not produce dramatic results, the essence of primary care is health promotion as it also saves great lives in the long term. Despite the importance of health promotion in overall patient care, there is a lack of public awareness and support on this issue, and primary care physicians are sometimes underappreciated. Reinforcement of nationwide financial support for health promotion is needed for primary care physicians practicing with earnest conviction to prevent and treat diseases.

Health promotion in primary care across Brazil: Genealogic-inspired qualitative study

Objective: To describe and analyze Health Promotion practices in Primary Health Care. Method: Genealogic-inspired qualitative, descriptive, and exploratory research conducted in a PHC service in Porto Alegre, Rio Grande do Sul, Brazil. Twenty-three semi-structured interviews were held with the service staff from February to May 2020. The data were qualitatively analyzed using genealogically inspired techniques, which allowed us to identify tensions, disputes, discourses, practices, and power relationships. Results: We established eight sets of Health Promotion practices: 1) Educational activities focused on behavioral/habit changes and development of personal abilities; 2) Intersectoral practices and community social networks involving other community equipment; 3) Practices that encourage community organization and participation; 4) Integrative and Complementary Health practices; 5) Practices that stimulate meeting people, sociability, art, and creativity; 6) Practices that encourage environmental and food sustainability; 7) Practices that stimulate income generation; 8) Community communication practices. Conclusion: We identified a heterogeneous field of practices to promote health established through the circulation of different types of knowledge and powers. The practices are permeated by discourses linked to neoliberal governability and practices that position themselves against such discourse.

Health promotion in primary care

Health promotion is the opportunistic encouragement of patients to manage their own health. Health promotion is an integral part of general practice and aims to improve patient, population and planetary health. During COVID-19, healthy behaviours have declined and health inequalities have widened in the UK. Now is a good time to encourage patients to engage with their overall health and well-being and to provide extra support to disadvantaged patients. GPs have a crucial role in helping to empower patients and guide them towards healthier living. This article will explore health promotion within primary care and suggest practical ways to implement health promotion holistically in practice.

Reanalysis of a Randomized Controlled Trial on Promoting Influenza Vaccination in General Practice Waiting Rooms: A Zelen Design.

In 2014–2015, we conducted a randomized controlled trial (RCT) assessing the effect of an advertising campaign for influenza vaccination using posters and pamphlets in general practitioner (GP) waiting rooms. No effect of the intervention could be demonstrated, but the immunization uptake increased in both arms of the study. In 2019, we deepened the investigations explaining the increased uptake conducting a registry-based 4/2/1 cluster RCT designed by Zelen with two extra years of follow-up of the study cohort. The study population included 23,024 patients eligible to be vaccinated who were registered with 175 GPs. The main outcome remained the number of vaccination units delivered per study group. Data were extracted from the SNIIRAM warehouse claim database for the Lille-Douai district (northern France). No difference in vaccination uptake was found in the Zelen versus the control group of the initial RCT. Overall, the proportion of vaccinated patients increased in the cohort from 51.4% to 70.4% over the three years. Being vaccinated the previous year was a strong predictor of being vaccinated in a subsequent year. The increase in vaccination uptake, especially among people older than 65, can be explained by a cohort effect. Health promotion and the promotion of primary health care may play an important role in this increase.

Telemedicine in Greek Remote Areas during CoViD-19 Outbreak: The case of Lakonia

The Hospital Unit of Molaoi (H.U.M.) organized telemedicine workshops in remote areas of Laconia province (South Greece), giving citizens the opportunity to undergo specialized medical examinations, free of charge and without moving from their homes, during the SARS- CoV-2 virus pandemic. These workshops are aimed at the prevention, the early diagnosis, and the general promotion of Primary Health Care. The implementation of the pro- gram was based on the principles of Telemedicine via the use of the advanced technology systems of the Vodafone Foundation. The examinations which took place during the telemedicine work included a brief medical history of each participant, hematological exams, cardiological inspection, vital signs monitoring, and – in the case of women over 45- an assessment of the current status of menopause. Furthermore, a questionnaire was distributed to participants to explore their opinions and views regarding the useful- ness of Telemedicine. The study population was selected through geographical criteria and specifically by taking into consideration the kilometer and/or the hourly distance of each rural area from the nearest Health center (primary or secondary). The telemedicine workshops took place on a given date and based on a specific timetable, in accordance with the safe- ty protocols of the National Public Health Organization in Greece (EODY, www.eody.gov.gr), for the CoViD-19 infec- tion. The processing and analysis of the health examina- tions were done in real-time by specialized Doctors of the Hospital, via the use of telemedicine technologies and the results (along with relevant medical instructions) were delivered personally to each examinee, a few days later. From July 2020 to October 2021, 11 Telemedicine workshops took place and a total of 535 citizens of rural areas, aged 15 to 99 years, were examined. According to the results, the general level of citizens’ health can be considered satisfactory, with only six (6) people requiring emergency health treatment and 10% of those examined, being referred for further health examination on a regular basis. The project has contributed to disease prevention and the creation of an electronic medical record file which in the future will help doctors in these remote areas to have com- prehensive monitoring of the health of each resident.

Healthcare organization and management barriers and facilitators for health promotion in primary care

Abstract Background There are challenges in translating evidence-based interventions into practice, and the need for health care organization, management, and policy changes to align with health promotion activities within the health and social care system is well-documented. This study aims to elucidate the role of these factors as barriers/facilitators influencing the implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain. Methods Seven focus groups were conducted with 49 health professionals from 6 primary care centers participating in the Prescribing Healthy Life (PVS) program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management, and policy. Results The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow, and (3) available resources to carry out the program. Specific barriers related to high caseloads, contracting issues, short consultation times, and lack of appointment times for lifestyle counselling. Other barriers/facilitators were related to CFIR constructs networks and communication, culture, relative priority, and leadership engagement. A set of nine specific barriers-facilitators emerged. Conclusions In some centers, certain facilitators addressed barriers identified in other centers influencing implementation of a health promotion intervention in primary care. Proactive identification and modification of barriers by healthcare managers and policy makers can help to ensure effective integration of health promotion into primary care. Key messages Implementation science methods for program evaluation can help identify barriers and facilitators to health promotion implementation in primary care. Policy and incentives, compatibility, available resources, networks and communication, culture, relative priority, and leadership engagement influenced successful health promotion implementation.

Patient capability: Justice and grassroots healthcare delivery in China

The current reform of China's healthcare system focuses mainly on two dimensions: the promotion of primary healthcare and the improvement of quality of grassroots healthcare (GH). Specifically, the reforms are aimed at meeting the needs of patients in the grassroots areas (PGAs) through the provision of universal healthcare and hierarchical diagnosis and treatment (HDT). In practice, however, disparities in health outcomes between the grassroots and upper levels persist. The gaps between increased health coverage and heightened barriers to accessing quality medical care in the grassroots areas are growing ever larger. What explains this paradox is the limited capability of PGAs to transform healthcare resources into better health-seeking behaviors and health outcomes, resulting in injustice that is built into the system, which is neither ethical nor fair. Using Amartya Sen's capability approach (CA) to explore issues of justice in relation to China's GH system and its performance, we suggest that an institutional structure, one that focuses on promoting universal coverage in the grassroots areas, although necessary, is by itself insufficient in promoting justice and equality in accessing healthcare. Institutional disparities in the healthcare system and China's household registration policy, constructed according to the rural-urban divide, have also produced injustices. We argue that greater attention should be given to meeting the medical needs of PGAs and empowering them with greater choice, permitting them a higher level of freedom and agency, and thus remedying the problems that we describe. We conclude with policy recommendations aimed at improving justice within the system.

Association of healthy lifestyle score with all-cause mortality and life expectancy: a city-wide prospective cohort study of cancer survivors

BackgroundAdherence to a healthy lifestyle could reduce the cancer mortality in the western population. We conducted a city-wide prospective study in China investigating the association of a healthy lifestyle score with all-cause mortality and the life expectancy in cancer survivors.MethodsThis prospective cohort study included 46,120 surviving patients who were firstly diagnosed with cancer in Guangzhou. Five low-risk lifestyle factors including never smoking, never alcohol use, regular physical activity (≥ 2 h/week), sufficient sleep (≥ 6 h/day), and normal or high BMI (≥ 18.5 kg/m2) were assessed and a lifestyle score (0–5, a higher score indicates healthier lifestyle) was generated. Hazard ratios (HRs) of all-cause mortality and the life expectancy by levels of the lifestyle scores were estimated.ResultsOf 46,120 cancer survivors registered from 2010 to 2017, during an average follow-up of 4.3 years (200,285 person-years), 15,209 deaths were recorded. Adjusted HRs for mortality in cancer survivors with lifestyle score of 0–2, versus 5, were 2.59 (95% confidence interval (CI): 2.03–3.30) in women, 1.91 (95%CI 1.77–2.05) in men, 2.28 (95%CI 2.03–2.55) in those aged <65 years, and 1.90 (95%CI 1.75, 2.05) in those aged ≥ 65 years. Life expectancy at age 55 for those with a score of 0–2 and 5 was 53.4 and 57.1 months, respectively. We also found that cancer survivors with healthy lifestyle scores of 5 showed 59.9 months of life expectancy on average, which was longer than those with a score of 0–2.ConclusionAdopting a healthy lifestyle was associated with a substantially lower risk of all-cause mortality and longer life expectancy in cancer survivors. Our findings should be useful for health education and health promotion in primary care and clinical practice.

Women's alcohol consumption in a Primary Health Care service.

To identify alcohol consumption patterns in people cared by a Primary Health Care service and verify the association between the patterns and the variables of the sample. Our observational study used both the Alcohol Use Disorders Identification Test instrument and a questionnaire with socio-demographic, clinical, and behavioral questions for data collection. We carried out the descriptive and univariate analysis with Kendall and Kruskal-Wallis correlation tests. We introduced variables with p ≤ 0.2 values in the multiple logistic regression - Mann-Whitney test. The sample of the study was constituted by 561 women. The analysis results indicated relevant influence for higher patterns of consumption: not having a partner, not having a religion, smoking and drug habits, and having arterial hypertension. Besides that, within each additional year in women's age, the alcohol consumption decreases. We endorsed data that female alcohol consumption is presenting a tendency to increase especially among younger women, this information is essential for the promotion of Primary Health Care.

ERROS DE PRESCRIÇÃO EM UMA FARMÁCIA BÁSICA DO DISTRITO FEDERAL

Objective: To analyze electronic and manual prescriptions regarding the occurrence of polypharmacy and potential types of medication errors in the context of primary care. Material and method: A descriptive, cross-sectional and retrospective study based on the evaluation of prescriptions filed at the pharmacy of a Basic Health Unit of the Federal District of Brazil. Copies of prescriptions for chronic non-communicable diseases were included. Results: 1500 prescriptions were analyzed according to evaluation criteria, such as illegibility (35.5 %), abbreviations (97.7%), dosage form (57.6%), and concentration (32.4%). Polypharmacy was identified in 46% of users and it was directly related to the age of the user. Conclusion: Prescriptions presented incomplete information regarding current legislation. Strategies that seek to improve health promotion in primary care, such as permanent education and more awareness from prescribers and other actors involved in the process of prescribing medications, are required.

Practicing health promotion in primary care -a reflective enquiry.

SummaryIntroductionHealth promotion is an integral part of routine clinical practice. The physicians’ role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha.MethodsAn exploratory study was planned between the months of January – February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice.ResultsThe study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education.ConclusionWe concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

Health promotion in primary care in disadvantaged areas in Stockholm

Health promotion in primary care in disadvantaged areas in Stockholm