Strengthen Health Promotion Research Articles

Strengthening health promotion practice: capacity development for a transdisciplinary field.

The growing burden of non-communicable and newly emerging communicable diseases, multi-morbidity, increasing health inequalities, the health effects of climate change and natural disasters and the revolution in communication technology require a shift of focus towards more preventive, people-centred and community-based health services. This has implications for the health workforce, which needs to develop new capacities and skills, many of which are at the core of health promotion. Health promotion is thus being mainstreamed into modern public health. For health promotion, this offers both opportunities and challenges. A stronger focus on the enablers of health enhances the strategic importance of health promotion's whole-of-society approach to health, showcases the achievements of health promotion with regard to core professional competencies, and helps build public health capacity with health promotion accents. On the other hand, mainstreaming health promotion can weaken its organizational capacity and visibility, and bears the risk of it being absorbed into a traditional public health discourse dominated by medical professions. To address these challenges and grasp the opportunities, it is essential for the health promotion workforce to position itself within the diversifying primary care and public health field. Taking the transdisciplinary status of health promotion and existing capacity development systems in primary and secondary prevention and health promotion as reference points, this paper considers the possibilities to integrate and implement health promotion capacities within and across disciplinary boundaries, arguing that the contribution of health promotion to public health development lies in the complementary nature of specialist and mainstreamed health promotion.

6.L. Workshop: On the way to health equity – strengthening health promotion governance at local level in Europe

Abstract Health equity is influenced by the local social and physical environment people are living in. Municipalities all over Europe have a key role in shaping and addressing these living conditions. This is why one of the Work packages in the Joint Action Health Equity Europe focussed on how municipalities can contribute to health promoting and equity-oriented living environments. 17 national, regional and local public health authorities from 13 countries collaborated in this 3-year policy-level project, exchanged knowledge and practices, and implemented actions, tools and policies that promote healthy living environments. The first step in the project was to adopt a common Policy Framework for Action which summarizes the current evidence for healthy living environments and the role of municipalities. It provides a conceptual model for integrated municipal approaches. As a second step in the project, country assessments were conducted. Municipalities have a clear mandate to promote health. However, there is a big heterogeneity in resources, structures and capacities within and between countries. Key challenges are deficits in political commitment, accountability and intersectoral working. Yet, national and regional public health authorities have the potential to contribute a lot to support municipalities, like quality development, providing data, integrating health equity in existing structures, plans and approaches or collaborating with the broad range of existing stakeholders and networks. A synopsis from all the project documents, evaluation and an accompanying research project resulted in the final Policy Recommendations for Healthy Living Environments that this workshop presents, focussing on the following questions: How should health promotion policies be formulated in order to mobilize local action for health? What are the opportunities and barriers for health promotion at local level? How can the experience from JAHEE be integrated into the different structures of municipal health promotion in different countries? The first question will be taken up in the first presentation, presenting the development and contents of the final Policy Recommendations for Healthy Living Environments. The second presentation addresses the opportunities and barriers identified by a Delphi Study that has been conducted in the frame of the project work. The last question around sustainability and transferability of structures will be addressed through a roundtable discussion bringing in the experience from project partners and a local policy-maker. The workshop will give the possibility for stakeholders that were not involved in the Joint Action to inform themselves about the activities in different European countries. The broadening of the audience is also crucial for enhancing awareness of health equity and healthy living environments, increasing the acceptance and dissemination of the policy recommendations at national levels and developing a perspective for future actions. Key messages Municipalities can be the motor to build sustainable and equitable health promotion policies and structures. A common quality process has to be promoted and supported by frameworks, tools and capacity-building across political levels and sectors.

Transformative health promotion: what is needed to advance progress?

Transformative health promotion actions are needed to achieve health equity and the Sustainable Development Goals (SDGs), advance human and planetary wellbeing, and ensure that we build back better post-COVID-19. Health policies and systems need to be aligned with the values, principles and strategies of health promotion and investment made in strengthening essential health promotion functions. This paper considers how transformative health promotion can be advanced, by reflecting critically on what progress needs to be made and the structures and processes that are required to strengthen health promotion at a systems level. Progress in implementing health promotion is variable, and there is a general lack of investment in developing the necessary health promotion systems for substantive progress to be made. Key enablers and system requirements for comprehensive health promotion are examined, including the following critical elements: (i) effective advocacy for the concept and practice of health promotion; (ii) enabling policy structures for universal health promotion actions on a cross-sectoral basis; (iii) effective implementation systems, support mechanisms and workforce capacity for multisectoral health promotion action; (iv) investment in innovative research methods and knowledge translation to inform transformative health promotion approaches. In strengthening capacity to implement transformative health promotion actions, political will needs to be mobilized to ensure that dedicated and sustainable funding is made available, and the organizational and workforce capacity to deliver effective health promotion interventions is in place. The International Union for Health Promotion and Education (IUHPE) plays a central role in advancing transformative health promotion through mobilising and supporting its global members and partners in strengthening health promotion systems.

Health and Sustainability: New Gender Perspectives

European health systems face important challenges related to the sustainability of health care, both from an economic point of view and in relation to the quality of health services provided in terms of continuous improvement of effectiveness, safety, clinical and organisational appropriateness. The ability of EU Member States to continue to provide high quality care to all, whatever their biological and socio-cultural characteristics, depends on their health systems becoming more sustainable. Therefore, there is a need to strengthen health promotion and disease prevention, to invest in primary care systems, to move health care out of the hospital and into more accessible ambulatory and domestic care, and to develop integrated care practices. Starting from these premises, the aim of this paper is to present a narrative overview of the main aspects related to Gender Medicine and its evolution over time. Our critical overview is, therefore, aimed at providing a general picture of what has been developed by health systems on Gender Medicine, with a particular focus on the relationship between social sustainability and Gender Medicine. To achieve our goal, we carry out a systematic literature review in order to understand what has been developed so far in the area and to highlight the possible evolution of studies in the field and to strengthen the awareness of the importance of encouraging prevention, training and information programs shared with hospitals, institutions, health professionals and patient associations. To the best of the authors' knowledge, this is among the first studies that investigate through a systematic literature review the phenomenon of gender medicine, especially with reference to the sustainability of the health care system. Although our analysis needs further investigation, due to the fact that the topic is not yet fully mature, our initial and preliminary results underline the importance of further investigating gender diversity and assessing the possibility of promoting a clinical pathway to personalised treatment. In fact, only through a “gender medicine” approach it is possible to guarantee a real right to health and an effective personalisation of treatments, thus reinforcing the concept of patient focussed care and contributing to the sustainability of the whole health system.

„Gesundheitsförderung – lohnt sich das?“ Ein Diskussionsspiel für Ausbildung und Praxis

In order to strengthen health promotion spreading knowledge is as essential as tackling typical problems of its implementation. Both aspects can be adressed by using game-based learning approaches. To this end, we specifically developed a discussion game divided into four phases of play. Our aim is to (1) spread facts, (2) raise awareness of the topic and (3) promote well-informed political opinion-forming at individual as well as group levels. Experience shows that these objectives can be achieved with this game. The game as a whole or parts of it can easily be integrated into university teaching in different ways. In addition, there is major potential for using the game in lifelong learning settings and health promotion projects. In the next step the game will be adapted to enable its implementation in the workplace as a special setting for health promotion.

Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes.

Prevention systems improve the performance of health promotion interventions. This research describes the establishment of the Australian state government initiative, Healthy Together Victoria’s (HTV) macro infrastructure for the delivery of large-scale prevention interventions. Methods: This paper reports on findings of 31 semi-structured interviews about participants’ understanding of systems thinking and their reflections of the strengths and weaknesses of the HTV prevention system. A chronic disease prevention framework informed the coding that was used to create a causal loop diagram and a core feedback loop to illustrate the results. Results: Findings highlighted that HTV created a highly connected prevention system that included a sizeable workforce, significant funding and supportive leadership. Operating guidelines, additional professional development and real-time evaluation were significant gaps, which hindered systems practice. For inexperienced systems thinkers, these limitations encouraged them to implement programs, rather than interact with the seemingly ambiguous systems methods. Conclusions: HTV was an innovative attempt to strengthen health promotion infrastructure, creating a common language and shared understanding of prevention system requirements. However, the model was inadequate for HTV to achieve population-level reductions in chronic disease as system oversight was missing, as was an intervention delivery focus. Clarity was needed to define the systems practice that HTV was seeking to achieve. Importantly, the HTV prevention system needed to be understood as complex and adaptive, and not prioritized as individual parts.

Current status and issues concerning Health Japan 21 (second term)

The national health promotion program, Health Japan 21 (second term), began in 2013. This program has set 5 basic goals: to extend healthy life expectancy and reduce health disparity, to prevent noncommunicable disease, to improve function for social life, to establish a social environment for health, and to improve lifestyle. To achieve these goals, Health Japan 21 (second term) set 53 targets for the period between 2013 and 2022. At the interim evaluation in 2018, only 21 of the 53 targets were judged likely to be achieved by 2022. In addition, 18 targets were judged as unchanged, and 1 target was judged to be deteriorating. Thus, to achieve the goals of Health Japan 21 (second term), further efforts to strengthen health promotion programs across Japan are needed.

Shaping Policy on Chronic Diseases through National Policy Dialogs in CHRODIS PLUS.

Policy dialogs are deliberative dialogue that gather policy makers and relevant stakeholders from across disciplines to discuss a topic of mutual interest. They typically serve as a single element in a broader policymaking cycle, either informing the content of new policy or forming a component of policy evaluation and review. In the joint action CHRODIS PLUS, national policy dialogs were conducted in fourteen EU Member States. The aim of the dialogs was to identify new policies or changes to existing policies and legislation that are capable of tackling major risk factors for chronic disease, to strengthen health promotion and prevention programs and to ensure health systems are equipped to respond to priority issues within the chronic diseases field. In this paper, we present the CHRODIS PLUS policy dialog methodology, as well as results and lessons learnt from three national policy dialogs held in Ireland, Portugal and Spain. After discussion of the results, we conclude that the CHRODIS PLUS methodology is an effective mechanism to provoke deliberative discussion around chronic disease prevention and management in different countries. However, it is essential to ensure adequate human and financial resources—as well as political commitment—to accomplish objectives set out during the policy dialogs. We argue that priority-setting across sectors can improve the resilience of health systems and opportunities for investment in Health in All Policies (HiAP), both at European Union and Member State levels.

MORBIDADE E MORTALIDADE INFANTIL COM FOCO NAS CAUSAS PERINATAIS NO NORDESTE BRASILEIRO

Introdução: Uma das fases da vida na qual o ser humano está mais sujeito a sofrer com o processo de morbimortalidade é na infância, isso é ocasionada por diversos fatores, tem-se, portanto foco nesse público quando se trata do estudo de mortalidade e morbidade infantil. Objetivo: analisar a morbidade hospitalar e mortalidade infantil por causas perinatais em menores de um ano no nordeste brasileiro no período de 2013 a 2017. Metodologia: Caracteriza-se como estudo do tipo ecológico, realizado a partir de dados secundários extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS) oriundos do Sistema de Informação de Mortalidade (SIM) e o Sistema de Informação Hospitalar do SUS (SIH/SUS), no período de 2013 a 2017. Resultados: Revelaram que as causas perinatais são grandes contribuintes para a mortalidade. Dos fatores que mais matam estão à septicemia bacteriana (30,7%) e afecções maternas (42,3%). O ano de 2013 e o estado da Bahia revelaram um maior número de óbitos. Quanto à morbidade pode-se observar os agravos afecções do período perinatal (33,8%) e transtornos respiratórios do período perinatal (49,7%) sendo aqueles com maior número de casos, além do ano de 2017 e o estado da Bahia como sendo os que apresentaram maior número de internações. Conclusões: As causas perinatais são um dos principais fatores responsáveis por gerar vítimas, tornando-se necessária a tomada de medidas. Deve-se melhorar a transmissão de conhecimentos a fim de prevenir as doenças e fortalecer a promoção à saúde e reduzir as taxas de morbimortalidade.
 Palavras-Chave: Mortalidade infantil; Mortalidade neonatal; Enfermagem perinatal; Cuidado perinatal; Morbidade; Mortalidade perinatal.

Protocol of a study to evaluate a lifestyle intervention during pregnancy

Abstract Background The risk of developing obesity and chronic diseases (e.g. diabetes mellitus) in children is influenced by the mother's lifestyle during pregnancy (prenatal programming). This study evaluates a computer-assisted preventive lifestyle counseling carried out during prenatal visits and infant check-ups. GeMuKi (acronym for 'strengthening health promotion: enhanced check-up visits for mother and child') is a complex intervention consisting of multiple components implemented by different cooperating healthcare providers. Methods GeMuKi supplements regular prenatal visits and infant check-ups with an additional counseling regarding physical activity, nutrition and alcohol and tobacco use. Providers, who carry out the counseling, receive communication training using motivational interviewing techniques. Pregnant women in 4 intervention regions in Germany receive GeMuKi from gynecologists, midwives and pediatricians, while participants in the 4 control regions receive standard care. As part of a hybrid effectiveness-implementation trial with 1860 participants, questionnaires are filled in at 4 time points. Weight development and health data of the mother and child are recorded. Health services use will be analyzed using statutory health insurance claims data. Interviews will be conducted to evaluate the implementation process. Results Targeted preventive measures at the beginning of pregnancy intend to reduce the risk of inadequate gestational weight gain (primary outcome). Secondary endpoints are amongst others maternal lifestyle, infant weight development and body composition. Conclusions GeMuKi is set up as a long-term, low-threshold, multimodal intervention in living environments and existing structures. Findings will add to the evidence on lifestyle interventions during pregnancy to reduce the risk for overweight and obesity. Results will contribute to the prevention of early programming of chronic disease and will inform decisions about scale up and public funding. Key messages Lifestyle interventions provided from the beginning of pregnancy intent to be beneficial for the health of both mother and child to prevent obesity and chronic diseases. Low-threshold interventions embedded in regular prenatal visits are accessible for the complete pregnant population, including vulnerable groups.

Recommendations for Effective Intersectoral Collaboration in Health Promotion Interventions: Results from Joint Action CHRODIS-PLUS Work Package 5 Activities.

The burden of chronic disease in Europe continues to grow. A major challenge facing national governments is how to tackle the risk factors of sedentary lifestyle, alcohol abuse, smoking, and unhealthy diet. These factors are complex and necessitate intersectoral collaboration to strengthen health promotion, counter-act the social determinants of health, and reduce the prevalence of chronic disease. European countries have diverse intersectoral collaboration to encourage health promotion activities. In the Joint Action CHRODIS-PLUS success factors for intersectoral collaboration within and outside healthcare which strengthen health promotion activities were identified with a mixed method design via a survey of 22 project partners in 14 countries and 2 workshops. In six semi-structured interviews, the mechanisms underlying these success factors were examined. These mechanisms can be very context-specific but do give more insight into how they can be replicated. In this paper, 20 health promotion interventions from national programs in CHRODIS PLUS are explored. This includes community interventions, policy actions, integrated approaches, capacity building, and training activities. The interventions involved collaboration across three to more than six sectors. The conclusion is a set of seven recommendations that are considered to be essential for fostering intersectoral collaboration to improve health-promoting activities.

Brazilian’s Health Policy and its misalignment with international guidelines for Health Promotion

Abstract Following the First Health Promotion Conference in Ottawa in 1986, several other global level Conferences were held, and Shanghai was the last City to host the 9th Health Promotion Conference in 2016, where several world leaders assume commitments that meet the common cause of the topic in question, presenting robust outcomes such as the Letters, Declarations and Implementation Guides. This work aimed to analyze the coherence of the development of the current National Health Plan in Brazil in relation to the central axes of the most recent international documents, referring to the Shanghai Declaration and the Guide for the National Implementation of the Shanghai Declaration. The results showed that Brazil presents a National Health Plan that definitely does not include the actions proposed in the most recent international documents, such as the Shanghai Conference report and the Guide for National Implementation of the Shanghai Declaration. Paradoxically, Brazil has other institutionally implemented instruments that consider the activities recommended from these international documents in a very satisfactory way. Among these instruments are a specific National Policy on Health Promotion, and several Health Care Programs and Networks aimed at some of the National Policy on Health Promotion strengthening axes, such as the National Tobacco Control Program, the Health at School Program, the Health Gym Program, in addition to other related National Policies, such as the National Policy on Integrative and Complementary Practices and the National Policy on Medicinal Plants and Herbal Medicines. It is concluded that the National Health Plan is a symbolic instrument that is not in line with international recommendations and, contradictorily, it is also not in line with the own policies and programs that are successfully implemented and developed in national territory. Key messages There is a misalignment between the real meaning that a National Health Plan should present and its current content, what leads to an insuficent instrument for enhancing health promotion. While the national health plan is out of alignment with strengthening health promotion, other nationwide specific policies developed reinforce international guidelines.

Strengthening health promotion research

Abstract Neither the Ottawa Charter nor any other WHO Conference declarations mention research and its role as a driver of health promotion practice. As a result, health promotion is often perceived as a discourse based on principles and values, an ideology that lacks scientific rigour. Despite this lack of recognition in health promotion documents, there is a burgeoning research domain that labels itself health promotion. The growing number of journals that publish empirical studies related to health promotion, the growing number of research training programs with a subspeciality in health promotion, and the growing number of research infrastructure (research chairs, research centres, institutes and so on) are all sure signs of a thriving research enterprise. However, these are institutionally disparate and dispersed in various disciplinary such as: education, public health, psychology and others. Up to now, health promotion research has followed what one could call “potluck” a development model. In this model, interested individuals come with their own piece of empirical study, anchored in their disciplinary perspective, and the study is labelled health promotion essentially because they have decided to label it this way. As a result, the field of health promotion research also appears as disparate, wherein various and even contradictory epistemological and ethical perspectives are present. In this presentation, we will argue that health promotion as a practice and as policy systems would benefit from a stronger and more unified field of health promotion research, to the extent that research creates knowledge based on these practices and policy systems. Using a sustainability framework, we will show how research reinforces the conditions for the sustainability of health promotion practice and systems and we will propose some methodological and ethical principles with the potential to strengthen the positive and mutual benefits of health promotion research and practice.

Strengthening health promotion practice

Abstract Health services in most developed countries were developed to meet the needs of a demand-led health care, and focus mostly on treatment, cure and care. This system is challenged by the growing burden of non-communicable diseases, increased multi-morbidity, newly emerging communicable diseases, and increasing anti-microbial resistance. At the same time, widening health inequalities pose an additional threat to health systems that do not give enough attention to the factors that produce health. To address these challenges, it is necessary to reorient health services towards more preventive, people-centred and community-based approaches, with a more prominent role for health promotion, integrated within the wider health system. This shift of focus requires the strengthening of health workforce capacities to effectively implement health promotion. Whereas a competent health workforce has always been considered a key condition for the delivery of effective health services, the nature of the necessary 'competencies' is being redefined in the light of the current changes of the health system. Within the diversifying primary care and public health workforce, new skills and tasks must be added to existing professional roles, new professional profiles emerge, and collaborations between professions become more important. This presentation will consider the place of health promotion workforce development within the broader context of public health and health promotion capacity building systems targeting a diversifying primary care and public health workforce. Drawing on recent reviews it will provide an overview of existing capacity development systems in primary and secondary prevention and health promotion, and consider possibilities for integration and implementation of capacity systems within and across disciplinary boundaries.

Strengthening health promotion policy

Abstract Policy development and implementation are too often considered the 'autonomous' result of a mix of good evidence production and social support for change. But both these policy drivers need to be created, supported, and - to be honest - manipulated toward the best possible configuration of different intervention modalities (or 'policy instruments') involving ranges of audiences (from the traditional 'risk group' to a much more fuzzy caste of politicians at many different levels of governments and governance). Whereas there is an acknowledgement that intervention development and evaluation must take into account multi-level complexity thinking, the realisation that this must translate into a similarly complex world of policy development has not yet sunk in. This presentation will review the interface between (a) the available evidence and knowledge bases for health promotion policy effectiveness; (b) the role and deceptive nature of social, political and determinants of health and political action; and (c) the nature of deliberative democracy and its various forms (e.g., 'participatory budgeting') and the prerogative of community action. I will claim - and demonstrate - that the discipline of health political science has made available functional toolkits for shaping and investigating systematically the policy process for health. Particularly, we need to progress our thinking from traditional mono-paradigmatic empirical research only, to a dynamic world of hybridisation of theories and practices. I will demonstrate the feasibility of this approach by showing the new policy opportunities that can be created by combining policy network research with language frame network mapping.

Budaya Gerakan Masyarakat Hidup Sehat (GERMAS) sebagai Upaya Promosi Kesehatan pada Masyarakat di Kecamatan Cipayung, Kota Depok

GERMAS AS AN EFFORT TO PROMOTE HEALTH TO COMMUNITIES IN CIPAYUNG DISTRICT, DEPOK CITY. Strengthening health promotion and disease prevention efforts will provide extraordinary benefits. Health promotion and disease prevention are the main investments to reduce the burden on the state in financing public health services. Developing countries feel this burden due to budget constraints and the threat of budget sustainability, especially non-communicable diseases that require expensive and long-term treatment. Therefore, the Indonesian government launched the Healthy Living Community Movement (GERMAS), in the form of efforts to promote health and prevent disease that emphasize the community as the main actor. GERMAS has six main activities, namely increasing physical activity, increasing healthy living behavior, providing healthy food and accelerating nutrition improvement, increasing prevention and early detection of disease; environmental quality improvement; and increasing education on healthy living. Therefore, to support the Healthy Living Community Movement (GERMAS), which has just been launched by the government, it is necessary to mobilize the community to familiarize healthy living in accordance with the objectives of the GERMAS program. In Cipayung Urban Village, community-based health promotion and disease prevention has not been carried out. When associated with GERMAS, it is necessary to initiate community-based health promotion and disease prevention.

Factors Influencing Health Literacy of Students in Health Science Curriculum: A Cross-sectional Study

Background: University students in health science curriculum are the future medical professionals responsible for promoting health literacy to the patients. Thus, it is important to study the level of health literacy in these students. Purpose: This study aimed to examine the factors influencing the health literacy of students in health science curriculum. Methods: In this cross-sectional study, a total of 270 undergraduate students in health science curriculum was selected using stratified sampling method. Data were analyzed using Chi-square test, Pearson’s correlation coefficient, and Stepwise-multiple regression analysis. Results: Findings showed that 64.4% of the students had a moderate level of health literacy. Based on the multiple regression model, the significant predictors of health literacy were social support (Beta= 0.441, t= 8.264, p-value <.001), policy to promote health perception (Beta= 0.186, t= 3.482, p-value <.001), family relationship (Beta= 0.154, t= -4.691, p-value <.001) and the GPA (Beta= 0.125, t= 2.246, p-value <.001). Together, these four factors could predict 38.0% of the variance in the health literacy of students in health science curriculum. Conclusion: The health literacy of students could be improved by encouraging social support from family and community, strengthening health promotion policies, and promoting good academic performance. Moreover, given the moderate level of health literacy observed in health science students, it is recommended that universities should incorporate more health literacy topics in their curriculum.

Caracterização epidemiológica dos casos notificados de Hepatite B no estado do Piauí entre 2008 e 2018

A infecção pelo vírus da hepatite B (HBV) continua sendo um problema de saúde pública mundial em virtude da sua alta transmissibilidade. Analisar os dados epidemiológicos de hepatite B no estado do Piauí, a partir dos casos notificados no período de 2008 a 2018, buscando contribuir para a adoção de novas propostas em saúde, relacionadas a prevenção e controle da doença. Trata-se de um estudo retrospectivo, descritivo, com abordagem quantitativa, realizado com dados coletados no site do Departamento de Informática do Sistema Único de Saúde (DATASUS), a partir dos casos registrados no Sistema de Informação de Agravos de Notificação (SINAN). Em relação ao gênero, observou-se que o masculino apresentou um maior número de casos, correspondendo a 53% do total. No que diz respeito a faixa etária, a maior porcentagem de infectados por hepatite B foi no intervalo entre 20 a 39 anos, representando 47,54% dos casos. De acordo com a zona de residência dos indivíduos, constatou-se que a zona urbana obteve o maior índice quando comparada as demais, correspondendo a 77,05%. Quanto a forma de contágio dos indivíduos, o maior percentual registrado foi Ign/Branco com 56,8%. Com relação à escolaridade, podemos verificar que 20,1% dos casos correspondem a indivíduos com o Ensino Médio Completo. Assim, se faz necessário o fortalecimento de atividades de promoção e prevenção de saúde, com a finalidade de orientar toda a população, principalmente a mais desfavorecida, sobre os cuidados contra esse vírus.

ASSOCIATION OF NUTRITION AND OVERCROWDED ON THE RISK OF PULMONARY TUBERCULOSIS IN SAMOSIR DISTRICT NORTH SUMATERA

Background: Pulmonary tuberculosis is an infection diseases that continues to increase morbidity and mortality in Indonesia. In 2017, the cases of pulmonary TB in Samosir District was 252 cases, with incidence rate a smear-positive of 126 per 100,000 population. Smear positive pulmonary tuberculosis potential to infect other people who living in the same environtment.&#x0D; &#x0D; Materials and Methods: This study aims to determine the association of nutritional status and lighting withsmear positive pulmonary tuberculosis. Methods: A case-control study was conducted among 63 cases of smear-positive pulmonary tuberculosis and 63 controls without pulmonary tuberculosis. The cases were retrieved from the TB Registry at health centre in Samosir District. The cases were recruited from June 2018 to March 2019. Data was collected using a set of questionnaireby interview. Simple logistic regressionwas used to compute the crude odds ratio for the association of nutritional and lighting with smear-positive pulmonary tuberculosis.&#x0D; &#x0D; Result: This study indicated that there was an association of poor nutrition status (OR = 4.280; 95% CI: 1.849, 9.906), and an overcrowded (OR = 5.084;95% CI: 1.852, 13,995) with the incidence of smear-positive pulmonary TB in Samosir District.&#x0D; &#x0D; Conclusion: The conclusion of this study there was an association between poor nutritional status and an overcrowded with smear-positive pulmonary TB in Samosir District. Some interventions needed including strengthening health promotion and supplementary feeding to TB patient.&#x0D;

Examining Interprofessional teams structures and processes in the implementation of a primary care intervention (Health TAPESTRY) for older adults using normalization process theory

BackgroundMany countries are engaged in primary care reforms to support older adults who are living longer in the community. Health Teams Advancing Patient Experience: Strengthening Quality [Health TAPESTRY] is a primary care intervention aimed at supporting older adults that involves trained volunteers, interprofessional teams, technology, and system navigation. This paper examines implementation of Health TAPESTRY in relation to interprofessional teamwork including volunteers.MethodsThis study applied Normalization Process Theory (NPT) and used a descriptive qualitative approach [1] embedded in a mixed-methods, pragmatic randomized controlled trial. It was situated in two primary care practice sites in a large urban setting in Ontario, Canada. Focus groups and interviews were conducted with primary care providers, clinical managers, administrative assistants, volunteers, and a volunteer coordinator. Data was collected at 4 months (June–July 2015) and 12 months (February–March 2016) after intervention start-up. Patients were interviewed at the end of the six-month intervention. Field notes were taken at weekly huddle meetings.ResultsOverall, 84 participants were included in 17 focus groups and 13 interviews; 24 field notes were collected. Themes were organized under four NPT constructs of implementation: 1) Coherence- (making sense/understanding of the program’s purpose/value) generating comprehensive assessments of older adults; strengthening health promotion, disease prevention, and self-management; enhancing patient-focused care; strengthening interprofessional care delivery; improving coordination of health and community services. 2) Cognitive Participation- (enrolment/buy-in) tackling new ways of working; attaining role clarity. 3) Collective Action- (enactment/operationalizing) changing team processes; reconfiguring resources. 4) Reflective Monitoring- (appraisal) improving teamwork and collaboration; reconfiguring roles and processes.ConclusionsThis study contributes key strategies for effective implementation of interventions involving interprofessional primary care teams. Findings indicate that regular communication among all team members, the development of procedures and/or protocols to support team processes, and ongoing review and feedback are critical to implementation of innovations involving primary care teams.Trial registrationClinicalTrials.gov, no. NCT02283723 November 5, 2014. Prospectively registered.