Responsibility For Health Research Articles

The effect of structured health promotion education given to adolescents on health literacy and health-promoting behaviors

PurposeThis study was conducted to determine the effect of structured health promotion education given to adolescents on health literacy and health promotion level. Design and methodsThe research was designed according to the pretest-posttest control group model and conducted using the quasi-experimental method. The population of the study consisted of students studying in the 6th, 7th, and 8th grades of a secondary school. A total of 191 students were assigned to the intervention group and the control group. The data were collected using the Sociodemographic Characteristics Form, the Adolescent Health Promotion Scale, and the School Age Health Literacy Scale. Structured Health Promotion Education consisting of six modules was given to the intervention group. The control group did not receive any intervention. ResultsOf the students, 33.9% were in the 8th grade, 76.6% were born in Turkey, 31.6% had a father and mother who were secondary school graduates, 72.5% were from moderate-income families, and 83% had no chronic health problems. The groups' health literacy and adolescent health-promoting behaviors pretest mean scores before the intervention were homogeneous (p > 0.05). There was a significant difference between the groups' health literacy and adolescent health-promoting behaviors posttest mean scores after the intervention (p < 0.05). ConclusionsWhile structured health promotion education was found to increase health literacy and health-promoting behaviors, nutrition, stress management, life satisfaction, and health responsibility behaviors in adolescents, it did not affect social support and exercise behaviors. Implications for practiceNurses should provide training to increase students' health literacy and health-promoting behaviors.

Development and psychometric properties of Iranian Women’s Quality of Life Instrument (IWQOLI): mixed exploratory study

BackgroundTo determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, that has credible validity and reliability, and its concepts are clearly defined and culturally appropriate. This study aimed to develop and assess the psychometric properties of “Iranian Women’s Quality of Life Instrument (IWQOLI)”.MethodsThe items of “IWQOLI” were generated from themes extracted (150 items) from a content analysis approach with the participation of 40 women. Face validity of the questionnaire with the participation of 10 women and content validity by 10 experts was approved. To determine the domains of the questionnaire, exploratory factor analysis (principal component extraction method) was performed. Internal consistency and test—retest reliability methods with 14-day intervals (30 women) were used to assess the reliability of WQOLI.ResultsAfter performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The IWQOLI score was significantly correlated with the SF-36 (r = 0.717, p < 0.001). Reliability was demonstrated with Cronbach’s alpha coefficient of 0.919 for the entire scale (90-item). Consistency of the instrument was established with test–retest reliability with an interval of 2 weeks (intra-cluster correlation = 0.889, P < 0.001).ConclusionsThe Iranian women’s Quality of life Instrument “IWQOLI”, consisting of 90 items representing 5 domains (sense of peace in life, sense of security, health responsibility, pleasant communication, received comprehensive support), demonstrated excellent psychometric properties, so it may be used for measuring women’s QOL in practical research.

Managing uncertainty - leaders’ perspectives on health system resilience during COVID-19 in Finland

Abstract Background The role of leadership in resilience is commonly acknowledged but empirical studies in the context of healthcare are less frequent. One key to public health preparedness is to understand how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks. Finland offers an opportunity to investigate resilience in a public sector setting where the health system is decentralized and local health systems, including primary healthcare, are responsible for most public health actions. In this study we examined how leaders responsible for local health systems interpreted changes in their operational environment in Finland during the first year of COVID-19, and to how these views reflect aspects of resilience in healthcare. Methods We identified 14 leaders in four regions in Finland from a larger data set of 53 interviews. Leaders had responsibilities for local health and social care during the COVID-19 pandemic. Semi-structured interviews were conducted in March-June 2021. The audio recorded data were transcribed and analysed with abductive thematic analysis using Atlas.TI. Results From the data we identified three core issues of leadership in building primary healthcare resilience. Firstly, living with constant uncertainty was seen as an integral part of leadership not only during crises but also at normal times. Secondly, health systems’ adaptability was considered important. This was maintained through decisions on workforce, information, and collaboration. Thirdly, the leaders responsible for local health systems emphasized holistic approach to crisis governance and service needs of the public. Conclusions Leaders in local health systems have to consider uncertainties and various entwined aspects of resilience during public health crises. This should be emphasised in decision-making and policy recommendations. Qualitative research designs are needed to obtain a broad understanding of the entity. Key messages • Holistic approach and adaptability were key factors of local health system resilience in Finland. • Resilience should be studied more in the context of local health systems and primary healthcare where complexities are processed continuously.

The concept of personal responsibility in Bulgarian health and social legislation

Abstract Background In the context of scarce health care resources, national policies and legislation increasingly advocate patients’ personal responsibility for their ill health. This report aims at studying the concept of personal responsibility as a basis for resources prioritisation in Bulgarian health and social legislation. Methods Official normative documents were subjected to content and comparative analysis. Results Indirect personal responsibility can be found in the Bulgarian Health Act, Art.94 stating the duty of the patient to take care of his own health. Further, in the liver transplant algorithm of the Recipient Selection Ordinance, it is possible to distinguish a hidden criterion of patient's responsibility. One possible interpretation of Article 12 of the Code of Professional Ethics of Physicians in Bulgaria is the right of a physician to refuse medical care on the grounds of lack of trust due to patient's non-compliance with prescriptions. The latter correlates with the idea of prospective responsibility. Direct personal retrospective responsibility is imputed in the Health Insurance Act, Art. 111, where persons who themselves have damaged their health or in a state of alcoholic intoxication or drug abuse have damaged the health of others, must reimburse the costs of the NHIF. We also find clearly defined personal responsibility in the Social Security Code, Art. 46, according to which monetary compensation for temporary incapacity is not paid to insured persons who intentionally damage their health. There is no official data on the applicability of these legal norms. Conclusions Although in a less categorical form and not in relation to access to specific planned treatments, the idea of the personal responsibility is embodied in the Bulgarian legislation. It is necessary to accumulate further data on the applicability of these norms, as well as to study the views of patients, users of social services, professionals and general public. Key messages • Personal responsibility is gradually entering Bulgarian legislation as an official criterion for the allocation of social and health resources. • It is necessary to accumulate further data on the applicability of the prescribed legal norms, as well as to study the views of patients, users of social services, professionals and general public.

Shifting towards a Well-being Economy in Wales for a fairer, sustainable and healthier society

Abstract Wales, and other nations globally, face long-standing challenges such as climate change and on-going impacts of the pandemic. This has increased persisting health inequities, widening the health gap and putting health and social systems and other public services under even more pressure. Economic models that prioritise growth and profit over well-being of societies and the planet underpin these developments, this is unsustainable and threatens human, economic and planetary well-being. New political imperatives are emerging across Wales that foster new collaborations and innovative, sustainable and inclusive solutions that shift towards a Well-being Economy, creating shared and co-created well-being for current and future generations. Health is key component to create a Well-being Economy in Wales and is a driver and beneficiary. Public Health Wales’ work has been focused around the social determinants of health taking a holistic approach enabling cross-sector responsibility for health to shift to a Well-being Economy. Wales has created an enabling legislative environment with the (i) Well-being of Future Generations (Wales) underpinning all public body decisions, (ii) created a strong Foundational Economy and (iii) established a Future Generations Commissioner that encourages public bodies to take greater account of the long-term impact of their decisions. Metrics were implemented that go being Gross Domestic Produce (GDP) and monitor well-being outcomes in all sectors decisions. Welsh culture and language has been vital to create a sense of belonging and community cohesion building trust and healing social fractures. Shifting towards a Well-being Economy in Wales takes a whole of systems approach, working across sectors at all levels. A variety of mechanisms such as legislations, metrics, accountability measures and participation takes the approach forward. Public health appears to be a driver, co-creator and beneficiary in the approach. Key messages • Re-envisioning the economy in Wales towards a Well-being Economy is crucial to improve health and well-being and tackle inequalities. • Wales’ Well-being Economy approach has created a national cultural change at all levels that focuses on co-created well-being for all.

An investigation of the relationship between the general vaccination attitudes of pregnant women and their attitudes toward the COVID-19 vaccine

ABSTRACT This study aimed to investigate the relationship between the attitudes of pregnant women toward general vaccines based on the Health Belief Model and their attitudes toward the COVID-19 vaccine. The study, which was designed as a descriptive, cross-sectional, and correlational study, was conducted with 348 pregnant women in three public hospitals in Northern Cyprus between June 24 and November 28, 2022. Data were collected using the “Participant Information Form,” “Public Attitude Toward Vaccination Scale-Health Belief Model” (PAVS-HBM), and “Attitudes Toward the COVID-19 Vaccine” (ATV-COVID-19). The COVID-19 vaccination rate among pregnant women was quite high. Pregnant women have a high perception of sensitivity, importance, benefit, and health responsibility for routine vaccines and vaccination programs based on the HBM, and a low perception of barriers to vaccination. These results showed that pregnant women have a determined and positive attitude toward the acceptance of vaccines in general. On the other hand, the attitude of pregnant women toward the COVID-19 vaccine was moderately negative. Despite the reservations about the COVID-19 vaccine, a determined and positive attitude toward vaccines in general has increased acceptance of the COVID-19 vaccine.

Interprofessional Team Members' Knowledge and Perceptions of Physical Therapist Education and Practice

Introduction. High-quality patient care requires that providers understand and optimize each health care team member's roles and responsibilities. Review of Literature. The purpose of this paper was to examine the contemporary knowledge and perceptions of physical therapist (PT) practice and education held by advanced practice interprofessional (IP) team members, including physicians, physician assistants (PAs), and advanced practice registered nurses (APRNs). Subjects. Physicians, PAs, and APRNs licensed in the state of Minnesota. Methods. Eligible individuals were invited to participate in an online survey assessing understanding of PT practice and education. Descriptive and nonparametric statistical analyses were used to evaluate respondent demographics, practice characteristics, and perceptions and knowledge of PT education and practice. Results. Survey responses were analyzed from 442 respondents including 210 APRNs, 182 physicians, 48 PAs, and 2 clinicians of unknown profession. Results demonstrated that most referring providers did not learn about physical therapy during their academic or posttraining education. Those who interacted with PTs more frequently perceived greater benefit for their patients, tended to refer to PTs more often, and demonstrated greater knowledge of PT practice. Poorly understood areas of PT practice and education included PT practice settings, specialties, salary, level of education, and the ability to see patients through direct access. Discussion and Conclusion. Multiple areas of poor provider knowledge regarding PT education and practice were identified; many unchanged from the literature in the 1980s. Three main areas of growth were identified from which actionable recommendations are made: increase IP interactions with PTs, address areas of poor understanding of PT education and scope, and maximize shifting perceptions of PTs through education and advocacy. This paper illustrates that PT education and practice are not well understood by referring providers, posing a threat to IP collaboration. A lack of collaboration may hinder patient and system outcomes because of suboptimal provider utilization.

Research on the Economic Responsibility Audit of Leading Cadres in Public Hospitals

In China, public hospitals, as the key role of the health responsibility of the people and the important practitioner of the implementation of national strategies, their internal economic activities show a development trend of complexity and diversification. In order to cope with this trend, it has become necessary to conduct economic responsibility audit of leading cadres in public hospitals. At the same time, it is also of great significance to promoting the healthy development of China's medical and health undertakings. Case audit project from the perspective of professional practice, the whole process of observation, and in view of the shortcomings of the audit project, around the reality of the economic responsibility audit work needs, on the audit evaluation system, the audit results using three aspects, hopes to help the audit department of public hospital leading cadres economic responsibility audit project.

Assessing the barriers and facilitators of climate action planning in local governments: a two-round survey of expert opinion

BackgroundClimate change is one of the greatest threats to public health in this century. The UK is one of six countries that has enshrined in law a commitment to become net zero by 2050. However, there is a lack of guidance and structure for local government in the UK, which has responsibility for public health, to reach this goal and help their communities mitigate and adapt to the health and health inequality impacts of climate change. This study aimed to identify common barriers and facilitators related to addressing the health and health inequality impacts of climate change in local governments.MethodsUsing Normalisation Process Theory, we developed a two-round survey for people working in local authorities to identify the barriers and facilitators to including the health and health inequality impact of climate change in their climate action plans. The survey was delivered online via Qualtrics software. In the first-round respondents were able to express their views on barriers and facilitators and in the second round they ranked common themes identified from the first round. Two hundred and fifty people working in local government were invited to take part and n = 28 (11.2%) completed the first round of the survey and n = 14 completed the second round. Thematic analysis was used in Round 1 to identify common themes and weighted rankings were used to assess key barriers and facilitators in Round 2.ResultsKey facilitators were the need to save money on energy, and successful partnership working already in place including across local government, with local communities and external stakeholders. Key barriers were insufficient staff, resources and lack of support from management/leaders, and lack of local evidence.ConclusionTo mitigate and adapt to the health impacts of climate change, local government must nurture a culture of innovation and collaboration to ensure that different departments work together This means not just working with external partners, but also collaborating and co-producing with communities to achieve health equity and mitigate the debilitating effect of climate change on public health.

Health Information Seeking Behavior Among Perinatal Women: A Systematic Review

The health of perinatal women is critical to maternal well-being and infant development. Understanding how perinatal women seek health information is essential for providing effective antenatal and postnatal care. However, there is a lack of systematic reviews on this topic. This study aimed to conduct a comprehensive literature review of existing research following the PRISMA-SCR guidelines. The results showed that perinatal women commonly seek pregnancy-related health information. Interpersonal sources were identified as the primary and most trusted sources of information. The study also identified various factors and barriers that influence health information seeking, including individual, socio-cultural, structural, and information-related factors, with personal responsibility for health being an influential factor that has not been emphasized previously. It provides valuable insights into the health information seeking behavior of perinatal women. The influence of personal health responsibility, social power dynamics and socio-cultural norms on health information seeking needs to be further investigated.

The Ontario Newborn Screening Program: Anovel referral center model.

Newborn screening (NBS) for inherited and congenital disorders is aform of secondary disease prevention and apublic health responsibility. The development of NBS programs is one of the most important achievements in health care. While the scope of the screening targets has expanded and methods have evolved, the screening process has remained essentially unchanged.In 2006, the Canadian province of Ontario implemented anew provincial NBS program that differs from conventional programs. One of the key differences is the structured and fully funded partnership between the ministry of health, the NBS laboratory, and the treatment centers in the province. Each one of these partners has defined roles and accountability. Another difference is the move away from the conventional recall process to an immediate referral system to selected treatment centers.In this article, we report our experience with the new screening structure and discuss it as amodel for future NBS programs.

Development and psychometric properties of Health-Promoting Lifestyle Scale in Colorectal Cancer Survivors (HPLS-CRCS): a mixed-method study

BackgroundDetecting a health-promoting lifestyle in colorectal cancer (CRC) survivors is of paramount importance to manage disease complications, prevent their recurrence, and enhance survival; however, no specialized tool has yet been provided to measure the lifestyle of these patients. Accordingly, this study aimed to develop and determine the psychometric properties of the Health-Promoting Lifestyle Scale in CRC Survivors (HPLS-CRCS).MethodsThis study was a mixed study with an exploratory sequential design in two phases. Concept analysis was performed in the first phase according to Schwartz-Barcott and Kim’s (2000) hybrid model to explain the concept, identify dimensions, and generate items. In the second phase, psychometrics including validity (face, content, and construct) and reliability (internal consistency and stability) were determined. Responsiveness, interpretability, ease of use, item weighting, and scale scoring were also determined.ResultsAfter explaining the concept, an initial scale encompassing 211 items was developed, content and item analyses were conducted, and the items decreased to 89 items after the face validity assessment. For construct validity, confirmatory factor analysis (CFA) was conducted with a sample size of 500 survivors, and convergent validity was performed for the Persian version of the Health-Promoting Lifestyle Profile II (HPLP-II). Accordingly, 80 items were classified into six factors: activity and rest, spiritual growth, health responsibility, nutrition, interpersonal relationships, and psychological management, with RMSEA = 0.055, χ2/df = 2.484, and χ2 = 6816.516. The reliability of the scale was confirmed, Cronbach’s alpha was between 0.865 and 0.928, and the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal important change (MIC), and the smallest detectable change (SDC) were 0.896, 3.36, 13.86, and 19.87, respectively.ConclusionThe HPLS-CRCS consists of 80 items in six dimensions and is a valid and reliable scale for evaluating the health-promoting lifestyle in CRC survivors. Using this scale to evaluate the healthy lifestyle in these survivors can lead healthcare providers to detect deficiencies and plan the lifestyle of CRC survivors during the post-treatment period.

Mercier’s Clinic: Public Health Utopianism in L’An 2440, rêve s’il en fut jamais

The eighteenth-century medical Enlightenment in France saw fierce conflicts between inoculistes and anti-inoculistes, attacks from philosophes and surgeons on the privileges and dogmas of elite academic doctors, and attempts by reformers to improve medicine, hospitals, and sanitation. In this article, I show that Louis-Sébastien Mercier’s L’An 2440, rêve s’il en fut jamais (1771) intervenes in this debate by portraying a France experiencing a public health crisis and providing compassionate remedies in a futuristic “public health utopia” for the diseases of France’s individual and political bodies, including a proposal for a new inoculation clinic. Mercier’s novel is the first French biopolitical novel, assigning responsibility for health and medicine to the state; it is also technocratic and sometimes anti-populist, and it aims to suppress as much as resolve social antagonisms on the eve of the French Revolution. I argue that Mercier’s view of the state’s role in public health is closer to physiocratic than republican or liberal positions, and affirms several characteristics of the absolutist tradition.

Stress, Burnout, and General Mental Health among Healthcare Workers in Poland during the Long-Lasting COVID-19 Pandemic.

Medical professions are characterized by a great responsibility for human health and life; they are also vulnerable to burnout. The outbreak of the COVID-19 pandemic has brought new challenges and threats. This study aimed to assess the mental health of healthcare workers after a year and a half of working in COVID-19 pandemic conditions. The Perceived Stress Scale (PSS-10), the Link Burnout Questionnaire (LBQ), and the General Health Questionnaire (GHQ-28) were utilized in this cross-sectional investigation. A total of 335 healthcare employees from Polish hospitals (median age 44 years) filled out online questionnaires between the 16 August 2021 and the 30 March 2022. Most of the sample was female (86%). In this study, 40.0% of the surveyed healthcare workers reported a high stress intensity. Burnout was reported by 9.6% of the workers, and the most frequently experienced symptom was psychophysical exhaustion. Almost half of the healthcare workers surveyed (49.6%) reported health disorders at both the mental and physiological levels. Interestingly, working in a COVID-19 ward did not significantly differentiate healthcare workers in any of the evaluated variables: PSS-10 (gr. A F = 1.21; gr. B F = 0.71; p > 0.05), LBQ (gr. A F = 1.89, F = 0.94, F = 1.08, F = 2.57; gr. B F = 0.32, F = 1.14, F = 0.77, F = 0.36; p > 0.05), and GHQ-28 (gr. A F = 0.85, F = 0.52, F = 0.57, F = 0.31; gr. B F = 0.31, F = 0.06, F = 0.06, F = 0.54; p > 0.05). Furthermore, there were no statistically significant differences between the compared occupational groups of healthcare workers: PSS-10 (F = 1.08; p > 0.05) and GHQ-28 (F = 1.78; F = 0.85; F = 0.62; F = 0.54; p > 0.05). The mental health of healthcare workers is alarming, and psychophysical conditions can affect the quality of work and relations with patients. Psychological care in workplaces and workshops that build resources for dealing with difficult situations are necessary.

Health Promotion and Social Support of Jordanian Adolescents during COVID-19 Pandemic

Background: During the COVID-19 pandemic, new policies were established to decrease the transmission of infection. These changes in policies might have an impact on health promoting activities and social support among adolescents. Purpose: The purpose of this study was to describe the levels of health promoting activities and social support among adolescents. Methods: A descriptive cross-sectional design was applied to collect data from 298 Jordanian adolescents. Results: Females reported a significantly higher mean score than males in total AHPS, peer support, health responsibility, life appreciation, and stress management. Male adolescents scored a significantly higher mean score in physical activity. The averages of peer support and family support were significantly higher among adolescents from private schools. Adolescents aged from 10 to 13 years scored a significantly higher average of nutrition dimension compared to adolescents aged from 17 to 19 years. In health responsibility, both groups of adolescents aged from 17 to 19 years and from 14 to 16 years reported significantly higher averages than adolescents aged from 10 to 13 years. Both groups of adolescents aged from 17 to 19 years and from 14 to 16 years reported significantly higher averages than adolescents aged from 10 to 13 years in life appreciation. Conclusion: Differences in health promoting activities based on adolescents’ gender is an area that needs more investigation. Because of the importance of social support, family and peer support must be improved. Implications for Nursing: The differences in performing health promoting activities based on adolescents’ gender are areas that need more attention. Fostering social support from family and peers is crucial to enhance adolescents’ health. It is mandatory to activate the role of the community health nurse as soon as possible. Parents and teachers must have adequate information about the developmental changes during adolescence. Keywords: Adolescents’ health, Health promotion, Peer support, Family support.

Tanggung Jawab Pemerintah Dalam Penyelenggaraan Kesehatan Mental

The right to mental health is an integral part of the right to health with the main responsibility for fulfilling it is the obligation of the state according toestablished right. The government as a tool of the state has an obligation to be responsible for the implementation of mental health efforts for its citizens. However, if you look atthe current condition of access to mental health services in Indonesia still does not meet the need for health services which are the responsibility of the government, such as the lack of quality, equitable and affordable health services. This study aims to find out more regarding the government's responsibility for community mental health and efforts to implement mental health. The research method used in this study is an empirical juridical research. This research will be conducted with an empirical approach supported by normative data. Based on the research that has been done An optimal strategy needs to be implemented for each individual, family and community with a comprehensive, integrated and sustainable promotive, preventive, curative and rehabilitative approach as an effort to tackle mental health in Indonesia

The Myth of Zero-Sum Responsibility: Towards Scaffolded Responsibility for Health.

Some people argue that the distribution of medical resources should be sensitive to agents' responsibility for their ill-health. In contrast, others point to the social determinants of health to argue that the collective agents that control the conditions in which agents act should bear responsibility. To a large degree, this is a debate in which those who hold individuals responsible currently have the upper hand: warranted appeals to individual responsibility effectively block allocation of any significant degree of responsibility to collective agents. We suggest that a different understanding of individual responsibility might lead to a fairer allocation of blame. Scaffolded agency is individual agency exercised in a context in which opportunities and affordances are structured by others. Appeals to scaffolded agency at once recognize the role of the individual and of the collective agents who have put the scaffolds in place.

Healthy Lifestyle Behaviors and Sociodemographic Characteristics Among Medical Students in Indonesia During the New Normal Era: A Cross-Sectional Study

This study aimed to identify medical students’ healthy lifestyle behaviors during the new normal era and to determine its relationship with sociodemographic factors, bearing in mind that, as future physicians and health role models, medical students play an important role in adopting and promoting healthy lifestyle behaviors to reduce the risk of future health problems as well as optimize communities’ health status. This cross-sectional study was conducted at the School of Medicine and Health Sciences of Universitas Katolik Indonesia Atma Jaya, with 111 medical students selected through stratified random sampling. Data were collected using sociodemographic characteristics (sex, residence, year of study, and participation in health promotion training) and the Health-Promoting Lifestyle Profile-II (HPLP-II) questionnaire and analyzed using descriptive and bivariate analyses. The results showed a moderate total HPLP-II score (2.46± 0.37). Interpersonal relations had the highest mean score, and health responsibility had the lowest. A significant difference in the total HPLP-II scores was identified between students participating in health promotion training and those who did not (p-value = 0.049). Further study is needed to explore other factors influencing healthy lifestyle behaviors among medical students.

Healthcare leaders’ and elected politicians’ approach to support-systems and requirements for complying with quality and safety regulation in nursing homes – a case study

BackgroundHealthcare leaders play an important and complex role in managing and handling the dual responsibility of both Health, Safety and Environment (HSE) for workers and quality and patient safety (QPS). There is a need for better understanding of how healthcare leaders and decision makers organize and create support structures to handle these combined responsibilities in practice. The aim of this study was to explore how healthcare leaders and elected politicians organize, control, and follow up the work of HSE and QPS in a Norwegian nursing home context. Moreover, we explore how they interpret, negotiate, and manage the dual responsibility and possible tensions between employee health and safety, and patient safety and quality of service delivery.MethodsThe study was conducted in 2022 as a case study exploring the experience of healthcare leaders and elected politicians in five municipalities responsible for providing nursing homes services in Norway. Elected politicians (18) and healthcare leaders (11) participated in focus group interviews (5) and individual interviews (11). Data were analyzed using inductive thematic analysis.ResultsThe analysis identified five main themes explaining how the healthcare leaders and elected politicians organize, control, and follow up the work of HSE and QPS:1. Establish frameworks and room for maneuver in the work with HSE and QPS.2. Create good routines and channels for communication and collaboration.3. Build a culture for a health-promoting work environment and patient safety.4. Create systems to handle the possible tensions in the dual responsibility between caring for employees and quality and safety in service delivery.5. Define clear boundaries in responsibility between politics and administration.ConclusionsThe study showed that healthcare leaders and elected politicians who are responsible for ensuring sound systems for quality and safety for both patients and staff, do experience tensions in handling this dual responsibility. They acknowledge the need to create systems and awareness for the responsibility and argue that there is a need to better separate the roles and boundaries between elected politicians and the healthcare administration in the execution of HSE and QPS.

The effect of a community-based group intervention on chronic disease self-management in a vulnerable population.

Chronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare. We evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe. A prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities. Of 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P < 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P < 0.001). This CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes.