Updating the determinants of health model in the Information Age

[Digital literacy as a key element in the digital transformation of health organizations]

In the last years, the digital transformation, has become a reality influencing organizational processes and advancing services for users. This transformation must align with WHO guidelines, addressing the needs of individuals globally and acknowledging Social Determinants of Health and emerging Digital Determinants of Health and the digital divide thas has been created. To accomplish this, the appropriate legislation and infrastructures are required. Correspondingly technology enables enhanced self-care and increased participation in decision-making across various levels, consequently, addressing the digital divide must not be an exception, and needs to include citizens, communities, entities, and professionals to work on how to diminish it and solve it. As a result of this national and supranational campaigns should formulate unified plans and strategies, that include training requirements and establishing programs for both professionals and users, highlighting the significance of incorporating digital knowledge on both groups.

Digital determinants of health as a way to address multilevel complex causal model in the promotion of Digital health equity and the prevention of digital health inequities: A scoping review

Background

With the progressive digitization of health services and the current spread of Telemedicine and e-Health, it became clear that promoting Digital health equity (DHE) is necessary to support health potential, to avoid that some individuals can incur in unintended inequities. In this paper, we address the complex causal process(es) that may generate risk of inequities, considering the so-called "Digital Determinants of health" (DDoH) and their relationship with determinants of health (DoH).

Design and methods

We conducted a scoping review, according to methodological framework proposed in PRISMA-ScR guidelines, on the definition of DDoH (Scopus, Pubmed and Web of Science electronic databases). Inclusion criteria: papers on the definition of DDoH, no time limits, all study designs eligible.

Results

There is an agreement on the link between DDoHs and "digital divide" and on their effects on a wide range of health, functioning outcomes, both as barriers and as facilitators. Authors proposed to modify or integrate with DDoHs the "Rainbow model" or other conceptual models on DoH. To promote DHE, authors suggest considering a multidimensional complex causal model, with interdependence among the different levels and the mutually reinforcing effects.

Conclusion

To study DDoH and their relationship with main determinants of health could be a way to address the complex causal model in the promotion of DHE. However, as they act in a multidimensional causal context, any intervention may consider the interdependence among different involved levels, within them, and the mutually reinforcing effects. Further research is needed to gain a more complete picture of the field.

'I wouldn't trust it …' Digital transformation of young people's sexual health services: a systems-informed qualitative enquiry

Introduction

Digital sexual health technologies for young people, such as websites, texting services and apps, could address some of the sexual health inequalities that many experience, since they have the potential to overcome concerns associated with traditional clinic based services such as embarrassment, privacy and accessibility. However, they are currently under-utilised internationally.

Methods

Using complexity theory and systems thinking as a theoretical framework, this qualitative descriptive study sought to explore the acceptability of digital sexual health technologies for 16-18 year olds. Data generation with 10 sexual health nurses with experience of digital service delivery took the form of minimally structured online one-to-one interviews lasting between 20 and 50 min. Focus groups of up to eight young people or individual interviews were used to explore 32 16-18 year olds' perspectives. Interviews lasted between 18 and 48 min. Both datasets were analysed using Braun and Clarke's reflexive thematic analysis.

Results

Three themes emerged from each dataset. Nurses' themes were: (1) digital sexual health services can be more comfortable for young people, (2) digital sexual health services can be complimentary to clinic visits but do not replace them and (3) challenges exist in providing sexual health services to young people through digital technologies. The young people's themes were: (1) sexual health is a 'difficult issue', (2) young people have specific expectations yet a desire for choice and (3) digital health interventions are not a panacea.

Conclusions

While digital sexual health interventions hold great potential, they need to be integral to the wider systems in which both young people and sexual health promotion services operate, otherwise there is a risk that their impact will be compromised. Collaborative approaches that connect causal factors and policy objectives and involve full engagement with all stakeholders are more likely to be efficacious.

Pharmaceutical indication pictograms for low literacy viewers: Health literacy and comprehension

Background

Poor comprehension of pharmaceutical pictograms used on medicine labels or leaflets can compromise understanding of medicine-taking information, potentially causing negative health outcomes.

Aim

The aim was to assess association of health literacy (HL) with comprehension of pictograms displaying indication and side effect information in a lower literacy, limited English proficiency (LEP) population.

Setting

Community centre, Makhanda, South Africa.

Methods

This was a quantitative cross-sectional study using simple random probability sampling. Ninety isiXhosa-speaking adults with a maximum of 12 years schooling, attending primary healthcare clinics were interviewed using structured interviews. Health literacy was assessed using the Health Literacy Test for Limited Literacy populations. Comprehension of 10 locally developed pictograms was evaluated.

Results

The mean pictogram comprehension score was 7.9/10, with 8/10 pictograms complying with the International Organization for Standardization criterion of 66.7% correct comprehension. Only 15.6% of participants had adequate HL. A significant association of HL with pictogram comprehension was established (p = 0.002). Pictogram misinterpretation was higher in those with lower HL; adequate HL was associated with superior comprehension. Pictogram comprehension was negatively associated with age (p < 0.006), and positively associated with education (p < 0.001) and English proficiency (p < 0.001).

Conclusion

Higher HL was associated with better pictogram comprehension. Low HL, LEP and low education levels are regarded as potential indicators for possible pictogram misinterpretation.

Contribution

This study observed the potential for misinterpretation of medication pictograms. Health professionals should be aware that low HL, limited schooling and limited English proficiency could signal difficulty in fully comprehending pictogram content.

TFOS Lifestyle Report Executive Summary: A Lifestyle Epidemic - Ocular Surface Disease

The Tear Film & Ocular Surface Society (TFOS) Workshop entitled 'A Lifestyle Epidemic: Ocular Surface Disease' was a global initiative undertaken to establish the direct and indirect impacts of everyday lifestyle choices and challenges on ocular surface health. This article presents an executive summary of the evidence-based conclusions and recommendations of the 10-part TFOS Lifestyle Workshop report. Lifestyle factors described within the report include contact lenses, cosmetics, digital environment, elective medications and procedures, environmental conditions, lifestyle challenges, nutrition, and societal challenges. For each topic area, the current literature was summarized and appraised in a narrative-style review and the answer to a key topic-specific question was sought using systematic review methodology. The TFOS Lifestyle Workshop report was published in its entirety in the April 2023 and July 2023 issues of The Ocular Surface journal. Links to downloadable versions of the document and supplementary material, including report translations, are available on the TFOS website: http://www.TearFilm.org.

Examining the Pathways from General Trust Through Social Connectedness to Subjective Wellbeing

The broad conceptualisation of wellbeing has allowed researchers to establish subjective wellbeing as a valid indicator of social development. However, changing social patterns, norms, and values suggest changes in how social determinants may predict subjective wellbeing. The current analysis tests a serial mediation hypothesis in which social participation and social resources mediate the effect of general trust on subjective wellbeing.

Data from 8725 participants were pooled from the German part of the European Social Survey (ESS) Wave 10. Structural models were estimated to access the path from general trust to subjective wellbeing (SWB). Three separate mediation analyses were performed to test (1) the indirect effect of general trust on SWB through social participation, (2) through social resources and (3) through social participation and social resources. A full-mediation model reveals the direct and indirect paths predicting SWB through general trust, social participation, and social resources. Gender, age, education, and household size were included as control variables.

The full-mediation model suggests significant results for direct paths from general trust to social participation, social resources, and SWB. Direct paths from social participation to social resources and SWB were also significant. However, the path from social resources to SWB became non-significant.

Results highlight general trust as a critical predictor of SWB. The finding that social participation is significant while social resources are not significant in a mediation model suggests that social participation directly affects wellbeing, independent of the effect of social resources. This highlights the importance of social participation in promoting wellbeing.

Lifestyle and Sense of Coherence: A comparative analysis among university students in different areas of knowledge

BACKGROUND

The concept of health has undergone profound changes. Lifestyle Medicine consists of therapeutic approaches that focus on the prevention and treatment of diseases. It follows that the quality of life of university students directly affects their health and educational progress.

EXPERIMENTAL METHODOLOGY

Socioeconomic, lifestyle (LS), and Salutogenesis Theory/sense of coherence (SOC) questionnaires were administered to college students from three different areas. The results were analyzed for normality and homogeneity, followed by ANOVA variance analysis and Dunn and Tukey post hoc test for multiple comparisons. Spearman's correlation coefficient evaluated the correlation between lifestyle and sense of coherence; p values < 0.05 were considered statistically significant.

RESULTS

The correlation between LS and SOC was higher among males and higher among Medical and Human sciences students compared to Exact sciences. Medical students' scores were higher than Applied sciences and Human sciences students on the LS questionnaire. Exact science students' scores on the SOC questionnaire were higher than Human sciences students. In the LS areas related to alcohol intake, sleeping quality, and behavior, there were no differences between the areas. However, women scored better in the nutrition domain and alcohol intake. The SOC was also higher in men compared to women.

CONCLUSION

The results obtained demonstrate in an unprecedented way in the literature that the correlation between the LS and SOC of college students varies according to gender and areas of knowledge, reflecting the importance of actions on improving students' quality of life and enabling better academic performance.

A New Health Care Paradigm: The Power of Digital Health and E-Patients

The integration of digital health into the field of medicine has seen a marked increase with the advancement of technology. Before the pandemic, a marked portion of the adult population, more than 66%, owned smartphones, and approximately 15% owned wearables. The widespread use of such devices, along with the effect of COVID-19 pandemic, has led to a transformation in health care culture that prioritizes cocreation, codesign, and collaboration. This shift promotes a model of health care centered on patient empowerment and self-management. In a recent interview with Dave deBronkart, known as e-Patient Dave, we revisited the possibilities of this new approach aimed at empowering, engaging, and equipping e-patients in the context of the pandemic. This interview with deBronkart was originally used for a graduate course on digital health. However, after noticing many reoccurring themes throughout the discussion, we decided to further explore this matter. It was discovered that participatory medicine is a new paradigm in health care, which challenges the conventional, paternalistic model and emphasizes the importance of a collaborative relationship between patients and providers. The realization of the full potential of health care can be achieved by promoting patient engagement and activation through the adoption of participatory medicine.

[Approach to digital transformation in healthcare to reduce the digital divide]

Digital transformation involves the integration of technology into all areas of an organization and a change in the way of operating and providing value. In the healthcare sector, digital transformation should focus on improving health for all by accelerating the development and adoption of digital solutions. The WHO considers digital health as a key factor in ensuring universal health coverage, protection against health emergencies, and better well-being for one billion people worldwide. Digital transformation in healthcare should include digital determinants of health as new factors of inequality alongside classic social determinants. Addressing digital determinants of health and the digital divide is essential to ensure that all people have access to the benefits of digital technology for their health and well-being.

Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study

Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.

Social Determinants of Health and Happiness of Older Adults in Ghana: Secondary Analysis of Ghana SAGE Wave 2 Longitudinal Data

Background

Social determinants of health [SDOH] and happiness have received meaningful consideration as foundational concepts in the field of public health. However, the relationship between the SDOH and happiness of older adults have not received the requisite recognition in Ghana. This study examined the relationship between the SDOH and happiness of older adults in Ghana.

Methods

The study used data from the 2014/2015 Ghana Study on Global Ageing and Adult Health (SAGE) Wave 2. Data was analysed using the Structural Equation Modeling (SEM) technique to investigate the direct, indirect and covariances of the SDOH and happiness of older adults.

Results

The results showed positive relationship between the SDOH and happiness among older adults. The economic stability (β = 0.07), neighbourhood and built environment (β = 0.02, P < 0.001), access to quality education (β = 0.56, P < 0.01), access to healthy food (β = 0.48, P < 0.001) social and community context (β = 0.41, P < 0.05), and access to quality healthcare (β = 0.80, P < 0.001) had direct relationship with happiness of the older adults in Ghana.

Conclusion

This study shows that the conditions in which older adults were born, live, learn, work, play, worship, and age (SDOH) positively impact their happiness in later life. Neighbourhood and physical environment influence the effect of quality education on happiness of older adults. Social policies and interventions aiming at happiness of older adults should consider the social determinants of health and the mediating effects of food on happiness through quality education, and quality of healthcare system.

Digital inclusion, online participation and health promotion: promising practices from community-led participatory journalism

A growing body of evidence demonstrates that digital inclusion mediates access to other social determinants of health - directly, through access to and literacy in technologies or services, and indirectly, by supporting people's capacity to participate fully and equitably in civic and cultural life online. Novel approaches to community-led participatory journalism, in which people from equity-deserving communities are supported to tell their own stories, suggest promising practices for online civic engagement as an emerging approach to promoting health though digital inclusion.

HPV vaccine narratives on Twitter during the COVID-19 pandemic: a social network, thematic, and sentiment analysis

INTRODUCTION

The COVID-19 pandemic has increased online interactions and the spread of misinformation. Some researchers anticipate benefits stemming from improved public awareness of the value of vaccines while others worry concerns around vaccine development and public health mandates may have damaged public trust. There is a need to understand whether the COVID-19 pandemic, vaccine development, and vaccine mandates have influenced HPV vaccine attitudes and sentiments to inform health communication strategies.

METHODS

We collected 596,987 global English-language tweets from January 2019-May 2021 using Twitter's Academic Research Product track. We determined vaccine confident and hesitant networks discussing HPV immunization using social network analysis. Then, we used a neural network approach to natural language processing to measure narratives and sentiment pertaining to HPV immunization.

RESULTS

Most of the tweets in the vaccine hesitant network were negative in tone (54.9%) and focused on safety concerns surrounding the HPV vaccine while most of the tweets in the vaccine confident network were neutral (51.6%) and emphasized the health benefits of vaccination. Growth in negative sentiment among the vaccine hesitant network corresponded with legislative efforts in the State of New York to mandate HPV vaccination for public school students in 2019 and the WHO declaration of COVID-19 as a Global Health Emergency in 2020. In the vaccine confident network, the number of tweets concerning the HPV vaccine decreased during the COVID-19 pandemic but in both vaccine hesitant and confident networks, the sentiments, and themes of tweets about HPV vaccine were unchanged.

CONCLUSIONS

Although we did not observe a difference in narratives or sentiments surrounding the HPV vaccine during the COVID-19 pandemic, we observed a decreased focus on the HPV vaccine among vaccine confident groups. As routine vaccine catch-up programs restart, there is a need to invest in health communication online to raise awareness about the benefits and safety of the HPV vaccine.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Fact or Fiction? The Development and Evaluation of a Tobacco Virtual Health Tool

The virtual setting is an important setting for health promotion as individuals increasingly go online for health information and support. Yet, users can have difficulty finding valid, trustworthy, and user-friendly health information online. In 2022, we launched an interactive Fact or Fiction Tobacco virtual health tool. The virtual health tool uses evidence-informed tailored content to engage users and refer them to local tobacco cessation resources. The present paper describes the development, user testing, and evaluation of this tool. The Fact or Fiction virtual health tool was designed by tobacco cessation and health marketing experts and informed by health behaviour theories of change. The tool captures data on who is seeking health information, the user's stage of readiness to quit tobacco products, and whether they act by accessing referred resources. In 2021, we conducted two phases of user testing prior to marketing the tool publicly. After 7 weeks of marketing, we collected data on user interactions with the tool and evaluated the reach of the tool. Results from user testing found the tool to be engaging, easy to use, and quick to complete. Adaptations were made to simplify and condense text and include additional animations. During the first seven weeks of the tool being live, it reached 2306 users, and 38.7% of those users were current or occasional tobacco users. Users were classified based on their intention to quit. Bivariate analysis found that the tool was successful in driving tobacco users towards action as 21.2% tobacco users who were looking to quit and 8.8% of tobacco users who were not looking to quit clicked on local tobacco cessation resources. This virtual health tool is reaching the targeted population and providing tailored information needed at each stage of the continuum of health behaviour change. Among tobacco users looking to quit, this virtual health tool acts as a quick referral to local tobacco cessation resources.

Facilitators and barriers to seeking and engaging with antenatal care in high-income countries: A meta-synthesis of qualitative research

Inadequate attendance to antenatal care has been associated with negative maternal and fetal outcomes, including stillbirth. This study aimed to identify facilitators and barriers to antenatal care attendance. A systematic search was conducted in March 2019 and updated in January 2021. Qualitative studies involving pregnant or post-partum women up to 12 months from high-income countries that provided data about facilitators and barriers to antenatal care attendance were sought. Meta-ethnography was used to inform this meta-synthesis. Fifteen studies were included in the analysis. Findings indicate that inadequate antenatal care attendance is influenced at different levels. Aspects like sociodemographic factors, difficulties navigating the health system, administrative delays, lack of flexibility and tailored care, constant change of carer and communication issues also act as barriers. These issues affect women's access to knowledge and the formation of women's beliefs and feelings towards seeking care. On the contrary, having a positive attitude towards the pregnancy, encountering empathetic healthcare professionals and availing of social support acted as facilitators. The reasons why women seek or delay attending antenatal care are multifactorial and can be explained using the Social Determinants of Health Framework. Any response needs to be taken across all levels of influence and not just focused on the individual. A better understanding of the barriers and facilitators to antenatal care might contribute to informing intervention or policy development addressing this issue.

The digital rainbow: Digital determinants of health inequities

The widely used socioecological rainbow model from Dahlgren and Whitehead specifies determinants of health inequity on multiple hierarchical levels and suggests that these determinants may interact both within and between levels. At the time of its inception, digital determinants only played a minor role in tackling inequities in public health and were therefore not specifically considered. This has dramatically changed: From today's perspective, health inequities increasingly depend on digital determinants. In this article, we suggest adapting the Dahlgren-Whitehead model to reflect these developments. We propose a model that allows formulating testable hypotheses, interpreting research findings, and developing policy implications against the background of the global spread of digital technologies. This may facilitate the development of a new line of research and logic models for public health interventions in the digital age. Using the COVID-19 pandemic as a case study, we illustrate how the digitization of all aspects of life affects the different levels of determinants of health inequities in the Dahlgren-Whitehead model. In doing so, we deliberately argue for not introducing a separate digital sphere in its own right, but for understanding digitization as a phenomenon that permeates all levels of determinants of health inequities. As a result, we present a digital rainbow model that integrates Dahlgren and Whitehead's 1991 model with digital environments to identify current health promotion and research issues without changing the rainbow model's initial structure.

Exploring behavioural factors influencing COVID-19-specific infection prevention and control measures in Finland: a mixed-methods study, December 2020 to March 2021

BackgroundCompliance with infection prevention and control (IPC) measures is critical to preventing COVID-19 transmission in healthcare settings.AimTo identify and explain factors influencing compliance with COVID-19-specific IPC measures among healthcare workers (HCWs) in long-term care facilities (LTCF) in Finland.MethodsThe study included a web-based survey and qualitative study based on the Theoretical Domains Framework (TDF). The link to the anonymous survey was distributed via email to LTCFs through regional IPC experts in December 2020. Outcome was modelled using ordinary logistic regression and penalised ridge logistic regression using regrouped explanatory variables and an original, more correlated set of explanatory variables, respectively. In-depth interviews were conducted among survey participants who volunteered during January-March 2021. Data were analysed thematically using qualitative data analysis software (NVIVO12).ResultsA total of 422 HCWs from 17/20 regions responded to the survey. Three TDF domains were identified that negatively influenced IPC compliance: environmental context and resources, reinforcement and beliefs about capabilities. Twenty HCWs participated in interviews, which resulted in identification of several themes: changes in professional duties and lack of staff planning for emergencies (domain: environmental context and resources); management culture and physical absence of management (domain: reinforcement), knowledge of applying IPC measures, nature of tasks and infrastructure that supports implementation (domain: beliefs about capabilities), that explained how the domains negatively influenced their IPC behaviour.ConclusionsThis study provides insights into behavioural domains that can be used in developing evidence-based behaviour change interventions to support HCW compliance with pandemic-specific IPC measures in LTCFs.

Immigrant women looking for information about the perinatal period on digital media: A qualitative study

BACKGROUND

Smartphones' development has allowed continuous access to information about the perinatal period on digital media. Knowing about immigrant women's experience on digital media may help health and social care professionals to fine-tune their care.

AIM

Our primary aim is to analyse how immigrant women experience information about the perinatal period on digital media. Our secondary aim is to discuss how health and social care professionals perceive the experiences of these women.

METHODS

A qualitative study conducted in Switzerland encompassing semi-directed interviews with immigrant women (n = 20), health and social care professionals (n = 30) and interpreters (n = 12) completed with ethnographic observations and interviews.

FINDINGS AND DISCUSSION

Immigrant women form a diverse social group. They consequently use an array of social media to find information about the perinatal period depending on their linguistic and digital skills. Reflexively, they expect information found online to be of unequal quality and value information provided by professionals. They adapt their practices to their experience and may avoid media that negatively affects them. Their experience with digital media reflects the overall perinatal experience, providing clues for carers. Professionals worry about the difficult situations some immigrant women live in and stress that digital portals form barriers to services. Professionals may overlook immigrant women's use of digital media and their need for guidance.

CONCLUSIONS

Immigrant women use digital media to find information about the perinatal period to prepare for birth and the post-partum. They rely on unequal capabilities to do so and need translated information and holistic woman-centred support.

Rainbows over the world's public health: determinants of health models in the past, present, and future

The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.

Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.

Social risk, health inequity, and patient safety

Social factors that affect health are called social determinants. Social determinants may also carry risk, known as social risk. Management and patient safety professionals understand health care and enterprise risk. Social risk may add a new dimension for some. Social risks are probably amenable to the strategies patient safety and risk management professionals already employ, such as enterprise risk management, a culture of safety, and just culture. A large body of evidence suggests that social risks, particularly literacy and discrimination, strongly affect patient safety and well-being. This paper examines the relationship between social determinants of health and social risks and considers how health care organizations might address literacy and discrimination from the perspective of patient safety and risk management.

Exercise motives impact on physical activities measured using wearable devices

Health officials advocate for increased physical activity to address negative health consequences. While previous studies have investigated what motivates different individuals to exercise, the motives were not verified using unbiased measurements. Information and Communication Technologies (ICT), including wearables, are essential for collecting and sharing data necessary for improving health initiatives. The purpose of this study was to use objective measures collected by wearable devices (Fitbit) to track activity and explore whether specific exercise motives impact participants' physical activities. Ninety-six college freshmen enrolled in the 90-day study. During orientation, participants completed an Exercise Motives Inventory-2 (EMI-2), and their current physical state was baselined. Partial Least Squares (PLS)-Structural Equation Modeling (SEM) was used to model the relationship between variables. The results revealed a relationship between Interpersonal Motives, Health Motives, and Fitness Motives, and participants' physical activities. Those striving to facilitate a change in exercise behavior in young adults should leverage activities that align with their motives of interest and consider the use of wearable devices to track physical activity.

eHealth literacy among older adults living with cancer and their caregivers: A scoping review

INTRODUCTION

Over 90% of people living with cancer access information online to inform healthcare decisions. Older adults with cancer are also increasingly adopting electronic healthcare services, or eHealth, particularly with the rapid transition to virtual care amidst the pandemic. Therefore, the purpose of this review is to understand the level of eHealth literacy among older adults with cancer and their caregivers, as well as any barriers and facilitators in terms of accessing, comprehending, and implementing eHealth information.

METHODS

This scoping review was guided by Arksey and O'Malley methodology and PRISMA ScR guidelines. Comprehensive searches for the concepts of "eHealth Literacy" and "cancer" were performed in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000 to 2021. We used descriptive quantitative and thematic analysis to analyze the literature.

RESULTS

Of the 6076 articles screened by two reviewers, eleven articles were included. Quantitative findings suggest older adults with cancer and their caregivers have low self-perceived eHealth literacy and less confidence evaluating online health information for cancer decision-making. Low socioeconomic status, lower education levels, rapid expansion of digital applications, broadband access, reduced familiarity, and frequency of use were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregivers seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system.

CONCLUSION

With the growing reliance on eHealth tools, developing credible digital health applications that require minimal internet navigation skills, patient education, and collaborative efforts to address access and affordability are urgently warranted.

Is Europe prepared to go digital? making the case for developing digital capacity: An exploratory analysis of Eurostat survey data

Digital divides are globally recognised as a wicked problem that threatens to become the new face of inequality. They are formed by discrepancies in Internet access, digital skills, and tangible outcomes (e.g. health, economic) between populations. Previous studies indicate that Europe has an average Internet access rate of 90%, yet rarely specify for different demographics and do not report on the presence of digital skills. This exploratory analysis used the 2019 community survey on ICT usage in households and by individuals from Eurostat, which is a sample of 147,531 households and 197,631 individuals aged 16-74. The cross-country comparative analysis includes EEA and Switzerland. Data were collected between January and August 2019 and analysed between April and May 2021. Large differences in Internet access were observed (75-98%), especially between North-Western (94-98%) and South-Eastern Europe (75-87%). Young populations, high education levels, employment, and living in an urban environment appear to positively influence the development of higher digital skills. The cross-country analysis exhibits a positive correlation between high capital stock and income/earnings, and the digital skills development while showing that the internet-access price bears marginal influence over digital literacy levels. The findings suggest Europe is currently unable to host a sustainable digital society without exacerbating cross-country inequalities due to substantial differences in internet access and digital literacy. Investment in building digital capacity in the general population should be the primary objective of European countries to ensure they can benefit optimally, equitably, and sustainably from the advancements of the Digital Era.

Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma

Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.

Intelligent Algorithm-Based Picture Archiving and Communication System of MRI Images and Radiology Information System-Based Medical Informatization

Objective

The study aimed to explore the application value of picture archiving and communication system (PCAS) of MRI images based on radial basis function (RBF) neural network algorithm combined with the radiology information system (RIS).

Methods

551 patients who required MRI examination in a hospital from May 2016 to May 2021 were selected as research subjects. Patients were divided into two groups according to their own wishes. Those who were willing to use the RBF neural network algorithm-based PCAS of MRI images combined with RIS were set as the combined group, involving a total of 278 cases; those who were unwilling were set as the regular group, involving a total of 273 cases. The RBF neural network algorithm-based PCAS of MRI images combined with RIS was trained and tested for classification performance and then used for comparison analysis.

Result

The actual output (0.031259–0.038515) of all test samples was almost the same as the target output (0.000000) (P > 0.05). In the first 50,000 learnings, the iteration error of the RBF neural network dropped rapidly and finally stabilized at 0.038. The classification accuracy of the RBF neural network algorithm-based PCAS of MRI images combined with RIS for the head was 94.28%, that of abdomen was 97.22%, and it was 93.10% for knee joint, showing no statistically significant differences (P > 0.05), and the total classification accuracy was as high as 95%. The time spent in the examination in the combined group was about 2 hours, and that in the regular group was about 4 hours (P > 0.05). The satisfaction of the combined group (96.76%) was significantly higher than that of the control group (46.89%) (P > 0.05).

Conclusion

The RBF neural network has good classification performance for MRI images. To incorporate intelligent algorithms into the medical information system can optimize the system. RBF has good application prospects in the medical information system, and it is worthy of continuous exploration.

Understanding and Responding to Health Literacy as a Social Determinant of Health

Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not a panacea for addressing health inequities created by the maldistribution of opportunity and resources. It is possible to optimize the contribution health literacy makes in mediating the causes and effects of established social determinants of health. Existing interventions demonstrate the feasibility of improving health literacy among higher-risk populations, but research remains underdeveloped and effects on health inequity are largely untested. Future health literacy intervention research should focus on (a) improving the quality of health communication that reaches a diversity of populations, especially by improving frontline professional skills and support; (b) enabling people to develop transferable skills in accessing, understanding, analyzing, and applying health information; and (c) ensuring that priority is proportionate to need by reaching and engaging the population groups who are disproportionately affected by low health literacy.

Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American academy of nursing

BACKGROUND

The 2019-2020 American Academy of Nursing (Academy, 2019) policy priorities document states that "they have a clear and distinct focus on social determinants of health and uses this lens to advance policies and solutions within each of the three overarching priorities" PURPOSE: This consensus paper seeks to establish conceptual clarity and consensus for what social determinants of health mean for nursing, with emphasis on examples of health policies that advance planetary health equity and improve planetary health-related quality of life.

METHODS

Volunteers from five Expert Panels of the Academy met via videoconference to determine roles and refine the focus of the paper. After the initial discussion, the first draft of the conceptual framework was written by the first three authors of the paper and, after discussion via videoconference with all the co-authors, successive drafts were developed and circulated for feedback. Consensus was reached when all authors indicated acceptance of what became the final version of the conceptual framework.

DISCUSSION

A conceptual framework was developed that describes how the social determinants of health can be addressed through nursing roles and actions at the individual, family, and population levels with a particular focus on the role of health policy. The paper provides a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health.

CONCLUSION

Nursing actions can support timely health policy changes that focus on upstream factors in the six key areas of the social determinants of health and thus improve population health. The urgent need to eliminate systematic and structural racism must be central to such policy change if equity in planetary health-related quality of life is to be attained.

Measuring Athletes' Perception of the Sport Nutrition Information Environment: The Adaptation and Validation of the Diet Information Overload Scale among Elite Athletes

The exponentially growing quantity of nutrition information creates a new situation and challenge for every stakeholder, from athletes, coaches and nutritionists to policymakers. To measure the perception of the information environment related to healthy eating, the diet information overload scale was developed. The scale consists of eight items, measuring the perceived importance of pieces of information overload on Likert-type scales. The objective of the study was to test the applicability and validity of the diet information overload scale among athletes. A cross-sectional validation study was conducted with elite athletes (n = 177). To validate each item of the scale, we applied Cronbach’s alpha test, and the inner consistency of the scale was analyzed with linear correlation coefficients of the different variables. To evaluate the relationship between question groups, we applied factor analysis. The different fit indices showed a good fit to the model; the Root Mean Square Error of Approximation (RMSEA) value was 0.09 and the Tucker–Lewis index (TLI) value was 0.84. The indicators of reliability (α based upon the covariances = 0.81) produced suitable results; thus, the sport nutrition information overload scale showed high reliability and applicability. Based on the sport nutrition information overload scale, further analysis could be carried out on how to optimize the content of key pieces of sport nutrition-related information.

Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research

BACKGROUND

Previous studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth.

AIM

This study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy.

METHODS

A systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women's experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis.

FINDINGS

Twenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals.

DISCUSSION

Perceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women's behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use.

CONCLUSION

Increased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice

Policy Points Persistent communication inequalities limit racial/ethnic minority access to life-saving health information and make them more vulnerable to the effects of misinformation.  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue. Public investments and support for minority-serving media and community outlets are needed to close persistent gaps in access to credible health information.

Multistakeholder Participation in Disaster Management-The Case of the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is affecting society's health, economy, environment and development. COVID-19 has claimed many lives across the globe and severely impacted the livelihood of a considerable section of the world's population. We are still in the process of finding optimal and effective solutions to control the pandemic and minimise its negative impacts. In the process of developing effective strategies to combat COVID-19, different countries have adapted diverse policies, strategies and activities and yet there are no universal or comprehensive solutions to the problem. In this context, this paper brings out a conceptual model of multistakeholder participation governance as an effective model to fight against COVID-19. Accordingly, the current study conducted a scientific review by examining multi-stakeholder disaster response strategies, particularly in relation to COVID-19. The study then presents a conceptual framework for multistakeholder participation governance as one of the effective models to fight against COVID-19. Subsequently, the article offers strategies for rebuilding the economy and healthcare system through multi-stakeholder participation, and gives policy directions/decisions based on evidence to save lives and protect livelihoods. The current study also provides evidence about multidimensional approaches and multi-diplomatic mechanisms during the COVID-19 crisis, in order to examine dimensions of multi-stakeholder participation in disaster management and to document innovative, collaborative strategic directions across the globe. The current research findings highlight the need for global collaboration by working together to put an end to this pandemic situation through the application of a Multi-Stakeholder Spatial Decision Support System (MS-SDSS).

Indicators of Healthy Architecture-a Systematic Literature Review

The design of the built environment plays an important role as a determinant of health. As a society, we are spending an increasing proportion of our time indoors and now spend over 80% of our life inside, so the design of buildings can greatly impact on human health. Accordingly, architecture health indices (AHIs) are used to evidence the effects on human health associated with the design of buildings. AHIs provide quantitative and empirical data upon which architects, clients, users and other stakeholders might monitor and evaluate the healthiness (or otherwise) of architectural design. A systematic literature review was conducted to reveal the current state of knowledge, reveal gaps, explore potential usage and highlight best practice in this area. Whilst there are a number of different health indicators for the built/urban environments more generally, the scope of this review is limited to the scale of a building and specifically those aspects within the remit of a professional architect. In order to examine the range and characteristics of AHIs currently in use, this review explored three electronic bibliographic databases from January 2008 to January 2019. A two-stage selection was undertaken and screening against eligibility criteria checklist carried out. From 15 included studies, 127 documents were identified, and these included 101 AHI. A sample of the most commonly used AHIs was then analysed at an item level. The review reveals that most AHIs are limited to measuring communicable diseases that directly affect physical health through e.g. air quality or water quality. There are very few indicators focusing on factors affecting mental and social health; given the increase in mental and social health problems, greater focus on AHIs related to these health issues should be included. Furthermore, the research reveals an absence of AHIs that address non-communicable diseases (NCDs). As the majority of all poor health outcomes globally are now related to NCDs, and many are associated with the design of the built environment, there is an urgent need to address this situation.

Understanding the decision to immunize: insights into the information needs and priorities of people who have utilized an online human papillomavirus (HPV) vaccine decision aid tool

Setting

People in Alberta are more likely to seek information about cancer prevention online than they are to have this conversation with their primary care provider. As people turn to the internet to support health decision-making, it is critical that we improve the supportiveness of the virtual health setting for cancer prevention.

Intervention

In 2014, the Alberta Cancer Prevention Legacy Fund launched an online HPV Decision Aid Tool to support evidence-informed decision-making in response to suboptimal uptake of the HPV (human papillomavirus) vaccine. Google Analytics data from approximately 2000 recent interactions with this tool have yielded insights into the concerns that impact people’s decision-making about the vaccine.

Outcomes

Most users of this tool are adults interested in the vaccine for themselves (69%), rather than parents considering immunizing their children (31%). No differences were found in the information-seeking behaviour of parents of girls compared with parents of boys, suggesting that mental models among those who are considering the HPV vaccine may have shifted in recent years. Concerns differed by respondent; cost was the most important concern among adults (62.0%), while parents were most concerned about vaccine safety (61.5%). Only 23% of users asked “what is HPV”, suggesting that many people in Alberta now have basic knowledge about the virus.

Implications

Results provide a real-time “pulse” on knowledge and attitudes towards HPV immunization, which informs our approach to tailoring messaging with the aim of increasing vaccine uptake in Alberta. Outcomes will provide evidence needed to inform new interventions aimed at increasing HPV immunization rates.

The Role of Chinese Medicine in Health Maintenance and Disease Prevention: Application of Constitution Theory

Traditional Chinese medicine (TCM) has guided health maintenance and disease treatment for thousands of years and has been widely used in many countries around the world. TCM regards each individual as unique so all corresponding therapeutic and preventive approaches in TCM are personalized. Personalized medicine, also referred to as precision medicine, is an emerging medical paradigm that points toward a new direction for future medical development. TCM constitution studies the holistic body condition, which is affected by both inborn and acquired factors. Body constitution lays the foundation for disease diagnosis, prevention and treatment. Different constitution types predispose individuals to different disease susceptibilities. Examining an individual's unique body constitution can promote effective health management and benefit the application of personalized medicine significantly. This review will introduce and discuss the application of the TCM constitution for health maintenance and disease prevention. In last decade, a number of modern techniques have been employed in the constitution research to evaluate the health status of individuals. The TCM constitution reflects the current status and future trends of human health in four aspects, i.e., individual differences, life processes, psychological condition and adaptability to natural and social environments. This TCM constitution theory has already been applied in the Chinese public health management at different levels with promising outcome. The constitution theory and practice provide a new approach for health maintenance and disease prevention.