Scoping Review Research Articles

Scoping Review of Health Literacy Interventions among Migrant Communities in Europe

Abstract Background The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language. Results Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach. Conclusions This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities. Key messages • Most European health literacy interventions for migrants target women and are conducted in North or West Europe. • Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.

Accounting for adaptation when projecting climate change impacts on health: a review of methods

Abstract Exposure to high and low temperatures can cause harm to health. Temperature related health effects are likely to increase in the future, due to global warming, unless populations can adapt to a warming environment. Adaptation occurs through multiple mechanisms, however, the amount that populations may adapt to rising temperatures is unclear. There are currently a variety of methods used to include adaptation in projections, but it is unclear how underlying assumptions are made and whether they are based on evidence. With increasing interest from decisionmakers around implementation of adaptation strategies, an important step in responding to climate change will be to understand how adaptation can statistically be incorporated when estimating future health burdens. A systematic scoping review was conducted to identify all quantitative methods to include adaptation in studies projecting future temperature-related health impacts under climate change. Approaches employed in studies were coded into methodological categories. Advantages and disadvantages of each method were also explored, along with the empirical basis for model assumptions. Eight methodological categories were identified from the included fifty-nine studies. More recent methods of including adaptation in projections use a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most used approaches in the literature to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were categorised as using an empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence where possible. Key messages • Including adaptation in future projections considerably affects temperature-related mortality numbers. • All future impact assessments should include adaptation uncertainty and assumptions should be based on evidence where possible.

A Qualitative Scoping Review of Community Firearm Violence in Low-Income Settings.

Firearm violence is a public health crisis in the United States that disproportionately impacts community members in low-income areas who witness and experience violence and violent victimization at elevated rates compared to other socioeconomic groups, often as result of community disinvestment and systemic racism (Smith et al., Soc Sci Med 246:112587, 2020). While quantitative reviews of firearm violence and related factors exist, a review of qualitative methods and findings regarding exposure to firearm violence has not yet been conducted. This scoping review sought to address a gap in the literature by summarizing the findings of qualitative studies on community firearm violence in low-income settings in the U.S. EBSCO databases, Criminal Justice Abstracts, National Criminal Justice Reference Service Abstracts, ProQuest, and PsycINFO were searched for studies that described the firearm related experiences of individuals and families in low-income communities. Thirty studies met the criteria for review. Findings were situated within the Centers for Disease Control and Prevention's (CDC) Social-Ecological Model as a framework for prevention (CDC, The social-ecological model: a framework for prevention, https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html , 2018; Dahlberg and Krug, World Report on violence and health, World Health Organization, Geneva, 2002). A critique of the literature, as well as implications and future directions of findings, are discussed. This study may inform future research questions and programs that center the voices of those most impacted by firearm violence.

The impact of tobacco retailers density reduction on smoking status of Belgian adults

Abstract Background Smoking being one of most impactful risk factors for causing non-communicable diseases (NCD) and consequently attributable death, represents an enormous public health issue. New policy interventions aimed at reducing smoking prevalence are planned in the Belgian Tobacco Free Generation plan. Within the plan, it is aimed to reduce the number of outlets that sell tobacco products, as a higher tobacco retail density (TRD) is believed to be linked to higher smoking prevalence. Using health impact assessment (HIA), this study aims to evaluate the policy before it is set in place. Methods For this intervention a 17% reduction in density was estimated according to the scoping review would be associated with an 0.39 percentage point reduction in prevalence. The Potential Impact Fraction (PIF) was calculated to assess the change in proportion of current smokers. Time series and projections of the Belgium Health Interview Survey provided data on the smoking status from 1997 untill 2040. The relative risk were retrived from the Global Burden of Disease 2021 study. Using data from the Belgian Burden of Disease Study, the avoidable burden was estimated. Results The policy is expected to reduce the density by 17 % by 2025, which results in a PIF for lung cancer of 0.92%, decreasing to 0.82% in 2040. The smoking prevalence would decrease from 12.62% to 12.23%. We estimated that this intervention would avoid the burden of more than 300 lung cancer cases and around 100 deaths in 2040. Conclusions The HIA in this study suggests that reducing TRD has a potential to contribute to achieving the objectives in Tobacco Free Generation plan. However, it should be noted that the impact is rather small, lower than 1% for most diseases. In addition, the actual impact may vary depending on the specific implementation of the policy and future smoking trends. Further research is needed to refine the effect size estimate based on the actual policy intervention details. Key messages • Reducing tobacco retail density can reduce the burden of smoking. • Modeling limitations need further research to refine HIA results.

Capability of ChatGPT to support the screening process of scoping reviews: A feasibility study

Abstract Background The time-consuming screening phase in health-related evidence syntheses is increasingly supported by artificial intelligence (AI). However, scoping reviews have not benefited as much as systematic reviews from such AI tools as they utilize conceptual rather than keyword-specific search strategies to address broad research questions. Context-understanding chatbots based on large language models could potentially enhance the efficiency of scoping review screenings. This study evaluates the performance of ChatGPT against an open-access AI tool used for abstract screening in systematic reviews and the costs involved. Methods Leveraging data from a prior scoping review, we compared the performance of ChatGPT 4.0 and 3.5 against Rayyan, using human researchers’ decisions as a benchmark. A random set of 50 included and 50 excluded abstracts was used to train Rayyan’s algorithm and to develop ChatGPT’s prompt. ChatGPT 4.0’s evaluation was repeated after 5-7 days to assess response consistency. We computed performance metrics including sensitivity, specificity, and accuracy. Results ChatGPT 4.0 and 3.5 achieved 68% accuracy, 11% precision, 99% negative predictive value, and 67% specificity. Sensitivity was high at 88-89% for ChatGPT 4.0 and 84% for ChatGPT 3.5. ChatGPT 4.0 showed a substantial interrater reliability between the two evaluations and moderate reliability compared to ChatGPT 3.5. The cost of deployment varied, with Rayyan being free, ChatGPT 3.5 costing $9.06 and ChatGPT 4.0 $505.72. Conclusions Given the exponential increase in publications, effective mechanisms to support the screening phase of scoping reviews are needed. Our feasibility study using ChatGPT to decide on abstracts’ inclusion or exclusion achieved good performance metrics. Given further positive evaluation, such chatbots might be incorporated in the standard screening process, possibly replacing a second screener, saving time and costs, and accelerating evidence synthesis. Key messages • ChatGPT performs well in supporting screening for scoping reviews, outperforming a traditional AI tool at reasonable costs. • Employing chatbots like ChatGPT could potentially cut costs and time in scoping reviews.

Strengthening public health professionals in policymaking in the Eastern WHO European region

Abstract Background The collaborative research between EUPHA and WHO aimed to explore factors impacting public health professionals’ (PHP) involvement in health policy processes in the Eastern WHO European Region, addressing barriers, enablers, and capacity-building needs. Methods Utilizing a mixed methodology, the study employed document analysis, scoping review, and interviews to triangulate data, with the document analysis focusing on 4 published Essential Public Health Operations Self-Assessment Reports, the scoping review analysing 15 key articles, and 5 semi-structured interviews providing additional insight from key country stakeholders. Results Core findings revealed significant barriers impeding PHPs' participation in policy processes. Among others, these included limited intersectoral collaboration, shortage of skilled public health (PH) personnel, financial resource constraints and inadequate governance structures. Conversely, several enablers were identified, such as a positive trend in increased intersectoral collaboration and innovative governance structures during Covid-19, the development of more trained PHPs and the utilization of International Health Organisations. The two main capacity building needs reported were the importance of modernizing PH education and promoting intersectoral collaboration. Conclusions This study offers a preliminary overview of how PHPs' involvement in health policy processes in these countries can be enhanced: More intersectoral collaboration, updated PH education curricula and trainings, and governance re-design building on positive trends seen during the pandemic. Following actions are recommended: Creation of an international platform for cross-sectoral PH communication & exchange, direct support for universities and PH researchers, development of comprehensive PH trainings, assistance in forming or strengthening national public health associations and identification & sharing of effective local governance practices. Key messages • This research identifies barriers to PHPs’ participation in Eastern WHO European Region's health policy processes, while highlighting enablers like increased collaboration during Covid-19 to build on. • Recommendations to harness the enablers include clear actions such as creating an international public health platform for interaction and exchange or build-up of national public health associations.

Scoping the EU’s health impact in the Southern Neighbourhood: Building resilience and trust

Abstract Background The European Neighborhood Policy (ENP) focuses on security, migration, and economic stability. Strengthening health systems can contribute to these aims by building local resilience and institutions; however, little is known about the EU’s health policy and impacts in the Southern Neighborhood (Syria, Lebanon, Jordan, Palestine, Egypt, Libya, Tunisia, Algeria, Morocco). This paper examines the role of health in the ENP and what is known about the health-related impacts of EU actions in this region. Methods This is a qualitative case study of the EU’s ENP commitments, outcomes, and impacts (2004-2024) in nine middle-income Southern Neighborhood countries. A scoping review of empirical evidence included 5 scholarly databases and grey literature published. Retrieved publications and the ENP documents were thematically analysed with WHO’s health systems building blocks and the alignment between the ENP and practice was assessed. Results ENP health actions have evolved from public health and selected communicable diseases (2004), to health service delivery, vaccine supply, and occupational health (2021). The review included 19 publications (2004-2024). Publications most often addressed the financing (n = 14 papers) and service delivery (n = 9) aspects of health systems (not mutually exclusive), and only once addressed workforce and health information. Publications addressed mostly intentional EU health actions in the region; 4 papers reported unintentional effects. Conclusions The limited scope of health actions in the ENPs suggests health may be instrumentalised to pursue the EU’s security and stability goals. The type of EU health actions reported most often in the literature were consistent with the ENP health priorities. There is no systematic evaluation of the impacts of the EU’s health-related commitments in the ENPs. To build resilience and trust in the region, future EU action should support a range of WHO building blocks and mitigate potential negative effects. Key messages • The EU’s health commitments in the European Neighborhood Policy evolved from public health & communicable diseases (2004), to health service delivery, vaccine supply, & occupational health (2021). • There is no systematic empirical evaluation of the impacts of the EU’s health-related commitments in the European Neighborhood Policy.

Accounting for health equity in policy evaluation: a content analysis of primary research

Abstract Background Public Health researchers increasingly make use of sophisticated study designs and methods to evaluate the effects of policies on health and social outcomes. Natural experiment evaluation (NEE) conceptualises policies as ‘natural’ experiments that occur outside of the control of researchers. Often, NEE employs quasi-experimental methods (QEM) which enable researchers to rigorously evaluate the effect of population-level interventions. As for other health-related research, it is unclear to what extent such public health evaluations can and do consider the (health) equity implications of policies. We sought to investigate how health equity is addressed in NEEs and other policy evaluations that employ QEM. Methods We identified a random sample of primary research as part of a pre-registered scoping review (https://osf.io/3h6cb/). Studies that employed methods labelled as interrupted time series, difference-in-differences, controlled before and after, regression discontinuity, and synthetic control were included. Through content analysis, we examined how health equity was considered in data analysis and discussion sections. Results We analysed 59 studies, of which 25 were stratified for one or more socially-stratifying factors. Results were mainly stratified by sex (n = 15, 25.4%), age (n = 13, 22%), and diverse measures of socioeconomic status (n = 14, 23.7%), i.e. income, employment, education, or other factors. Of these, 21 studies included a discussion of health equity-related results, ranging from a few sentences to a holistic discussion including recommendations for decision-makers. Most commonly, researchers recommended monitoring of policy effects in different sub-populations, and careful policy design that conceptualises complex policy effects, including unintended and unequitable effects. Conclusions Policy evaluations have great potential for informing public health decision-making but health equity aspects were under-examined in these studies. Key messages • Health equity is assessed by evaluating policy effects in relevant sub-populations. Only 25 of 59 studies included results that were stratified for one or more socially stratifying factors. • Studies that were focused on disadvantaged populations commonly included recommendations for policymakers, calling for better policy design and improved monitoring of policy effects.

Healthcare access for people with disabilities: a scoping review of COVID-19 policies in Europe

Abstract Introduction The COVID-19 pandemic raised healthcare inequalities, affecting the most vulnerable groups. There is limited evidence of whether the COVID-19 measures and the health system’s preparedness for outbreaks among European countries were sufficient to cover the health access needs of PWDs. Aim To provide a structured overview of the COVID-19 measures and policies addressing access to primary and specialist health services for PWDs during the COVID-19 pandemic in the European Members States (MS) and the United Kingdom (UK), using ten dimensions of healthcare access by Levesque et al. (2013) and the PoliMap taxonomy. Methods This study followed the PRISMA guidelines for Scoping Reviews. A search strategy was employed on PubMed, Embase, Scopus, and Web of Science databases from January 2020 to January 2023. Studies published in peer-reviewed journals in English, Portuguese, and Spanish were included, informing a COVID-19 measure or policy and assessing or providing a rationale with access to primary or special healthcare services. Results The final search strategy yielded 2.076 results, 188 studies were reviewed for full-text analysis, and 74 were included in the final analysis. One hundred twenty-one policies or measures addressing primary or specialist care access were identified. Only thirteen target PWDs, focussing on intellectual or mental disability and addressing mental healthcare services. Results revealed that COVID-19 measures for PWDs were oriented to increase health system response capacity and reduce virus transmission, describing a predominantly negative effect on healthcare access for PWDs. Conclusions The needs of PWDs in access to primary and specialist care were not fully covered by the policies and measures placed during the COVID-19 pandemic among the MS and the UK. One-size approaches focussing on the attendance of COVID-19 infection with stigmatizing measures overlook the specific health necessities of this population. Key messages • Adopting disabled-inclusive measures in the daily healthcare provision and engaging PWDs in the policy cycle is paramount to preparing for the next outbreak and public health crises. • Additional research focusing on primary and specialized healthcare access during outbreaks for PWDs, especially with sensory and physical disabilities, is crucial to furthering health equity.

Navigating the complexity of User Engagement: need for normative evaluations in digital interventions

Abstract Digital behavioral change interventions (DBCI), leveraging digital technology to promote cognitive behavioral therapy or positive psychology techniques, can potentially revolutionize health promotion. With applications across a spectrum of health behaviors-from managing common mental health disorders to enhancing physical activity, addressing smoking cessation, alcohol use, and weight management-these interventions offer promise for both healthy and clinical populations. However, their effectiveness hinges significantly on user engagement. Digital interventions are prone to attrition due to their self-help and unguided nature, which impedes their translation from research to real-life settings. This talk discusses the findings of a scoping review to shed light on these complexities. Firstly, we explore the various methodologies used to evaluate engagement across studies, hindering effective comparison and understanding. Secondly, we address the lack of systematic assessment of engagement strategies, advocating for experimental research to fill this gap. Lastly, we emphasize the need to establish an optimal level of engagement for desired outcomes, noting that continuous engagement may not always be conducive to behavioral change interventions, which aim to instill lasting changes in individuals. This underscores the importance of comprehensive assessment using both objective and subjective measures. In conclusion, engagement with digital interventions encompasses both quantitative usage metrics and qualitative subjective experiences, highlighting the need for comprehensive assessment beyond the mere evaluation of frequency or duration. Contrary to common belief, increased engagement does not always lead to better outcomes. Too much engagement can lead to exhaustion, while too little can result in inefficiency. Therefore, designing a DBCI that encourages optimal use is essential, fostering a balance that maximizes effectiveness while minimizing adverse effects.

Integrating social inequalities in the burden of environmental stressors

Abstract In the process of designing equitable policies to reduce the burden of environmental stressors, it needs to be taken into consideration that socially disadvantaged communities are disproportionately exposed to environmental pollutants. These environmental health inequalities are currently however not routinely taken into account when designing mitigation measures, amongst others because of the absence of a coherent methodological framework. Within the BEST-COST project, an innovative framework for assessing social inequalities in the socioeconomic impact of environmental stressors will be developed and implemented. In particular, a novel index of multiple deprivation was developed. This includes indicators that are considered to be temporally and culturally valid for assessing social and material deprivation in Europe. In particular the new index was developed to make comparison across different European countries and to be used at a small geographical level. Within the workshop we will discuss the stepwise framework developed, starting from the results of a scoping review conducted to gather information methodological approaches used in the currently existing MDIs developed in Europe. The results of the scoping review were used to make informative decisions about the selection of indicators and other relevant methods (e.g. weighting). The construction of the composite score for the use within BEST-COST was evaluated also considering the data availability of the selected indicators at a small geographical level (i.e. LAU2) for the case-study countries: Belgium, Estonia, France, Norway and Portugal. Initial results of the quantification of social inequalities in the burden of environmental will be presented. Participants to the workshop will be able to understand the advantages and challenges of this kind of exercises with specific examples.

Statistical methods leveraging the hierarchical structure of adverse events for signal detection in clinical trials: a scoping review of the methodological literature

BackgroundIn randomised controlled trials with efficacy-related primary outcomes, adverse events are collected to monitor potential intervention harms. The analysis of adverse event data is challenging, due to the complex nature of the data and the large number of unprespecified outcomes. This is compounded by a lack of guidance on best analysis approaches, resulting in widespread inadequate practices and the use of overly simplistic methods; leading to sub-optimal exploitation of these rich datasets. To address the complexities of adverse events analysis, statistical methods are proposed that leverage existing structures within the data, for instance by considering groupings of adverse events based on biological or clinical relationships.MethodsWe conducted a methodological scoping review of the literature to identify all existing methods using structures within the data to detect signals for adverse reactions in a trial. Embase, MEDLINE, Scopus and Web of Science databases were systematically searched. We reviewed the analysis approaches of each method, extracted methodological characteristics and constructed a narrative summary of the findings.ResultsWe identified 18 different methods from 14 sources. These were categorised as either Bayesian approaches (n=11), which flagged events based on posterior estimates of treatment effects, or error controlling procedures (n=7), which flagged events based on adjusted p-values while controlling for some type of error rate. We identified 5 defining methodological characteristics: the type of outcomes considered (e.g. binary outcomes), the nature of the data (e.g. summary data), the timing of the analysis (e.g. final analysis), the restrictions on the events considered (e.g. rare events) and the grouping systems used.ConclusionsWe found a large number of analysis methods that use the group structures of adverse events. Continuous methodological developments in this area highlight the growing awareness that better practices are needed. The use of more adequate analysis methods could help trialists obtain a better picture of the safety-risk profile of an intervention. The results of this review can be used by statisticians to better understand the current methodological landscape and identify suitable methods for data analysis - although further research is needed to determine which methods are best suited and create adequate recommendations.

Effectiveness of Digital Health Interventions (DHI) in Chronic Pain Management: A Scoping Review of Current Evidence and Emerging Trends

Effectiveness of Digital Health Interventions (DHI) in Chronic Pain Management: A Scoping Review of Current Evidence and Emerging Trends

Sailing along the global tobacco supply chain: public health insights of innovative database project

Abstract Background Tobacco control commonly focuses on reducing tobacco demand rather than tobacco supply. This paper presents findings from a major four-year project on the tobacco supply chain. Transnational Tobacco and Leaf Companies (TTLCs) and other tobacco supply chain companies argue that provision of livelihoods, exports and corporate social responsibility (CSR) exonerates tobacco. Our objective was to consider these claims. Methods This paper presents the results of three studies: a literature review and two analyses of data from the innovative Tobacco Supply Chain Database (TSCD). Study 1: A scoping review of academic literature (n = 124 papers) reviewing how the tobacco supply chain embeds the tobacco industry as a development actor. Study 2: The statistical association between countries hosting TTLC subsidiaries (TSCD) and TTLC interference in health policy (Global Tobacco Industry Interference Index) was analysed (n = 76 countries). Study 3: Document and website analysis of TSCD non-TTLC tobacco supply chain companies comparing descriptions of CSR and tobacco supply chain involvement (n = 80 companies). Results Study 1: Although there are instances of advantages of involvement in the tobacco supply chain, TTLCs tends to be associated with declines in tobacco workers’ income, equality, quality of life (cultural and health and wellbeing) and nations’ environment and economy. Study 2: Countries that hosted more TTLCs had more policy interference (farming subsidiaries p=.046, tobacco product manufacturing subsidiaries p=.008). Study 3: Non-TTLC companies often lack transparency regarding their connection to tobacco. For example, 68% linked to CSR activity on their homepage whereas only 16% linked to involvement in the tobacco supply chain. Conclusions Tobacco supply chain involvement is detrimental to public health, the environment and governance. Countries and companies should seek to extricate themselves from the tobacco supply chain. Key messages • Tobacco supply chain involvement weakens public health governance despite CSR activities. Lack of transparency on supply chain involvement by companies is thus a concern. • The new Tobacco Supply Chain Database illuminates previously hidden areas of the tobacco supply chain: the location of tobacco industry subsidiaries and presence of independent companies.

Eco-friendly treatment: a win-win for patients, health systems, and the planet. Rapid scoping review

Abstract Background As the fifth-largest CO2 emitter globally, the healthcare industry must act to mitigate its environmental impact. This includes de-implementing low-value care and adopting eco-friendly innovative treatment alternatives. Our study aims to explore existing research on the environmental effects of these actions and the outcome measures utilized. Methods We conducted a rapid scoping review following a pre-published protocol, searching Ovid MEDLINE® and Scopus (Elsevier) from January 2015 to June 19, 2023. Initially, dual abstract and full-text screening was performed, followed by a single review. Data extraction was cross-checked by a second reviewer. Findings were narratively described using summary statistics. Results We analyzed 182 articles, primarily life cycle assessments and modeling studies (92 out of 182), with only one study being a randomized controlled trial. The research covered various healthcare practices, including consultation methods/telemedicine (32%), surgical and medical device usage (26%), medication (25%), surgical procedures (19%), as well as diagnostic tests, screening, and imaging (13%). The main sustainability strategies mentioned were ‘Rethink’ (99%) and ‘Reduce’ (81%), with ‘Reuse’ (32%), ‘Recycle’ (19%), and ‘Refuse’ (10%) being less utilized. Environmental outcomes reported included global warming (88%), resource consumption (27%), and chemical hazards (23%). Most studies were conducted in Europe (48%), followed by the USA (37%), with 75% published after 2020. Conclusions The environmental impact of healthcare is a pivotal area for public health action and fortunately, it is also emerging as a significant research field. Utilizing methodological approaches less common in evidence-based healthcare research underscores the necessity for innovative interdisciplinary collaboration and capacity building. The most pressing research gap lies in the impact of de-implementation strategies (“refuse”) targeting low-value care practices. Key messages • Measuring the environmental impact of healthcare demands the development of novel cross-disciplinary research methods and collaborations. • De-implementing low-value care represents a future win-win scenario for patients, the financial viability of healthcare systems, and global environmental sustainability.

Closing the Gap: Implementing Gender-Sensitive Care to Address Healthcare Disparities

Abstract Background Women still face a higher mortality rate after a heart attack compared to men, and the reasons remain unknown. The project HeartGap aims to investigate the disparity between evidence-based guidelines and the integration of Gender-Sensitive Care (GSC+) in clinical settings. By exploring healthcare providers’ attitudes and knowledge on GSC+, the project seeks to develop holistic recommendations for its effective implementation. Methods The project HeartGap employs a mixed-methods approach, including a scoping review, qualitative focus group interviews, and quantitative surveys. The focus of this abstract will be on the qualitative survey. From June 13, 2023, to April 26, 2024, a total of 18 focus group interviews were conducted in 9 hospitals of varying sizes and levels of care in Germany. These interviews involved separate groups of 3-8 nurses or physicians to explore attitudes, knowledge including the european guidelines for cardiology and current implementation of GSC+ into clinical practice. Facilitating factors and barriers were also discussed and in which fields measures should be applied. The results were evaluated using a qualitative content analysis. Results The interviews revealed discrepancies in healthcare providers’ awareness of GSC+ and identified both facilitating and hindering factors in its implementation. Facilitating factors included increased awareness, more evidence by considering gsc+ in research, university and professional education, support from hospital leadership and politics. Barriers included a lack of time and knowledge, other priorities and vague content on GSC+ in medical and nursing guidelines. Conclusions Gender-sensitive care is crucial for personalized healthcare, yet its implementation remains inconsistent in clinical practice. Targeted strategies are necessary to enhance awareness, knowledge, and guidelines and policy support for GSC+. The Identified recommendations for action are transferable throughout Europe. Key messages • Gender-sensitive care is pivotal for addressing healthcare disparities but faces implementation challenges. • Comprehensive strategies, including awareness, teaching and policy support, are indispensable for integrating gender-sensitive care into clinical practice.

Needs Assessment for Primary Care for Best Practice Implementation: The CIRCE Joint Action

Abstract Introduction CIRCE is a Joint Action (JA) supporting the transfer of six best practices (BPs) to new primary care settings in Europe. High-quality needs assessment can set the foundation for strong planning and implementation of the CIRCE-JA best practices in these new primary care settings. Methods A needs assessment tool was developed based on the TO-REACH knowledge transfer framework and learnings from a scoping review of international knowledge transfer frameworks. The needs assessment provides structured tool for local sites to self-assess the alignment of the BP with local priorities, readiness of the local site to successfully implement the BP, the availability of necessary leadership, resources and partnerships, and an examination of barriers to local BP implementation and mitigation strategies. Results Twenty-six CIRCE-JA teams completed the needs assessments. Local teams identified the CIRCE-JA BPs were value-adding and aligned with local priorities. Cross-cutting barriers were identified which were common among the six CIRCE-JA best practices across five thematic areas: (1) provider level, (2) intervention level, (3) health system/policy level, (4) partnership and physical resources and (5) information technology. The needs assessment supported primary care sites with a structured approach to planning for transfer of BPs to their local setting that is based on established international best practices and knowledge transfer frameworks including early identification of barriers and mitigating strategies. Conclusions The needs assessment has supported teams with conducting a self-assessment and informing initial planning for adoption of the BP in their local primary care practice. Given the importance of the local needs assessment to high quality implementation of BP the CIRCE-JA experience with local needs assessment may provide learnings for future BP transfer initiatives. Key messages • Local needs assessment supports the transfer of best practices to primary care settings, which is a critical component of service transformation during the post-COVID-19 period. • For successful transfer of best practices in primary care, it is vital to give to examine such as provider capacity, available human resources, health policy, and information technology.

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.

A Review of Lifestyle Interventions in Weight Loss Programs for Community-Based Psychiatric Patients

Abstract Background Psychiatric patients face aggravated physical health issues and reduced life expectancy, primarily due to premature cardiovascular diseases. The intricate relationship between lifestyle factors, illness, and psychotropic medications contributes to this phenomenon. The focus of this research is to evaluate weight management interventions for individuals with Severe Mental Disorders through a comprehensive scoping review, focusing on diverse study designs, outcomes, and their clinical implications. Methods 20 studies were analyzed to understand the effectiveness of interventions and characteristics, such as duration, delivery, and professional involvement. Assessment criteria included weight modifications, BMI changes, and metabolic measures like blood pressure and lipid profiles. Results The total number of participants included in the 20 studies evaluated was 3886. All trials included individuals of all genders. The studies included patients with a weighted mean age of 44.37 (SD = 4.72) and a mean BMI of 34.7 kg/m2 (SD = 3.56). Varied interventions, mostly conducted in the US, showed promising weight reduction and cardiovascular risk management results among psychiatric patients. However, disparate methods used in the studies hindered the evaluation of outcomes. The studies which yielded more interesting results included Gaughran F. et al, 2017 who showed improvements in HDL cholesterol and metabolic indicators, (HR 0.085; 95% CI:0.007-0.16), and Bartels S. et al, 2015 who reported that 51% of participants achieved clinically significant reduction in overall cardiovascular risk. Conclusions Although interventions displayed potential benefits for beneficiaries, the lack of standardized protocols and non-uniform endpoints poses challenges in effectively addressing weight-related concerns in psychiatric patients. Clear guidelines and standardized assessments are necessary to implement psychiatric patients’ weight management interventions. Key messages • The health issues and reduced life expectancy of psychiatric patients is a major health burden. The mean BMI of 34.7 kg/m2, indicating a prevalence of Obese individuals needs to be addressed. • Psychotropic medications are associated with increase in weight. More effort in increasing awareness and including mandatory nutritional educational classes when prescribing these drugs is needed.

Challenges And Strategies For Implementing Performance-Based Capitation In Indonesian Community Health Center : A Scoping Review

This study examines the implementation and challenges of performance-based capitation (KBK) at Community Health Centers (Puskesmas) in Indonesia, as a part of the National Health Insurance Program, aiming to improve the efficiency and quality of primary health services. Despite its potential, the implementation of KBK faces various challenges including inadequate human resources, limited infrastructure, and insufficient monitoring systems. The study uses a scoping review framework based on the Public Health Care Monitoring Conceptual Framework by WHO, analyzing 11 selected studies from 2021 to 2024. Findings indicate that internal factors such as management capacity, health worker competence, and organizational culture significantly impact the effectiveness of KBK. External factors like local government support, funding policies, and infrastructure availability also play crucial roles. Technological barriers, particularly in remote areas, hinder optimal policy implementation. The study emphasizes the need for clear regulations, consistent policy dissemination, and effective monitoring to ensure successful KBK implementation. Recommendations include strengthening leadership, training health workers, improving infrastructure, and enhancing digital health technology utilization. These strategies aim to optimize resource allocation, enhance service access, and improve patient satisfaction in Indonesia’s primary health care system.