Photovoice as a research, advocacy, and harmonization tool for refugee and local youth in Turkey

Background

Turkey has millions of refugee and local youth, who share common youth health problems. As part of the REACH Project, this study aimed to assess youth's access to health information, health care, and healthy environments, in addition to their perspectives on using digital health technologies.

Methods

We used photovoice, a community based participatory research approach, and worked with 4 mixed (refugee and local) youth groups between the ages of 15 to 24 in Istanbul. Each youth group met with the research team and a professional photographer before data collection. Young people then took photos of barriers and facilitators regarding their access to health information, health care, and digital health technologies, in addition to their health problems. This was followed by focus group-like discussions, where young people discussed the photos and their meanings for them. Content analysis was used for data analysis and findings were shared with stakeholders via photo exhibits, panels, and policy briefs for advocacy purposes. The study was funded by TaiwanICDF and Columbia University.

Results

Findings showed that youth had a wide range of physical, social and mental health problems coupled with problems in accessing health information and youth-friendly services. Problems with social determinants of health were more prominent for refugees. Although youth often used the internet to access information, their experiences with digital health technologies were very limited.

Conclusions

Our study findings indicated that despite legal rights to access health care for all youth, refugee youth faced more barriers in accessing information and services. On the other hand, refugee and local youth showed similarities regarding common youth health problems and access to youth-friendly services. The photovoice approach enabled active participation and created a shared environment for refugee and local youth to discuss their mutual problems and understand each other.

Key messages

Photography is a communication tool that acts as a bridge between participants, researchers, and decision makers. Photovoice, as a participatory approach, creates a learning environment for both participants and researchers.

Promoting rational antibiotic use in Turkey and among Turkish migrants in Europe - implications of a qualitative study in four countries

Background

Antimicrobial resistance is considered one of the major threats to global health. The emergence of resistant microorganisms is a consequence of irrational use of antibiotics. In Turkey, the consumption of antibiotics is relatively high and antibiotics are among the most commonly used drugs. However, Turkey has adopted new, more restrictive policies and regulations on antibiotics. In addition, Turkish migrants to EU countries, such as Germany, the Netherlands and Sweden, may encounter health systems that promote a more restrictive and rational antibiotic use.

The objective of this paper was to explore the variation in implemented policies related to rational antibiotic use that citizens in Turkey and Turkish migrants in Germany, the Netherlands and Sweden are subjected to and to discuss the implications for the promotion of rational antibiotic use.

Data were collected through focus groups and individual interviews with citizens, physicians and pharmacists in the four countries. In total, 130 respondents were interviewed. Content analysis was used.

Results

Three relevant themes were identified: Implementation of regulations and recommendations, Access to antibiotics and Need for health communication. Irrational use of antibiotics was reported mainly in Turkey. While it had become less likely to get antibiotics without a prescription, non-prescribed antibiotics remained a problem in Turkey. In the three EU countries, there were also alternative ways of getting antibiotics. Low levels of knowledge about the rational antibiotic use were reported in Turkey, while there were several sources of information on this in the EU countries. Communication with and trust in physicians were considered to be important. There were also system barriers, such as lacking opportunities for physicians to manage care in accordance with current evidence in Turkey and factors limiting access to care in EU countries.

Conclusions

Several fields of importance for promoting rational antibiotic use were identified. There is a need for harmonisation of health-related regulations and policy programmes. Antibiotics should only be available with a prescription. Programmes for rational antibiotic use should be implemented on a broad scale, in medical care, at pharmacies and in the population. Methods for health communication and patient-centred care should be further developed and implemented in this field.

Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey

Background

Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption.

Methods

This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393).

Results

Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education.

Conclusions

Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care.

Key messages

Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.

Co-designing mHealth technologies with youth: REACH Initiative in Turkey and Lebanon

Issue

Many young people face barriers in accessing youth-friendly health information and health care. Differing cultural norms, languages, laws, and stigma pose additional challenges for young refugees in host countries. There is a need to implement more innovative, youth-friendly and widely used solutions to address the health education and health care needs of young people.

Description of the practice

REACH (REfugees Act and Communicate for Health) is a regional initiative, which aims to bridge the gap in health literacy and health care access among refugee and local youth via digital technologies in Turkey and Lebanon. Using community based participatory action research (CBPAR) approach, REACH aims to assess the impact of information and communication technologies on accessing health information and services among youth in countries that host large refugee populations. The initiative is supported by TaiwanICDF, Blue Chip Foundation and Columbia University.

Results

With a strong youth-adult partnership, the initiative includes stakeholders’ meetings, a mixed-methods study (survey and photovoice study with youth, qualitative interviews with service providers and policy makers), photo exhibitions, panels, and production of policy reports and scientific publications. Based on local needs in each country, REACH works with refugee and local youth, software developers, academia, local health authorities, UN organizations and NGOs to develop a multilingual mHealth application to increase health literacy and improve health care access among young refugee and host communities, and aims to assess its effectiveness to contribute to the limited evidence base on using health technologies for youth health promotion in forced migration settings.

Lessons

Using CBPAR and co-design approaches and engaging both refugee and local youth in the process of assessing needs and developing mHealth technologies can help to mitigate risks and increase the success rate of interventions.

Key messages

Community involvement and empowerment as well as harmonization between refugee and host communities increases the success of health interventions and builds a shared environment in host countries. mHealth solutions can be used for youth health promotion in a cost-effective way, and help in reaching vulnerable or stigmatized youth that struggle with health information and health care access.