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Rosário J, Raposo B, Santos E, Dias S, Pedro AR. Efficacy of health literacy interventions aimed to improve health gains of higher education students-a systematic review. BMC Public Health 2024; 24:882. [PMID: 38515114 PMCID: PMC10958870 DOI: 10.1186/s12889-024-18358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Health literacy (HL) among higher education students is low, making them vulnerable about their health. To reverse this trend, higher education institutions promote HL interventions with various topics and methods. A comprehensive understanding of HL interventions is essential to determine whether these interventions meet the health information needs to improve health outcomes (health gains). The aim of this review was to identify and synthesise evidence on the efficacy of HL interventions implemented in academic settings to improve health outcomes. METHODS A systematic review was performed followed the PRISMA guidelines, protocol was registered in PROSPERO (CRD42022369869). A search strategy was performed in the EBSCO Host Web platform, the time limit placed was: 01/01/2017 to 30/09/2022. Eligible studies were those published in peer-reviewed journals and involved higher education students over the age of 18 as the subject of the intervention. Eligible interventions included any interventions evaluated in a study with comparison group that included a pre-post measure of health outcomes, were conducted in an academic setting. To methodology quality of included studies, it was used the Joanna Briggs Institute critical appraisal tool. To synthesise results narrative and thematic synthesis was conducted. RESULTS A total of 9 articles were included in this review, identified health literacy interventions with an impact on health outcomes. The total studies involved 2902 higher education students. All 9 studies were randomised controlled trials. The synthesised evidence supports the efficacy of interventions that contributed to positive changes in mental health, attitudes, norms, and self-efficacy of condom use, emotional, social, and psychological well being, subjective sleep quality, sleep latency, and habitual sleep efficiency, physical activity, and self-reported servings fried foods. HL interventions were educational or motivational and related to health promotion, disease prevention or healthcare. CONCLUSIONS HL interventions in higher education students can significantly improve health outcomes protecting them from the negative effects of threats for their health. The interventions designed with different strategies are more effective. HL interventions are associated with health benefits on health promotion, disease prevention and healthcare. For the attendance of higher education to be a successful experience, continuity of HL interventions developed in academic settings is necessary.
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Affiliation(s)
- Jorge Rosário
- Comprehensive Health Research Centre, University of Évora, Évora, Portugal.
- Institute for Advanced Studies and Research, University of Évora, Évora, Portugal.
- Polytechnic Institute of Beja, Beja, Portugal.
| | - Beatriz Raposo
- NOVA National School of Public Health, Public Health Research Centre, CISP, NOVA University Lisbon, Lisbon, Portugal
| | - Eunice Santos
- Comprehensive Health Research Centre, University of Évora, Évora, Portugal
- Institute for Advanced Studies and Research, University of Évora, Évora, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Azevedo FO, Neto A, Gama A, Subtil A, Fuertes R, Pereira C, Tavares J, Medinas RL, Silva AV, Dias S. Problemas ligados ao álcool em centros de emergência (PLACE)-People experiencing homelessness with alcohol-related problems in Lisbon's emergency shelters during the COVID-19 pandemic: a description and analysis of a harm reduction intervention. Front Psychol 2023; 14:1165322. [PMID: 37275696 PMCID: PMC10236796 DOI: 10.3389/fpsyg.2023.1165322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Alcohol-related problems disproportionally affect people experiencing homelessness. As the first wave of the COVID-2019 pandemic spread in 2020, a number of emergency shelters were opened in Lisbon. Increased difficulties in obtaining alcohol could have led to an increased incidence of alcohol withdrawal. Therefore, a low-threshold harm reduction intervention was introduced to these emergency shelters. This consisted of a fixed medication treatment, made available immediately for those with specific conditions, without the need for a medical evaluation or abstinence from alcohol, together with an offer of subsequent access to specialized addiction centers. The Problemas Ligados ao Álcool em Centros de Emergência (PLACE) study (alcohol-related problems in emergency shelters) is a retrospective mixed-methods observational study. It describes the demographic, health, and social characteristics of shelter users participating in the program and aims to evaluate the intervention as well as the experience of the patients, professionals, and decision-makers involved. Results A total of 69 people using shelters self-reported alcohol-related problems. Among them, 36.2% of the people accepted a pharmacological intervention, and 23.2% selected an addiction appointment. The take-up of the intervention was associated with better housing outcomes. A description of an individual's trajectory after leaving the shelter is provided. Discussion This study suggests that non-abstinence-focused interventions can be useful and well-tolerated in treating addiction in this population.
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Affiliation(s)
- Filipe Oliveira Azevedo
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Neto
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Ana Gama
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Subtil
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | - Raquel Luis Medinas
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana V. Silva
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Sónia Dias
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
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Egid B, Ozano K, Hegel G, Zimmerman E, López Y, Roura M, Sheikhattari P, Jones L, Dias S, Wallerstein N. Can everyone hear me? Reflections on the use of global online workshops for promoting inclusive knowledge generation. Qual Res 2023; 23:195-216. [PMID: 37485303 PMCID: PMC10361666 DOI: 10.1177/14687941211019585] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Online research methods have risen in popularity over recent decades, particularly in the wake of COVID-19. We conducted five online workshops capturing the experiences of participatory health researchers in relation to power, as part of a collaborative project to develop global knowledge systems on power in participatory health research. These workshops included predominantly academic researchers working in 24 countries across Africa, Asia, Europe, and the Americas. Here, we reflect on the opportunities, limitations, and key considerations of using online workshops for knowledge generation and shared learning. The online workshop approach offers the potential for cross-continental knowledge exchange and for the amplification of global South voices. However, this study highlights the need for deeper exploration of power dynamics exposed by online platform use, particularly the 'digital divide' between academic partners and community co-researchers. Further research is needed to better understand the role of online platforms in generating more inclusive knowledge systems.
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Affiliation(s)
- Beatrice Egid
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Kim Ozano
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Guillermo Hegel
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala
| | - Emily Zimmerman
- Center on Society and Health, Virginia Commonwealth University, VA, USA
| | - Yaimie López
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Maria Roura
- School of Public Health, University College Cork, Republic of Ireland
| | | | - Laundette Jones
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa & Comprehensive Health Research Center (CHRC), Portugal
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Trindade A, Dias S, Morais A. A curious manifestation of mechanical tension theory in idiopathic pulmonary fibrosis. Pulmonology 2023; 29:170-172. [PMID: 35963830 DOI: 10.1016/j.pulmoe.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- A Trindade
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal.
| | - S Dias
- Pulmonology Department, Hospital Pedro Hispano, Porto, Portugal
| | - A Morais
- Pulmonology Department - Centro Hospitalar Universitário de São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
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Marques P, Geraldes M, Gama A, Heleno B, Dias S. What is the role of attitudinal barriers on cervical cancer screening non-attendance? Findings from a cross-sectional study with migrant women in Portugal. BMC Womens Health 2023; 23:52. [PMID: 36759781 PMCID: PMC9909634 DOI: 10.1186/s12905-023-02198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Cervical cancer is a common disease which can be effectively and timely detected by cervical cancer screening. However, access to cervical cancer screening is unequal, and it is known that migrant women have a lower attendance to cervical cancer screening. These inequalities are associated with several factors, including attitudes and beliefs of the women regarding screening practices, which prevents them from participating. This study aims to explore the attitudinal barriers to cervical cancer screening among migrant women in Portugal. METHODS A web-based cross-sectional survey was conducted with 1100 migrant women residing in Portugal. Women were recruited through social media platforms. The survey included items on socioeconomic characteristics, cervical cancer screening history and an 11-item attitudinal questionnaire to assess attitudinal barriers. Logistic regression models were used for statistical analysis. RESULTS The attitudinal barriers to CCS most often reported by participants were fear of the test result (25.3%), worry about seeing a male health professional (23.8%), perceiving the test as painful (23.1%), embarrassment (18.5%), difficulties scheduling the test (14.3%), and having a negative experience in screening (12.4%). Low perceived need in absence of symptoms and lack of motivation to be screened were reported by less than 5% of the women. However, the results suggest that most of the attitudinal barriers with higher agreement percentage have no association with cervical cancer screening attendance. Among all the attitudinal barriers, low perceived need of screening and lack of motivation were associated with CCS non-attendance. CONCLUSIONS Based on the findings, out of all the factors analyzed, low perceived need of screening and lack of motivation are the most relevant factors associated with non-attendance among migrants in Portugal. Promoting health literacy and empowering women with knowledge about benefits of screening may help overcoming these barriers. Therefore, this study provides a foundation for stakeholders on which areas should be prioritized when developing strategies aiming to reduced cervical cancer screening non-attendance among migrant women.
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Affiliation(s)
- Patrícia Marques
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Mariana Geraldes
- grid.10772.330000000121511713NOVA Nacional School of Public Health, Public Health Research Centre, NOVA University Lisbon, 1600-560 Lisbon, Portugal
| | - Ana Gama
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Bruno Heleno
- grid.10772.330000000121511713CHRC, NOVA Medical School, NOVA University Lisbon, 1169-056 Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
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Dinis Teixeira JP, Santos MJDS, Soares P, Azevedo LD, Barbosa P, Boas AV, Cordeiro JV, Dias S, Fonseca M, Goes AR, Lobão MJ, Moniz M, Nóbrega S, Peralta-Santos A, Ramos V, Rocha JV, da Silva AC, Brazão MDL, Leite A, Nunes C. LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol. PLoS One 2023; 18:e0285051. [PMID: 37099589 PMCID: PMC10132590 DOI: 10.1371/journal.pone.0285051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.
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Affiliation(s)
- J P Dinis Teixeira
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Mário J D S Santos
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Luísa de Azevedo
- Serviço de Medicina Interna, Centro Hospitalar Póvoa de Varzim-Vila do Conde, EPE, Póvoa de Varzim, Portugal
| | - Patrícia Barbosa
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Andreia Vilas Boas
- Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
- Portuguese Society of Internal Medicine, Lisbon, Portugal
| | - João V Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Centro Interdisciplinar de Ciências Sociais, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Marta Fonseca
- NOVA Medical School, Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Rita Goes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Maria João Lobão
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Internal Medicine Department, Hospital de Cascais, Alcabideche, Cascais, Portugal
| | - Marta Moniz
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Sofia Nóbrega
- Hospital Central do Funchal, Serviço de Saúde da Região Autónoma da Madeira, SESARAM, EPE, Funchal, Portugal
| | - André Peralta-Santos
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Víctor Ramos
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Victor Rocha
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - António Carlos da Silva
- Public Health Department, Regional Health Administration of Lisbon and Tagus Valley, Ministry of Health, Lisbon, Portugal
| | - Maria da Luz Brazão
- Hospital Central do Funchal, Serviço de Saúde da Região Autónoma da Madeira, SESARAM, EPE, Funchal, Portugal
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Dias S. Health Literacy Promotion in Complex Systems: A Paramount Paradigm when “One-Size-Fits-All” Is Not Enough. Port J Public Health 2022. [DOI: 10.1159/000527722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Vázquez ML, Vargas I, Rubio-Valera M, Aznar-Lou I, Eguiguren P, Mogollón-Pérez AS, Torres AL, Peralta A, Dias S, Jervelund SS. Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study. BMJ Open 2022; 12:e067439. [PMID: 36523219 PMCID: PMC9748968 DOI: 10.1136/bmjopen-2022-067439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador. METHODS AND ANALYSIS This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers). ETHICS AND DISSEMINATION This study complies with international and national legal stipulations on ethics. It was approved by each country's ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.
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Affiliation(s)
- Maria-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Maria Rubio-Valera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ignacio Aznar-Lou
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Research and Development Unit, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | - Ana-Lucía Torres
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Andrés Peralta
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, NOVA University of Lisbon & Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Signe Smith Jervelund
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Osborne RH, Elmer S, Hawkins M, Cheng CC, Batterham RW, Dias S, Good S, Monteiro MG, Mikkelsen B, Nadarajah RG, Fones G. Health literacy development is central to the prevention and control of non-communicable diseases. BMJ Glob Health 2022; 7:bmjgh-2022-010362. [PMID: 36460323 PMCID: PMC9723891 DOI: 10.1136/bmjgh-2022-010362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/19/2022] [Indexed: 12/04/2022] Open
Abstract
The WHO's report Health literacy development for the prevention and control of non-communicable diseases (NCDs) delivers practical what-to-do how-to-do guidance for health literacy development to build, at scale, contextually-relevant public health actions to reduce inequity and the burden of NCDs on individuals, health systems and economies. The key premise for health literacy development is that people's health awareness and behaviours are linked to lifelong experiences and social practices, which may be multilayered, hidden and beyond their control. Meaningful community engagement, local ownership and locally driven actions are needed to identify health literacy strengths, challenges and preferences to build locally fit-for-purpose and implementable actions. Health literacy development needs to underpin local and national policy, laws and regulations to create enabling environments that reduce community exposures to NCD risk factors. Deficit approaches and siloed health system and policy responses need to be avoided, focusing instead on integrating community-based solutions through co-design, cognisant of people's daily experiences and social practices.
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Affiliation(s)
- Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia .,Section of Health Services Research, University of Copenhagen, Kobenhavn, Denmark
| | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Christina C Cheng
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Roy W Batterham
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia,Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Sónia Dias
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
| | - Suvajee Good
- Department of Universal Health Coverage/Family Health, Gender, and Life Course, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Maristela G Monteiro
- Noncommunicable Diseases and Mental Health Department, Pan American Health Organization, Washington, District of Columbia, USA
| | - Bente Mikkelsen
- Division for Universal Health Coverage/Communicable Diseases and Noncommunicable Diseases, WHO, Geneve, Switzerland
| | - Ranjit Gajendra Nadarajah
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Guy Fones
- Global Noncommunicable Diseases Platform, World Health Organization, Geneve, Switzerland
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Freire M, Graça SR, Dias S, Mendes S. Oral health-related quality of life in portuguese pre-school children: a cross-sectional study. Eur Arch Paediatr Dent 2022; 23:945-952. [PMID: 35982276 DOI: 10.1007/s40368-022-00741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/26/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To study Oral Health related Quality of Life (OHRQoL) of pre-school children and its associated factors. METHODS Cross-sectional study with sample data collected through an on-line questionnaire to a non-probabilistic sample. The questionnaire included the Portuguese version of the Early Childhood Oral Health Impact Scale (ECOHIS) and questions about sociodemographic characteristics, oral health behaviours, and reported oral health of the child. Data analyses included descriptive statistics, Mann-Whitney and Kruskal-Wallis tests and Linear regression (α = 0.05). RESULTS The sample consisted of 1475 parents of pre-school children (3-5 years-old), residing in Portugal. The mean ECOHIS total score was 1.5 (sd = 3.4). In the bivariate analysis the child's age, starting toothbrushing after one year of age, frequent intake of sugary food and drinks, previous appointment with an oral health professional, all reported of oral health problems, and a negative perception of oral health were negatively associated with OHRQoL (p < 0,05). In the regression model the factors that most contributed to a worse quality of life were dental caries and abscess, contributing to an ECOHIS average increase of 2.56 and 3.34, respectively. CONCLUSIONS The studied population presented a good OHRQoL, with the item related to pain being the most relevant for the ECOHIS score. Worst OHRQoL was found in older children, whose parents negatively rated the children's oral health and with reported dental caries, trauma, and abscess.
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Affiliation(s)
- M Freire
- Faculdade de Medicina Dentária, Unidade de Investigação E Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal
| | - S R Graça
- Faculdade de Medicina Dentária, Unidade de Investigação E Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal
| | - S Dias
- Estatística, ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
| | - S Mendes
- Faculdade de Medicina Dentária, Unidade de Investigação E Ciências Orais E Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal.
- Faculdade de Medicina Dentária da Universidade de Lisboa, Rua Teresa Ambrósio, Cidade Universitária, 1600-277, Lisbon, Portugal.
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Vega Crespo B, Neira VA, Ortíz Segarra J, Andrade A, Guerra G, Ortiz S, Flores A, Mora L, Verhoeven V, Gama A, Dias S, Verberckmoes B, Vermandere H, Michelsen K, Degomme O. Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals. BMC Public Health 2022; 22:2144. [DOI: 10.1186/s12889-022-14601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer.
Methodology
A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data.
Results
Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment.
Conclusions
The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.
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Oliveira FPSLD, Vargas AMD, Hartz Z, Dias S, Ferreira EFE. Integration of School Health Program actions among health and education professionals: a case study in Belo Horizonte, Minas Gerais. Saúde debate 2022. [DOI: 10.1590/0103-11042022e305i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
ABSTRACT The School Health Program aims to build healthy schools. This qualitative case study aimed to identify and understand how professionals involved in the School Health Program behave in the integration based on their inclusion in the recommended activities. The consensus was reached with experts to develop a matrix of indicators after building the Program’s logical model, resulting in a semi-structured roadmap. Twenty-five interviews were held in the Basic Health Units, Elementary Schools, and the Regional Health and Education Administrations. The practices were multisectoral, with no combined efforts and effective co-participation, planned by a single sector or professional, the existing gaps are recognized as much as the importance of the program, and the practices are implemented with a low bond between teams. The fragmented perception of students’ problems hinders this integration.
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Affiliation(s)
| | | | | | - Sónia Dias
- Universidade Nova de Lisboa (UNL), Portugal
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13
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Oliveira FPSLD, Vargas AMD, Hartz Z, Dias S, Ferreira EFE. Integração das ações do Programa Saúde na Escola entre profissionais da saúde e da educação: um estudo de caso em Belo Horizonte, Minas Gerais. Saúde debate 2022. [DOI: 10.1590/0103-11042022e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
RESUMO O Programa Saúde na Escola tem como meta a construção de escolas saudáveis. Estudo de caso, de abordagem qualitativa com intenção de identificar e compreender como se comportam, no esforço de integração, profissionais envolvidos no Programa Saúde na Escola, a partir de sua inserção nas atividades preconizadas. Após construção do modelo lógico do programa, foi realizado consenso com experts para elaboração de matriz de indicadores, originando roteiro semiestruturado. Foram realizadas 25 entrevistas, nas Unidades Básicas de Saúde e Escolas de Ensino Fundamental, além das Gerências Regionais da Saúde e da Educação. As práticas foram consideradas multissetoriais, sem soma de esforços e coparticipação efetiva, sendo planejadas por um único setor ou profissional; os gaps existentes são reconhecidos tanto quanto a importância do programa; as práticas acontecem com baixo vínculo entre equipes. A forma fragmentada de perceber os problemas dos escolares dificulta essa integração.
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Affiliation(s)
| | | | | | - Sónia Dias
- Universidade Nova de Lisboa (UNL), Portugal
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14
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Marques MJ, Gama A, Cheng C, Osborne R, Dias S. Addressing health literacy to reduce inequalities among migrants: which profiles need our attention? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Health literacy, the ability to access, understand, appraise, remember and use health information and services, has great potential to reduce inequalities in access to and outcomes of care. People may have different patterns of health literacy needs and strengths. Yet, the design of interventions is frequently not responsive to the specificities of different segments of the population, including migrant groups. We aimed to identify profiles of migrants to inform the co-design of interventions targeting people at risk of poor outcomes. A cross-sectional survey was conducted with 1126 adult migrants living in Portugal. Data were collected using the 9-dimension HLQ (Health Literacy Questionnaire), and a sociodemographic questionnaire. A cluster analysis of data was performed. Semi-structured interviews were conducted with 15 migrants, stratified by the clusters. The optimal cluster solution yielded 16 profiles revealing diversity in combinations of strengths and needs across the HLQ domains. While 29.8% of migrants scored moderate to high on all 9 domains (profiles 2, 6, 8, 16), 63.4% of participants struggled with 1 or several aspects of health literacy, namely ‘Feeling understood and supported by healthcare providers'. Notably, 36.8% (6 profiles) exhibited difficulty across most of health literacy domains. The interviews provided a tangible description of the health literacy needs and resources with five main themes (access, understand, appraise, retrieve and use). Regarding ‘access', migrants expressed different preferred learning styles and needed to access different sorts of information at distinct times. The ‘use’ of information was rarely a one-time decision but a decision that people needed to make repeatedly. Health literacy is a highly diverse concept where subgroups exhibited diverse patterns. The cluster analysis can be used to inform the co-design, prioritisation and implementation of locally designed, fit-for-purpose solutions to improve health literacy.
Key messages
• Health literacy profiles can inform interventions to mitigate health inequalities among vulnerable migrant groups.
• The identification of distinct profiles can contribute to minimise the disconnect between what people/communities need and what is developed to improve health and equity.
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Affiliation(s)
- MJ Marques
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - C Cheng
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology , Melbourne, Australia
| | - R Osborne
- Centre of Global Health and Equity, School of Health Sciences, Swinburne University of Technology , Melbourne, Australia
| | - S Dias
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
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15
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Gama A, Marques MJ, Pedro AR, Hoffmeister LV, Rodrigues F, Ribeiro JS, Dias S. Which effects had the pandemic in migrants’ health and well-being? A mixed-methods approach. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic affected populations’ health, with a disproportionate impact on those most socially vulnerable such as migrants. The way these populations experienced the pandemic lockdowns and its effects on daily life are yet to be known. This study aimed to understand the effects of the pandemic on health and well-being of migrants in Portugal.
Methods
In a mixed-methods approach, a survey was conducted with a community-based sample of 1126 migrants in the Lisbon Metropolitan Area, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on health. In addition, n = 12 migrants purposively recruited were invited to participate in a photovoice study, sharing photographs about their daily life during the lockdowns. Following semi-structured interviews were conducted. Quantitative data were analysed using multivariable analysis and qualitative data were analysed through content analysis.
Results
A fifth of the participants perceived having worse health condition since the pandemic, which was more likely among women (OR = 1.58, CI95% 1.13-2.20), those >45 years old (OR = 1.78, CI95% 1.02-3.16), with lower education (Basic education: OR = 1.57, CI95% 1.01-2.47) and with lower monthly income (<EUR 650: OR = 1.69, CI95% 1.18-2.44). Two themes emerged from the photovoice: effects of the pandemic lockdowns on daily life (routines, social relations, work) and on health and well-being (eating habits, physical exercise, leisure). Strategies to cope with the adverse effects included social activation and changes in lifestyles.
Conclusions
The pandemic had disproportionate effects on some migrant groups, intensifying social and health inequalities, with consequences for their well-being. Participatory methods can contribute to further understand migrants’ experiences while involving and empowering them for health promotion.
Key messages
• The pandemic had adverse effects on migrants’ health and well-being, disproportionately affecting most socially vulnerable migrant groups.
• Participatory research methods as photovoice are valuable to gain access to individual experiences and perspectives, while involving and empowering participants.
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Affiliation(s)
- A Gama
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - MJ Marques
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - LV Hoffmeister
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
| | - F Rodrigues
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - JS Ribeiro
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, PHRC, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center , Lisbon, Portugal
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16
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Marques MJ, Gama A, Pedro AR, Magano R, Tiessen C, Hollanders P, Dias S. Mental health of migrants during the COVID-19 pandemic: additional stressors, increased inequalities. Eur J Public Health 2022. [PMCID: PMC9594497 DOI: 10.1093/eurpub/ckac131.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has resulted in an unprecedent range of negative mental health outcomes across populations worldwide. Such effects are increasingly being documented, however an evidence gap persists on the consequences on most vulnerable groups, as certain subgroups of migrants. These populations already suffer from increased psychological burden, and the pandemic effects may potentially exacerbate adverse experiences and outcomes. This study aims to uncover the perceived impact of the COVID-19 pandemic on the mental health of migrants in Portugal and the associated sociodemographic aspects. A survey was conducted with a community-based sample of 1126 adult migrants in Portugal, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on mental health. Association between sociodemographics and mental health indicators was measured through bivariable analysis. In total, 1126 adult migrants were surveyed: 53.4% female, mean age of 35.8 years (range 18-77), 48.9% from African countries, 29.5% from Middle East/Asian countries, 21.6% from Brazil. Most participants (80%) reported feelings of agitation, anxiety or sadness during the pandemic period with 26.4% experiencing these feelings most days. The pandemic had a disproportionate impact on women (86.9% reported negative impact compared to 72.5% of men, p < 0.05), those undocumented (83.3% vs 75.4%, p < 0.05), those whose financial situation got worse since the pandemic (82.8% vs. 77.3%, p < 0.05) and those who had increased food shortages (84.4% vs 79%, p < 0.05). Migrants perceived an elevated deterioration of their mental health during the COVID-19 pandemic. In addition, particular groups such as women and those with a more insecure income or residence status are particularly susceptible to experiencing negative mental health outcomes. Key messages • There is a need to recognize the detrimental mental health impact of the COVID-19 pandemic on particular migrant groups and to develop interventions that target their unique needs. • Investigating sociodemographic and migration aspects could help identifying migrants at a higher risk of experiencing mental health distress.
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Affiliation(s)
- MJ Marques
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - R Magano
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - C Tiessen
- Universiteit Amsterdam Vrije , Amsterdam, Netherlands
| | | | - S Dias
- NOVA National School of Public Health, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa , Lisbon, Portugal
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17
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Gama A, Marques MJ, Rocha JV, Azeredo-Lopes S, Kinaan W, Machado AS, Dias S. 'I Didn't Know Where to Go': A Mixed-Methods Approach to Explore Migrants' Perspectives of Access and Use of Health Services during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:13201. [PMID: 36293781 PMCID: PMC9603706 DOI: 10.3390/ijerph192013201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic put pressure on health systems, affecting populations' use of health services, especially those experiencing increased difficulties in healthcare access, as some migrant groups. This study aimed to investigate access and use of health services during the COVID-19 pandemic among migrants in Portugal. A mixed-methods approach was used. A community-based cross-sectional survey was conducted involving migrant communities residing in the Lisbon Metropolitan Area. Analyses of a subsample of participants (n = 929) examined factors associated with perceived worsening of access to health services during the pandemic. Semi-structured interviews with 14 migrants were conducted and thematically analyzed to further understand experiences and difficulties in health services' use. Around 44% of surveyed participants reported worsening of access to health services since the pandemic, more frequently women, those with lower income, and those who perceived being at moderate or high risk for COVID-19 infection. Digital change in services and lack of formal and informal support during lockdowns were highlighted by interviewers as main barriers in access to healthcare for migrants. The pandemic renewed concerns about inequalities in healthcare access among migrants. It is key that in following years health systems are able to address the potential accumulated burden of disease.
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Affiliation(s)
- Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Maria J. Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - João Victor Rocha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Sofia Azeredo-Lopes
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Statistics and Operational Research Department, Sciences Faculty, University of Lisbon, 1749-016 Lisboa, Portugal
| | - Walaa Kinaan
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
| | - Ana Sá Machado
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
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Osborne RH, Cheng CC, Nolte S, Elmer S, Besancon S, Budhathoki SS, Debussche X, Dias S, Kolarčik P, Loureiro MI, Maindal H, Nascimento do O D, Smith JA, Wahl A, Elsworth GR, Hawkins M. Health literacy measurement: embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice. BMJ Glob Health 2022. [PMCID: PMC9462086 DOI: 10.1136/bmjgh-2022-009623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.
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Affiliation(s)
- Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Christina C Cheng
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephane Besancon
- Santé Diabète Headquarter, Grenoble, France
- Santé Diabète delegation of Mali, Bamako, Mali
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, St. Mary’s Campus, London, UK
- Nepalese Society of Community Medicine, Lalitpur, Nepal
| | - Xavier Debussche
- Centre Expert Plaies Chroniques, Centre Hospitalier Max Querrien Paimpol, Paimpol, France
| | - Sónia Dias
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Peter Kolarčik
- Department of Health Psychology and Research Methodology, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Maria Isabel Loureiro
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helle Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dulce Nascimento do O
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
- Associação Protectora dos Diabéticos, Lisbon, Portugal
| | - James A Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Astrid Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
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Paulino A, Pedro AR, Roque R, Dias S. Quality and performance indicators in Portuguese anatomical pathology laboratories: a panel validation by qualitative Delphi technique. BMJ Open Qual 2022. [PMCID: PMC9362786 DOI: 10.1136/bmjoq-2021-001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In laboratory medicine, quality and performance indicators (QPIs) are essential tools to ensure the quality of healthcare services and patient safety. QPIs allow comparison of outcomes, favouring accountability and transparency. Internationally, there are some QPI evaluation models, but the fact that they are paid limits their dissemination in smaller/poorer laboratories. In Portugal, each laboratory defines its own QPIs, with no uniformity between institutions. The development of a free QPI panel suitable for anatomical pathology laboratories (APLs) would allow for quality assessment and improvement. Objective To develop a consensual and validated QPI panel suitable for Portuguese APLs. Methods The study was developed in two stages. First, a bibliographic review was carried out, selecting the adequate QPIs. Afterwards, these QPIs were evaluated by experts through the Delphi method, where they could also suggest other pertinent QPIs. Results By the end of the Delphi method, there was a consensus on 64 QPIs (31 for ‘structure’, 30 for ‘process’ and 3 for ‘result’). The consensual QPIs covered all phases of the total test cycle. The lack of specific anatomical pathology QPIs in the bibliography was noticeable. There was greater consensus on ‘process’ and ‘result’ QPIs than on ‘structure’. This was supported by the bibliography, where the first ones were more valued. Nevertheless, it is important to monitor all the main laboratory processes, prioritising the evaluation of QPIs with greater impact on healthcare quality and patient safety. These results should allow APLs to identify the causes behind poor performance and improve their services. Conclusions This panel is a valuable tool for APLs, contributing to quality awareness. It can be the first step towards the development of a free benchmarking quality programme in Portugal, encouraging competitiveness and cost-efficiency.
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Affiliation(s)
- Ana Paulino
- Anatomical Pathology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ruben Roque
- Anatomical Pathology Department, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
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Lopes S, Soares P, Gama A, Pedro AR, Moniz M, Laires P, Goes AR, Nunes C, Dias S. Association between perception of COVID-19 risk, confidence in health services and avoidance of emergency department visits: results from a community-based survey in Portugal. BMJ Open 2022; 12:e058600. [PMID: 35803630 PMCID: PMC9271839 DOI: 10.1136/bmjopen-2021-058600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To examine the association between the perception of COVID-19 risk, confidence in health services and avoidance of emergency department (ED) visits in Portugal during the COVID-19 pandemic. DESIGN Community-based, cross-sectional survey. SETTING Volunteer sample that completed the online survey between April 2020 and May 2021. PARTICIPANTS 987 participants who perceived needing ED care. Of those, 242 reported avoiding ED visits. OUTCOME MEASURES Logistic regression models for ED avoidance were conducted to estimate the effect of risk perception and confidence in health services, adjusted for sociodemographics, health status and time. RESULTS The adjusted odds for ED avoidance were higher for participants lacking confidence in health service response to non-COVID-19 conditions (adjusted OR: 6.39; 95% CI 3.19 to 12.82) and COVID-19 (1.81; 1.19 to 2.77) and lower for those perceiving a low risk of being infected at a health provider (0.16; 0.07 to 0.38). CONCLUSION In our sample, confidence in health services and risk perception of infection at a health provider were associated with the decision to avoid the ED. These results suggest that policymakers and care providers need to mitigate the negative consequences of delayed healthcare; be aware of the implications of distrust and fear from those in need of healthcare and provide equally distributed safe alternatives to ED care.
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Affiliation(s)
- Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Marta Moniz
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Pedro Laires
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Ana Rita Goes
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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21
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de Noronha N, Moniz M, Gama A, Laires PA, Goes AR, Pedro AR, Dias S, Soares P, Nunes C. Non-adherence to COVID-19 lockdown: who are they? A cross-sectional study in Portugal. Public Health 2022; 211:5-13. [PMID: 35988506 PMCID: PMC9271418 DOI: 10.1016/j.puhe.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives The SARS-CoV-2 virus has spread worldwide, leading governments to implement mitigation measures. Understanding the reluctance to adhere to non-pharmacological interventions might help promote adherence to these measures. This study aimed to identify factors associated with non-adherence to the first lockdown in Portugal. Study design Cross-sectional study. Methods This study used data from a Portuguese community-based survey entitled ‘COVID-19 Barometer: Social Opinion’. Data were collected on risk perception, health status and social experiences using a snowball sampling technique. The event of interest corresponded to participants who reported not staying home during the lockdown period, serving as a proxy for non-adherence to lockdown. Logistic regression was used to identify factors associated with non-adherence to the first lockdown. Results Responses from 133,601 individual questionnaires that were completed during the first week of the first lockdown in 2020 were analysed. A minority of participants (5.6%) reported non-adherence to lockdown (i.e. leaving home for reasons other than essential situations). Working in the workplace was the factor with the strongest association of non-adherence to the lockdown. Several other factors were also associated with non-adherence to the first lockdown; namely, being a man, being a student, having a low level of education, having a low income, living alone or with a high-infection-risk professional (e.g. doctor, nurse, pharmaceutical, health technician, firefighter, police officer, military, essential services worker), perceiving the risk of getting COVID-19 to be high, not having social support in case of infection, feeling agitated, sad or anxious every day, and considering the preventive measures to be unimportant or inadequate. Conclusions Non-adherence to lockdown was associated with socio-economic, trust and perception factors. Future research should investigate the mechanisms underlying these associations to help identify the population groups who are most at risk of non-adherence.
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Affiliation(s)
- N de Noronha
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal.
| | - M Moniz
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - P A Laires
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A R Goes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - A R Pedro
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - P Soares
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
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22
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Lees JS, Hanlon P, Butterly E, Wild SH, Mair FS, Taylor RS, Guthrie B, Gillies K, Dias S, Welton N, McAllister DA. 963 THE IMPACT OF AGE, SEX AND MORBIDITY COUNT ON EARLY TERMINATION: A META-ANALYSIS OF INDIVIDUAL PATIENT DATA FROM CLINICAL TRIALS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Multimorbidity is found in around half of people with any long-term condition but is substantially less common in randomised controlled trials (‘trials’). Multimorbidity may diminish a participant’s ability to complete a trial. However, empirical estimates of the association between individual patient characteristics and early termination are lacking.
Method
Individual patient-level data were obtained from Phase 3/4 trials contained within two clinical trial repositories. Eligible trials for inclusion were identified according to pre-specified criteria (PROSPERO CRD42018048202). Within each trial, the association between morbidity count and early termination (failure for any reason to complete the final trial visit) was estimated in logistic regression models, adjusting for age and sex. These estimates were meta-analysed in Bayesian linear models, with partial pooling across index conditions and drug classes. Using these estimates, the impact of morbidity count on early termination was modelled for a set of notional trials.
Results
In 92 trials across 20 index conditions and 17 drug classes, the mean morbidity count ranged from 0.3–2.7. Neither age nor sex was associated with early termination (OR 1.04, 95% CI 0.98–1.11; OR 1.00, 95% PI 0.95–1.07 respectively). Morbidity count was associated with early termination (OR per additional morbidity: 1.11, 95% CI: 1.07 to 1.14). There was no evidence of non-linearity in the association between morbidity count and early termination, and there was minimal variation across drug classes and index conditions. For a notional trial with high level of early termination in individuals without multimorbidity, doubling the mean morbidity count from 1 to 2 increases risk of early termination from 29% to 31%.
Conclusion
Multimorbidity, irrespective of age and sex, is associated with a relatively modest increased odds of early termination of trial participation. The benefit of increased generalisability of trials by including patients with multimorbidity appears likely to outweigh the disadvantages of lower retention.
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23
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Hanlon P, Butterly E, Shah AV, Hannigan LJ, Wild SH, Guthrie B, Mair F, Dias S, Welton NJ, McAllister DA. 955 ANALYSIS OF RANDOMISED CONTROLLED TRIAL SERIOUS ADVERSE EVENT RATES AS A MARKER OF TRIAL REPRESENTATIVENESS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial Serious Adverse Events (SAEs: most of which reflect hospitalisations/deaths) to rates of hospitalisation/death in routine care (which, in a trial setting, would be SAEs be definition).
Method
We identified 483 trials (n = 636,267) from clinicaltrials.gov across 21 index conditions. A routine care comparison was identified from SAIL databank (n = 2.3 M). SAIL data were used to derive the expected rate of hospitalisations/deaths by age, sex and index condition. We then calculated the expected number of SAEs for each trial compared to the observed number of SAEs (observed/expected SAE ratio). We then re-calculated the observed/expected SAE ratio additionally accounting for comorbidity count in 125 trials for which we accessed individual participant data.
Results
For 12/21 index conditions the observed/expected SAE ratio was <1, indicating fewer SAEs in trials than expected given community rates of hospitalisations and deaths. A further 6/21 had point estimates <1 but the 95% CI included the null. The median observed/expected SAE ratio was 0.60 (95% CI 0.56–0.65; COPD) and the interquartile range was 0.44 (0.34–0.55; Parkinson’s disease) to 0.88 (0.59–1.33; IBD). Higher comorbidity count was associated with SAEs and hospitalisations/deaths across index conditions. For most trials, the observed/expected ratio was attenuated but remained <1 after additionally accounting for comorbidity count.
Conclusion
Trial participants experience fewer SAEs than expected based on age/sex/condition specific hospitalisation/death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess applicability of trial findings to older populations in whom multimorbidity and frailty are common.
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Affiliation(s)
- P Hanlon
- Institute for Health and Wellbeing, University of Glasgow
| | - E Butterly
- Institute for Health and Wellbeing, University of Glasgow
| | - A V Shah
- London School of Hygiene and Tropical Medicine
| | - L J Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital , Oslo, Norway
- Population Health Sciences , Bristol Medical School,
- University of Bristol , Bristol Medical School,
- Department of Mental Disorders, Norwegian Institute of Public Health
| | - S H Wild
- Usher Institute for Population Health Sciences, University of Edinburgh
| | - B Guthrie
- Usher Institute for Population Health Sciences, University of Edinburgh
| | - F Mair
- Institute for Health and Wellbeing, University of Glasgow
| | - S Dias
- Centre for Review and Dissemination, University of York
| | - N J Welton
- Population Health Sciences , Bristol Medical School,
- University of Bristol , Bristol Medical School,
| | - D A McAllister
- Institute for Health and Wellbeing, University of Glasgow
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24
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Quintas J, Guerreiro A, de Carvalho MJL, Duarte V, Pedro AR, Gama AF, Keygnaert I, Dias S. The Implication of the First Wave of COVID-19 on Mental Health: Results from a Portuguese Sample. Int J Environ Res Public Health 2022; 19:ijerph19116489. [PMID: 35682079 PMCID: PMC9180313 DOI: 10.3390/ijerph19116489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022]
Abstract
The social conditions created by the COVID-19 pandemic had a great potential to affect the mental health of individuals. Meta-analyses indicate a rise in these problems in these periods among general populations, patients and health professionals, even with substantial heterogeneous results. This paper examines mental health impacts specifically during the first wave of COVID-19. An online survey was conducted with a Portuguese convenience sample (N = 1.062) comprising questions about substance use, perceived stress, post-traumatic stress disorder and self-damage behaviors. The results concerning substance use show an extensive use of medication to sleep or calm down, especially among women and older respondents, a small percentage of alcohol consumers with a high pattern of use and less frequent cannabis consumption, even with a quarter of users who began only in the COVID-19 period. The rates of perceived stress and PTSD were higher compared with international prevalence estimations during the pandemic conditions. Both correlated measures were worse for women and young people. Another problematic issue was the rate of suicidal ideation, with a relevant proportion of starters during this period. These data reinforce the need to promote access to mental health services.
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Affiliation(s)
- Jorge Quintas
- CJS—Interdisciplinary Research Centre on Crime, Justice and Security, School of Criminology, Faculty of Law, University of Porto, 4050-123 Porto, Portugal;
- Correspondence:
| | - Ana Guerreiro
- CJS—Interdisciplinary Research Centre on Crime, Justice and Security, School of Criminology, Faculty of Law, University of Porto, 4050-123 Porto, Portugal;
- Department of Social and Behavioral Sciences, University of Maia (UMAIA), 4475-690 Maia, Portugal;
| | - Maria João Leote de Carvalho
- NOVA School of Social Sciences and Humanities (NOVA FCSH), 1069-061 Lisbon, Portugal;
- CICS.NOVA—Interdisciplinary Centre of Social Sciences, 1099-085 Lisbon, Portugal
| | - Vera Duarte
- Department of Social and Behavioral Sciences, University of Maia (UMAIA), 4475-690 Maia, Portugal;
- CICS.NOVA—Interdisciplinary Centre of Social Sciences, 1099-085 Lisbon, Portugal
| | - Ana Rita Pedro
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (A.R.P.); (A.F.G.); (S.D.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
| | - Ana Filipa Gama
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (A.R.P.); (A.F.G.); (S.D.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
| | - Inês Keygnaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
- WHO Collaborating Centre: International Centre for Reproductive Health (ICRH), Centre for Social Studies on Migration and Refugees (CESSMIR), 9000 Ghent, Belgium
| | - Sónia Dias
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (A.R.P.); (A.F.G.); (S.D.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal
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25
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Duea SR, Zimmerman EB, Vaughn LM, Dias S, Harris J. A Guide to Selecting Participatory Research Methods Based on Project and Partnership Goals. Journal of Participatory Research Methods 2022; 3. [PMID: 35799626 PMCID: PMC9258244 DOI: 10.35844/001c.32605] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Participatory research engages community stakeholders in the research process, from problem identification and developing the research question, to dissemination of results. There is increasing recognition in the field of health research that community-engaged methods can be used throughout the research process. The volume of guidance for engaging communities and conducting participatory research has grown steadily in the past 40+ years, in many countries and contexts. Further, some institutions now require stakeholder engagement in research as a condition of funding. Interest in collaborating in the research process is also growing among patients and the public. This article provides an overview for selecting participatory research methods based on project and partnerships goals.
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Affiliation(s)
| | | | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center/University of Cincinnati
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26
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Morse DF, Sandhu S, Mulligan K, Tierney S, Polley M, Chiva Giurca B, Slade S, Dias S, Mahtani KR, Wells L, Wang H, Zhao B, De Figueiredo CEM, Meijs JJ, Nam HK, Lee KH, Wallace C, Elliott M, Mendive JM, Robinson D, Palo M, Herrmann W, Østergaard Nielsen R, Husk K. Global developments in social prescribing. BMJ Glob Health 2022; 7:e008524. [PMID: 35577392 PMCID: PMC9115027 DOI: 10.1136/bmjgh-2022-008524] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/02/2022] [Indexed: 11/09/2022] Open
Abstract
Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the 'Beyond the Building Blocks' framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs.
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Affiliation(s)
| | - Sahil Sandhu
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stephanie Tierney
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | | | | | - Siân Slade
- University of Melbourne, Melbourne, Victoria, Australia
| | - Sónia Dias
- Universidade Nova de Lisboa Escola Nacional de Saúde Pública, Lisbon, Portugal
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Leanne Wells
- Consumers Health Forum of Australia, Deakin, Victoria, Australia
| | - Huali Wang
- Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Beijing, China
| | - Bo Zhao
- Health Administration, Yonsei University-Wonju Campus, Wonju, Gangwon-do, Republic of Korea
| | | | | | - Hae Kweun Nam
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | | | | | | | | | - David Robinson
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Miia Palo
- Lapland Hospital District, Rovaniemi, Finland
| | | | - Rasmus Østergaard Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus, Denmark
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27
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Pérez YM, Gama A, Pedro AR, de Carvalho MJL, Guerreiro AE, Duarte V, Quintas J, Aguiar P, Keygnaert I, Dias S. The links of stress, substance use and socio-demographic factors with domestic violence during the Covid-19 pandemic in Portugal. J Public Health (Oxf) 2022:6551086. [PMID: 35312006 DOI: 10.1093/pubmed/fdac024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lockdown, as a measure implemented to combat the coronavirus disease 2019 (COVID-19) pandemic, left many domestic violence (DV) victims trapped with their abusers. This study intends to explore the links between perceived stress, substance use and socio-demographic factors with DV experiences during COVID-19 pandemic in Portugal. METHODS A cross-sectional study was carried out on a sample of 1062 participants over 16 years old, residing in Portugal. Data were collected through an online survey conducted between April and October 2020. The associations between potential factors and DV were investigated using bivariable analysis and multivariable logistic regression. RESULTS The prevalence of DV reported was 13.75% (n = 146), disaggregated into psychological violence (13%, n = 138), sexual violence (1.0%, n = 11) and physical violence (0.9%, n = 10). Multivariable analyses confirmed that perceived financial difficulties (OR = 1.608; P = 0.019), use of medications to sleep or calm down (OR = 1.851; P = 0.002) and perceived stress (OR = 2.443; P = 0.003) were responsible for DV exposure during COVID-19 pandemic. Younger age (<25 years old) and consumption of alcohol were associated with a higher risk of DV victimization. CONCLUSIONS Interventions aimed at preventing and confronting DV are necessary within the strategies to combat COVID-19 in Portugal, especially aimed at groups in vulnerable situations, during and after the pandemic.
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Affiliation(s)
- Yilian M Pérez
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), 1169-056 Lisbon, Portugal
| | - Ana R Pedro
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), 1169-056 Lisbon, Portugal
| | - Maria J L de Carvalho
- CICS.NOVA - Interdisciplinary Centre of Social Sciences, 1070-312 Lisbon, Portugal.,NOVA School of Social Sciences and Humanities (NOVA FCSH), 1069-061 Lisbon, Portugal
| | - Ana E Guerreiro
- University Institute of Maia (ISMAI), 4475-690 Maia, Portugal.,School of Criminology, Faculty of Law, University of Porto, 4050-123 Porto, Portugal
| | - Vera Duarte
- CICS.NOVA - Interdisciplinary Centre of Social Sciences, 1070-312 Lisbon, Portugal.,University Institute of Maia (ISMAI), 4475-690 Maia, Portugal
| | - Jorge Quintas
- School of Criminology, Faculty of Law, University of Porto, 4050-123 Porto, Portugal.,CJS, Interdisciplinary Research Center on Crime, Justice and Security, 4050-123 Porto, Portugal
| | - Pedro Aguiar
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), 1169-056 Lisbon, Portugal
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium.,WHO Collaborating Centre: International Centre for Reproductive Health (ICRH), Centre for Social Studies on Migration and Refugees (CESSMIR), 9000 Ghent, Belgium
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), 1169-056 Lisbon, Portugal
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28
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Gomes IA, Soares P, Rocha JV, Gama A, Laires PA, Moniz M, Pedro AR, Dias S, Goes AR, Leite A, Nunes C. Factors Associated with COVID-19 Vaccine Hesitancy after Implementation of a Mass Vaccination Campaign. Vaccines (Basel) 2022; 10:vaccines10020281. [PMID: 35214739 PMCID: PMC8879669 DOI: 10.3390/vaccines10020281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 01/27/2023] Open
Abstract
An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September–November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, “COVID-19 Barometer: Social Opinion”. Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.
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Affiliation(s)
- Inês Afonso Gomes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
- Laboratórios Pfizer Lda., Lagoas Park, 2740-271 Porto Salvo, Portugal
- Correspondence:
| | - Patricia Soares
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - João Victor Rocha
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Gama
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Pedro Almeida Laires
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Marta Moniz
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Pedro
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Sónia Dias
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Goes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Andreia Leite
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Carla Nunes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (P.S.); (J.V.R.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (S.D.); (A.R.G.); (A.L.); (C.N.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
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Marques P, Geraldes M, Gama A, Heleno B, Dias S. Non-attendance in cervical cancer screening among migrant women in Portugal: A cross-sectional study. Womens Health (Lond Engl) 2022; 18:17455057221093034. [PMID: 35435057 PMCID: PMC9019366 DOI: 10.1177/17455057221093034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Cervical cancer has a high mortality rate among women worldwide. Although cervical cancer screening (CCS) is an effective strategy in reducing mortality of the disease, inequalities in accessing screening exist, particularly among migrant women. This study aims to characterize migrant women’s participation in CCS and determine factors associated with non-attendance to CCS. Methods: A cross-sectional study based on a web-based survey targeting adult migrant women living in Portugal was conducted. Prevalence of non-attendance to CCS was examined, and its associations with socioeconomic, migration-related, and health-related factors were determined using adjusted logistic regression models. Results: A total of 1100 migrant women were included in the study. Prevalence of CCS non-attendance was 24.5%. CCS non-attendance was associated with younger age, being born in Africa or Asia, being single/divorced/widowed, never having had a GP appointment in Portugal and not having regular gynecology appointments. Being born in South and Central America, shorter length of stay in Portugal, having had HPV vaccination, and not having children are associated with CCS attendance. Conclusion: These findings point out that an important percentage of migrant women do not attend CCS. Strategies to increase participation should be developed, considering the inequalities identified and designed to target the specific needs of migrant women to improve their CCS attendance and increase cervical cancer prevention.
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Affiliation(s)
- Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Mariana Geraldes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
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Soares P, Leite A, Esteves S, Gama A, Laires PA, Moniz M, Pedro AR, Santos CM, Goes AR, Nunes C, Dias S. Factors Associated with the Patient's Decision to Avoid Healthcare during the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18:13239. [PMID: 34948847 PMCID: PMC8701299 DOI: 10.3390/ijerph182413239] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient's decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, "COVID-19 Barometer: Social Opinion", which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen's Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.
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Affiliation(s)
- Patrícia Soares
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Andreia Leite
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Sara Esteves
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
| | - Ana Gama
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Pedro Almeida Laires
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Marta Moniz
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Pedro
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Cristina Mendes Santos
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
| | - Ana Rita Goes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Carla Nunes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Sónia Dias
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.L.); (S.E.); (A.G.); (P.A.L.); (M.M.); (A.R.P.); (C.M.S.); (A.R.G.); (C.N.); (S.D.)
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
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Egid BR, Roura M, Aktar B, Amegee Quach J, Chumo I, Dias S, Hegel G, Jones L, Karuga R, Lar L, López Y, Pandya A, Norton TC, Sheikhattari P, Tancred T, Wallerstein N, Zimmerman E, Ozano K. 'You want to deal with power while riding on power': global perspectives on power in participatory health research and co-production approaches. BMJ Glob Health 2021; 6:e006978. [PMID: 34764147 PMCID: PMC8587355 DOI: 10.1136/bmjgh-2021-006978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/23/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Power relations permeate research partnerships and compromise the ability of participatory research approaches to bring about transformational and sustainable change. This study aimed to explore how participatory health researchers engaged in co-production research perceive and experience 'power', and how it is discussed and addressed within the context of research partnerships. METHODS Five online workshops were carried out with participatory health researchers working in different global contexts. Transcripts of the workshops were analysed thematically against the 'Social Ecology of Power' framework and mapped at the micro (individual), meso (interpersonal) or macro (structural) level. RESULTS A total of 59 participants, with participatory experience in 24 different countries, attended the workshops. At the micro level, key findings included the rarity of explicit discussions on the meaning and impact of power, the use of reflexivity for examining assumptions and power differentials, and the perceived importance of strengthening co-researcher capacity to shift power. At the meso level, participants emphasised the need to manage co-researcher expectations, create spaces for trusted dialogue, and consider the potential risks faced by empowered community partners. Participants were divided over whether gatekeeper engagement aided the research process or acted to exclude marginalised groups from participating. At the macro level, colonial and 'traditional' research legacies were acknowledged to have generated and maintained power inequities within research partnerships. CONCLUSIONS The 'Social Ecology of Power' framework is a useful tool for engaging with power inequities that cut across the social ecology, highlighting how they can operate at the micro, meso and macro level. This study reiterates that power is pervasive, and that while many researchers are intentional about engaging with power, actions and available tools must be used more systematically to identify and address power imbalances in participatory research partnerships, in order to contribute to improved equity and social justice outcomes.
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Affiliation(s)
- Beatrice R Egid
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - María Roura
- School of Public Health, University College Cork, Cork, Ireland
| | - Bachera Aktar
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jessica Amegee Quach
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ivy Chumo
- Urbanisation and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa and Comprehensive Health Research Centre, Lisboa, Portugal
| | - Guillermo Hegel
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Laundette Jones
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Luret Lar
- Department of Community Medicine, University of Jos, Jos, Nigeria
| | - Yaimie López
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Apurvakumar Pandya
- Parul Institute of Public Health, Faculty of Medicine, Parul University, Vadodara, Gujarat, India
| | | | - Payam Sheikhattari
- School of Community Health and Policy, Prevention Sciences Research Center, Morgan State University, Baltimore, Maryland, USA
| | - Tara Tancred
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nina Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily Zimmerman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Gama A, Alves J, Costa D, Laires PA, Soares P, Pedro AR, Moniz M, Solinho L, Nunes C, Dias S. Double jeopardy from the COVID-19 pandemic: risk of exposure and income loss in Portugal. Int J Equity Health 2021; 20:231. [PMID: 34670581 PMCID: PMC8527282 DOI: 10.1186/s12939-021-01569-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing evidence indicates that the first wave of the COVID-19 pandemic had immediate health and social impact, disproportionately affecting certain socioeconomic groups. Assessing inequalities in risk of exposure and in adversities faced during the pandemic is critical to inform targeted actions that effectively prevent disproportionate spread and reduce social and health inequities. This study examines i) the socioeconomic and mental health characteristics of individuals working in the workplace, thus at increased risk of COVID-19 exposure, and ii) individual income losses resulting from the pandemic across socioeconomic subgroups of a working population, during the first confinement in Portugal. METHODS This study uses data from 'COVID-19 Barometer: Social Opinion', a community-based online survey in Portugal. The sample for analysis comprised n = 129,078 workers. Logistic regressions were performed to estimate the adjusted odds ratios (AOR) of factors associated with working in the workplace during the confinement period and with having lost income due to the pandemic. RESULTS Over a third of the participants reported working in the workplace during the first confinement. This was more likely among those with lower income [AOR = 2.93 (2.64-3.25)], lower education [AOR = 3.17 (3.04-3.30)] and working as employee [AOR = 1.09 (1.04-1.15)]. Working in the workplace was positively associated with frequent feelings of agitation, anxiety or sadness [AOR = 1.14 (1.09-1.20)] and perception of high risk of infection [AOR = 11.06 (10.53-11.61)]. About 43% of the respondents reported having lost income due to the pandemic. The economic consequences affected greatly the groups at increased risk of COVID-19 exposure, namely those with lower education [AOR = 1.36 (1.19-1.56)] and lower income [AOR = 3.13 (2.47-3.96)]. CONCLUSIONS The social gradient in risk of exposure and in economic impact of the pandemic can result in an accumulated vulnerability for socioeconomic deprived populations. The COVID-19 pandemic seems to have a double effect in these groups, contributing to heightened disparities and poor health outcomes, including in mental health. Protecting the most vulnerable populations is key to prevent the spread of the disease and mitigate the deepening of social and health disparities. Action is needed to develop policies and more extensive measures for reducing disproportionate experiences of adversity from the COVID-19 pandemic among most vulnerable populations.
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Affiliation(s)
- Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal. .,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Daniela Costa
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Pedro A Laires
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Marta Moniz
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Luísa Solinho
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
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Goes AR, Soares P, Moniz M, Gama A, Pedro AR, Laires P, Dias S, Nunes C. Factors associated with motivation to avoid meeting family and friends during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574604 DOI: 10.1093/eurpub/ckab164.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The widespread adherence to behaviours that prevent the transmission of the SARS-CoV-2 virus depends on human will. There is a paucity of research on the factors that influence adherence to social distancing. Available research suggests that it varies with the specific behaviour and that reducing contact with family and friends is the hardest one. This study aims to identify factors associated with motivation to avoid meeting with family and friends during the second lockdown of the COVID-19 pandemic in Portugal. Methods We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes sociodemographics, psychosocial variables, and subjective health and wellbeing indicators from 20th February to 19th March 2021. We included 1336 participants who answered the question “To what extent is it easy for you to avoid visiting family and friends?”. Logistic regression analysis was used to identify factors associated with difficulty to avoid visiting family and friends. Results Preliminary data shows that 38.4% (513) had difficulties avoiding meeting with family and friends. Those with greater difficulty were the ones who have less education, higher negative emotionality, do not work remotely, have more difficulties to stay home and practice physical distancing and consider the Government's measures inadequate. Contrarily, those who have less difficulty avoiding visiting friends and family are older and have low risk perception of COVID-19 infection. Conclusions This study suggests higher difficulty in avoiding visiting friends and family for those whose routines demand not staying at home, with low agreement with Government measures, and struggle with higher negative emotionality, confirming the personal costs of these behaviours and the importance of habits. Older people had less difficulty, suggesting that these measures may be closer to their usual routines. Interventions should consider the specificities of social interaction. Key messages Social distancing comes at an enormous cost to people's livelihoods and it also depends on people living circumstances. Interventions to improve adherence to social distancing should consider the specificity of social interaction and the potential dissonance created by the overall routines.
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Affiliation(s)
- AR Goes
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Moniz
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Pedro
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Laires
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- Public Health Research Center, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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Gama A, Marques MJ, Pedro AR, Mendonça J, Fernandes AC, Dias S. Perceived need of health care and barriers in access to health services among migrants in Portugal. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Health care has been pointed out as a key determinant of migrants' health and social integration, but there is evidence of disparities in its access across subgroups. A deeper understanding of the barriers in access to health care, particularly among vulnerable groups, is needed. Our study aims to examine perceived need of health care, access to health services and barriers among migrants in Portugal. A cross-sectional survey was conducted with 1126 adult migrants (53.4% females), originated from African, Middle East, Asian countries and Brazil, living in Portugal for no longer than 10 years. The collected data included sociodemographic characteristics, perceived need of health care, access to health services and difficulties experienced. Differences between groups were analysed through chi-square tests. Results showed that most of the participants (64.7%) have needed health care in the previous 12 months in Portugal. Of these, 87.8% accessed a health care service. However, even needing health care, 3.3% decided not to seek care and 8.8% were not able to access a health care service. Reporting no access to health care was more frequent among migrants with shorter length of stay in the country (<1 year: 19.4% vs. 1 to 5 years: 7.3% and 6 to 10 years: 4.6%; p = 0.001) and those with non-regular migration status (in regularisation process: 11.5% and undocumented: 9.5% vs. documented: 7.2%; p = 0.040). Most common barriers were lack of the National Health Service user card (38%), financial constraints (15%), undocumented status (11%) and language difficulties (7%). Although efforts have been made over the past decades in Portugal to adopt inclusive policies and promote migrants' access to health care, strategies are needed to improve information on migrants' health rights, especially of those undocumented and recently arrived. Economic and language difficulties should be further addressed in comprehensive interventions to promote equal access to health care.
Key messages
Migrants residing in the country for less than a year and those with non-regular migration status reported more frequently not being able to access health care. Despite the efforts to adopt inclusive policies and promote migrants’ access to health care, strategies are needed to improve information on migrants’ health rights and promote equal access to care.
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Affiliation(s)
- A Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - MJ Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - J Mendonça
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AC Fernandes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
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35
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Dias S, Figueiredo C, Hoffmeister L, Gama A. Developing evidence on social prescribing initiative in Lisbon: Challenges and insights for improving. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Social prescribing is recent in Portugal and evidence is needed on the potential of this complex intervention to improve health and wellbeing outcomes but also to inform the commissioning of these programmes. In a collaborative approach, an evaluation protocol of the social prescribing in two primary healthcare units in Lisbon was developed, aiming to assess its implementation and impact at three levels: patients, health system and health-social sector intersection, within a mixed-methods approach. Exploring the social prescribing contribution to enhance patients' quality of life, well-being and activation involves assessing these outcomes throughout a longitudinal perspective. In an exploratory, prospective study, baseline data collection and three follow-ups are included. Secondary data comprise health status indicators collected from patients' medical records as well as referral and social responses elaborated within the intervention. Patients' experiences on the social prescribing activities performed, perceived changes in lifestyle, and perspectives about positive and negative aspects are assessed in semi-structured interviews. The need for further understanding the impact at the health system' level calls for an attentive look at the processes of change in patients' patterns of healthcare services use (appointments in primary healthcare units, hospital admissions and emergency episodes), but also changes in the services' reorganization to better integrative health care. At a broader level, insights will be obtained on the effects on the intersection between the health and social sectors and the experiences of networking, through focus group discussions with all the stakeholders involved. The social prescribing implementation process, barriers, facilitators and suggestions for improvement will also be explored. In this presentation, challenges will be debated, as well as insights for reflection about opportunities for improving evidence development.
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Affiliation(s)
- S Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - C Figueiredo
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Central Lisbon Health Center Cluster, Lisbon, Portugal
| | - L Hoffmeister
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Centre, Lisbon, Portugal
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Nogales Crespo K, Muniz Rocha J, Vázquez M, Ricoca Peixoto V, Dias S. The COVID-19 policy response in Spain and Portugal: a study of measures to slow down infection rate. Eur J Public Health 2021. [PMCID: PMC8574229 DOI: 10.1093/eurpub/ckab165.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 global pandemic triggered massive policy responses worldwide. Measures taken during the pandemic differed across countries and time. Governance systems may influence the capacity of countries to respond promptly and mobilize the necessary resources in time. Identifying measures and when they appeared are critical questions to assess emergency response strategies. The objective of this study was to analyze the policy response to slow down the infection rate of COVID-19 cases in Portugal and Spain according to timing (related to death rates) and stringency. Methods A descriptive comparative study of non-pharmaceutical interventions was conducted through a content analysis of policies and records review of official government sources. Portugal and Spain were selected considering the similarities between national health systems, but different government organization and epidemic impact. The Autonomous Community of Madrid was also included as example of subnational systems. Death rates were retrieved from daily statistics of open secondary sources. Results Results show that countries responded with a complex mix of measures across policy sectors, following dynamic patterns established by the epidemic evolution and governance systems. Policies aimed to reduce the spread of the virus, enable individuals and businesses to comply with restrictions, and reinforce National Health System's capacity. The declaration of state of emergency was a critical tool to organize actions under clear leadership, especially in devolved contexts. Conclusions Our findings suggest that, in early epidemic phases, a centralized command can be more effective at timely enacting nationwide stringent measures. Evidence from this study contributes to the argument that a fast, robust, and early response might have been more effective at containing spread at the initial stages of the pandemic. Key messages The policy response included measured to reduce spread of infection, enhance adherence and strengthen health systems capacity to deal with the pandemic. The declaration of state of emergency was essential to ensure an organized, coherent, timely, and robust response, especially in devolved contexts.
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Affiliation(s)
- K Nogales Crespo
- NOVA National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | - J Muniz Rocha
- NOVA National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- Department of Culture and Society, Linköping University, Linköping, Sweden
- Public Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
| | - M Vázquez
- Health Policy Research Unit, Consortium for Health and Social Care of Catalonia, Barcelona, Spain
| | - V Ricoca Peixoto
- Public Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - S Dias
- NOVA National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- Public Health Research Center, NOVA University of Lisbon, Lisbon, Portugal
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Marques P, Gama A, Geraldes M, Silva J, Vaccari N, Dias S. Sociocultural factors of cervical cancer screening uptake among migrant women: a mixed methods study. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cervical cancer has a high mortality in Europe despite being preventable by cervical cancer screening (CCS). Migrant women have a lower CCS attendance compared to non-migrants. This study aims to describe CCS uptake among migrant women in Portugal and explore sociocultural influences. Within a mixed-methods approach, an online survey and focus group discussions (FGs) were conducted. The survey included 655 migrant women and collected data on sociodemographics, attendance and attitudes toward CCS. Four FGs with 12 healthcare workers and a FG with 5 community workers were conducted exploring perceptions on CCS attendance and barriers among migrant women. Quantitative data was analyzed using descriptive analysis and Chi-Square test and qualitative data through content analysis. Survey data shows that 24.9% of women never had CCS or had it over 5 years ago, more Asian and African women (51.3% and 36.7%, respectively) (p < 0.001). Non-attenders reported significantly more often embarrassment towards CCS (21.7% vs. 18.8% of CCS attenders, p = 0.002) and being unaware of their risk of cancer and the relevance of CCS (28.8% vs. 12.5%, p < 0.001). Around 24% of non-attenders reported concern with having a consultation with a male doctor. For FGs participants, CCS is a taboo in some communities, particularly African, Asian and Muslim. Lack of information about CCS along with feelings of embarrassment and discomfort related to pap smear and with being seen by a male doctor were referred as reasons for avoidance of CCS. Participants also stated that some women have low autonomy and often their husbands have a key role in deciding whether they should attend CCS. Lack of a preventive mindset was also stated as reason for low CCS attendance. The sociocultural background can influence migrant women's attendance to CCS. A culturally grounded approach is needed to provide tailored information on CCS and to create opportunities to engage migrant communities on CCS and improve their uptake.
Key messages
Lack of information, embarrassment and low autonomy hinder some migrant women’s attendance to CCS. The sociocultural influences on CCS uptake call for a culturally grounded approach to provide tailored information and engage migrant communities on CCS.
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Affiliation(s)
- P Marques
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Geraldes
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J Silva
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - N Vaccari
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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Lopes S, Soares P, Gama A, Pedro AR, Moniz M, Laires P, Goes AR, Nunes C, Dias S. Factors associated with avoidance of emergency department visits in Portugal during the pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Avoiding an emergency department (ED) visit risks irreversible negative consequences for patients' health. EDs are a frequent access point to the Portuguese health system. Previous studies have shown that patients may avoid visiting ED during the pandemic. This study aims to identify factors associated with avoidance of ED visits in Portugal during the COVID-19 pandemic.
Methods
We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes healthcare utilisation, health status, and risk perception in Portugal from 11th April 2020 to 16th April 2021. We included respondents that reported having needed ED care. Data were collected on sociodemographics, health status (comorbidities, mental health), risk perception (COVID-19 and complications), level of trust in health services and self-assessment of the severity of the reason for ED visit. The outcome of interest was the decision to avoid ED care. We used logistic regression to identify factors associated with the decision to avoid ED.
Results
Preliminary data showed that 914 respondents reported needing ED care (74.8% female; mean age 43 years). From those, 224 (25%) decided to avoid ED care. ED visits avoidance was higher during lockdowns (28%). People reporting specific comorbidities (cardiac, autoimmune, respiratory) avoided ED more than those without them. Perception of no severe reason for ED visit, poor mental health, perception of higher risk of COVID-19 and complications, and low trust in health services response to the pandemic were associated with higher odds of ED visit avoidance.
Conclusions
People avoiding ED visits represented a considerable share. The decision to avoid ED visit was associated with clinical characteristics, but the perception of risk and assessment of the context and health system response also played a role in decision making.
Key messages
The effect of avoided ED visits on health should be a research and policy concern. People with certain comorbidities or perception of high risk of COVID-19 and complications may be closely monitored.
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Affiliation(s)
- S Lopes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Gama
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Pedro
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Moniz
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Laires
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - AR Goes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Nunes
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - S Dias
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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Marques MJ, Gama A, Mendonça J, Fernandes AC, Osborne RH, Dias S. Assessing health literacy among migrants and associated socioeconomic factors. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Health literacy, the ability to understand, access, appraise, remember and use health information and health services, has great potential to reduce health inequalities and improve access to and quality of health care, particularly among groups that experience vulnerability, including migrant groups. Across Europe, including in Portugal, little is known about the health literacy strengths, needs and preferences among migrants. We aimed to assess the health literacy of diverse migrants living in Portugal and identify if health literacy needs differ across sociodemographic subgroups. A cross-sectional survey was administered to migrants living in Portugal. Data were collected using the Health Literacy Questionnaire (HLQ), an internationally tested and robust multi-dimensional measurement tool with nine scales, and a demographic and socioeconomic questionnaire. Associations were tested using Welch's ANOVA. In total, 1126 adult migrants were surveyed: 53.4% female, mean age of 35.8 years (range 18-77), 48.9% from African countries, 29.5% from Middle East/Asian countries, 21.6% from Brazil. Low scores on most HLQ scales were clearly associated with sociodemographic characteristics such as lower levels of education: 1. Feeling understood and supported by healthcare providers (p = 0.045); 2. Having sufficient information to manage health (p < 0.001); 3. Actively managing health (p = 0.036); 4. Social support for health (p = 0.001); 5. Appraisal of health information (p < 0.001); 7. Navigating the health system (p = 0.031); 8. Finding health information (p = 0.007). Similar patterns were found for participants who were unemployed and with lower income (<650€). Health literacy needs of migrant communities should be taken into account when designing interventions aiming to mitigate health inequalities and to promote health literacy. This is even more pertinent in the current context of the COVID-19, where its adverse social and economic impacts are likely to aggravate health inequalities.
Key messages
Lower health literacy is related to lower socioeconomic status. Mapping health literacy needs can inform interventions to mitigate health inequalities among vulnerable migrant groups.
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Affiliation(s)
- Maria J Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Joana Mendonça
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Adalberto Campo Fernandes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
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Souza LLL, Santos FLD, Crispim JDA, Fiorati RC, Dias S, Bruce ATI, Alves YM, Ramos ACV, Berra TZ, da Costa FBP, Alves LS, Monroe AA, Fronteira I, Arcêncio RA. Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil. BMC Health Serv Res 2021; 21:1033. [PMID: 34592970 PMCID: PMC8483800 DOI: 10.1186/s12913-021-07057-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. METHODS We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework. RESULTS The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. CONCLUSION The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.
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Affiliation(s)
- Ludmilla Leidianne Limirio Souza
- Master of Science, Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Felipe Lima Dos Santos
- Master of Science, Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Postdoctoral Fellowship in the Interinstitutional Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Regina Célia Fiorati
- University of São Paulo at Ribeirão Preto Medical School at Ribeirão Preto, São Paulo, Brazil
| | - Sónia Dias
- Universidade NOVA de Lisboa at National School of Public Health, Lisbon, Portugal
| | - Alexandre Tadashi Inomata Bruce
- Master of Science, Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Antônio Carlos Vieira Ramos
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Thaís Zamboni Berra
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Luana Seles Alves
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Aline Aparecida Monroe
- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
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Dias S, Silva-Junior AL, Garcia NP, Cardoso EC, Tarragô AM, Fraiji NA, Paula EV, Costa AG, Malheiro A. CARACTERIZAÇÃO DE ANAFILOTOXINAS EM PACIENTES COM ANEMIA FALCIFORME EM CRISE VASO-OCLUSIVA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Marques P, Gama A, Santos M, Heleno B, Vermandere H, Dias S. Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal. Int J Environ Res Public Health 2021; 18:ijerph18147248. [PMID: 34299698 PMCID: PMC8305801 DOI: 10.3390/ijerph18147248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening.
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Affiliation(s)
- Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
| | - Mário Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
| | - Bruno Heleno
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
- NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Heleen Vermandere
- International Centre for Reproductive Health, Ghent University, 9000 Ghent, Belgium;
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
- Correspondence:
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Sherriff NS, Jones AM, Mirandola M, Gios L, Marcus U, Llewellyn C, Rosinska M, Folch C, Dias S, Toskin I, Alexiev I, Kühlmann-Berenzon S. Factors related to condomless anal intercourse between men who have sex with men: results from a European bio-behavioural survey. J Public Health (Oxf) 2021; 42:e174-e186. [PMID: 31090894 PMCID: PMC7251420 DOI: 10.1093/pubmed/fdz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.
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Affiliation(s)
- N S Sherriff
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, Brighton, BN1 9PH, UK
| | - A M Jones
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom, BN13 3EP, UK
| | - M Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - U Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - C Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - M Rosinska
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - C Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya / CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública & GHTM, Universidade NOVA de Lisboa, Portugal
| | - I Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - I Alexiev
- National Reference Laboratory of HIV, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - S Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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Hoffmeister LV, Nunes MF, Figueiredo CEM, Coelho A, Oliveira MFF, Massano P, Gama A, Aguiar P, Dias S. Evaluation of the Impact and Implementation of Social Prescribing in Primary Healthcare Units in Lisbon: A Mixed-Methods Study Protocol. Int J Integr Care 2021; 21:26. [PMID: 34220390 PMCID: PMC8231481 DOI: 10.5334/ijic.5592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Social Prescribing (SP) is an intervention to link users of the primary healthcare services to non-clinical organizations based on the community to tackle social determinants of health. Despite the potential benefits of SP, the effectiveness of this complex intervention remains uncertain. This paper presents the study protocol of the evaluation of the first SP project in Portugal. METHODS A mixed-methods study will be conducted to evaluate the SP project. For the quantitative component, a longitudinal, prospective study with a pre-post design will be performed. Data on patients referred to SP will be collected in four different points in time throughout the intervention, using questionnaires on patients' health status and sociodemographic characteristics, and scales on patients' well-being, quality of life and activation. The secondary data will be collected using patients' medical records and SP's forms about the referral and social responses elaborated within the intervention. Semi-structured interviews with patients and focus groups with stakeholders will be conducted to assess experiences of participation and improvement suggestions on SP. CONCLUSION Comprehensive and complementary evidence will provide insights and learning for the implementation of future SP interventions. This can contribute to inform policy and practice, and to increase investment in social prescribing interventions.
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Affiliation(s)
- Louíse Viecili Hoffmeister
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Campo Mártires da Pátria, 130 1169-056 Lisboa, Portugal
| | - Mariana Fortuna Nunes
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
| | - Cristiano Emanuel Marta Figueiredo
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
- Central Lisbon Health Center Cluster, Rua Carvalho Araújo, 103 1900-181 Lisboa, Portugal
| | - Andreia Coelho
- Central Lisbon Health Center Cluster, Rua Carvalho Araújo, 103 1900-181 Lisboa, Portugal
| | | | - Paula Massano
- Central Lisbon Health Center Cluster, Rua Carvalho Araújo, 103 1900-181 Lisboa, Portugal
| | - Ana Gama
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Campo Mártires da Pátria, 130 1169-056 Lisboa, Portugal
| | - Pedro Aguiar
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Campo Mártires da Pátria, 130 1169-056 Lisboa, Portugal
| | - Sónia Dias
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Campo Mártires da Pátria, 130 1169-056 Lisboa, Portugal
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Dias S, Gama A, Maia AC, Marques MJ, Campos Fernandes A, Goes AR, Loureiro I, Osborne RH. Migrant Communities at the Center in Co-design of Health Literacy-Based Innovative Solutions for Non-communicable Diseases Prevention and Risk Reduction: Application of the OPtimising HEalth LIteracy and Access (Ophelia) Process. Front Public Health 2021; 9:639405. [PMID: 34136449 PMCID: PMC8200814 DOI: 10.3389/fpubh.2021.639405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Catarina Maia
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Maria J Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Adalberto Campos Fernandes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Ana Rita Goes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Isabel Loureiro
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Comprehensive Health Research Centre, Lisboa, Portugal
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Centre of Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia.,Department of Health Services Research, The University of Copenhagen, Copenhagen, Denmark
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Rego de Figueiredo I, Branco Ferrão J, Dias S, Vieira Alves R, Drummond Borges D, Torres M, Guerreiro Castro S, Lourenço F, Antunes AM, Gruner H, Panarra A. Tuberculosis infection in HIV vs. non-HIV patients. HIV Med 2021; 22:775-779. [PMID: 34000080 DOI: 10.1111/hiv.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. METHODS The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. RESULTS This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. CONCLUSIONS There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.
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Affiliation(s)
- I Rego de Figueiredo
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - J Branco Ferrão
- Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - S Dias
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - R Vieira Alves
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - D Drummond Borges
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - M Torres
- Serviço de Doenças Infecciosas, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - S Guerreiro Castro
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - F Lourenço
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - A M Antunes
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - H Gruner
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - A Panarra
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
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Sousa ÁFLD, Queiroz AAFLN, Lima SVMA, Almeida PD, Oliveira LBD, Chone JS, Araújo TME, Brignol SMS, Sousa ARD, Mendes IAC, Dias S, Fronteira I. The authors reply. CAD SAUDE PUBLICA 2021; 37:e00029921. [PMID: 33950072 DOI: 10.1590/0102-311x00029921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Álvaro Francisco Lopes de Sousa
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil.,Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Artur Acelino Francisco Luz Nunes Queiroz
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil.,Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | | | - Layze Braz de Oliveira
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | | | | | | | | | | | - Sónia Dias
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Inês Fronteira
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
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Abstract
It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, "COVID-19 Barometer: Social Opinion", which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.
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Affiliation(s)
- Patricia Soares
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - João Victor Rocha
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Marta Moniz
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Gama
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Pedro Almeida Laires
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Pedro
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Sónia Dias
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Andreia Leite
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Carla Nunes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
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Soares P, Rocha JV, Moniz M, Gama A, Laires PA, Pedro AR, Dias S, Leite A, Nunes C. Factors Associated with COVID-19 Vaccine Hesitancy. Vaccines (Basel) 2021; 9:300. [PMID: 33810131 PMCID: PMC8004673 DOI: 10.3390/vaccines9030300] [Citation(s) in RCA: 363] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/21/2023] Open
Abstract
It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, "COVID-19 Barometer: Social Opinion", which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.
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Affiliation(s)
- Patricia Soares
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - João Victor Rocha
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Marta Moniz
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Gama
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Pedro Almeida Laires
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Ana Rita Pedro
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Sónia Dias
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Andreia Leite
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Carla Nunes
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal
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Gama A, Pedro A, de Carvalho M, Guerreiro A, Duarte V, Quintas J, Matias A, Keygnaert I, Dias S. Domestic Violence during the COVID-19 Pandemic in Portugal. Port J Public Health 2021. [DOI: 10.1159/000514341] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The measures implemented to combat the COVID-19 pandemic led populations to confinement at home, with increased risk of domestic violence due to extended shared time between victims and offenders. Evidence on domestic violence in times of pandemic is lacking. This study examines the occurrence of domestic violence, associated factors and help seeking during the COVID-19 pandemic. An online survey was conducted in Portugal between April and October 2020 by NOVA National School of Public Health. The survey was disseminated through partner networks, media, and institutions working within the scope of violence. Data were collected on the experience of domestic violence, and help seeking during the pandemic. In a total of 1,062 respondents, 146 (13.7%) reported having suffered domestic violence during the pandemic, including psychological (13.0%, <i>n</i> = 138), sexual (1.0%, <i>n</i> = 11), and physical (0.9%, <i>n</i> = 10) abuse. Overall, the lower the age, the more the reported domestic violence. Also, a higher proportion of participants who perceived difficulties to make ends meet during the pandemic reported domestic violence. Differences between women and men and across educational levels on reported domestic violence were not statistically significant. Bivariate logistic analyses showed that, among women, reported domestic violence was more likely among those with up to secondary education compared to higher education. Most of the victims did not seek help (62.3%), the main reasons being considering it unnecessary, that help would not change anything, and feeling embarrassed about what had happened. Only 4.3% of the victims sought police help. The most common reasons for not coming forward to form a complaint were considering the abuse was not severe and believing the police would not do anything. Our findings indicate that domestic violence during the COVID-19 pandemic was experienced by both sexes and across different age groups. There is a need for investing in specific support systems for victims of domestic violence to be applied to pandemic contexts, especially targeting those in more vulnerable situations and potentially underserved.
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