Health System Research Articles

Health literacy measurement: a comparison of four widely used health literacy instruments (TOFHLA, NVS, HLS-EU and HLQ) and implications for practice

Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach’s alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman’s R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76–0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r = 0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.

Immediate Postintervention Outcomes from a Randomized Trial that Sought to Enhance Access to Live Donor Kidney Transplant for Black and African Americans.

Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems. The aim of this study was to determine whether adding culturally sensitive, web-based patient education to a transplant center-level intervention was associated with increased knowledge, motivation to pursue living donor kidney transplant, and confidence in the behavioral skills to discuss living donation among Black/African American patients with end-stage kidney disease. A total of 411 transplant candidates were randomized to intervention (N = 222) or control groups (N = 189) and completed measures at baseline and immediate follow-up during the transplant evaluation visit. Results indicated no significant change in knowledge across time or study condition. At immediate follow-up, participants of both study conditions exhibited a significantly higher motivation to pursue living donation (t = 3.066, P < .01) versus at baseline. Both study conditions demonstrated increased confidence in the behavioral skills to discuss living donation over time (t = 3.580, P < .001). Process evaluation findings demonstrated limited engagement with the online video content across both conditions. Results suggest that the intervention did not perform better than control but raised important considerations for the delivery of transplant education targeting Black/African American patients in a busy clinical setting.

Sodium toxicosis in chickens: case series (2014-2023) and literature review.

Cases of sodium toxicosis (ST), although reported infrequently, can result in acute morbidity and mortality and extensive losses in affected poultry. We analyzed the clinical, pathologic, and toxicologic findings of 7 diagnosed cases of ST in chicken autopsy submissions at the California Animal Health & Food Safety Laboratory System (CAHFS), University of California-Davis, from 2014 to 2023. We also evaluated the brain sodium concentrations in 10 clinically normal broiler chickens to elucidate potential differences with salt-intoxicated chickens, and reviewed the literature of field cases of ST in chickens and turkeys. Lesions of anasarca described in the 7 ST cases (66 chickens) identified from the CAHFS database included: ascites (62 of 66; 6 of 7 cases); hydropericardium and cardiomegaly (54; 6 of 7); edematous, congested lungs (24; 6 of 7); enlarged, pale kidneys (24; 6 of 7); subcutaneous edema (17; 4 of 7); cystic testes (14; 6 of 7); and cerebral edema (7; 4 of 7). Brain sodium concentrations exceeded 1,800 ppm in only 4 of 24 brains analyzed in our case series. In the feed samples analyzed from 5 ST cases, sodium concentrations exceeded the recommended 2,000 ppm; concentrations detected were 2,500-12,000 ppm. In brains from the 10 clinically normal chickens evaluated, brain sodium concentrations were 1,500-1,700 ppm.

Causes of mortality following PCI: the University of New Mexico hospital experience.

Mortality after percutaneous coronary intervention (PCI) remains a problem. Clinical databases such as the American College of Cardiology National Cardiovascular Data CathPCI Registry do not contain enough information to determine the specific cause of death after PCI, and thus are not able to identify opportunities for improvement (OFIs) that might have prevented the death of specific patients. We reviewed cases of death after coronary intervention to identify specific OFIs. The University of New Mexico electronic medical record system was used to identify PCI patients who died before discharge from 1 January 2019 to 30 June 2021. Electronic medical records for each patient were reviewed by two physicians to identify presentation before PCI, procedural success of PCI, complications of PCI, contribution of PCI complications to death, and causes of death after PCI. During the study period, 48 of 894 PCI patients died before discharge. Presentation was ST elevation myocardial infarction in 23 (48%) and out of hospital cardiac arrest in 17 (35%). PCI success rate was 90%. Causes of death were most frequently cardiac (80%), septic shock (4%), mixed cardiogenic and septic shock (4%), COVID (8%), and anoxic brain injury (4%). All post-PCI deaths in this series occurred in acutely unstable patients, with cardiac comorbidities and myocardial infarction or cardiac arrest prior to catheterization. PCI reduced culprit stenosis to ≤50% in 96% of cases with an overall procedural success rate of 90% and only one major complication. No deaths were clearly related to operator error.

Dietitian-nutritionist intern resident (D-NIR) - A need light years away from occurring in Spain

The dietitian-nutritionist (D-N) is a health professional with a university degree in human nutrition and dietetics in charge of the correct nutrition according to the physiological and pathological needs of people, as stated in the Law on the Regulation of Healthcare Professions since 2003. Various national and international societies, supported by numerous studies, point to the need to incorporate the D-N in the National Health System (NHS) to improve healthcare in the context of multidisciplinary teams. However, despite the importance of the functions of the D-N within the NHS portfolio, and unlike the rest of the health professions, there are many regions in Spain that still do not have the figure of this professional. Likewise, there is no specific system of Specialized Health Care Training (SHCT) for this professional, which is a need that impedes his or her own official training and specialization. Therefore, the creation of an SHCT for the dietitian-nutritionist intern resident (D-NIR) is proposed with the aim of improving their comprehensive training, competencies and responsibilities, thus improving the quality of care in the NHS in the context of multidisciplinary teams.

The availability of essential medicines in public health facilities in Afghanistan: navigating socio-political and geographical challenges.

During the past two decades, the Afghan government, along with international community, has developed a system aimed at improving access to essential health services under Afghanistan's challenging socio-political and geographical circumstances. In 31 provinces, non-state actors competed for fixed-term contracts to implement a predefined package of health services. In three provinces, the government organised the provision of health services. An independent third party monitored service provision, including access to medicines. This study examines the availability of essential medicines in Afghanistan's public health facilities and how this is shaped by socio-political challenges, geographical barriers, and the organisation of the health system. Between March and July 2021, enumerators collected data at 885 health facilities across Afghanistan. For our analysis, we combined data about medicine availability and the functioning of the health system with publicly available information about geographical and socio-political factors, including security incidents. Using regression analysis, we identified facility, district, and province-level factors related to medicines availability in public health facilities. On average, 70% of 31 selected essential medicines were available in 2021. The availability of medicines varies significantly between provinces and was considerably higher in those where services were contracted out to non-state actors (n=34; 91%) compared to provinces where service provision was organised by the government (n=3; 9%). The most important drivers of variation in medicine availability included geographical barriers, securing and allocating funds on the provincial level, and organising and sustaining physical capacity on the facility level. Insecurity was not a key factor driving variation in medicine availability. Despite the socio-political challenges in 2021, the availability of essential medicines in public health facilities was relatively high. The results suggest that decentralized procurement of medicines by non-state actors and timely payment of funds contribute to medicines availability. Strategies to improve medicines availability should target hard-to-reach areas and lower-level facilities.

Updates in Human Papillomavirus Vaccination to Improve Medical Readiness in Active Duty Service Members

ABSTRACT Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is associated with the development of genital warts, precancerous lesions, and cancers of the oropharynx, anus, penis, vulva, vagina, and cervix. HPV-associated diseases are preventable through vaccination. An Australian nationwide vaccination program will effectively eliminate cervical cancer as a public health concern by the year 2035. Despite safety and efficacy data, vaccination against HPV is not mandatory for military service members. Active duty service women are more likely to test positive for HPV when compared to dependents, and veterans diagnosed with HPV-associated cancers have higher health care resource utilization and costs. Even if a patient has a prior HPV infection, vaccination at the time of HPV diagnosis or following treatment can reduce recurrence of HPV and dysplasia. In addition, patients with a history of cancer have a higher incidence of secondary HPV-associated malignancies and should be offered vaccination or re-vaccination if they received a hematopoietic stem-cell transplant. Improving HPV vaccination rates within the military health system requires a multidisciplinary approach. Providers should use every opportunity to recommend HPV vaccination, including recommending HPV vaccines for individuals who do not have a record of HPV vaccination. The electronic health record can be utilized to generate prompts for vaccine reminders, and clinics should stock HPV vaccines to allow for easy administration. Additionally, adoption of an opt-out policy for HPV vaccines rather than mandatory vaccination may be an acceptable alternative to increase HPV vaccination while allowing active duty service members to retain autonomy.

Reputational risks associated with nurses' presence on social media: proposed actions following the Vall d'Hebron case

A Spanish nurse posted a video on TikTok criticizing the requirement of a certain level of Catalan to work in the public health system of Catalonia (Spain). The video went viral, eliciting reactions from social media users, politicians, and professional nursing organizations. This study aims to evaluate the reputational damage suffered by the nurse, her hospital, and the nursing profession, with the goal of proposing actions to prevent, avoid, or manage similar situations. A sequential exploratory mixed-methods design was used to analyse the content of the video, its impact on the press and social media, and the management of the communication crisis by the hospital and nursing organizations involved. The nurse exercised her right to freedom of expression. However, her choice to convey the message, wearing the uniform that identified her as a staff member of a specific hospital, and her criticism of the language level requirement, led to reputational damage after the video spread via the press and Twitter/X. The hospital's reputation was affected due to the nurse being identified as one of its employees. In contrast, the reputation of the nursing profession was not significantly harmed, as multiple information sources suggested the incident was isolated. The creation of a safe, self-regulatory framework and training in social media and communication management are proposed as measures for healthcare centres, nursing organizations, and academic institutions to implement. The reputations of both the nurse and her hospital were impacted. A methodological model for analysing similar situations is proposed.

The Needs and Experiences of Black Families in the Neonatal Intensive Care Unit.

To identify opportunities for improvement in quality of care, we explore Black families' experiences of family support in the neonatal intensive care unit (NICU) during their infant's hospital stay. Semistructured qualitative interviews or focus groups (FGs) were conducted to explore Black families' experiences of NICU hospitalization. Inclusion criteria were self-identification as a Black family member and infant admission to our NICU between January 2020 and February 2022. We conducted reflexive thematic analysis of recorded transcripts using Dedoose software. Three interviews and 2 FGs were conducted with 9 unique families (n = 13 individuals). We organized 10 key themes into "Experiences" and "Recommendations." Experience themes included distrust and fear of the medical setting, hypervigilance and trauma trajectory formation, the myth of "Black hardiness," policing and surveillance, and undermining of Black parenting. Recommendation themes implored NICU staff to earn rather than assume trust, respect family concerns, improve mental health support, provide compassionate care, and support the parenting role. In this single-center qualitative study of Black families' NICU encounters, families continue to experience differential treatment, which reinforces an untrustworthy medical system perpetuating structural racism. Family recommendations for improving care through transparent communication, advocacy and mental health support, increased engagement in their parental role, and decreasing biased treatment and provision of resources may improve their experience and mitigate hypervigilance and trajectory formation in our NICU.

Triglyceride glucose index is associated with vertebral fracture in older adults: a longitudinal study.

Diabetes is a risk factor for bone fractures. However, the association between insulin resistance and the risk of fracture has not been well studied. In the present study, we explored the association of the triglyceride glucose index as a measure of insulin resistance with the risk of vertebral fracture in older adults. A total of 1995 subjects aged 50 years or older who underwent computed tomography (CT) for lung cancer screening from 2016-2021 were included in this study. They were followed until July 2023. Demographic information and laboratory test data were collected from the electronic medical system. Vertebral fractures were evaluated on the basis of sagittal CT images of the spine. The triglyceride glucose (TYG) index was calculated via the following equation: Ln [fasting glucose (mg/dl)×fasting triglyceride (mg/dl)/2]. The association between the TYG index and vertebral fracture incidence was evaluated via a multivariable Cox proportional hazards model. Ninety-five cases of fracture were observed during the 60 months of follow-up. The incidence of fracture was lower for the fourth TYG index than for the first TYG index (3.26% vs. 6.00%, P = 0.04). The risk of vertebral fracture decreased with increasing TYG index (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.35-0.90). Fracture risk was significantly lower in subjects with the highest TYG (the fourth quartile) than in those with the first quartile (aHR: 0.46, 95% CI: 0.22-0.96) according to the fully adjusted model. A similar association was observed in subjects without diabetes (aHR = 0.44, 95% CI: 0.21-0.95). Restricted cubic splines further revealed that the risk of vertebral fracture decreased with increasing TYG index. A greater TYG index was associated with a lower risk of vertebral fracture, independent of body mass index and bone mass.

The role of regulatory agencies within health systems during emergencies in BrazilPapel de los organismos regulatorios en los sistemas de salud en situaciones de emergencia en Brasil

The performance of health systems is related to ensuring the right to health, an important component of human rights that includes the right to health protection. Regulatory action by the state aims to reduce risks to health and thus help improve health system performance, particularly with respect to the principles of comprehensiveness and equity. The aim of this article is to discuss resilience from the perspective of national regulatory agencies - especially when they are faced with public health emergencies (PHEs) - and their contribution to health system resilience, taking as a model the work of the Brazilian Health Regulatory Agency (ANVISA). In the context of PHEs, health regulators have been improving their practices and working on several fronts. Regulatory agencies have used specific regulatory instruments to speed up access to effective and safe products for responding to pandemics, to ensure the quality of care, and to communicate with the public. ANVISA specifically has brought new areas of action under its purview, such as overseeing the development of mechanical ventilators. It is crucial to recognize the interdependence between improving response capacity and improving performance in dealing with PHEs. Examples include the fast-track approval of COVID-19 vaccines, which allowed more rapid vaccination; cooperation among regulatory agencies; and, in the case of Brazil, work by ANVISA to strengthen the role of the country's Unified Health System (SUS) and the right to health in the face of disinformation and denialism.

The role of a structured community health worker network in achieving malaria elimination goals in the Dominican Republic: An impact evaluation amid COVID-19 disruptions.

Community health workers (CHWs) can play a key role in malaria elimination through expanding access to malaria testing and treatment. The Dominican Republic, a low endemic country committed to eliminate malaria by 2025, implemented a structured malaria CHW network in the three main urban foci of Greater Santo Domingo. This research quantifies the networks' contributions towards malaria elimination from its implementation in 2019 until 2022. The study highlights the impact of COVID-19 disruptions on CHWs' performance and explores the network's ability to bounce back from health systems' shocks. The performance of the malaria CHW network was evaluated using weekly data collected from CHWs and routinely collected surveillance data from the Ministry of Public Health (MoH). We assess performance of CHWs by analyzing key variables including (1) reporting compliance, (2) household visitation rates, (3) malaria rapid diagnostic tests performed, (4) malaria cases detected, and (5) time between symptom onset and malaria diagnosis. To evaluate the impact of COVID-19 on the network, CHW's performance indicators are evaluated across three time periods (prior to, during, and after COVID-19 interruptions). Over the evaluation period, reported malaria cases in study foci decreased from 1,243 cases in 2019 to 6 cases in 2022. CHWs diagnosed and treated over 43% of malaria cases in study foci before COVID-19 interruptions and 14% during interruptions. 83% of cases detected by CHWs were detected through active case detection, with 17% detected passively. CHWs detected malaria cases and initiated treatment 1.5 days earlier than health facilities and MoH personnel performing active case detection. This evaluation provides evidence that a structured CHW network with clearly defined responsibilities and management protocol can help curb local malaria transmission. It adds to a growing body of research on the feasibility and benefits of CHW-led proactive household visitation.

Quality improvement for parenteral nutrition in hospital: Applying a gap analysis to an electronic health record to review parenteral nutrition processing.

In light of the complex and high-risk nature of parenteral nutrition (PN), reviewing PN processing steps is essential to minimize patient harm. The main steps include ordering, verification, compounding, and administration. Electronic health records (EHRs) have become increasingly utilized and can play a critical role in enhancing the safety of PN processin. Epic EHR is used throughout all PN processing steps within our health system. There is limited literature on health system quality improvement initiatives in PN processing. We reviewed the steps of PN processing in our health region and applied a gap analysis to assess Epic's functionality in PN processing. This gap analysis aimed to identify opportunities to enhance PN safety. Epic applies 32 of 40 functions that enhance PN safety. We selected three functions to prioritize adding into future EHR iterations; these include (1) bidirectional automatic interfacing between the automated compounding device and EHR reflecting real-time updates on product availability/shortages, (2) automatically transmitting a pharmacist-modified PN order back to the prescriber for approval, and (3) adding additional clinical decision support tools, one of which is incorporating a 3-in-1 qualification calculator and the second is requiring prescriber justification for using compounded formulations over multichamber bags. Additional opportunities for improving safety in PN processing were identified and added to the gap analysis. Using a gap analysis is a simple process to review a health system's EHR to identify opportunities to enhance patient care.

Challenges and solutions in implementing electronic prescribing in Iran’s health system: a qualitative study

BackgroundThe use of electronic prescribing is recognized as a strategic tool for improving healthcare. Given the nationwide implementation of electronic prescribing systems initiated in 2020, this study aims to explore the challenges and solutions for implementing electronic prescribing in Iran’s health system as a developing country.MethodsThis qualitative study was conducted through interviews with physicians, pharmacy staff, and electronic prescribing representatives in 2023. Initially, three in-depth interviews were conducted to develop the interview questions, resulting in three separate interview guides for each participant group (supplementary file no.1). Participants were purposively selected, including 12 physicians, 15 electronic prescribing representatives, and 9 pharmacy staff members. Interviews continued until data saturation was reached. The interviews were recorded, transcribed, and analyzed using Inductive content analysis with MAXQDA version 10 software. To identify challenges, sessions were held, and a final list of challenges was categorized. In the final stage, expert panels including 3 researchers, 4 e-prescribing representatives, and 3 insurance experts were formed to propose solutions.ResultThe challenges identified in this study were categorized into two main domains: “Organizational Challenges” and “Systemic Challenges.” Organizational challenges included issues related to insurance (16 cases), patient referrals (4 cases), stakeholder education and communication (6 cases), and supervision (8 cases). Systemic challenges included infrastructure problems (18 cases), user interface (UI) issues (14 cases), and database issues (10 cases). The primary challenges in implementing electronic prescribing were system downtime and sluggishness, internet connectivity issues, and the existence of multiple insurance systems. Expert panel discussions resulted in proposed solutions, including the uniform design of software by the Ministry of Health, the establishment of an integrated electronic referral system, conducting practical training sessions for physicians, and implementing electronic signatures.ConclusionElectronic prescribing in Iran is still in its early stages and will inevitably face challenges and problems. Continuous monitoring of electronic prescribing systems is essential to address implementation issues promptly. Issues related to training insurance monitoring the user interface and database infrastructure were challenging. Overall, improvements in infrastructure, integration of insurance systems, implementation of electronic signatures, adherence to electronic prescribing standards, and provision of practical training are recommended.

Supporting Children's Mental Health Needs in Disasters.

Public health emergencies, including climate-related and manmade disasters such as active shooter incidents, occur regularly in the United States. A comprehensive approach is needed to ensure that children's mental health needs are adequately addressed following disasters. This article summarizes the latest evidence on how health systems can effectively address children's unique developmental, social, emotional, and behavioral needs in the context of disasters. To do so requires the integration of mental health considerations throughout all disaster phases, including preparedness, response, and recovery. We discuss the role of traditional emergency response systems and emerging models for responding to mental health crises. These include the national children's disaster mental health concept of operations and specific resources such as crisis lines, mobile crisis units, and telemental health. To achieve a broader reach in addressing children's mental health needs during disasters, health systems can foster a "pediatric disaster system of care" by partnering with community touch points such as schools, faith-based organizations, public health, and law enforcement. Unique considerations during disasters are required to maintain access to care for children with preexisting behavioral health conditions. During disasters, attention is needed to promote equitable identification of mental health needs and linkage to services, particularly for minoritized groups and children living in rural, frontier, and high-poverty areas. Strategies to address children's mental health needs during disasters include the provision of psychological first aid, screening for and triaging mental health needs, and stepped care approaches that progressively allocate higher-intensity evidence-based treatments to children with greater and enduring needs.

Perception of medical students at public universities in Uganda on their education environment: a cross-sectional study

BackgroundThe healthcare workforce is one of the six core components of a well-functioning and sufficient health system. The WHO highlights that improving education and training of the health workforce is critical to improving health systems. Medical education is a pillar of the healthcare workforce. The educational environment - the physical circumstances or conditions under which learning takes place - is an important factor determining medical education’s effectiveness. Its academic and clinical effects significantly determine medical students’ attitudes, knowledge, skills, progression, and behaviors. To ensure strong health systems, there is a need for improvement in medical education. Improvement must be contextual and informed by locally relevant data. This study, which assessed Ugandan medical students’ perception of their learning environment, provides crucial context-specific data highly relevant to the current state of medical education in Uganda.MethodsThis quantitative cross-sectional study was conducted among medical students across five medical schools in Uganda between December 2021 and February 2022. Participants completed an online questionnaire with a demographics section and the Dundee Ready Education Environment Measure (DREEM) tool. The data was analyzed using R in R Studio version 2021.09.0 + 351. The average score for each DREEM sub-scale and the total DREEM score were calculated, and their relationship with demographic characteristics was examined.ResultsThe average total DREEM score of the 335 participants was 112.27/200 (56.12%). We found that 69% (231/335) of the students had a positive perception. The sub-scale mean scores were as follows: Perception of Atmosphere – 25.14/48, Social Self-perception − 14.94/28, Perception of Teachers − 24.86/44, Perception of Learning − 28.8/48, and Academic Self-perceptions – 19.04/32. “There is a good support system for students who get stressed” was the item with the lowest mean score (1.41/5).ConclusionsThe study’s findings indicate that medical students’ perceptions of their learning environment are just above average. This suggests a need for improvement, particularly in the atmosphere and social support, to ensure the training of a robust health workforce. The results of this study should motivate stakeholders to initiate changes that will enhance the quality of medical education in Uganda.

Objective-Oriented Health Systems Reform

ABSTRACT This paper emphasizes the importance of orienting health system reforms to address underlying system-level performance problems. Too often in practice, the objective-orientation that is stressed in health system frameworks gets lost in relation to policies or schemes that are promoted without plausible linkages to the actual objectives of the reforms. The objective-orientation can also get subsumed by political agendas that are disconnected, or can even detract from, people’s health needs. There are three core attributes to objective-oriented health system reform: (i) problem-oriented; (ii) consistent (extent to which reforms are connected to the problems they are meant to address and reflect lessons from global and national experience); and (iii) continuously evaluated. Country experiences reviewed in the paper, and presented in this special issue, illustrate how taking an objective-orientation led reformers to alter the details of implementation. Continuous learning also informed adaptations needed to strategically sequence and link reforms with objectives. An objective-oriented approach enables reformers to: (i) seize windows of opportunity; (ii) find room to maneuver under the label of the reform; (iii) integrate applied research into reform implementation; and (iv) skillfully interpret political statements to align with technical best practices. The approach and attributes laid out in this paper put forward considerations for policy makers as they design, implement, evaluate, and adapt policies to feasibly improve health system performance. They also, importantly, help guard against a rush toward policies or schemes that may sound good in speeches or declarations but do not have a plausible link to objectives.

Occupational health and safety management systems – analysis of selected requirements for evaluation of occupational health and safety performance

The publication undertakes the problems of occupational health and safety in the aspect of requirements for occupational health and safety management systems. The aim of the work was analysis of selected aspects of evaluation of occupational health and safety performance according to the ISO 45001:2018 standard. Performance evaluation and improvement are one of the basic requirements, that determine the suitability, adequacy, effectiveness and efficiency of management systems. The essential element of the study was the development of assumptions for evaluation of occupational health and safety performance, which include the analysis of occupational health and safety state and the evaluation of occupational health and safety management systems.

Collection and sharing of health information in mental health and related systems in Australia: perspectives of people who access mental health services

BackgroundInformation sharing and information privacy are important issues in mental health services. Yet the perspectives of Australians who access mental health services about these issues are poorly understood. This article addresses the research question: What are the concerns of people who use mental health services about the collection and use of their health information in mental health and related systems in Australia?MethodsParticipants were 16 people who had accessed mental health services and were involved in a series of co-design workshops as part of a larger study. Focused group activities were conducted in which participants were asked to discuss and create a visual map to describe their collective experiences of sharing information relating to mental health and recovery. The data were analysed using qualitative content analysis and the coding techniques of constant comparative analysis.ResultsParticipants expressed a sense of unknowability about the information held and accessed by various organisations. They described providing information to a wide variety of entities, though not always in a free or informed way. They believed other information held about them had been generated and/or shared by people other than themselves, often without their knowledge or consent. Participants reported that both the collection and storage of this information involved risks for them, and they sometimes restricted the information they provided. To improve their comfort with the use of their information, participants recommended customised and transparent information collection; individuals’ access and input to their own information; and use of information only for their benefit.ConclusionsTrust is key to positive experiences of information provision and information sharing. Central to establishing trust are transparent practices that facilitate greater choice and control.

Trust in Healthcare, Medical Mistrust, and Health Outcomes in Times of Health Crisis: A Narrative Review

Background/Objectives: The concepts of trust and distrust in health systems during health crises are significantly related to public adoption of health behaviors and health outcomes. The aim of this review is to examine trust and mistrust during times of health crisis, such as periods of viral pandemics and epidemics, and how these concepts relate to public health behaviors and, by extension, affect health outcomes. Methods: A focused search was conducted in PubMed and Scopus using a Boolean expression to identify relevant articles written in the English language and published between 2003 and 2023. The research methods comprised content analysis, thematic analysis, and a word cloud visualization to identify frequent themes related to trust and mistrust in healthcare systems. Results: The analysis included 57 studies and revealed that trust in healthcare systems, institutions, and professionals plays a significant role in shaping public health behaviors during health crises. The study also highlighted how mistrust leads to negative health outcomes, such as increased belief in conspiracy theories, vaccine hesitancy, and non-compliance with public health measures. Conclusions: The review emphasizes the importance of building and maintaining trust in healthcare systems to ensure better public health outcomes during crises. It calls for further research to better understand the nuances of trust and mistrust, aiming to inform public health strategies and interventions that could lead to more effective crisis management and improved health outcomes.