Health System Barriers for HPV-vaccine uptake in females with a Turkish or Moroccan Migration background in the Netherlands

Background

HPV vaccine uptake in female adolescents with a Turkish or Moroccan migration background in the Netherlands is lower as compared to the national average. This study aimed to study health system barriers for HPV vaccine uptake in these groups.

Methods

Semi-structured interviews with Turkish/Moroccan (2nd and 3rd degree migrants) female adolescents (12-18 years old), their parents and grandparents were conducted. In addition a focus group discussion with healthcare providers with particular experience with HPV immunization and the target groups was organized. Data was collected between November 2021-April 2022.

Results

22 interviews were conducted among twenty-three individual participants. Sixteen participants with a Turkish migration background were recruited and seven participants were having a Moroccan migration background. In thirteen cases young women in the families did not receive an HPV vaccination. Health system barriers identified were: language barriers in the information provided, focus on HPV being a sexually transmitted disease in information campaigns, lack of knowledge and awareness on HPV among participants and healthcare providers and inability to reach the target groups with tailored immunization programs. Similar health system barriers were mentioned by the healthcare providers, but also included a lack of trust in the government and healthcare institutions, insufficient coordination and collaboration between different healthcare providers. National immunization programs with mass campaign vaccination is mentioned as a barrier to reach families with a Turkish/Moroccan migration background.

Conclusions

Various health system barriers were addressed to be related to HPV vaccine uptake in females with a Turkish/Moroccan migration background in the Netherlands. Despite similarities concerning health system barriers among community members and healthcare providers, different health system barriers were also mentioned.

Women who smoke during pregnancy are more likely to be referred to an obstetrician during pregnancy and birth: results from a cohort study

Background

Women who smoke during pregnancy make less use of prenatal care; the relation of smoking behavior with the use of other forms of maternal healthcare is unknown. The objective of this study is to investigate the association between women’s smoking behavior and their use of healthcare during pregnancy, birth and six weeks postpartum.

Methods

We analyzed data from the Dutch Midwifery Case Registration System (VeCaS), period 2012–2019. We included women with a known smoking status, singleton pregnancies, and who had their first appointment before 24 weeks of gestation with the primary care midwife. We compared three groups: non-smokers, early stoppers (stopped smoking in the first trimester), and late- or non-stoppers (stopped smoking after the first trimester or continued smoking). Descriptive statistics were used to report maternal healthcare utilization (during pregnancy, birth and six weeks postpartum), statistical differences between the groups were calculated with Kruskal–Wallis tests. Multivariable logistic regression was conducted to assess the association between smoking behavior and referrals to primary, secondary or tertiary care.

Results

We included 41 088 pregnant women. The groups differed significantly on maternal healthcare utilization. The late- or non-stoppers initiated prenatal care later and had less face-to-face consultations with primary care midwives during pregnancy. Compared to the non-smokers, the early- and late- or non-stoppers were statistically signficiantly more likely to be referred to the obstetrician during pregnancy and birth. Postpartum, the early- and late- or non-stoppers were statistically signficantly less likely to be referred to the obstetrician compared to the non-smokers.

Conclusions

Although the early- and late- or non-stoppers initiated prenatal care later than the non-smokers, they did receive adequate prenatal care (according to the recommendations). The results suggest that not smoking during pregnancy may decrease the likelihood of referral to secondary or tertiary care. The large population of smokers being referred during pregnancy underlines the important role of the collaboration between healthcare professionals in primary and secondary or tertiary care. They need to be more aware of the importance of smoking as a medical and as a non-medical risk factor.

Assessing Dutch women's experiences of labour and birth: adaptations and psychometric evaluations of the measures Mothers on Autonomy in Decision Making Scale, Mothers on Respect Index, and Childbirth Experience Questionnaire 2.0

Background

The Mothers Autonomy in Decision Making Scale (MADM) assesses women’s autonomy and role in decision making. The Mothers on Respect Index (MORi) asseses women’s experiences of respect when interacting with their healthcare providers. The Childbirth Experience Questionnaire 2.0 assesses the overall experience of childbirth (CEQ2.0). There are no validated Dutch measures of the quality of women’s experiences in the intrapartum period. Therefore, the aim of this study was to evaluate the psychometric properties of these measures in their Dutch translations.

Methods

The available Dutch versions of the MADM and MORi were adapted to assess experiences in the intrapartum period. The CEQ2.0 was translated by using forward-backward procedures. The three measures were included in an online survey including items on individual characteristics (i.e. maternal, birth, birth interventions). Reliability was assessed by calculating Cronbach’s alphas. Mann-Whitney, Kruskal Wallis or Student T-tests were applied where appropriate, to assess discrimination between women who differed on individual characteristics (known group validity). We hypothesized that women who experienced pregnancy complications and birth interventions would have statistically lower scores on the MADM, MORi and CEQ2.0, compared with women who had healthy pregnancies and physiological births. Convergent validity was assessed using Spearman Rank correlations between the MADM, MORi and/or CEQ2.0. We hypothesized moderate to strong correlations between these measures. Women’s uptake of and feedback on the measures were tracked to assess acceptability and clarity.

Results

In total 621 women were included in the cross sectional study. The calculated Cronbach’s alphas for the MADM, MORi and CEQ, were ≥ 0.77. Knowngroup validity was confirmed through significant differences on all relevant individual characteristics, except for vaginal laceration repair. Spearman Rank correlations ranged from 0.46-0.80. In total 98% of the included women out of the eligible population completed the MADM and MORi for each healthcare professional they encountered during childbirth. The proportions of MADM and MORi-items which were difficult to complete ranged from 0.0-10.8%, 0.6-2.7%, respectively.

Conclusions

The results of our study showed that the Dutch version of the MADM, MORi and CEQ2.0 in Dutch are valid instruments that can be used to assess women’s experiences in the intrapartum period.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04445-0.

The needs of pregnant women and their significant others regarding professional smoking cessation support

Introduction

Despite the health risks of smoking, some women continue smoking during pregnancy. Professional smoking cessation support (SCS) has shown to be effective in increasing the proportion of women who quit smoking during pregnancy. However, few women actually make use of professional SCS. The aim of this study is to investigate the needs of women and their partners for professional SCS.

Methods

Semi-structured interviews were held with pregnant women and recent mothers who smoked or quit smoking during pregnancy, and their partners, living in the North of the Netherlands. Recruitment was done via Facebook, LinkedIn, food banks, baby stores and healthcare professionals. The interviews were recorded, transcribed and thematically analyzed.

Results

28 interviews were conducted, 23 with pregnant women and recent mothers, and five with partners of the women. The following themes were identified: 1) Understanding women's needs, 2) Responsibility without criticism, and 3) Women and their social network. These themes reflect that women need support from an involved and understanding healthcare professional, who holds women responsible for smoking cessation but refrains from criticism. Women also prefer involvement of their social network in the professional support.

Conclusions

For tailored support, the guideline for professional SCS may need some adaptations, and women and their partners should be involved in the development of future guidelines. Women prefer healthcare professionals to address smoking cessation in a neutral way and to respect their autonomy in the decision to stop smoking.

Barriers by professionals in primary care in discussing children of substance abusing parents

Background

Children of substance abusing parents are more at risk to develop addiction or psychiatric problems than children of healthy parents. It is therefore important to detect in an early stage, which consequences the problems of the parents might have on the child. Previous research shows that within addiction care children of substance abusing parents are not always in the picture. However for early detection it is at least as important to discuss the influence of parental substance abuse on the children in primary care: early detection of problems in children contributes in starting prevention or treatment programs in a timely manner, so that the chance that a child grows up safely will increase.

Aim

To gain insight in the barriers of professionals working in primary care and public health in bringing up the topic of children in a conversation with substance abusing parents.

Methods

A qualitative design was used. 15 interviews have been conducted with participants consisting of primary care and public health professionals in the Netherlands. By discussing several themes, information on the barriers experienced by the professionals were obtained, written down and analyzed.

Results

The results are being analyzed at this moment, but will be ready to present at the congres in November. The interviews will show which barriers are experienced by the participants. Based on literature the expectation is that the barriers can be divided in three categories: barriers on the content of care, moral dilemma’s and organizational barriers.

Conclusions

The results of this study will provide insight in the barriers of professionals in primary and public health on discussing the circumstances of children of substance abusing parents. Knowing these barriers might serve as input for interventions to remove these barriers and for recommendations to improve so that children of substance abusing parents receive (preventive) care earlier.

Key messages

Gain insight in barries of professionals in primary care and public health on discussing circumstances of children of substance abusing parents. input for interventions so that children of substance abusing parents receive care earlier.

Teenage mothers: a long-term view on their well-being

Background

This study aims to address the lack of information about teenage mothers in different stages of their lives by exploring how they are doing in the long term and the social support they receive.

Methods

From December 2018 to February 2019 teenage mothers in the Netherlands were recruited by Fiom (an expert centre for unintended pregnancy), via social media and a website for teenage mothers (n = 248). Using an online survey, data were obtained to assess various outcomes, such as well-being, education, work, income, housing and social support. Respondents were divided into three groups: 0-3 years after teenage childbearing (short-term), 4-12 years (medium-term), >12 years (long-term). Results were analysed using univariate and bivariate descriptions in SPSS.

Results

Almost 80% of the respondents reported that they were doing well and were satisfied with their life. 63.3% had a job, and 17.0% was enrolled in education. Short-term mothers worked fewer hours per week compared to long-term mothers (p < 0.001). 85.1% of the respondents reported that they received benefits, short-term mothers receiving more benefits than long-term mothers (p < 0.001). The majority (78.2%) was satisfied with their living conditions; short-term mothers were less satisfied than long-term mothers (p = 0.031). 36.3% of the respondents smoked cigarettes. Most support was given by family (83.1%), mainly from female relatives. About 24% of the respondents received formal support.

Conclusions

This study shows that teenage mothers, on average, were doing well and were satisfied with their life, in both the short and long term. Regarding income and housing, short-term mothers were in a less favourable position. These results suggest that as the years pass, teenage mothers overcome difficulties. Since the association between well-being and social support on the long term is unknown, we advise investigating the effect of social support on the outcomes of teenage childbearing.

Key messages

Both in the short-term and the long-term, most teenage mothers were doing well and satisfied with life. Regarding housing and income, short-term mothers function less well compared to long-term mothers.

Organization and content of primary care for adolescents – comparison of actual and desired situation

To successfully navigate increasing autonomy, independence and health behaviors in adolescence, accessible adolescent health care services (AHS) are essential. AHS comprise all services in primary care that are aimed at the specific needs of adolescents and can be provided in various settings such as public services, private services, schools and hospitals. In the MOCHA project (Models of Child Health Appraised) we assessed the structure and content of AHS in 30 European countries against the standards in the field of adolescent health services: accessibility, staff attitude, communication, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community. The results revealed that although half of the 30 countries did adopt adolescent-specific policies, many countries did not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care is limited. In addition, one third of the countries do not have a formal policy which guarantees the confidentiality of a consult and the possibility to consult a physician without parents knowing. Finally, around half of the countries do not have specialized centers in adolescent health care in order to tackle comprehensive health issues. Access to adolescent health care services needs to be improved for vulnerable adolescents such as migrant adolescents. Schools, ambulatory settings and hospitals should offer accessible, comprehensive health care and a culturally appropriate approach, particularly given the number of migrant adolescents living in EU and EEA countries. Finally, the health care systems should improve their communication strategies, to assist young people in understanding their rights and responsibility in the domain of health, and how and where to access to adequate care.

Limited concordance between teachers, parents and healthcare professionals on the presence of chronic diseases in ID-adolescents

Evidence on teachers' knowledge about somatic and mental chronic diseases among ID-adolescent compared to the knowledge parents and healthcare professionals have, is limited. The aim of this study is: (1) to assess the knowledge of teachers on the presence of chronic diseases in ID-adolescents; (2) to compare teachers with parents and healthcare professionals and parents with healthcare professionals regarding the knowledge on the presence of chronic diseases in ID-adolescents. We obtained data on 1044 ID-adolescents attending secondary schools, fully covering one region of the Netherlands. Teachers, parents and general practitioners (GPs) of the adolescents completed a questionnaire about the occurrence of chronic diseases in their child during the previous 12 months. The questionnaire was derived from the Dutch National Permanent Survey on Living Conditions questionnaire periodically administered in a representative population sample (n ≈ 10,000). Concordance between teachers, parents and healthcare professionals on the presence of chronic diseases in ID-adolescents was relatively low. In about half of all 66 dyads the concordance was for the most part fair and just in 10 dyads good to very good; nine of these latter cases concerned somatic chronic diseases. In addition, teachers reported mostly lower prevalence rates of chronic diseases in ID-adolescents compared to the parents, in particular on mental chronic diseases. Although prevalence rates of chronic diseases among ID-adolescents are very high, knowledge on this among teachers is limited. While information on chronic diseases in ID-adolescents is available among different informants, the disagreement between them reflects different points of view between the informants and probably indicates a lack of communication. The communication among teachers, parents and GPs should be improved to combine the knowledge and information on the presence of chronic diseases in ID-adolescents. This may provide opportunities to improve the support of these adolescents in their school career and in their transition from school to work.

Prevalence of chronic diseases in adolescents with intellectual disability

Valid community-based data on the prevalence of chronic diseases in adolescents (12-18 years) with intellectual disability (ID-adolescents) are scarce. The aim of this study was to assess the prevalence rates and the nature of chronic diseases in a population of ID-adolescents and to compare them with the rates among adolescents in the general population. Therefore, we obtained data on 1083 ID-adolescents attending secondary schools, day care centers or living in residential centers fully covering one region of The Netherlands. Parents of the adolescents completed a questionnaire about the occurrence of chronic diseases in their child during the previous 12 months and about background characteristics. The questionnaire was derived from the Dutch National Permanent Survey on Living Conditions questionnaire periodically administered in a representative population sample (n approximately = 10,000). Prevalence rates of chronic diseases in ID-adolescents were compared with those in adolescents in the Dutch general population. Among ID-adolescents, high prevalence rates of a wide range of chronic diseases were found. The five most prevalent were: ADHD (21.1%), PDD-NOS (14.0%), dyslexia (13.9%), migraine or chronic headache (12.7%), and autistic disorder (10.9%). These prevalence rates were all higher (p<0.05) than among adolescents in the general population. Of all ID-adolescents, 62.9% was reported to have at least one chronic disease. The burden of chronic diseases among ID-adolescents is very high, showing a high need for adequate care. These high prevalence rates should alert policymakers and clinicians regarding the widespread of chronic diseases among ID-adolescents.

Pervasive developmental disorder behavior in adolescents with intellectual disability and co-occurring somatic chronic diseases

Evidence on the association between somatic chronic diseases in ID-adolescents and the full range of pervasive developmental disorder behavior (PDD behavior) is scarce. The aim of the present study is to assess the association between somatic chronic diseases in ID-adolescents and mild PDD behavior. We obtained data on 1044 ID-adolescents, aged 12-18, attending secondary schools in the Netherlands. Parents of the adolescents completed the Dutch version of the Children's Social Behavior Questionnaire (CSBQ) parent version, covering a wide range of PDD behavior, and questions about chronic diseases and background characteristics of their child. ID-adolescents with somatic chronic diseases showed more PDD behavior, in particular milder forms, than their peers without chronic diseases. In addition, ID-adolescents with somatic chronic diseases in combination with pervasive development disorders (PDD) and attention deficit hyperactivity disorder (ADHD) also showed more PDD behavior than their peers with only PDD/ADHD. Clinicians should be extra alert on PDD behavior, in particular the milder forms, in ID-adolescents when somatic chronic diseases are present. However, to strengthen our results about the relationship between somatic chronic diseases in ID-adolescents and PDD behavior studies are needed using both the CSBQ and standardized diagnostic instruments.

Emotional and behavioural problems in adolescents with intellectual disability with and without chronic diseases

BACKGROUND

Adolescents with intellectual disability (ID) (ID-adolescents) and adolescents with chronic diseases are both more likely to have emotional and behavioural problems. The aim of this study was to assess the association between chronic diseases in ID-adolescents and emotional and behavioural problems in a large school-based sample.

METHODS

We obtained data on 1044 ID-adolescents, aged 12-18 years, attending secondary schools in the Netherlands. Parents of the adolescents completed the Dutch version of the Strengths and Difficulties Questionnaire and questions about chronic diseases in their child and about the background of the child.

RESULTS

Prevalence rates of emotional and behavioural problems were generally high in ID-adolescents with chronic diseases (45%), compared with ID-adolescents without chronic diseases (17%). The likelihood of emotional and behavioural problems was high in ID-adolescents with two [odds ratios (OR) 4.47; 95% CI: 2.97-6.74] or more than two chronic diseases (OR 8.01; 95% CI: 5.18-12.39) and for ID-adolescents with mental chronic diseases (OR 4.56; 95% CI: 3.21-6.47). Also ID-adolescents with somatic chronic diseases had a high likelihood of emotional and behavioural problems (OR 1.99; 95% CI: 1.33-2.99), in particular in the combination of somatic and mental chronic diseases (OR 5.16; 95% CI: 3.46-7.71).

CONCLUSIONS

The current study showed that chronic diseases in ID-adolescents, in particular mental chronic diseases, largely increase the likelihood of emotional and behavioural problems. This should be taken in the provision and planning of care for ID-adolescents.

Integrated care for MS patients

PURPOSE

The problem of complex healthcare to MS patients, together with the rising prevalence of MS and escalating costs, has caused healthcare policy makers to consider innovative approaches to controlling costs and improving the quality of care. An integrated care approach may provide a means for better coordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for MS patients.

METHOD

A literature search was conducted to trace relevant literature on integrated care for MS patients published between 1995 and 2003.

RESULTS

Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in healthcare for MS patients, there are few published studies which have evaluated its implementation with MS patients.

CONCLUSIONS

Even though the potential advantages of integrated care are well known, the applicability of this approach for MS patients has still to be demonstrated.

Mental health problems in children with intellectual disability: use of the Strengths and Difficulties Questionnaire

BACKGROUND

The assessment of mental health problems in children with intellectual disability (ID) mostly occurs by filling out long questionnaires that are not always validated for children without ID. The aim of this study is to assess the differences in mental health problems between children with ID and without ID, using a short questionnaire, the Strengths and Difficulties Questionnaire (SDQ).

METHODS

We studied 260 children (6-12 years) selected from special education schools for trainable children (response: 57%). Parents completed the extended Dutch version of the SDQ, questions on background characteristics and on the care provided. A non-ID control group of 707 children (response: 87%) was included to compare mental health problems.

RESULTS

In total, 60.9% of children with ID had an elevated score on the SDQ, compared with 9.8% of children without ID. Only 45% of the children with ID and an elevated SDQ score had visited a healthcare professional for these problems in the last 6 months.

DISCUSSION

The SDQ or an adapted version could contribute to the early identification of mental health problems in children with ID. Further research is needed to confirm the validity of the SDQ when used in a sample of children with ID.

People with intellectual disability and their health problems: a review of comparative studies

BACKGROUND

The transition of people with intellectual disability (ID) from care institutions to the community - according to Western policy - results in a shift of responsibility towards primary health care services. In order to provide optimal care to people with ID living in the community, general practitioners need to be aware of the specific health problems of this patient category. The aim of this paper is to present an overview of recent studies on the specific health problems of people with ID, in particular on health problems of people with ID in the community, compared to those of the general population.

METHOD

To reliably compare health problems of individuals with and without ID, this review is limited to comparative research using a control group of individuals without ID. The focus of the review concentrates on international literature, published between 1995 and 2002.

RESULTS

Most comparative research among people with ID presents higher prevalence rates for epilepsy, diseases of the skin, sensory loss and (increased risk of) fractures. These health problems are specific for people with ID, both in general and living in the community in particular.

CONCLUSIONS

there are only few studies focusing on health problems in people with ID in which a control group of individuals without ID is included. Most comparative studies on health problems in people with ID are based on comparison with reported prevalence rates of general health surveys.