Local Health Services Research Articles

A School Health Program to Foster Understanding of Sensory Processing Challenges.

School-age children experience sensory processing challenges, especially among children living with intellectual and developmental disabilities. As the modern classroom strives to be an inclusive environment, more schools are adopting measures to provide sensory processing support. School nurses can be at the forefront to spearhead this initiative and are well-positioned to promote support and inclusivity for students through increased education for this population, including their peers. This article explores a collaboration between local school health services and a college of nursing to provide school-age children the opportunity to learn about the challenges faced by children living with sensory processing challenges.

Gambaran Sanitasi Lingkungan Pasar dan Tingkat Kepadatan Lalat di Pasar Inpres Larantuka, Kecamatan Larantuka, Kabupaten Flores Timur

Market environment sanitation is an effort to monitor, prevent, control and control everything in the market environment such as flies. The density of flies can increase if the environment is dirty, for example markets that do not meet market environmental sanitation requirements such as rubbish dumps, waste water drainage channels and adequate water supplies. The aim of this research is to determine the description of environmental sanitation conditions and the density of flies at the Larantuka Inpres Market, Larantuka District, East Flores Regency. The type of research used is descriptive observation. The samples used in this research were all market sanitation facilities or facilities. The data obtained was then analyzed descriptively. The results of the research show that the results of the environmental sanitation conditions of the Larantuka Inpres Market based on the results of calculating the assessment variables on the external supervision observation sheet for environmental health inspections are categorized as not meeting the requirements for a healthy market (57.5%). The level of fly density at the Larantuka Inpres Market based on the results of measurements and calculations was obtained. 7 birds/blockgrill with a high density category of flies, it is necessary to secure the fly breeding places and if possible plan control measures. Therefore, it is necessary to collaborate between the government and local communities, including traders, market managers and district health services, to pay attention to the cleanliness of the market environment.

Kajian Pengetahuan Ibu Tentang Autis dan Gizi Anak Autisdi Sekolah Luar Biasa (SLB) Negeri Nunumeu-Soe

Autism is a variant of autism spectrum disorder characterized by social communication difficulties and language barriers, narrow interests and rigid and repetitive behavior. This research aims to examine mothers' knowledge about autism and nutrition for autistic children at Nunumeu-Soe State Special School. This research is a qualitative research. Data collection was carried out using in-depth interview techniques with six informants who have autistic children at Nunumeu-Soe State Special School. The results of the research found that not all informants knew the symptoms of children with autism, so it was discovered that when children were 3-5 years old, the symptoms of autism that were often noticed were difficulty speaking and hyperactivity. Not all informants gave breast milk until the child was two years old due to work factors and replaced it with formula milk. All informants did not know the type of autistic behavior that influences children's consumption patterns, but the informants already knew the levels of autism. Mother's knowledge about nutrition for autistic children regarding types of food that adapt to the child's wishes containing gluten and casein. Food taboos in children are well known, but often escape the mother's attention due to permissive parenting, which causes serious symptoms in children. Barriers to health services and a lack of health workers in TTS district resulted in a lack of informant knowledge. Schools need to consult with local health services to educate parents about the nutrition of autistic children regarding the type of behavior and dietary restrictions of autistic children.

Public health preparedness, syndromic surveillance, and response during the largest religious gathering at the Catholic pilgrimage center of Velankanni in South India: 2016.

The dynamicity and mobility of the population in a mass gathering setting pose a challenge to traditional disease surveillance methods and strain the local health services. Velankanni is one of the most sacred Christian pilgrimage places located in Nagapattinam, Tamil Nadu, India. We participated in the Velankanni festival to describe the public health preparedness, surveillance, and response activities carried out during the festival. This was a cross-sectional study. We reviewed the national and international guidelines and published literature and discussed with the key stakeholders. We developed a checklist to observe public health preparedness activities. We facilitated the staff and monitored the activities by the implementers. We established the syndromic surveillance in the designated locations of the event and used tracker software to capture the data. Emergency medical teams were formed with trained health personnel to respond to medical emergencies. The team monitored all the public health activities. There are 59 primary care public health facilities and nine ambulatory Mobile Medical Units, with 160 medical officers available at the site. Of the 16,169 persons who attended the medical camps, 9863 (61%) were males and 8408 (52%) were aged 15-44. Acute diarrheal disease was the most frequent of the reported syndromes, followed by injuries, acute febrile illness, and animal bites. There was no outbreak of any disease either identified or reported. Our findings suggest that risk assessments should be used, and establishing an Incident Command Center is vital for executing command and control mechanisms during mass gatherings.

TABLET TOSCANA to Develop Innovative Organizational Models for Tele-Rehabilitation in Subjects with Congenital and Acquired Developmental Disabilities: A Wait-List Control Group Trial Protocol.

Background/Objectives: In recent years, the advent of new technologies has fostered their application in neuro-psychomotor and language rehabilitation, particularly since the COVID-19 pandemic. Tele-rehabilitation has emerged as an innovative and timely solution, enabling personalized interventions monitored by clinicians. TABLET TOSCANA project aims to develop innovative tele-rehabilitation organizational models in children, adolescents and young adults with congenital and acquired developmental disabilities, using the Virtual Reality Rehabilitation System (VRRS) Home Kit and the MedicoAmico APP. Methods: The trial is designed according to the CONSORT statement guidelines. The project encompasses three phases: adapting the technologies for pediatric use, validating them through a wait-list study, and analyzing feasibility and effectiveness data to define new organizational models. A randomized wait-list-control study with 100 subjects aged 6 to 30 years will compare tele-rehabilitation versus prosecution of standard care. Discussion: Although literature highlights tele-rehabilitation benefits such as improved access, cost savings, and enhanced treatment adherence, practical implementation remains limited (i.e., the definition of standardized procedures). TABLET TOSCANA project seeks to address these gaps by focusing on multi-domain treatments for neurodevelopmental disabilities and emphasizing the integration of tele-rehabilitation into local health services. Conclusion: The project aims to improve the continuity and intensity of care through innovative models that integrate tele-rehabilitation into local health services. The results could inform healthcare policies and promote the development of innovative and collaborative models of care, paving the way for more effective and widespread tele-rehabilitation solutions and fostering collaborative networks among professionals.

Integrated Surveillance of Disparities in Vaccination Coverage and Morbidity during the COVID-19 Pandemic: A Cohort Study in Southeast Sweden.

We aimed to use the digital platform maintained by the local health service providers in Southeast Sweden for integrated monitoring of disparities in vaccination and morbidity during the COVID-19 pandemic. The monitoring was performed in the adult population of two counties (n = 657,926) between 1 February 2020 and 15 February 2022. The disparities monitored were relocated (internationally displaced), substance users, and suffering from a psychotic disorder. The outcomes monitored were COVID-19 vaccination, SARS-CoV-2 test results, and hospitalization with COVID-19. Relocated residents displayed an increased likelihood of remaining unvaccinated and a decreased likelihood of testing as well as increased risks of primary SARS-CoV-2 infection and hospitalization compared with the general population. Suffering from a major psychiatric disease was associated with an increased risk of remaining unvaccinated and an increased risk of hospitalization but a decreased risk of SARS-CoV-2 infection. From the digital monitoring, we concluded that the relocated minority received insufficient protection during the pandemic, suggesting the necessity for comprehensive promotion of overall social integration. Persons with major psychiatric diseases underused vaccination, while they benefitted from proactively provided testing, implying a need for active encouragement of vaccination. Further research is warranted on legal and ethical frameworks for digital monitoring in vaccination programs.

BT37 Can patients with psoriasis and eczema support their self-management by being involved in care decision making?

Abstract Eczema and psoriasis are often associated with psychological and metabolic comorbidities. They usually require long-term medical care. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in decision making and self-management. The objective of this study was to explore the acceptability and potential of a self-developed questionnaire (study tool) in addressing the needs, comorbidities and feedback of patients with psoriasis and eczema, to support their involvement in decision making and self-management of their chronic conditions. A mixed-methods study was conducted that included a postal survey on adult male and female patients with psoriasis and eczema. The study tool contained the Dermatology Life Quality Index and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semistructured face-to-face interviews with a sample of the patients who had participated in the survey. The final study involved sharing the research findings along with a prototype of the proposed online version of the study tool with a group of healthcare professionals. Of the 114 patients who participated in the postal survey, 108 (94.7%) expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63.2%) participants. Thirty-three (28.9%) participants reported that they could not cope with their chronic illness. Eighteen (15.8%) had anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25.4%) participants addressed their needs for support at home, and 16 (14.0%) of them asked for support at work. In the interviews, all the participants (22, 100%) welcomed the use of the study tool on a regular basis to support their needs and feedback. Nineteen (86%) of them preferred using an online version of the tool (portal system) as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final study, the healthcare experts agreed that the proposed online version of the study tool (portal) would be a convenient platform for such patients to address their unmet needs, comorbidities and feedback. It can be designed to provide access to supportive services including links to patient information on skin diseases, local mental health services, patient forums and other relevant support groups and charities. In conclusion, the study tool has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. All the interviewees welcomed regular use of the study tool. The use of an online version of the tool can have the potential to fill important gaps in patient self-management and in health service improvement.

Perceived Public Participation and Health Delivery in Local Government Districts in Uganda.

Citizen participation is a crucial aspect of the national health system, empowering individuals to contribute to improving local health services through Health Committees (HCs). HCs promote the participation of citizens in the delivery of primary healthcare services. The study explores the perceptions of citizen participation in the context of the Ruhama County Ntungamo local government area, Uganda. This study aims to understand the impact of HCs on healthcare service delivery. Using a qualitative approach of inquiry grounded in thematic analysis and rooted in principal-agent theory in a single case study, this study examined citizens' participation in the delivery of a local healthcare service. The study is based on interviews with 66 participants comprising health workers, patients, residents, health administrators, local councillors, and HC members. The findings reveal a notable absence of a health committee in healthcare delivery in Ruhama County. The absence is attributed to a need for a formalised citizen participation structure in managing health facilities and service delivery. It raises concerns about the limited influence of citizens in shaping healthcare policies and decision-making processes. The study recommends the incorporation of health committees into the local health systems to enhance participation and grant communities greater influence over the management of health facilities and service delivery. Incorporating health committees into local health systems strengthens citizen participation and leads to more effective and sustainable healthcare services aligned with people's needs and preferences. Integrating health committees within Itojo Hospital and similar facilities can grant citizens a meaningful role in shaping the future of their healthcare.

Clinicians' experiences and perspectives of a web-based lung cancer referral pathway.

e13539 Background: Efficient and streamlined referral of patients with suspected lung cancer is an integral part of providing optimal care for these patients. There is emerging evidence that use of online care pathways, such as HealthPathways is associated with improved referral quality from primary care, more timely access to secondary care and standardization of clinical management decisions by general practitioners (GPs). The Townsville Lung Cancer Referral Pathway (TLCRP) is part of ' Townsville HealthPathways', which is the evidence-based clinical pathway portal used in the Townsville Hospital and Health service in northern Australia. This study aimed to explore the experiences and perspectives of clinicians about TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews of GPs and lung cancer specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was undertaken to derive key codes and themes regarding participant experiences and perceptions. Results: Twenty interviews were conducted, 14 with GPs and six with specialists across disciplines of respiratory medicine, oncology, and cardiothoracic surgery. Of the GPs, 11 were practicing in the regional locality of Townsville and three practiced in surrounding rural areas. Interview analysis identified two major themes and several sub-themes (Table). Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Enablers included clinical usefulness of TLCRP, support from HealthPathways implementing team, integration of TLCRP with the electronic referral system and positive feedback from specialists. Conclusions: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service. Improving the uptake of TLCRP may mean that more patients in our region experience a streamlined journey to more timely specialist lung cancer care and improved health outcomes. [Table: see text]

Dilemma of Local Health Service Policy in the Era of National Health Insurance: A Political Perspective Analysis

The strengthening of political priorities in terms of developing health policies for various parties needs to be carried out both for the doctor and for the recipients of health services. Various health policies are influenced by various things based on certain contextual factors. In the Minister of Health Number 59 of 2014, it is stated that the amount of capitation funds is for first-level dental health services in independent practices, but it is not stated how much the capitation rate is for dental health services at community health centers. This research uses quantitative descriptive methods. The calculation method used is the Activity-Based Costing (ABC) method. The results of this study show that the average unit cost of dental health services at the Community Health Center is IDR. 104714. The largest unit cost is the GIC patching action. By using the activity-based cost calculation method, it can be seen that the largest costs for dental health services at the Community Health Center come from employee costs. And this shows that the situation is not fair for various parties. This raises a dilemma that is important to be discussed. The capitation rates set by the government are considered inappropriate for dentists in first-level health facilities. This can cause a decrease in the quality of health services provided by dentists at community health centers.

Delivering Integrated Community Care for the Elderly: A Qualitative Case Study in Southern China.

The rapid aging and increasing care demands among the elderly population present challenges to China's health and social care system. The concept of aging in place has prompted the implementation of integrated community care (ICC) in the country. This study aims to provide empirical insights into the practices of integrated care policies and approaches at the community level. Data for this study were collected through six months of participatory observations at a local community health service center in a southern Chinese city. Semi-structured interviews were conducted with the multidisciplinary community care team to gather frontline formal caregiver perceptions of ICC, thereby facilitating a better understanding of the obstacles and opportunities. Qualitative analysis revealed four themes: the ICC delivery model and development strategies within the community care scheme, the person-centered guiding principle, and the challenges and struggles encountered by formal caregivers within China's current ICC system. The case study presented herein serves as a notable example of the pivotal role of primary care in the successful implementation of elderly care within a community setting. The adoption of a private organization-led approach to medico-social integration care in the community holds significant potential as a service delivery model for effectively addressing a wide range of elderly care issues.

Continuities of Public Service Innovations (PSIs) in Indonesia's Local Governments' Health Services: Whose Initiative Has a Higher Success Rate?

Public Service Innovations (PSIs) have improved public services and increased public values. However, previous studies have shown that public servants saw PSIs as risky interventions because of the perceived uncertain outcomes, lack of support and recognition, opposition against incumbent culture, and negative public scrutiny in case of failure. These perceived risks have led to risk-averse behaviour in public service and incremental or discontinued innovations. Earlier studies on PSIs’ continuity have focused on leadership, engagement, collaborations, and organisational cultures in developed countries. However, the mechanism of engagements, collaborations, organisational culture, and leadership types remains unclear. This study aims to investigate the characteristics of sustainable PSIs in Indonesia and how authorities are exercised. In doing so, 11 PSIs in Indonesian health services—facilitated by staff or leaders—are compared and contrasted. The findings indicate that staff-initiated PSIs are prompted by community needs, use routine visits as a collaboration mechanism, and engage more stakeholders. The shortcoming is that the staff-initiated PSIs need more formal team assignments. The advantage is that they strengthen social capital and decrease community health problems. On the other hand, PSIs that were initiated by formal leaders are stimulated by formal antecedents, such as low achievement of development targets. Leaders-initiated PSIs also use capacity development programs to collaborate and increase the achievement of development targets. A novel finding to add to previous studies is that collaborating with other existing programs contributes to PSIs’ continuity. The managerial implication of this study is to stimulate front-liners in initiating PSIs.

Factors Associated With Extrapulmonary Tuberculosis in Southeastern Mexico: A Case-Control Study.

Extrapulmonary tuberculosis (EPTB) is a disease that can affect any organ or tissue. Due to its potential to cause more dangerous sequelae and the barriers to its timely diagnosis, greater clinical awareness of this disease is crucial.This study aimedto identify the factors associated with EPTB in the population of Oaxaca, Mexico. This is an unpaired case-control study. The cases were patients with EPTB+ while the controls were patients with pulmonary tuberculosis (PTB+) registered in the Tuberculosis Epidemiological Surveillance System. Sociodemographic, clinical, and microbiological variables were recovered. Bivariate analyses were performed and logistic regression analyses were performed to calculate the odds ratio (OR). A total of 75 EPTB+ cases and 300 PTB+ controls were included. Of the total sample, 57.1% were men and 60.3% indigenous. The most frequent clinical presentations of EPTB+ were nodal (21.3%), miliary (21.3%), and breast (20.0%). According to logistic regression analysis, age <40 years (OR: 2.25(95% CI: 1.13-4.49), female sex (OR: 1.92(95% CI: 1.03-3.56)], urban residence (OR: 2.25 (95% CI: 1.11-4.55)), comorbidity with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 3.46 (95% CI: 1.31-9.10)), dyspnea (OR: 2.67 (1.22-5.82)), and adenopathy (OR: 3.38 (95% CI: 1.42-8.06)) were positively associated with EPTB+. These results can serve as a basis for screening EPTB+, thus improving the preventive and diagnostic capacity of local health services, taking as a starting point women under 40 years of age and patients with HIV/AIDS in urban areas, as well as the presence of adenopathy and dyspnea as clinical characteristics of the disease.

Perancangan Sistem Pencatatan Berbasis Website pada Posyandu RT 004 RW 011 Kelurahan Kramat Jati

Within the scope of this service, the focus is on the urgent needs of Posyandu as the foundation of community health services related to implementing a more efficient recording and reporting system. The main challenge arises from manual recording methods using Microsoft Excel at Posyandu Cempaka 3 RT 004 RW 011 Kramat Jati, East Jakarta, which hinders the reporting process to the health center. As a solution, the proposed development of a web-based information system for recording aims to improve the administrative efficiency of Posyandu. This service adopts the waterfall method in designing an efficient web-based recording information system. The result is a prepared web application interface for implementation, expected to overcome manual recording constraints and support timely reporting to the health center. Thus, the use of information technology in Posyandu recording is expected to contribute positively to the smooth administration and quality of local community health services, creating a solid foundation for monitoring and improving the health of mothers and children.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

Clinicians' Experiences and Perspectives about a New Lung Cancer Referral Pathway in a Regional Health Service.

Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings.

Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0–8) across UK early years and children’s services

BackgroundHalf of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective.MethodsA non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children’s services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child’s play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years.DiscussionThis study will address feasibility questions associated with progression to a future randomised trial of WMP.Trial registrationISRCTN13644899. Registered on 14th April 2023.

Care navigation addresses issues of tele-mental health acceptability and uptake in rural and remote Australian communities.

People living in rural and remote areas face substantial barriers to accessing timely and appropriate mental health services. In the Bowen Basin region of Queensland, Australia, barriers include: limited local providers, long waiting lists, unreliable telecommunication, and reluctance to trial telehealth. Isaac Navicare is a new, community co-designed care navigation service which addresses these barriers by coupling care navigation with supported telehealth, and referrals to mental health providers and other supports. We aimed to understand the reach and effectiveness of Isaac Navicare in improving access to mental health services and address an evidence gap on strategies for improving telehealth acceptability. This mixed-methods implementation science evaluation used the RE-AIM Framework. It involved a client database review, survey and semi-structured interviews with service users during the 12-month pilot from November 2021. 197 clients (128 adults, 69 minors) were referred to Navicare during the pilot. Half of adult clients were unemployed, meaning referral options were limited to low-cost or bulk-billed services. Participants described Navicare as supportive and effective in helping to access timely and appropriate mental health supports. Most clients who expressed a treatment modality preference selected face-to-face (n = 111, 85.4%), however most referrals were for telehealth (n = 103, 66.0%) due to a lack of suitable alternatives. The rapport and trust developed with the care navigator was critical for increasing willingness to trial telehealth. Barriers to telehealth included privacy issues, technical difficulties, unreliable internet/phone, and perceived difficulties developing therapeutic rapport. The supported telehealth site was under-utilised. The majority (88.3%, n = 182) of referrals to Navicare were from local health or community service providers or schools. Coupling supportive, individualised care navigation with tele-mental health provider options resulted in increased uptake and acceptance of telehealth. Many barriers could be addressed through better preparation of clients and improving promotion and uptake of the supported telehealth site. Attitudes towards telehealth have changed during the COVID-19 pandemic, however although the need exists, barriers remain to uptake. Telehealth alone is not enough. Coupling telehealth with other supports such as care navigation improves acceptance and uptake.

Recovery among people with mental health challenges and alcohol and drug use issues in the Northern Territory, Australia

IntroductionThe Northern Territory (NT) has Australia’s highest mental health burden. It has a diverse and transient population, including Aboriginal and Torres Strait Islander people and various multicultural communities. While peer support has been widely used nationwide, in the NT, peer support is poorly implemented in psychosocial support activities.ObjectivesThe NT Lived Experience Network (NTLEN), in allyship with a team of researchers from Flinders University, has secured multiple fundings aimed to develop, implement, and evaluate a peer education and recovery program called Recovery Together (RT) for individuals with mental health and alcohol and drug use issues and related challenges.MethodsThe suitable evaluation approach was co-designed with live experience representatives from NTLEN and other local key stakeholders. It applied a mixed-method approach, including pre and post-program surveys (n=64) and individual interviews with program participants and the program delivery team (n=32). The evaluation findings were also informed by data collected by NTLEN via feedback forms n=38). We also used a co-design approach to develop survey instruments to ensure they were strengths-based and recovery-oriented.ResultsParticipants reported poor and fair self-perceived health, high stress levels, dissatisfaction with their relationships and relatively low recovery scores, which showed improvements at post-program completion. They discussed their journeys in the interviews and shared their experiences with local mental health services and the Recovery Together program. Many expressed that mental health professionals are not necessarily the care providers they feel comfortable engaging with. However, they described their experience with the peer program as highly positive, empowering, safe, non-judgmental, and beneficial, satisfying their support needs. The program gave them hope and tools to manage their mental health challenges and opportunities to gain insight into non-clinical aspects of recovery. Participants conceptualised personal recovery in their own words and described the facilitators and barriers to their recovery. They emphasised that recovery is being empowered, strong within themselves and the leader of their journey, living their best possible life, understanding themselves, having the necessary knowledge about mental health, and looking forward in a hopeful way.ConclusionsOur findings highlighted the demand and need for ongoing delivery of the RT program in the NT, which was highly effective in supporting personal recovery, addressing the service delivery gap and complementing the available clinical and mental health practices. They also showed the importance of providing recovery-oriented and trauma-informed education for medical and mental health professionals.Disclosure of InterestNone Declared

Strategic Communication for Local Public Health Services in Portugal: A Delphi Study.

Strategic communication plays a decisive role in public health planning and project implementation. However, Portuguese Local Public Health Units, which are responsible for community interventions, still lack guidance models, tools, specialized resources, and training in health communication. The aim of this study was to develop a conceptual model of strategic organizational communication for local public health services, in Portugal. This study presents a conceptual model of strategic organizational communication for Local Public Health Units, which was developed through a three-round, modified Delphi online panel. Thirty-seven Portuguese specialists in public health, communication, and community members were invited to analyse a proposed framework, based on an up-to-date literature review. High retention rates were observed in all rounds (first = 22 valid participations; second = 21 valid participations; third = 18 valid participations). Most participants believed that Portuguese Public Health Units were not prepared to communicate effectively and that they would benefit from adequate planning and identification of a communication lead or team. Websites and social media were also identified as essential for effective communication. The validated conceptual model integrated different partners in health and in the community, with emphasis on the relationships with the national network of health authorities, other Public Health Units, primary health care units, municipalities, and schools. The preferred channels identified for communicating with these partners included interpersonal relationships, email, and mobile phone. No consensus was obtained for preferred communication channels between Local Public Health Units and the media. Strategic planning based on the proposed conceptual model involving different stakeholders, has potential to improve the effectiveness of internal and external communication and facilitate the implementation of public health programs and projects. The proposed model needs to be validated in Local Public Health Units, considering the potential human, material, and financial constraints.