Self-Care and Sense of Coherence: A Salutogenic Model for Health and Care in Nursing Education.

BACKGROUND: Effective advocacy on self-care and the enhancement of a sense of coherence among nurses don't only benefit control over one's health and personal performance, but it may have a direct impact on clinical care and on the entire healing system. In this regard, nursing curricula grounded on a salutogenic model of health (SMH) operate with strategies to engage students in self-care and contribute to improving their mental health and wellbeing. The aim of this study was to explore the relationships between self-care agency and a sense of coherence as dependent variables and the age and self-reported academic performance as independent variables in nursing assistant students. METHODS: For this cross-sectional study, data were collected from a full sample of 921 Certified Nursing Assistant (CNA) Spanish students. A self-administered questionnaire, including sociodemographic variables, the 'appraisal of self-care agency' (ASA), and the 'sense of coherence' (SOC) constructs, was administered. RESULTS: Older participants presented significantly stronger values of both constructs. Apart from a significant and positive correlation between ASAS and SOC, ANOVA analyses indicate significant differences in terms of academic performance according to different ASAS and SOC degrees. CONCLUSIONS: The findings of this study endorse the assumption that there is a consistent relationship between ASA and SOC constructs that might, indeed, have a potential effect on students' academic performance. In practical terms, it seems relevant to try to recognise the students' self-care agency and the sense of coherence as forceful predictive variables of mental health and wellbeing, in addition to academic success as a strength implied in the future career achievement.

[Theory of change implemented in the program to promote physical activity "La Ribera Camina"]. / Teoría del cambio aplicada al programa de promoción de la actividad física «La Ribera Camina¼.

OBJECTIVE: To develop a theory of change of a program to promote physical activity in eleven health districts, in order to improve its design and plan its evaluation. METHOD: Four focus groups were carried out, to develop a participatory theory of change, to identify the expected changes (long, medium and short term) of "La Ribera Camina" program, according to the following stakeholders: primary healthcare professionals, local government representatives and community members. A thematic analysis was used to identify the actions to be taken to achieve these changes, as well as the difficulties and facilitators to enhance the sustainability of the program. RESULTS: The identified changes were classified into four themes: 1) changes in physical and social health (improved physical condition, healthy habits, self-esteem and perceived well-being); 2) organizational and relational changes (better coordination between institutions); 3) specific changes to the program (incorporation of more "assets" and local associations, especially male participants, more trails and schedules); and 4) changes in the environment (improved trails' infrastructures and safety). CONCLUSIONS: The theory of change allows to identify and classify the changes that are expected, the actions to be carried out and the links between elements of the program. This will serve as the basis for its evaluation. This methodology could be applied to other programs interested in incorporating intersectorality and community engagement in their design and evaluation.

Associations and community health workers: analysis and time trends over ten years of training-action.

OBJECTIVE: To analyse the profile of the persons and associations that participated in the course, quantify peer education activities and analyse their evolution. METHOD: A quantitative study using an analysis of the course records from 2009 to 2018 was designed for this purpose inside mihsalud program designed to promote health amongst persons in vulnerable situations in the city of Valencia (Spain). It offers a yearly training-action course of community health workers (CHW) that is attended by persons who have been proposed by associations. The associations were defined according to their population (immigrant, local or intercultural) and the CHWs according to gender, country of birth, year of course, association and continuity after training. Means and confidence intervals were calculated at 95% and a bivariate analysis was conducted in order to compare the activities that took place in 2009 to 2013 with those of 2014 to 2018. The time trends were analysed by applying linear regression models that included the different years studied as the dependent variable. RESULTS: 201 CHW of 31 nationalities were trained, 81.6% (95% confidence interval [95% CI]: 75.5-86.7] were women. Eighty-two associations participated, 51.2% (95% CI: 39.9-62.4] worked with culturally diverse populations. Participation by associations (p=.017) and CHWs (p=.377) increased in a statistically significant manner over the years. After the course, 35.3% (95% CI: 28.7-42.4] of the CHWs continued to collaborate voluntarily in the associations. CONCLUSIONS: The results of the CHW training-action course improve over time given that a significant increase in participation by associations and women can be seen, along with a greater number of activities completed during the training. One effect of this is that CHWs are contracted or carry out voluntary activities in the associations.

Health Assets, Vocation and Zest for Healthcare work. A Salutogenic Approach to Active Coping among Certified Nursing Assistant Students.

People's health assets (HA) mapping process and design dynamization strategies for it are paramount issues for health promotion. These strategies improve the health heritage of individuals and communities as both the salutogenic model of health (SMH) and health assets model (HAM) defend. Connecting and mobilizing HA and strengthens the 'sense of coherence' (SOC) are both related to enhancing stress active and effective coping strategies. This study aims to describe the HA present in a population of certified nursing assistant students (n = 921) in Spain and then to explore their relationships with the SOC, the motivation to choose healthcare studies and their academic performance. A great variety of HA were identified and mapped. Findings showed that individuals with greater motivation towards self-care and 'caring for others' as internal HA, possessed higher SOC levels and a strong vocation for healthcare work. Differences in HA were identified according to gender, age and employment situation. Consistent connections between the care-relation factor and vocational factor with interpersonal and extrapersonal HA were reported. Evidence and results substantiated the salutogenic and asset-based approach as a proper strategy to strengthen SOC, dynamize their HA map, reinforce the sense of calling and enable Certified Nurse Assistant (CNA) students to buffer against caregiving-related stress and thrive in their profession.

Community engagement to promote health and reduce inequalities in Spain: a narrative systematic review.

OBJECTIVES: Over the past decade, increasing attention has been paid to community engagement in health (CEH) across Europe. This study aimed to identify and review CEH interventions to promote health and reduce inequalities within the Spanish context and the key facilitators for these community processes. METHODS: A systematic search in six databases, followed by a forward citation search, was conducted to identify implementation literature on CEH in Spain. Articles were included when engagement occurred in at least two stages of the interventions and was not limited to information or consultation of stakeholders. RESULTS: A total of 2023 results were identified; 50 articles were reviewed full text. Five articles were finally selected for inclusion. Data were extracted on various factors including details of the interventions, results achieved, stakeholders involved and their relationships. A narrative synthesis was performed to present results and support the discussion. CONCLUSIONS: Three main points are discussed: the role of professionals and citizens in CEH interventions, providing training to enable a reorientation towards a CEH practice and the relevance of contexts as enablers for community engagement processes to thrive.

[Theory of change: a tool for participatory planning and evaluation in community health]. / La teoría del cambio: una herramienta para la planificación y la evaluación participativa en salud comunitaria.

There is a growing interest in finding innovative approaches to the evaluation of complex interventions in public health. This methodological note presents the theory of change as a useful tool to facilitate both the planning and the evaluation of community health promotion interventions. A theory of change is a visual representation of how a programme or intervention works, in which its different components can be identified, together with how they relate to each other: what its objectives are, its expected results and through which actions they are expected to be achieved. It can be an applied research tool, developed using participatory approaches together with all relevant stakeholders, who can identify and jointly decide what to evaluate and how to.

Sense of coherence, academic performance and professional vocation in Certified Nursing Assistant students.

BACKGROUND: The sense of coherence (SOC) of the salutogenic health model explains why people in stressful situations are able to maintain or even improve their health. There are some studies on which measures are more effective to reduce stress in Nursing assistant students. There are no studies that link SOC with the two key aspects in the prevention of stress in Nursing assistant students: the motivation of pursuing this profession and the academic level. OBJECTIVES: To explore the salutogenic paradigm among Nursing assistant students in a region of Spain (Comunitat Valenciana). DESIGN: Cross-sectional, analytical and exploratory study carried out in 2016. METHODS: Students of the first year of Nursing Assistant certification. Self-administered questionnaire to collect the variables: Sense of Coherence (SOC-13 instrument); professional vocation; Self-reported grades of the academic record. RESULTS: The mean score for the total SOC measurement was M = 56.38 (SD = 12.236; 71). Regarding the SOC components, the average score was for Manageability M = 16.45 (SD = 4.53; 24); Comprehensibility M = 19.27 (SD = 5.642; 30) and Meaningfulness M = 20.65 (SD = 4.48; 23). Students who lived in rural environments presented a weaker SOC (M = 54.05), compared to those who were located in urban environments (M = 56.83) and large cities (M = 56.15). The students who reported a choice of studies motivated by professional vocation presented a stronger SOC, scoring also a remarkable academic performance (p < 0.05). CONCLUSIONS: Strong levels of SOC in Nursing assistant students, are related to a greater motivation to study something desirable, and to obtaining high academic performance, despite being a demanding and high-stress profession. Therefore, a strong SOC seems to contribute to being more resistant to stress. The environments that provide and facilitate greater external resources such as health, education, culture, association, leisure and recreation, for the community, have higher global levels of sense of coherence.

[Evidence of community engagement in health in Spain: thoughts and proposals. SESPAS Report 2018]. / Evidencia sobre la participación comunitaria en salud en el contexto español: reflexiones y propuestas. Informe SESPAS 2018.

Community engagement has recently become key in the development of health promotion programmes at a local level. However, evidence-based tools are necessary to implement strategies and interventions with a participatory approach. The objective of this article is to reflect on the existing evidence in Spain about community engagement in health, drawing on the results of the AdaptA GPS Project (Adapt and Apply Health Promotion Guidelines), intended to adapt NICE guideline NG44 on community engagement to improve health and wellbeing, and to reduce inequalities. After describing the methodology for the adaptation process, we discuss some of the findings from the review of the evidence on community engagement in the Spanish context. We ask whether the limited evidence identified is due to the difficulties involved in evaluating these interventions, or to the lack of interest in these programmes and the limited resources and funding dedicated to them. Two recommendations are proposed: to promote more and better research, fostering training, research and evaluation towards the development of community engagement interventions in health, and to promote more and better interventions using evidence-based tools, supporting their long-term sustainability by taking into account the time needed for community engagement programmes to be properly developed. Generating more evidence on community engagement in health in Spain will allow us to learn from successful processes and encourage the transfer of good practice to different contexts.

[Changes attributed to a program based on the action-training of health agents. What do the associations say?] / Cambios atribuidos a un programa basado en la formación-acción de agentes de salud ¿Qué dicen las asociaciones?

OBJECTIVE: Interventions aimed at improving health must take into account the health inequalities and the target the population in need. The mihsalud program (Women, Children and Men creating health) promotes health in vulnerable populations through engaging and collaborating with the local third sector. The objective of the study was to describe the changes attributed to the mihsalud programme and the process of action-training of community-based health volunteers (ASBC in Spanish) as perceived by the local organizations where they work or volunteer. METHODS: Qualitative descriptive study through semi-structured interviews with representatives of organizations that trained ASBC during 2012 in Valencia. Twelve semi-structured interviews were conducted with representatives of organizations which had trained some of their volunteers to become ASBC during the 2012 action-training session. The interviews were transcribed verbatim and analysed with the programme for qualitative analysis Nvivo. Themathic analysis was performed: transcripts were coded line by line from an inductive perspective. RESULTS: Three main categories were identified: 1) The role of the ASBC: The associations recognise the role of the ASBC among their peers and the importance of the training received in the program; 2) Perceived changes: The associations recognize having a broader vision of health, identify the role of the figure ASBC that coordinates with health professionals in their health area and networking with other associations that were previously unknown; 3) Challenges and opportunities: Lack of support for the continuity of projects with ASBC due to the precariousness of small organisations and coordination with services, recognition at the local level and promotion of participation and interculturality through ASBC and their peers. CONCLUSIONS: The organizations recognize that the program and ASBC have made collaboration with health sector possible, have promoted health among their peers and have encouraged networking with other organizations and areas.

OBJETIVO: Las intervenciones dirigidas a mejorar la salud deben tener en cuenta las desigualdades de la población y orientarse a la población más necesitada. El programa mihsalud (Mujeres, Infancia y Hombres construyendo salud) promueve la salud en poblaciones en situación de vulnerabilidad implicando al ámbito asociativo. El objetivo del estudio fue describir los cambios atribuidos al programa mihsalud y al proceso de formaciónacción de agentes de salud de base comunitaria (ASBC) por parte de las asociaciones a las que pertenecen. METODOS: Estudio descriptivo cualitativo mediante entrevistas semiestructuradas a representantes de asociaciones participantes que formaron ASBC durante 2012 en Valencia. Se realizaron 12 entrevistas semiestructuradas con representantes de asociaciones que formaron ASBC tras 4 años de la formación. Las entrevistas se transcribieron verbatim y se analizaron con el programa para análisis cualitativo "Nvivo (análisis temático)": Las transcripciones se codificaron línea por línea con perspectiva inductiva. RESULTADOS: Se agruparon en tres categorías principales: 1) Reconocimiento del rol del ASBC: Las asociaciones reconocieron el rol del ASBC entre sus iguales y la importancia de la formación recibida; 2) Cambios percibidos: Las asociaciones reconocieron tener una visión más amplia sobre la salud, identificaron el rol del ASBC que se coordina con los profesionales sanitarios de su zona de salud y el trabajo en red con otras asociaciones que antes desconocían; 3) Dificultades y oportunidades: La falta de apoyo para la continuidad de los proyectos vinculados con ASBC por la precariedad de las asociaciones pequeñas; y la coordinación con los servicios, el reconocimiento a nivel local y el fomento de la participación e interculturalidad a través de ASBC y sus iguales. CONCLUSIONES: Las asociaciones reconocen que el programa y ASBC han hecho posible la colaboración con recursos sanitarios, han promocionado la salud entre sus iguales y han fomentado el trabajo en red.

[Applicability and perceived utility of the European Quality Instrument for Health Promotion (EQUIHP) in a health promotion programme]. / Aplicabilidad y percepción de utilidad del European Quality Instrument for Health Promotion (EQUIHP) en un programa de promoción de la salud.

OBJECTIVE: To describe the results of applying the European Quality Instrument for Health Promotion (EQUIHP) tool in the MIHsalud programme and to discuss its perceived utility by the programme's team members. METHOD: Evaluation study applying EQUIHP to a health promotion programme. A total of ten MIHsalud staff (eight women and two men) completed the EQUIHP and participated in two group interviews to discuss its perceived utility. RESULTS: The programme obtained a total score of 6.5 points out of 10 in quality. The use of EQUIHP enabled the programme's weaknesses to be identified, such as lack of a communication plan, evaluability and sustainability; as well as its strengths, such as the inclusion of health promotion principles. The MIHsalud team believes that the EQUIHP is a useful tool which can facilitate a comprehensive evaluation of the programme in terms of a health promotion initiative. CONCLUSION: The use of the EQUIHP has made it possible to evaluate the quality of the programme and to make recommendations for its improvement, and it could be applied to other programmes and activities.

Sentido de coherencia y mapa de activos para la salud en jóvenes presos de la Comunidad Valenciana en España.

Estudio realizado desde el enfoque de la salutogénesis que pretende determinar el sentido de coherencia (SOC) en jóvenes presos de la Comunidad Valenciana en España y elaborar un mapa de activos para la salud dirigido a promover la salud en esta población. Se utilizó el test "SOC-13" y un cuestionario de preguntas abiertas elaborado ad hoc, el cual autocompletaron los internos de 18 a 22 años de edad, de los tres centros penitenciarios de la región. Participaron 124 jóvenes varones (ya que no había ninguna mujer) y se recogieron variables sociodemográficas y penitenciarias. En el análisis cuantitativo, las variables categóricas se expresaron como frecuencias absolutas y relativas; y las cuantitativas, mediante medias con intervalos de confianza (IC) al 95%. Se realizó un estudio comparativo bivariante, utilizando las siguientes pruebas: Student t-test, análisis de variación (ANOVA), Wilcoxon y Ji-cuadrado. Del cuestionario de preguntas abiertas, se realizó un análisis cualitativo descriptivo temático de los activos identificados, clasificándolos en: internos (recursos personales, en relación con los demás y capacidad para realizar comportamientos saludables) y externos (personas, grupos, instituciones y espacios físicos, situados tanto dentro como fuera de prisión). La edad media fue de 21,1 años (IC 95%: 20,8-21,3); y el SOC de 52,4 (IC 95%: 50,5-54,3), de entre un valor mínimo de 13 y máximo de 91 para la prueba. Los internos del centro penitenciario que ofrecía más actividades escolares y deportivas obtuvieron una puntuación mayor en la dimensión de significatividad del SOC ( p = 0,024), y los internos inmigrantes presentaron un SOC superior ( p = 0,037) a los españoles, en los tres centros. Los jóvenes identificaron los activos internos que cualitativamente se vinculan con las dimensiones de comprensibilidad, manejabilidad y significatividad del SOC; y los activos externos, sobre todo los amigos, familiares y espacios relacionados con la actividad físico-deportiva, tanto dentro como fuera de prisión. Estos activos y sus interrelaciones podrían incorporarse al diseño de futuras intervenciones de promoción de la salud.

Promoting good practice in health promotion in Spain: the potential role of a new agency.

Health promotion (HP) activities should be evaluated both in terms of process and results. However there remains a lack of information regarding the types of HP community interventions that are performed in our country, which of these are based on the best available evidence, and how the evidence available can be translated into HP recommendations for action? Spain does not have a dedicated body to answer such questions. If one existed, its role should be to identify the full range of interventions available to promote health, evaluate them and, in cases where there are positive results, facilitate their transfer and implementation. The aim of this article is to reflect on the need and usefulness of an institution with these functions. It also aims to identify the possible strengths and weaknesses of such an institution and what external experiences could be used in developing it. The discussion draws on the experience of the National Institute for Health and Care Excellence (NICE) highlighting possibilities for collaborative strategies. One might argue that the largely published English language evidence base needs simply to be translated to improve knowledge. However, good practice in HP is based and nurtured within the context where it is to be implemented. Therefore, a strategy to improve practice cannot rely solely on direct translations. Successful evidence-based HP must rely not only on robust scientific evidence but also on a process that ensures appropriate contextualization, that tests methodologies and develops guidance for action appropriate to the country, and that systematizes the process and evaluates the impact once the guidance have been put into practice.

[A good investment: promoting health in cities and neighbourhoods]. / Una buena inversión: la promoción de la salud en las ciudades y en los barrios.

Local administration is responsible for health-related areas, and evidence of the health impact of urban policies is available. Barriers and recommendations for the full implementation of health promotion in cities and neighbourhoods have been described. The barriers to the promotion of urban health are broad: the lack of leadership and political will, reflectes the allocation of health outcomes to health services, as well as technical, political and public misconceptions about the root causes of health and wellbeing. Ideologies and prejudices, non-evidence-based policies, narrow sectoral cultures, short political periods, lack of population-based health information and few opportunities for participation limit the opportunities for urban health. Local policies on early childhood, healthy schools, employment, active transport, parks, leisure and community services, housing, urban planning, food protection and environmental health have great positive impacts on health. Key tools include the political prioritisation of health and equity, the commitment to «Health in All Policies¼ and the participation of communities, social movements and civil society. This requires well organised and funded structures and processes, as well as equity-based health information and capacity building in the health sector, other sectors and society. We conclude that local policies have a great potential for maximising health and equity and equity. The recommendations for carrying them out are increasingly solid and feasible.

[Immigrant women care in a health intercultural mediation program]. / Atención a mujeres inmigrantes en un programa de mediación intercultural en salud.

BACKGROUND: Intercultural Mediation is a strategy for quality health care aimed at reducing inequalities in immigrant population. The aim is to analyse main reasons consultation with the mediation service, women care profile and characteristics of intervention. METHODS: Cross-sectional study of 339 episodes of care by two intercultural mediators (MI) from February 2008 to October 2011 in Valencia. Variables were analysed individual records of the consultations of the MI: reasons for referral to MI and professionals who refer, motives and problems identified by MI, kind of intervention, kind of derivation of MI and socio-economic variables. To evaluate the differences between countries, X2 test was used for qualitative variables and one-way ANOVA test for quantitative variables. RESULTS: 123 women (36,3%), were referred to the MI by the Sexual and Reproductive Health Centre and 98 (28,9%) by the midwife. 272 women (80,24%) were referred for information and demand for contraception. The MI conducted health education and detected social problems in 67 women (19,7%) and gender violence in 38 (11,21%). CONCLUSIONS: The women attending were Latin American immigrants (those of Bolivia showed more vulnerability) and were referred for contraception. The MI provided information, education and facilitated access to reproductive health services. Bolivian women showed more vulnerability factors: irregular situation, precarious work and low residence time.

[RIU project: perceived changes by health agents and professionals after a health intervention in an urban area of socioeconomic disadvantage]. / Projecte RIU: cambios percibidos por agentes de salud y profesionales tras una intervención en salud en un barrio en situación de vulnerabilidad.

OBJECTIVE: To describe how health agents and professionals working in a community project perceive the changes related to the population health status and their use of health-care services after the RIU intervention in an urban area of socioeconomic disadvantage. DESIGN: A qualitative descriptive study based on individual and group interviews and participant observation conducted between October 2008-July 2009. LOCATION: Raval (Algemesí-Valencia) PARTICIPANTS: We selected by purposive sample 7 women health agents, all persons who completed the intervention, and 10 professionals for their involvement in the intervention. METHOD: We conducted a group interview with the women at 6 months and a group and 7 individuals interviews both at 9 months of intervention. We realized a thematic descriptive analysis from health promotion framework. We used participant observation in a meeting with professionals at 9 months and analyzed field notes as: appraisal project, detected changes, challenges and recommendations. RESULTS: Women acquired information about health, contraception, pregnancy and heath services; they noted changes in self-care and social skills and leadership; they internalized the role of health worker disseminating what they learned and showed improvement in self-esteem and social recognition. They caused changes in the people related on health care and access to services. Professionals didn't incorporate at their work the community perspective; they valued positively the project; professionals and women agreed on improving access and use of services and closeness population-professionals. CONCLUSIONS: RIU increases the capabilities of the participants, their social recognition and improves access and use of health services.

[Experience of knowledge translation in the ITSAL (immigration, work and health) research project with representatives of the target population]. / Experiencia de transferencia de conocimiento en el proyecto de investigación ITSAL (Inmigración, Trabajo y SALud) con representantes de la población diana.

This article describes the experience of knowledge translation between researchers of the ITSAL (immigration, work and health) project and representatives of organizations working with immigrants to discuss the results obtained in the project and future research lines. A meeting was held, attended by three researchers and 18 representatives from 11 institutions. Following a presentation of the methodology and results of the project, the participants discussed the results presented and research areas of interest, thus confirming matches between the two sides and obtaining proposals of interest for the ITSAL project. We understand the process described as an approach to social validation of some of the main results of this project. This experience has allowed us to open a channel of communication with the target population of the study, in line with the necessary two-way interaction between researchers and users.

[How to design workshops to promote health in community groups]. / Cómo diseñar talleres para promover la salud en grupos comunitarios.

One of the strategies of health promotion is to develop life skills people considering themselves as the main health resource. A workshop has to get its participants become «asset¼ to make decisions and create health, focusing on the development and acquisition of skills in a motivating group and in order to achieve health objectives. The concepts behind the design of a workshop are: participatory planning, training, meaningful learning, group learning and participatory techniques. The steps to follow to design a workshop and facilitate their application are: Stage 0, founding; initial stage, host and initial evaluation; central or construction stage based learning in the acquisition of knowledge, attitudes and skills, and final stage or evaluation.