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Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

ABSTRACT: OBJECTIVE:Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN:Two case-control studies. SETTING:Performed in primary care of five Spanish regions. SUBJECTS:In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES:Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS:The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS:Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

SUBMITTER: March S

PROVIDER: S-EPMC5640008 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case<b>-</b>control studies.

March Sebastià S Ripoll Joana J Jordan Martin Matilde M Zabaleta-Del-Olmo Edurne E Benedé Azagra Carmen Belén CB Elizalde Soto Lázaro L Vidal Mª Clara MC Bauzà Amengual María de Lluc ML Planas Juan Trinidad T Pérez Mariano Damiana Maria DM Llull Sarralde Micaela M Ruiz-Giménez Juan Luís JL Bajo Viñas Rosa R Solano Villarubia Carmen C Rodriguez Bajo Maria M Cordoba Victoria Manuela M Badia Capdevila Marta M Serrano Ferrandez Elena E Bosom Diumenjo Maria M Montaner-Gomis Isabel I Bolibar-Ribas Buenaventura B Antoñanzas Lombarte Angel A Bregel Cotaina Samantha S Calvo Tocado Ana A Olivan Blázquez Barbara B Magallon Botaya Rosa R Marín Palacios Pilar P Echauri Ozcoidi Margarita M Perez-Arauta María Jose MJ Llobera Joan J Ramos Maria M

BMJ open 20171008 10

<h4>Objective</h4>Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities.<h4>Design</h4>Two case<b>-</b>control studies.<h4>Setting</h4>Performed in primary care of five Spanish regions.<h4>Subjects</h4>In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. ...[more]

PMID: 28993380

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Project description:BackgroundGiven the scarcity of specialist mental healthcare in India, diverse community mental healthcare models have evolved. This study explores and compares Indian models of mental healthcare delivered by primary-level workers (PHW), and health workers' roles within these. We aim to describe current service delivery to identify feasible and acceptable models with potential for scaling up.MethodsSeventy two programmes (governmental and non-governmental) across 12 states were visited. 246 PHWs, coordinators, leaders, specialists and other staff were interviewed to understand the programme structure, the model of mental health delivery and health workers' roles. Data were analysed using framework analysis.ResultsProgrammes were categorised using an existing framework of collaborative and non-collaborative models of primary mental healthcare. A new model was identified: the specialist community model, whereby PHWs are trained within specialist programmes to provide community support and treatment for those with severe mental disorders. Most collaborative and specialist community models used lay health workers rather than doctors. Both these models used care managers. PHWs and care managers received support often through multiple specialist and non-specialist organisations from voluntary and government sectors. Many projects still use a simple yet ineffective model of training without supervision (training and identification/referral models).Discussion and conclusionIndian models differ significantly to those in high-income countries-there are less professional PHWs used across all models. There is also intensive specialist involvement particularly in the community outreach and collaborative care models. Excessive reliance on specialists inhibits their scalability, though they may be useful in targeted interventions for severe mental disorders. We propose a revised framework of models based on our findings. The current priorities are to evaluate the comparative effectiveness, cost-effectiveness and scalability of these models in resource-limited settings both in India and in other low- and middle- income countries.

Project description:BackgroundDespite the limited genetic heterogeneity of Spanish populations, substantial evidences support that historical African influences have not affected them uniformly. Accounting for such population differences might be essential to reduce spurious results in association studies of genetic factors with disease. Using ancestry informative markers (AIMs), we aimed to measure the African influences in Spanish populations and to explore whether these might introduce statistical bias in population-based association studies.Methodology/principal findingsWe genotyped 93 AIMs in Spanish (from the Canary Islands and the Iberian Peninsula) and Northwest Africans, and conducted population and individual-based clustering analyses along with reference data from the HapMap, HGDP-CEPH, and other sources. We found significant differences for the Northwest African influence among Spanish populations from as low as ? 5% in Spanish from the Iberian Peninsula to as much as ? 17% in Canary Islanders, whereas the sub-Saharan African influence was negligible. Strikingly, the Northwest African ancestry showed a wide inter-individual variation in Canary Islanders ranging from 0% to 96%, reflecting the violent way the Islands were conquered and colonized by the Spanish in the XV century. As a consequence, a comparison of allele frequencies between Spanish samples from the Iberian Peninsula and the Canary Islands evidenced an excess of markers with significant differences. However, the inflation of p-values for the differences was adequately controlled by correcting for genetic ancestry estimates derived from a reduced number of AIMs.Conclusions/significanceAlthough the African influences estimated might be biased due to marker ascertainment, these results confirm that Northwest African genetic footprints are recognizable nowadays in the Spanish populations, particularly in Canary Islanders, and that the uneven African influences existing in these populations might increase the risk for false positives in association studies. Adjusting for population stratification assessed with a few dozen AIMs would be sufficient to control this effect.

Project description:BackgroundOur aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics.MethodsA cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample.ResultsOn a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants.ConclusionsFamily doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

Dataset Information

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

Publications

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case<b>-</b>control studies.

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