Utilization Of Services Research Articles

Expectation, perception, and satisfaction of antenatal care services among pregnant women attending health facilities of Lumbini province, Nepal: a cross-sectional study

Background: Antenatal care (ANC) plays a crucial role in ensuring the health and well-being of pregnant women by providing regular checkups to identify potential complications and deliver important guidance on pregnancy and childbirth. While the expectations surrounding ANC services are shaped by user's individual needs and preferences, the quality of care experienced is largely determined by the service providers. The level of service quality significantly influences the utilization of ANC service, as women are more likely to use services that satisfied their expectations. This study aimed to assess the expectations, perceptions, and satisfaction levels of pregnant women concerning the ANC services offered by health institutions in Lumbini Province. Methods: An institution-based cross-sectional analytical study was carried out involving 2,986 pregnant women, selected through multistage cluster sampling. Quantitative analysis was carried out to calculate the perception, expectation, and satisfaction score. The SERVQUAL tool was utilized to measure expectation, perception and service quality gap. Results: The study involved 2,986 pregnant women, the majority of whom (76.7%) were aged 20-30 years, 38.5% were Janajati, most of them (32.5%) had a secondary level of education, and 78.8% were housewives. The expectation score was higher than the perception. Overall, only 67% of pregnant women were satisfied with the services. Conclusions: Significant disparities exist between the expectations and actual perceptions of ANC users, indicating a lower level of satisfaction among mothers with the ANC services. The study concluded that decreased satisfaction with the service is likely to reduce the trend of service utilization.

Mental Illnesses and Stigma among Medical Undergraduates in India.

The current Medical Education system of India, with its enormous workload and academic demands tend to cause the medical students stress. There is evidence showing medical students at a higher risk of depression, anxiety and burnout compared to other Indian students. Despite, the huge reported numbers, the proportion of students and doctors who seek help for their problems is alarmingly low. One of the reasons provided for the same is stigma towards mental health and an apprehension regarding labels and treatment history on the careers of the students. Increased awareness and with a National Health Programme catered towards mental health, there has been a boost in the utilization and provision of mental health services but it rarely translates into better mental health facilities for the healthcare providers. The special set of challenges faced by a medical students are gradually being recognized and efforts are being made to address them. Curriculum guidelines, teaching methods, student welfare centres and helplines have been the areas of intervention. There should also be changes in approaches towards the students who face problems and providing a safe environment for them to discuss their problems, including encouraging peer support. Thus, a fine balance needs to be present between ensuring the protection of the mental health of a medical student and ensuring a quality medical education for them. Further exploration to address stigma and building empathy among the students and evaluation of the intervention methods devised to address the same becomes very necessary to ensure fruitful interventions. It is the need of the hour to help Indian Medical students overcome their struggles with mental health.

A holistic approach to supporting death in the home: Implementation of a home hospice program in a northern community–A study protocol

Introduction To enhance support for individuals at end of life to die at home, a new community-driven home-based hospice program was developed–Home Hospice. This wholistic hospice care program, co-designed by hospice care staff, community end-of-life care providers, researchers, and health systems decision-makers, will provide around the clock care to clients and their families. Methods and analysis This mixed methods study, guided by a process evaluation framework, will use secondary client and caregiver data collected as part of regular Home Hospice program processes, as well as primary interview data collected from caregivers at least three months post-death of the client and from hospice staff and volunteers involved in the Home Hospice program. Analysis will include descriptive statistical analysis of quantitative data and thematic analysis employing an inductive and a deductive qualitative analysis approach. Ethics Ethics approval has been received from the University of Northern British Columbia (File No: 6009117). All individuals and caregivers who enroll in the Home Hospice program will be invited to participate in this study. At three months post-death of the client, hospice staff will contact caregivers to ask if they would like to participate in a one-on-one interview with a research team member. Staff and volunteers will also be eligible to participate in one-on-one interviews with research team members. De-identified participant data will be provided by hospice staff to the research team. All participants will provide informed consent prior to participation in the study. Dissemination This study will use an integrated Knowledge Translation/Knowledge Mobilization (iKTKM) lens wherein the research team will work closely and meaningfully with knowledge users and community partners at all stages. Evidence-based and targeted iKTKM products will be created, including community event presentations and social media posts to share findings with participant and community audiences. Further, findings will be disseminated at conferences, workshops, and policy rounds with academic and decision-making audiences. Preliminary and full project findings will be published in high-quality open access journals. Strengths and limitations of this study Co-design of Home Hospice program and evaluation metrics involves researchers, hospice staff, health systems decision-makers, and community members. Evaluation metrics involve prospective collection of service utilization from client, family, hospice, and health systems perspectives. Integrated knowledge translation approach which frames the knowledge dissemination plan for the study findings focuses on a range of audiences, including local citizens, hospice and community end-of-life care providers, health systems decision-makers, and academic professionals. As a one-year pilot study, the number of clients who may be able to participate in this program will be approximately 50 persons.

Barriers to young people’s use of sexual and reproductive health services in Asia-Pacific

Abstract Background Qualitative literature extensively documents young people’s barriers to accessing sexual and reproductive health (SRH) services in Asia-Pacific countries. However, efforts to synthesise this research for practical use in healthcare policy and practice are lacking. This systematic review aims to systematically review and synthesise published qualitative literature focusing on young people’s utilisation of SRH services and understanding common access barriers. Methods We systematically searched five electronic databases from inception until 24 June 2022: MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science. Google Scholar and reference lists of all included studies were also searched. We used the Critical Appraisal Skills Programme (CASP) checklist for appraising the quality of included studies and analysed the data using a thematic synthesis approach. Results We included 31 papers reporting the experiences of over 1800 young people from 16 Asia-Pacific countries. Thematic synthesis identified several factors affecting adolescents’ utilisation of SRH services, which were grouped into six descriptive themes: navigating puberty; lack of SRH knowledge; embarrassment and confidentiality concerns; low decision-making autonomy; traditional practices and religious beliefs; and socio-cultural norms. Our overreaching analytical theme highlighted the role of shame as a key emotion hindering young people’s utilisation of SRH services. Conclusions Direct communication about SRH issues is crucial for teenagers. Embarrassment, privacy concerns, and stigma significantly affect their service utilisation decisions. Inclusive interventions for both youth and their communities by addressing socio-cultural factors are essential for optimising service accessibility and guiding evidence-based interventions and policies across diverse cultural contexts. Key messages • Understanding young people’s SRH service barriers in Asia-Pacific countries: Socio-cultural norms are highlighted as crucial for optimising service utilisation among young individuals in this area. • Inclusive interventions and policies are needed for enhanced accessibility.

Comorbidity Patterns in Chronic Obstructive Pulmonary Disease and Their Associations with Service Utilization

Background The prevalence of combinations of comorbidities and their associations with inpatient service utilization and readmission among patients with chronic obstructive pulmonary disease (COPD) have not been extensively examined. To address this gap in knowledge, an observational prospective study was conducted using retrospective data. Aims To identify patterns of comorbidities linked to length of hospital stay, daily expenses, and one-year readmission. Methods The 30 most common comorbidities were identified in patients with secondary diagnoses using the association rule mining (ARM) method. Regression models were used to examine the relationships between combinations of comorbidities and service utilization, with adjustments for covariates. Results The five most prevalent comorbidities were pulmonary heart disease (40.99%), ischemic heart disease (38.97%), heart failure (36.77%), hypertension (34.11%), and respiratory disorders (19.12%). Most combinations of comorbidities identified by ARM showed significant associations with an extended length of stay (>13 days), increased daily expenses (>930 CNY), and reduced readmission rates. Among these combinations, glycoprotein metabolism disorder had the strongest association with prolonged length of stay (adjusted odds ratio [aOR]): 1.89, 95% confidence interval [CI]: 1.82–1.95). Conversely, the combination of other brain diseases and respiratory failure was linked to higher daily expenses (aOR: 11.34, 95% CI: 10.58–12.15), and the presence of pulmonary heart disease was associated with elevated one-year readmission rates (aOR: 1.41, 95% CI: 1.37–1.46). Conclusion Common combinations of comorbidities among inpatients with COPD were identified from an extensive collection of discharge medical records. Furthermore, the associations between comorbidities, inpatient service usage, and readmission rates were determined.

Prevalence of Mental health and Receipt of Services in Latino Immigrants Living in Philadelphia

Abstract Background and Purpose Research shows that Latino populations are less likely to seek formal mental health services, these attitudes combined with difficulty finding affordable services impact the ability to receive a mental health diagnosis. This project examines mental health symptoms, utilization of mental health services, and socio-ecological barriers to receive mental health services among Latino immigrants, including region of origin, health insurance, immigration status, and English proficiency. Methods Data was collected between 2021-2022 by Drexel University’s CRISOL lab using a cross-sectional respondent-driven sample survey of Latinos born outside the U.S. mainland and residing in Philadelphia. The final sample included 420 Latino/a/e immigrants. Descriptive statistics and bivariate associations using Chi-square analyses were computed. Outcomes The findings revealed that 29.1% of the surveyed individuals exhibited signs of Depression, 36.1% experienced symptoms of Anxiety, 8.7% showed signs of PTSD, and 43.4% possessed one or more mental health conditions. The findings show that country of origin (p<.01), health insurance (p<.05), immigration status (p<.01), and language proficiency (p<.001) are significantly associated with whether an individual has received mental health services in the past year or in their lifetime. Of the survey population, only 39.5% of individuals with one or more mental issues had received mental health services in their lifetime. Conclusions Interventions to increase access to mental health services for Latino communities are needed. Solutions addressing disparities in access to mental health services must address systemic, cultural, and language barriers. Key messages • Region of origin, health insurance, immigration status, and English proficiency impact the utilization of mental health services. • Immigrant populations face stressors that increase the risk for mental health disease and experience multiple barriers to access mental health services.

Associations between maternal origin, breastfeeding and health service use: a mediation analysis

Abstract Background The influence of maternal health utilization on breastfeeding practices is well established. However, research shows that immigrant women tend to face challenges in accessing maternal health services. Our aim was to examine any variation in maternal and child health service utilization between immigrant and native-born mothers as well as to examine potential mediation roles of service utilization on the association between maternal origin and breastfeeding practices. Methods We used a nationwide FinChildren (2020) survey on parents with infants focusing on Somali (n = 29), Arabic (n = 81) and Russian speaking (n = 181) parents and their infants. We compared them with native Finnish speakers (n = 7508). We used Process Macro to conduct mediation analysis. Results Almost 25%/ of Somali-/Arabic-speaking mothers reported not taking their infants to routine child health clinic visits. The proportion was 0.4% for native-born mothers and 1.6% for Russian-speaking mothers (p < 0.001). Around 18% of Somali-/Arabic-speaking mothers and only 0.6% of the native-born mothers reported not utilizing child health clinic services in the past year (p < 0.001). Somali-/Arabic speaking mothers were more likely to receive breastfeeding support from maternity clinics and native-born mothers from maternity hospital or peer support groups. Russian-speaking mothers were most satisfied with the received child healthcare services while Somali/Arabic-speaking mothers were least satisfied with these services (p < 0.001). Only participating in breastfeeding peer support groups had mediation effects on association between maternal origin and breastfeeding practices. Conclusions This study shows that immigrants mothers, particularly Somali/Arabic speaking mothers use less the maternal health services particularly routine health visits. It is essential to encourage them to use the services to be able to monitor the health of both mother and the child. Key messages • Somali-/Arabic-speaking mothers are in a vulnerable position when it comes to utilizing healthcare services. • This study call for more research exploring factors contributing to this.

A Qualitative Study of Implementation Outcomes of a Group-Based Intervention for Immigrant Parents

Abstract Background Inequities in service utilization between immigrant families and native populations have emerged within the Nordic welfare countries, highlighting the need for culturally sensitive parenting support. Despite the proven efficacy of parenting interventions, their implementation phases have not been adequately addressed in extant implementation research, particularly regarding structural racism and inequities. This study aims to contribute to the literature from an implementation perspective by describing a pilot of ‘Being a Parent in Finland,’ a culturally sensitive group-based intervention for migrant parents. Its specific focus is on investigating barriers to and facilitators of implementation outcomes from the perspectives of service providers. Methods The qualitative data consisted of thematic interviews (N = 6) with service providers (N = 9) compiled at distinct phases of the pilot from 2021 to 2023. In addition, data triangulation was utilized through document analysis of 125 pages of various documents regarding the pilot as a supplementary data collection method. Content analysis was conducted on the data using Atlas.ti 23. Results The findings stress the alignment of the target group, service placement, and preventive measures for enhancing parenting intervention’s acceptability, appropriateness, and feasibility. Implicit objectives, such as perceiving the target group as ‘at-risk,’ can impede intervention success and exacerbate stigmatization of the target group. Culture- and context-specific adaptations, and community engagement foster parental trust and intervention accessibility. Conclusions The findings underscore the significance of congruent objectives, community engagement, and adaptive iterations in preventive parenting interventions. Advocating for these elements in implementation strategies is crucial for reducing stigmatization and enhancing equity and efficacy in services tailored to minority parents. Key messages • Acknowledging equity in both implementation research and strategies is paramount. • Implementing trust-building is crucial for culturally sensitive parenting interventions.

Examining Barriers to the Utilization of Malaria Control and Prevention Services in the South West Region, Cameroon

Purpose: The purpose of this study is to examine the barriers to the utilisation of malaria control and prevention services in the southwest region of Cameroon precisely in the Fako division. Cultural beliefs and practices significantly influence health-seeking behaviours in communities, even when faced with life-threatening diseases like malaria. Methodology: Qualitative data were collected through structured interviews to understand the preferred treatment methods for malaria, the rationale behind the disease's continuous prevalence within the community, and the low usage of prevention methods prescribed in the hospitals. The data were analysed using a thematic technique, and presented following the themes that were elicited during the in-depth interviews and focus group discussions. Findings: This study found that herbal medical practices are deeply rooted in the community's culture and need to be more quickly supplanted by modern medical practices. The study found that the resistance to malaria prevention methods was fueled by a lack of awareness about the importance of malaria prevention and control, contributing to the high malaria prevalence rate in the community. Also, the study found that the current healthcare system needs to be culturally sensitive, potentially leading to a lack of trust and confidence among community members. Additionally, financial constraints significantly impact the utilisation of preventive and treatment measures like mosquito nets, health centres, and community health workers. Unique Contribution to Theory, Practice and Policy: These findings aligned with the Health Belief Theory (HBT), which explains that individuals' beliefs and attitudes towards malaria prevention in these communities constitute a significant barrier to malaria eradication. Community members perceive malaria as a severe disease and believe they are at risk of contracting it, leading to action due to susceptibility. However, traditional remedies are preferred due to perceived barriers to mosquito nets, such as cost, lack of access, and perceived ineffectiveness of the mosquitoes’ nets. The study concluded that a culturally sensitive approach to malaria treatment and prevention, built on the community's beliefs and practices, can improve health outcomes. Therefore, organisations in charge of malaria prevention must adapt their approach to align better with the community's cultural values. The study further recommended that education and awareness campaigns about malaria prevention and control should be tailored to the community's cultural realities.

Digital Literacy Among Migrants in Portugal: Access, Usage, and Trust in Health Information

Abstract Background Digital literacy is crucial for effective utilization of health-related services and information. This study evaluates digital literacy among migrants in Portugal, focusing on three key components: access to digital services, usage of these services for health information, and trust in online health resources. Methods A cross-sectional survey was conducted to assess migrants’ access to digital devices such as smartphones and computers, their ability to use these devices for health-related purposes, and their perceptions of the credibility of online health information. Data were analyzed across various sociodemographic and migration-related factors. Results 1,048 migrants were included, of which 90.3% had access to digital services, and 64.9% reported ease in using these services to obtain health information. Despite widespread access and usability, about 45.6% of migrants doubted the reliability of online health information. Access and usage varied significantly with age, education, income, employment status, and region of origin. Older, less educated, lower-income, and African migrants faced more significant challenges in access and usage. Additionally, trust issues were predominantly reported by females, those with lower education levels, recent arrivals, and non-Portuguese speakers. Conclusions The study highlights significant disparities in digital literacy among migrants, influenced by socio-economic and demographic factors. While access to digital tools is high, challenges in usage and trust present barriers to effective health communication. Key messages • High access to digital services among migrants, yet significant disparities affect older, less educated, and lower-income groups. • Usage difficulties combined with low trust in online health info highlight the need for targeted digital literacy interventions.

Health-related quality of life among refugees from Nagorno Karabagh resided in Kotayk, Armenia

Abstract Background In September 2023, more than 100,000 ethnic Armenians were displaced from Nagorno Karabakh (NK). This study assessed the health-related quality of life (HRQoL) and associated factors among NK refugees who settled in Kotayk province of Armenia. Methods We surveyed 197 refugees using a structured interviewer-administered questionnaire, which collected information about socio-demographics, chronic diseases, smoking status, HRQoL, utilization of healthcare services, living conditions and food access. The SF-36 Health Survey assessed HRQoL. Ophthalmic examination was conducted. Eyeglasses and medications were provided at no cost to those requiring them. Results The participants’ mean age was 64.8 years and 59.4% were retired. The most commonly reported chronic diseases were bone/joint diseases (67.5%), hypertension (55.3%) and heart diseases (24.9%). Around 48.7% of participants experienced sleeping disorders often/ very often. The mean total SF-36 score was 57.42±23.12; the mean physical (PHC) and mental health component (MHC) scores were 63.57±26.28 and 59.37±20.04, respectively. Only 28% of the participants utilized healthcare services after displacement. Most participants had consistent access to an adequate food supply. In the adjusted analysis age (B/PHC=-0.94, p < 0.001; B/MHC=-0.61, p < 0.001), sleeping disorder (B/PHC=-21.86, p = 0.011; B/MHC=-17.44, p = 0.001), use of medical service (B/PHC=-8.63, p = 0.022; B/MHC=-6.95; p = 0.015) and having more than one chronic disease (B/PHC=-17.35, p < 0.001; B/MHC=-10.90, p = 0.001) were associated with both PHC and MHC. Conclusions This study marks the first assessment of HRQoL among NK refugees. Governmental support and interventions targeting individuals with ophthalmic, sleeping, and chronic diseases might be beneficial. Follow-up assessments should track changes in both physical and mental health scores in this population, as they may fluctuate over time in response to displacement challenges. Key messages • Age, sleeping disorder, use of medical service, and the number of chronic diseases were significantly associated with decreased PHC and MHC of HRQoL • Interventions targeting individuals with restricted access to healthcare services, as well as those affected by eye diseases and chronic health issues might be beneficial.

Adoption and Utilization of Telemedicine and Digital Health Services among Older Adults in Israel

Abstract Background As the population ages and the prevalence of long-term diseases rises, telecare is being used increasingly frequently to aid elderly people. Aims We aimed to explore the usage and adoption of 3 types of telehealth services among the senior population in Israel- prior, during, and after the COVID-19 pandemic rise in Israel. Methods We explored the usage characteristics of older adults (age 65 and above) belonging to ‘Clalit’, in the use of three types of telehealth services: digital services for administrative tasks, synchronous ‘online visits’ with the patient’s personal physician during clinic business hours, and ‘afterhours’ consultations during evenings, nights, and weekends. The data was collected and analyzed throughout three distinct time periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic and following the COVID-19 ‘peak’. Results Data of 618850 patients who met the inclusion criteria was extracted. Telehealth services utilized for administrative purposes were the most popular. The older population significantly increased their use of all types of telehealth services during the COVID-19 period, and in the majority of types, this usage decreased after the COVID-19 peak, but to a level that was higher than the baseline level prior to the COVID-19 period. Prior to the COVID-19 period, 23.1% of the study population used ‘online visits’, and 2.2% used ‘afterhours’ consultations, at least once. The percentage of usage for these services increased during the COVID-19 period to 59.2% and 5.0%, and then decreased during the third period to 39.5% and 2.4%, respectively (P < 0.001). Multiple patient variables have been found to be associated with the use of the different telehealth services, in each time-period. Conclusions The senior population uses telehealth services, and can increase their consumption, when they are needed. Suitable and straightforward telehealth solutions tailored for this population should be created. Key messages • The senior population uses telehealth services, and can increase their consumption, when they are needed. • Suitable and straightforward telehealth solutions tailored for this population should be created.

Hospital satisfaction among older adults by European Union health system clusters

Abstract Background Health systems are influenced by political, historical, cultural and socio-economic factors and differ across countries. Classification of EU health systems into 5 clusters has allowed for international comparison and policy recommendations. This study is based on the Andersen’s Behavior Model, that predicts that a sequence of predisposing, enabling and need factors influence satisfaction and utilization of healthcare services. Aim Examine the nature and relationship of predisposing, enabling and need factors associated with hospital satisfaction of older adults across EU nations by health system classification clusters. Methods Data from Wave 9, of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of older adults from 10 EU countries. Analysis: Non-parametric one-way ANOVA (Kruskal- Wallis test) and Multinominal Logistics regression were performed to test the null hypothesis that (1) hospital satisfaction is equal across all clusters, and (2) predisposing, enabling, and need factors, are not predictors of hospital satisfaction. Findings There was a statistically significant difference in hospital satisfaction by cluster [Chi Square= 231.44, df = 21; p< .001]. Age, mental health, technology and chronic disease are predictors of healthcare facilities satisfaction. [Chi Square 50.94, df = 3, p< .001], Among those that reported to be highly unsatisfied with healthcare facilities, [chronic disease (Beta = -2.64) and mental health (Beta = -4.41) df = 1 p< .001] significantly predicted hospital satisfaction. Implications for Policy and Practice: Initiatives for the care of older adults should not only aim to increase access to care but also provide targeted services for sub populations such as older adults with mental health and chronic diseases. Further, significant investment is required in technology infrastructure within hospitals and technological assistance or training should be provided to older adults. Key messages • Older adults satisfaction with hospitals varies by health system clusters and is predicted by age, mental health, use of technology and chronic disease. • Chronic disease and mental health are strong predictors of hospital dissatisfaction among older adults.

Investigation of usage of antenatal care services by Syrian immigrant pregnant women and the frequency of anaemia and hypertension during the pandemic.

During the pandemic period, the use of health services by disadvantaged groups such as immigrants has deteriorated. The study aims to evaluate the use of antenatal care services by Syrian pregnant women during the pandemic. It is a cross-sectional type of study. The population consisted of 495 pregnant women who applied to the Extended Migrant Health Center (EMHC) between August 2020 and December 2022. Demographic data and pregnancy-related health records were examined through the system records, without any contact with the pregnant women. The percentage of pregnant women who had timely follow-up for each antenatal visit were 11.5% (n=56), 17.2% (n=80), 20.0% (n=88), and 17.4% (n=73), respectively. Only 17.7% (n=87) of the pregnant women made the recommended number of visits during their pregnancy period. The recommended number of follow-ups was statistically significantly higher in women with high-risk pregnancies (p=0.045). Of the pregnant women, 27.4% had anaemia and 2.4% had hypertension. The use of antenatal care in immigrant pregnant women is very low. Interventions are needed in this regard. Increasing the utilization of antenatal care services by immigrant pregnant women is extremely important for both the health of the pregnant woman and the health of the baby.

Empowering People Experiencing Homelessness for cancer prevention using the Health Navigator Model

Abstract Cancer poses a significant public health concern. Reports highlight that cancer-related mortality rates are double among people experiencing homelessness (PEH). CANCERLESS project delivered an innovative solution based on the Health Navigator Model (HNM). The HNM is an evidence-based patient-centred intervention that develops patient empowerment through health education and social support, promoting timely access to cancer prevention services. A pre-post design study conducted across four pilot sites in Europe (Austria, Greece, Spain, UK) involved 652 PEHs. Pilot interventions based on the HNM were implemented, with effectiveness evaluated at baseline and post-intervention. The study assessed the impact of the HNM on various factors including risk behaviors, lifestyles, quality of life, empowerment, health literacy, psychological distress and utilization of health and care services. Preliminary findings from CANCERLESS HNM intervention showed significant improvements (p= .000) in participants’ quality of life (55.82 (27.65) vs. 66.18 (22.27)) and sense of empowerment (25.58 (19.95) vs. 59.94 (43.10)). However, there were no observable impacts in health literacy (p= .509) or psychological distress (p= .140), which remained within acceptable ranges both pre- and post-intervention. Similarly, there were no significant changes observed in lifestyle or risk behaviours among PEHs. Nonetheless, the evaluation of effectiveness suggested that the HNM increase in the uptake of cancer prevention care, such as cancer screening (p= .000). The CANCERLESS HNM intervention significantly improved the quality of life and empowerment of PEHs. Additionally, it successfully promoted their involvement in cancer prevention efforts, addressing disparities in access to preventive healthcare services. Increased engagement in such initiatives can lead to early detection and treatment, ultimately reducing cancer morbidity and mortality rates, thereby positively impacting public health. Key messages • By promoting health equity and social justice, interventions like CANCERLESS HNM contribute to building healthier and more resilient public health systems. • CANCERLESS boosts cancer prevention awareness, tackles healthcare disparities, enhances cancer early detection, benefiting public health.

Trust in sources of information about digital health technologies: The User’s Perspective

Abstract Background Trust is key to healthcare, including all types of health information. This applies not only to the process of healthcare delivery, but also to health-related behaviors and the utilization of healthcare services. Trust in health information sources has been shown to vary by social and health characteristics. Therefore, the research question is: Are there social and health-related differences in perceptions of trust in sources of information (government agencies or physicians) about digital health technologies? Methods The analysis is based on a cross-sectional online survey (STELLAR) conducted in 2022 (N = 1,200), Participants were asked whether they perceive trust (1= fully agree- 4= not at all) in information about digital health technologies provided by government agencies (institutional trust) or physicians (interpersonal trust). For the analysis, binary logistic regressions (references: traditionalists, low education level, poor self-perceived health) were used. Results Institutional Trust. Overall, 43.9% of the participants perceived trust in this information source. Baby Boomers (OR 2.022), Generation Y (OR 2.544), and Generation Z (OR 2.566), as well as medium (OR 2.526) and high (OR 3.823) educational level, increased the odds of perceived trust; the same was found for better self-perceived health (OR 1.569). Interpersonal Trust. In general, 94.8 % of the participants expressed trust physicians. Belonging to Generation Z decreased the chance (OR 0.097) and a better subjective health status increased the chance (OR 4.250) of perceiving trust. Education did not emerge as a significant determinant. Conclusions The study confirmed that interpersonal and institutional trust varies by social and health characteristics. There seems to be a need to strengthen efforts to explain the process of trust building in different population groups., e.g. to find explanations for why educational level was only relevant for institutional trust but not for interpersonal trust. Key messages • Trust in sources of information about digital health technologies differ by generation, educational level, and subjective health status. • Given the existing differences in perceptions of trust, it is worthwhile to explore the unknown mechanisms of the trust-building process among different population groups.

Diagnoses of mental health disorders among Norwegian youth and young adults with immigrant parents

Abstract Introduction Adolescence and early adulthood are associated with an increase in mental health problems. Migration is also a risk factor for mental disorders. Yet, there is a notable gap in research concerning the mental well-being of descendants of immigrants. This study investigates the risk of a diagnosis of a mental health disorder among those aged 16-30 years, born in Norway with at least one immigrant parent. Methods Data were sourced from the Medical Birth Registry of Norway, the Norwegian Patient Register, and Statistics Norway. Cox proportional hazard regressions were used to estimate hazard ratios (HR) of being diagnosed with different mental disorders, in total and by parental region of origin, compared to individuals of Norwegian background. Analyses were adjusted for sex, year of birth, and parental education. Results Individuals with two immigrant parents had a lower risk of most mental disorder diagnoses, while those of one immigrant parent had a higher risk. With the exception of schizophrenia, individuals with two immigrant parents had a lower risk of most mental disorder diagnoses compared to those with Norwegian-born parents. The HR for the risk of a diagnosis of anxiety for those with two immigrant parents was: 0.79 [95% CI 0.76 - 0.81], with immigrant mother: 1.07 [95% CI 1.04-1.10], with immigrant father: 1.28 [95% CI 1.24 -1.30]. Similarly, for depression, two immigrant parents: 0.85 [95% CI 0.82-0.88], immigrant mother: 1.13 [95% CI 1.09 - 1.17], immigrant father: 1.31 (95% CI 1.28-1.37). Bipolar disorders, two immigrant parents: 0.67 [95% CI 0.60-0.76], immigrant mother: 1.19 [95% CI 1.07 - 1.31], immigrant father: 1.47 [95% CI 1.35-1.61]. The pattern was relatively consistent across parental regions of origin. Conclusions Those with one immigrant parent are more likely to use specialist mental health services, while those with two immigrant parents are not. These need special attention in adulthood. Key messages • Differences in risk of diagnosis for mental disorders could be due to differences in the utilization of mental health services. • Early prevention of mental health issues seems to be especially important among children and youth raised in families with one immigrant parent.

Evaluation of specific offers for mothers with mental stress

Abstract Background As part of the Austrian early intervention programme ‘Frühe Hilfen’, specific interventions (a psychotherapeutic short-term intervention and a therapeutic group) were implemented in some regions. An evaluation was carried out to gain general insights into the need for and benefits of psychosocial services as well as in-depth information on the benefits of the two selected services. The results of the project should also enable further conclusions/recommendations for appropriate services. Methods Mixed-methods approach: qualitative (focus groups, individual interviews, online surveys, participant observation) and quantitative (screening questionnaires) instruments involving a large number of relevant stakeholders and actors. Data analysis: content-structuring qualitative content analysis according to Kuckartz; descriptive analysis of the screening questionnaires. Results The analysis revealed a great need for specific psychosocial services for this target group as well as a high level of satisfaction with the psychosocial services utilised. However, all respondents pointed out barriers to the utilisation of psychosocial services. The evaluation results show that the two specific services make an important contribution to improving the well-being of mothers with mental health problems. Both services largely reach their target group well and, thanks to their focus, contribute to the well-being of mothers with mental health problems. The effectiveness of the service is underpinned by the fact that all participants perceive a reduction in mental stress and notice a reduction in stress during the screenings. Conclusions Based on the evaluation results, it is generally recommended that low-threshold, free and needs-based services be established or expanded. In addition, there is a need for more educational and public relations work on psychosocial stress/diseases and more information on support services. Key messages • There is a great need for psychosocial support among mothers. • The high level of satisfaction with the services evaluated indicates that more such services are needed to support families.

Variations in access to acute care services by immigrant background and sociodemographic factors

Abstract Background The Emergency Medical Communication Center (EMCC) plays a vital role in the medical emergency response system by triaging contacts, notifying local physicians, and providing medical advice. The utilization of acute care services and the subsequent care pathway by individuals with immigrant background remains unclear in the Norwegian context. This study aims to investigate whether disparities exist in the acute care pathway for patients with different sociodemographic background who use ambulance services. Methods We examined all code red ambulance dispatches for life-threatening emergencies in 2021 in Norway. These ambulance dispatches were linked to primary health care and specialist health care contacts to trace patient pathways and outcomes. Statistical analyses were conducted using linear regression models, adjusted for patient characteristics, such as immigrant background, age, sex, municipality of residence, living condition, socioeconomic status, comorbidity and cause of emergency contact. Results Preliminary crude findings indicate that patients with immigrant background are overrepresented in the groups receiving acute primary care only and underrepresented in the groups transferred directly to specialist health care, within 8 hours after ambulance arrival at the patients’ location. Conclusions The preliminary results suggest challenges for the EMCC in triaging patients with immigrant background, but further research is needed to explore potential systematic differences. This study aims to improve understanding of disparities in access to acute care and inform targeted interventions to optimize resource allocation in emergency departments. Key messages • This study may improve understanding of disparities in access to acute care in Norway. • This study can inform targeted interventions to improve resource allocation in emergency departments.

Barriers and facilitators to healthcare services of people with mental ill-health in Europe

Abstract Background People with mental ill-health (PMIH) have higher cancer mortality rates than the general population. Barriers to healthcare service access may be a contributing factor. The EU-funded CO-CAPTAIN project aims to reduce health inequalities by improving overall health and reducing cancer burden by adapting and implementing the Patient Navigation (PN) Model targeted at PMIH. This qualitative study explored healthcare system experiences of PMIH in Austria, Greece, Poland, and Spain. Methods Eighty-one participants (22-76 years old), including 34 PMIH, 10 caregivers, 14 care team members, 12 mental health organization representatives, and 11 service manager representatives, were recruited. Semi-structured interviews focused on awareness of cancer risk factors, healthcare system experiences, and perspectives on PN as an intervention. Interviews were transcribed verbatim and analyzed using thematic analysis. Results Three major themes emerged: (1) somatic health relevance and preventive services utilization and (2) barriers / (3) facilitators to preventive services access. Knowledge of cancer prevention services varied greatly. Participants were aware of associations between risky health behaviors and health. Burden of mental health problems and discrimination, insufficient access to information, and lack of service flexibility were noted as barriers. Considerations of individual circumstances, social support, and empowerment were named as facilitators. Conclusions Tailored interventions involving healthcare professionals and PMIH in development of supportive environments and health literacy have the potential of overcoming identified barriers to the use of healthcare services. Key messages • People experiencing mental ill-health are faced with significant structural barriers when accessing somatic health services. • Understanding people’s needs in terms of access and utilization of health care allows us to define guidelines for future personalized healthcare solutions.