Health Initiatives Research Articles

Collaborating for Health Equity: A Perspective of an Federally Qualified Health Center's Community Partnerships and Initiatives.

Collaborating for Health Equity: A Perspective of an Federally Qualified Health Center's Community Partnerships and Initiatives.

Pediatric Trauma - A Silent Epidemic.

Trauma is the leading cause of preventable deaths in children all over the world. In the majority of cases, children are innocent victims of road traffic accidents. They suffer from both short-term and long-term impacts of trauma. Deaths from road traffic accidents can be prevented by adopting simple road safety measures and the use of protective equipment. Worldwide programs have been initiated to curb this ever-rising menace; however, the success of these programs depends on their outreach and acceptance among the population in general. Golden hours in trauma management is the initial hour post-trauma, the success of resuscitation depends on the appropriate management of pediatric trauma victims in hospitals dedicated to the management of pediatric trauma victims. The current review highlights the epidemiology, pattern of injury, road safety measures, and global health initiatives for the prevention of accident-related injury in children. The shortcomings of this review are as follows- Firstly pediatric trauma is an exhaustive topic, it is impossible to cover all aspects of pediatric trauma. Thus, the review might have missed some important aspects of pediatric trauma. Secondly, the concept of a pediatric trauma registry is nonexistent in almost all developing countries; hence a true picture of pediatric trauma epidemiology and injury patterns is missing. Thirdly not much work has been done on pediatric trauma in developing countries leading to insufficient data from these countries.

Enhancing Methodological Approaches for Studying Health Effects of High-Concentration THC Products.

For public health protection, informed decision-making relies on having a robust foundation of evidence concerning risks and their prevention. Application of an evidence-based framework depends on the availability of pertinent, scientifically sound data generated by well-directed and valid research endeavors. In this essay, we address the current state of research in humans and the evidential base concerning high-concentration delta-9-tetrahydrocannabinol (delta-9-THC) products, which are readily available in the United States. Furthermore, we explore the intricate challenges faced in carrying out research on these products, which reflect the full range of study design issues: measurement of exposure and outcomes, confounding, selection bias, and the generalizability of findings. We offer recommendations to guide future research toward providing more informative evidence. By following these recommendations, researchers and funders on this emerging topic could move toward generating the valid and comprehensive evidence needed to effectively inform public health initiatives and guide policy decisions regarding high-concentration delta-9-THC products and their use. The urgency of generating such evidence cannot be overstated, given the widespread legalization and increasing availability and use of these products. (Am J Public Health. 2024;114(S8):S639-S644. https://doi.org/10.2105/AJPH.2024.307724).

Custodial Shadows: Lived Experiences of Postpartum Mothers Deprived of Liberty

Postpartum care is critical for women, particularly for those who are incarcerated, as they navigate both physical recovery and the unique challenges of their circumstances. Access to adequate healthcare within correctional systems remains severely limited, impacting the well-being of these women. While existing research has examined various prison-based programs—such as parenting classes, prison nurseries, and health initiatives—the voices and experiences of Postpartum Mothers Deprived of Liberty (PMDL) raising infants while imprisoned are often overlooked. This study aims to illuminate these experiences and how the prison environment influences their roles as mothers. Employing a descriptive phenomenological approach, this research involved a comprehensive literature review and purposive sampling to gather a targeted research sample. Specific criteria were established to identify eligible primary data sources. Data collection primarily utilized semi-structured interviews, allowing for open dialogue that facilitated a deep exploration of the informants' thoughts, beliefs, and experiences. Data analysis followed Colaizzi’s descriptive phenomenological method, ensuring credibility and trustworthiness through triangulation techniques, including audio recordings, field notes, pilot testing, and consultations with a research expert and psychometrician. Member checking was also conducted to verify the accuracy of the findings based on the informants' experiences. The analysis revealed five key themes: "Accepting the Inevitable: The Problems Arise After Birth," "Amusement Amidst Dilemma," "Supporting the Unsung: Building Bridges for Mothers Behind Bars," "Resilient Solitude: Embracing Inner Peace Amidst Maternal Separation," and "Maternal Bonds in Confinement: Underdeveloped Maternal Identity." The study concludes that while PMDLs engage in livelihood initiatives, skill development, and support networks, their separation from their infants significantly hampers their ability to fulfill maternal obligations and undermines their identity as mothers.

A conceptual framework for digital health marketing strategies to enhance public health outcomes in underserved communities

This paper proposes a conceptual framework for integrating digital health marketing strategies with public health initiatives to enhance healthcare access and outcomes in underserved communities. The framework focuses on leveraging digital marketing tools such as social media, mobile applications, email campaigns, and search engine optimization to disseminate critical health information, promote preventive measures, and engage communities in healthier behaviors. It addresses the persistent challenges faced by underserved populations, including limited healthcare access, low health literacy, and cultural barriers, by utilizing the accessibility and broad reach of digital channels. The proposed framework incorporates three core components: (1) Health Information Dissemination, which explores the use of targeted digital campaigns to provide culturally relevant and accessible health education; (2) Community Engagement, which leverages interactive platforms such as social media and mobile apps to foster participation in preventive healthcare initiatives and healthy lifestyle practices; and (3) Behavioral Change Promotion, which emphasizes using digital tools to influence health behaviors through personalized messaging, reminders, and virtual support groups. By integrating digital marketing strategies into public health programs, the framework aims to improve healthcare outcomes by increasing awareness of preventive measures, enhancing early diagnosis, and promoting disease management. It also underscores the role of data analytics in refining outreach efforts by identifying specific health needs, tracking engagement, and measuring the effectiveness of interventions. This conceptual framework holds promise for healthcare providers, policymakers, and digital marketers seeking to enhance public health outcomes in underserved communities. It provides a structured approach to combining the strengths of digital marketing with public health goals, creating more inclusive, accessible, and effective health interventions. Future research and case studies can build on this model to refine digital health marketing strategies and assess their long-term impact on public health in underserved populations.

Pharmacists in global primary healthcare systems: A comprehensive model for community health empowerment

Pharmacists play an increasingly important role in global primary healthcare systems, evolving from traditional dispensers to active participants in patient-centered care. This paper advocates for the stronger integration of pharmacists into healthcare teams to improve patient outcomes, medication adherence, and overall healthcare delivery. Through a comprehensive review, we examine the evolving role of pharmacists, the key challenges to their full integration, and the substantial opportunities they present, particularly in managing chronic diseases, providing preventative care, and enhancing patient education. We propose a model for empowering pharmacists to contribute more effectively to community health, especially in underserved areas. The paper also highlights the potential global impact of pharmacists in reducing healthcare costs, improving disease management, and promoting public health initiatives. Lastly, recommendations for future policy reforms, education enhancements, and research directions are offered to support the continued expansion of pharmacists' roles in primary healthcare systems worldwide.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

Strengthening Equity, Diversity, and Inclusion in medical education via an intersectional approach

Abstract Background In the wake of COVID-19, equity, diversity, and inclusion (EDI) policies have been taken up in the health field, yet the actual impact of these initiatives, particularly for multiply marginalized individuals, is debated. Despite progress in areas such as diversity promotion, EDI has been critiqued as superficial and as failing to challenge the drivers of health inequity. This presentation discusses how an intersectionality-informed approach can help harness the transformative potential of EDI. Methods This research is informed by a literature review of EDI initiatives in the health field, and is an offshoot of a 4.5 year international project funded by the Canadian Institutes for Health Research focused on evaluating and strengthening intersectionality-informed policy guidance. Results There is a disconnect between EDI commitments and substantive action on health inequities and an intersectional approach can help bridge this divide. We demonstrate this with a case example which brings an intersectional approach to EDI initiatives in medical education - including bias trainings, courses on the social determinants of health, and the engagement of community groups. Drawing on promising equity promoting work across these areas, we show how intersectionality can harness the potential of EDI by bringing to the fore what has often been missing, including the promotion of health stakeholder reflexivity, attention to interacting systems and structures shaping health, and meaningful engagement with underrepresented communities. Conclusions An intersectionality-informed approach to EDI has the potential to enhance the health equity impacts of initiatives within medical education and the broader health field. Key messages • EDI initiatives in health often have limited impact on health inequities. • An intersectionality-informed approach to EDI can help health stakeholders drive transformative action on health inequities.

Community gardening: metaphorical reconstruction of transformative health governance

Abstract Transdisciplinary working has been defined by the inclusion of non-academic stakeholders in the process of knowledge production. While theoretical, phenomenological and experimental dimensions have been described in the literature, Rigolot proposes transdisciplinarity as a ‘way of being’ that stretches beyond professional life. The promise of transdisciplinarity however does not always meet the expectations in practice. How to get started, maintain and overcome barriers requires guidance. In an action-oriented evaluation research study we explored this dimension in the Dutch All about Health collaborative platform, which since 2014 facilitates a continuous development of bottom up health initiatives, networks, alliances and other forms of collaboration and learning. From our case studies we developed the Transformative Health Governance model. The model shows the ongoing and reciprocal connections between the actions, the context and intermediate results that were verified in a survey among 103 platform participants. Five types of returns are also building blocks that increase the chance of real (yet hardly measurable) increasing health benefits. They reinforce each other in a continuous process of ideation, integrative approach, innovation, implementation, and impact. The context provides for acceleration or deceleration of that process. With the help of a cartoonist we translated our model into an ongoing cycle of community gardening and maintenance. This metaphor makes the intangible of underlying social processes more tangible, providing a bit more grip on the building blocks, timing and time aspects, as well as deeper understanding the role and necessity of conflict and explicit conflict engagement rather than management. Moreover the cartoon elicits recognition, acknowledgement and spirit to continue their rowing against the systems-invoked tide for better health. It serves as a concrete aid to transdisciplinary working towards planetary health.

Public health prevention programmes for mental illness in school-age children and adolescents

Abstract Background Psychiatrists, psychotherapists and other mental health professionals have long stated the importance of adequate social groups and early intervention for the prevention of severe mental diseases. With psychiatric illness incidence increasing most in the adolescent and young adult populations, we propose the use of school-age directed public mental health initiatives to combat remaining social stigma and promote mental wellbeing, as well as educate children and adolescents in how to recognise symptoms and ask for help. Methods We conducted a systematic review on PubMed as well as government and NGO websites to identify public health initiatives in the prevention and early identification of mental illness among young individuals. Results Preliminary results show that, while certain countries have delineated guidelines on how to support students’ mental health, very few have implemented nation-wide, or even region-wide programmes that directly target prevention and education. A particular note should be made regarding substance abuse and addiction, one of the few illnesses for which many countries have already enacted in-school programmes, that however often overlook the medical aspect of such diseases. Of further note are certain local programmes aimed at offering quality and accessible care to adolescents struggling with mental diseases. Conclusions With psychiatric diseases projected to become one of the greatest contributors to the global burden of disease by 2030, and the importance of early intervention in preventing severe psychiatric illness, we advocated for European public health initiatives implemented in schools, which could be crucial in curbing the spread of mental illness. Key messages • Adolescent and young adults are those most affected by the rising prevalence of mental illness. Consequently, we advocate for in-school programmes to aid in early identification and intervention. • Early identification of mental diseases is crucial in the prevention of severe psychiatric illness, but little has been done so far in terms of public health interventions to tackle such problems.

Antimicrobial resistance trends in Italian hospitals: insights from two point prevalence surveys

Abstract Background Antimicrobial resistance (AMR) presents a critical challenge to global healthcare systems, necessitating vigilant surveillance efforts. The European Centre for Disease Prevention and Control (ECDC) conducts point prevalence surveys (PPSs) to monitor AMR trends across European hospitals. This study focuses on comparing AMR patterns in Italian hospitals using data from two surveys: PPS2 (2016-2017) and PPS3 (2022-2023). Methods A total of 140 hospitals enrolling 28991 patients participated in PPS2, while 325 hospitals with 58506 patients contributed data to PPS3. Microbiological samples were collected and tested for antimicrobial susceptibility. Prevalence ratios (PR) with corresponding 95% confidence intervals (CI) were calculated to assess changes in resistance patterns between PPS2 and PPS3. Statistical significance was determined with p-value <0.05. Results Staphylococcus aureus showed a trend towards decreased oxacillin resistance, (PR: 0.77, 95% CI: 0.60 - 0.99). Enterococcus faecalis exhibited a non-significant decrease in glycopeptide resistance. Pseudomonas aeruginosa and Acinetobacter baumannii maintained stable carbapenem resistance between the two surveys. Escherichia coli and Klebsiella pneumoniae showed a decreasing trend in resistance to carbapenems and third-generation cephalosporins, but only Klebsiella pneumoniae was found to be significant (PR: 0.69, 95% CI: 0.55 - 0.88, p 0.004 and PR: 0.78, 95% CI: 0.66 - 0.94, p 0.01, respectively). Conclusions These findings underscore the importance of surveillance in monitoring AMR trends. Observed decreases, especially in Klebsiella pneumoniae, suggest potential improvements. However, the overall stability of resistance highlights the ongoing challenge of combating AMR. A multifaceted approach, including antimicrobial stewardship and One Health initiatives, is crucial to address this global health threat effectively. Key messages • Surveillance efforts are crucial to understand antimicrobial resistance (AMR) trends, as demonstrated by comparing data from two surveys in Italian hospital. • Results highlight the need for data-driven interventions, guiding future strategies within a One Health framework to address antimicrobial resistance comprehensively.

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.

Association between frailty and fear of falling among the elderly in Latvia

Abstract Background Frailty and fear of falling in the ageing population represent notable public health challenges. Fear of falling among the elderly population is a significant concern, as it can lead to decreased mobility, loss of independence, and increased risk of injury. Frailty intensifies this fear, as frail individuals often have reduced strength, balance, and coordination, making them more susceptible to falls. Methods Data from the population-based survey SHARE with respondents aged 50+ in Latvia of Wave 9 (collected 2022) was analysed. Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported and grip strength was measured using a hand grip dynamometer. Fear of falling was evaluated using visual material. Financed by the project RSU internal and RSU with LSPA external consolidation No.5.2.1.1.i.0/2/24/I/CFLA/005, Postdoctoral Grant Associated factors of frailty and fall-related mortality in the older population in Latvia No.RSU-PG-2024/1-0005. Results The sample comprised 1439 older adults from Latvia (60.4 % female) with a mean age of 67.9 (95% CI 67.5 - 68.4). Based on SHARE-FI, frailty and pre-frailty prevalence were 7.2% and 44.5% respectively. In the study, 11.3% of females and 6.5% of males interviewed reported experiencing fear of falling. Frailty was correlated with fear of falling in 43.7% of frail individuals and 11.5% of pre-frail individuals. After adjusting for age and gender, those with pre-frailty and frailty had greater odds of fear of falling. Conclusions Understanding the interaction between the fear of falling and frailty in older adults can guide the development of public health policies and initiatives that aim to mitigate the fear of falling and, consequently, reduce the prevalence of frailty. Promoting healthy ageing behaviours, such as regular exercise, balanced nutrition, and social engagement, can help prevent frailty and its associated risks. Key messages • Fear of falling results in limitation of activities, intensification of physical decline, and increased susceptibility to frailty. • Encouraging healthy ageing underscores the significance of early recognition of frailty symptoms and accessing suitable support.

Strengthening youth mental health capacities in Albania: Training primary healthcare professionals

Abstract Background Addressing mental health issues among children and adolescents globally is crucial, necessitating interventions at the primary healthcare (PHC) level. The training programme in Albania equipped PHC professionals with skills for early identification, support, and referral for youth mental health issues. Given the global prevalence of such challenges, our intervention serves as a valuable model for enhancing mental health services in communities. Objectives The training aimed to develop the capacities of Albanian PHC professionals in improving mental health and psychosocial wellbeing among youth. Through innovative training sessions using participatory action methods, it was sought to answer key questions: How can Albanian PHC professionals better identify and support youth mental health issues? What innovative approaches can enhance mental health training for Albanian healthcare personnel? How can community engagement be strengthened to support youth mental health initiatives in Albania? Results Following the programme, 525 healthcare professionals in Albania received training, showing improved knowledge and skills in youth mental health support. They emphasized the importance of community engagement, standardized documentation, and specialized mental health services. Preliminary results indicate increased awareness and readiness among Albanian PHC professionals to address youth mental health needs. Conclusions The programme underscores the significance of equipping Albanian PHC professionals with comprehensive skills to tackle youth mental health challenges. Lessons learned have broader implications for strengthening mental health services globally, emphasizing collaboration, standardized protocols, and targeted interventions. Key messages • Strengthening PHC capacity in Albania improves early identification and support for youth mental health, enhancing overall wellbeing. • Tailored training and community engagement are vital for effective mental health interventions at the grassroots level in Albania.

Passing the hot potato: a multinational study on public trust in the health policy process

Abstract Background Health data-sharing initiatives are central to European and national e-health strategies, aiming to improve healthcare quality, inform policymaking, and drive research. Public trust is crucial for their success, influencing public participation and policymakers’ legitimacy. This study investigates the role of public trust in the health policy process at both the European level and in Italy, France, and Switzerland to determine 1) if a common conceptual understanding of public trust across different countries and policy stages exists, and 2) if policymakers explicitly discuss and implement trust-building measures in their legislative work Methods A total of 60 interviews were conducted with 16 European, 15 Italian, 14 French, and 15 Swiss policymakers from the World Health Organization, the Council, Parliament, and Commission at the European level, along with representatives from the Ministry of Health, Parliament, regional councils, local health authorities, frontline staff, and relevant agencies at the national levels Results Preliminary results reveal that a common definition of public trust in health data sharing is missing. Associations to public trust are observed at the European level with citizens’ reassurance about their sensitive data being shared, and in Switzerland with data security. In France, public trust is connected to public engagement, while no distinct patterns were identified in Italy. Findings also reveal a consensus among interviewees on the central role public trust plays in health data-sharing initiatives; yet public trust is perceived as a vague concept, often addressed implicitly without a clear strategy Conclusions The study reveals widespread ambiguity among policymakers regarding the definition of public trust and its translation into policy. Practical guidance is crucial to effectively integrate elements of public trust into policymaking, thereby actively reinforcing trust in health data sharing through legislative efforts Key messages • While policymakers recognize the importance of public trust for data-driven health initiatives, they lack a common conceptual understanding on what trust is and how to build it. • Guidance is needed to help policymakers actively contributing building trust in health data sharing through their legislative work.

About the need for a Swiss digital health ‘Sistine Chapel’ – lessons from 25 years of health policy

Abstract Background The Swiss government’s ‘DigiSanté’ program 2025-2034 aims to address Switzerland’s delay in digitising its healthcare system. Public and professionals’ trust is central for the implementation of digital health initiatives and partially based on past experiences with the digital health system. To inform DigiSanté, it is crucial to analyse the evolution of the socio-political discourse surrounding health data sharing in Switzerland in the past 25 years to identify the main obstacles encountered and lessons learned during this period. Methods We designed a multi-method study comprising a policy analysis of 65 Swiss policies on health data sharing from 1998 to 2023; scoping review of 250 editorials; sentiment analysis of 400 news articles from six major Swiss newspapers; and thematic analysis of transcripts from 11 online interviews with key stakeholders. Results We identified 32 key policy milestones in Swiss health data sharing, with the COVID-19 pandemic emerging as a trigger for present policymakers’ awareness of health data’s potential and the need for healthcare system digitization. The troubled implementation of the Electronic Patient Dossier (EPD) and its negative narrative are identified as more central in eroding long-term public trust than scandals. Primary obstacles to implementation of the EPD include misaligned stakeholders’ interests, slow policy processes, lack of professional support, low public awareness, and technical interoperability issues. Future strategies involve increasing actors’ involvement to establish a common vision and strategy and improving public communication. Conclusions The present socio-political discourse on health data sharing in Switzerland is shaped by past negative experiences with the EPD, compounded by additional scandals. To cultivate public trust, stakeholders should collaborate to align interests and ensure all parties work cooperatively toward common goals. Key messages • National and international scandals marginally affect public trust compared to the impact of the negative narrative surrounding the slow EPD implementation. • Misalignment of stakeholder interests is the main barrier to implementing health data sharing initiatives, causing delays and trust erosion.

Evaluating mental health care initiatives after Ghana’s mental health act: a systematic analysis

Abstract Mental health disorders affect 970 million people worldwide. Particularly in Africa, mental health is a growing concern, as it faces poverty and limited healthcare services. The Ghana Mental Health Act (GMHA 2012) marked a significant milestone in the development of a legislative framework supporting the provision of mental healthcare. However, evidence of progress since then is scarce. This systematic review examines the mental health initiatives that have been implemented since GMHA. Bronfenbrenner’s Socio-Ecological and Vygotsky’s Sociocultural Theory are used as frameworks to organize the interventions by ecological layers and cultural practices. All peer-reviewed articles published since the GMHA were retrieved from PubMed, Cochrane and Science Direct, using “mental health interventions,” “-collaborations,” “-health programs” and “Ghana” as keywords. The search yielded 3839 articles. Next, publications that were not conducted in Ghana or did not focus on mental health were excluded yielding a final sample of 69 articles for the review. Consistent with the GMHA’s guidelines interventions were conducted in communities (n = 56; 81%) rather than hospitals (n = 13; 19%). Most of them focused on institutional ecological levels (i.e., schools, health centers, traditional healing conventions; n = 29; 42%), followed by interpersonal (n = 14; 20%) and community-level (n = 14; 20%) approaches. Half (n = 33; 48%) entailed some form of cultural responsiveness, such as adapting educational tools to cultural contexts or accounting for spiritual beliefs. Only 23% (n = 16) of the interventions targeted children or adolescents. The findings of this review suggest three implications for future mental health research. First, stigma reduction and mental health literacy need to become a stronger focus. Second, research on children and adolescents needs to be increased. Third, interventions led by European partners must be tailored carefully to the Ghanaian beliefs system. Key messages • Assessing the community-based approach of mental health interventions following the Mental Health Act’s legalization in Ghana. • European partners need to understand the context and the local culture before planning to research or implement intervention materials. Adaptation is key in the effectiveness of the intervention.

Application of artificial intelligence to study the causality in public health: a systematic review

Abstract Introduction In epidemiology, establishing causation requires meeting rigorous criteria beyond mere association. Traditional methodologies often struggle to provide definitive causal conclusions due to confounding variables. However, leveraging artificial Intelligence (AI) and machine Learning (ML) offers a promising solution by modeling complex interactions among relevant factors. This systematic review explores the AI techniques utilized to uncover causal relationships in public health applications. Methods A literature search was conducted in Pubmed, Web of Science, and Scopus, employing the following search strategy: (Causalit*[Title/abstract] OR Causation*[Title/abstract] OR Causal[Title/abstract]) AND (‘Machine Learning’[Title/abstract] OR “Deep Learning” [Title/abstract] OR ‘Artificial Intelligence’ [Title/abstract] OR Algorithm* [Title/abstract]). The search aimed to identify studies encompassing causal inference techniques utilizing ML and AI methodologies in public health. Results From a total of 28,230 articles published up to August 2023, after removing duplicates (11,158) and articles that did not meet the inclusion criteria (16,168 post title/abstract screening, and 856 post full-text screening), the systematic review included 48 articles. Bayesian additive regression trees, Bayesian network models, causal forests analysis, and graphical causal models emerged as the prevailing causal methodologies. AI-driven causal methodologies have been investigated across various domains within public health, encompassing disease prediction, evaluation of treatment efficacy, identification of risk factors, analysis of health behaviors, precision Public Health initiatives, and environmental health assessment. Discussion While our systematic review affirms the potential of AI-driven causal approaches across several public health domains, further research is warranted before these emerging techniques can be effectively integrated into real settings. Key messages • In epidemiology, establishing causation requires meeting rigorous criteria beyond mere association and traditional methodologies often struggle to provide definitive causal conclusions. • This systematic review explores the AI techniques utilized to uncover causal relationships in public health applications.

Regional disparities and socio-demographic factors associated with eight or more antenatal care visits in Ghana

BackgroundAntenatal care is vital for maternal health and wellbeing, with the World Health Organization recommending a minimum of eight visits during pregnancy. In this study, we examined the regional disparities and factors associated with eight or more antenatal care visits in Ghana.MethodsWe performed a cross-sectional analysis of data from the 2022 Ghana Demographic and Health Survey. Our study comprised 3,893 women of reproductive age with birth history in the last two years before the survey. Regional disparities in the proportion of eight or more antenatal care visits were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was conducted to determine the factors associated with eight or more antenatal care visits using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of eight or more antenatal care visits in Ghana was 38.4% [95% CI = 36.0–41.0]. The regions with the highest prevalence were Eastern, Greater Accra, Western, and Volta. Those with the lowest prevalence were Northern, North East, Savannah, and Oti. The odds of eight or more antenatal care visits were lower among women aged 40–49 [aOR = 0.42, 95% CI = 0.18–0.96], women with four or more children [aOR = 0.57, 95% CI = 0.36–0.93], women who wanted pregnancy later [aOR = 0.63, 95% CI = 0.46–0.85], and women in five regions: Western North [aOR = 0.43, 95% CI = 0.19–0.94], Bono [aOR = 0.33, 95% CI = 0.14–0.76], Northern [aOR = 0.29, 95% CI = 0.13–0.66], Savannah [aOR = 0.30, 95% CI = 0.14–0.65] and North East [aOR = 0.33, 95% CI = 0.14–0.75]. Women in the richer [aOR = 1.99, 95% CI = 1.19–3.33] and richest [aOR = 4.82, 95% CI = 2.45–9.51] wealth index showed a higher likelihood of completing eight or more antenatal care visits relative to women in the poorest wealth index.ConclusionA significant proportion of women in Ghana fall short of the recommended eight or more antenatal care visits. Age, parity, desired pregnancy timing, wealth status, and region of residence are associated with the number of antenatal care visits. Women in five regions (Bono, Northern, North East, Savannah, and Western North) are significantly less likely to have eight or more antenatal care visits than those in the Western region. The government and policymakers should design programs to address the needs of older women, those with high parity, and women who want to delay pregnancy. Increased healthcare resources, educational campaigns, and addressing regional barriers to antenatal care access are crucial. Promoting public health initiatives to emphasise the importance of completing the recommended number of antenatal care visits for a healthy pregnancy is essential.

User technology for AI-supported objective measurement of Work-related Quality of Life (MI-LQ)

Abstract Background Understanding and enhancing job satisfaction is crucial for improving Work-Related Quality of Life (WrQoL) in today’s office work environments. Our work uses multimodal data collection and analysis techniques to objectively assess WrQoL, thus mitigating respondent bias and survey fatigue. Leveraging machine learning (ML) and automated methods measuring WrQoL presents a promising approach in public health research, particularly concerning stress-related health outcomes. Methods Through a systematic literature search of 9,242 publications to identify WrQoL indicators, we selected over 100 publications for data extraction. A base model, including workload, commute, overtime, valence, and arousal was formulated. To amass a wide data set, Objective measurement tools (computers, smartphones, and wearables) complemented by questionnaire data. This data will inform ML algorithms to predict individual WrQoL indicators. Developed as an input/output data platform, an app-prototype will objectively assess WrQoL, facilitating a field study with office workers to refine the model. A mobile app prototype serves as a user interface and data relay for WrQoL metric analysis. Results Our research develops instruments for measuring WrQoL using smartphones, wearables, and specialized trackers for heart rate variability (HRV) analysis, alongside a software prototype for keyboard and mouse tracking for workload assessment of valence and arousal. Fitness trackers with photoplethysmography functionality are favored for HRV assessment. Conclusions The systematic search identified influences on WrQoL, translated into measurable indicators in a base model. Leveraging user tech for assessment and a ML and mobile app framework, this approach facilitates objective WrQoL determination. By presenting the relationship between digital service use and WrQoL indicators, this methodology promises new insights, informing stress and burnout prevention strategies within public health initiatives. Key messages • Progressive approach: ML-driven WrQoL assessment offers promising avenues for stress prevention in workplace health research. • Methodological Advancement: The novel framework for WrQoL assessment using digital tools contributes to effective workplace health promotion strategies, with potential for tailored interventions.