Midwives' experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project.

BACKGROUND: The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The "Operational Refugee and Migrant Maternal Approach" (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives' experiences of the training and providing care within the ORAMMA project. METHODS: Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives' experiences of the training and of caring for migrant women within the ORAMMA project. RESULTS: A significant improvement of the median score pre to post-test was observed for midwives' knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives' experiences of the training revealed themes of "appropriate and applicable", "made a difference" and "training gaps" and data from ORAMMA project experiences identified three further themes; "supportive care", "working alongside peer supporters" and "challenges faced". CONCLUSIONS: The training improved midwives' knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters' roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Participatory implementation research in the field of migrant health: Sustainable changes and ripple effects over time.

OBJECTIVE: This study aimed to explore whether positive impacts were sustained and unanticipated ripple effects had occurred four years after the implementation of interventions to improve cross-cultural communication in primary care. BACKGROUND: Sustaining the implementation of change using complex interventions is challenging. The EU-funded "RESTORE" study implemented guidelines and training on cross-cultural communication in five Primary Care sites in Europe, combining implementation theory (Normalisation Process Theory) with participatory methodology (participatory learning and action-PLA). There were positive impacts on knowledge, skills and clinical routines. DESIGN, SETTING AND PARTICIPANTS: Four of the five original sites (England, Ireland, Greece, The Netherlands) were available for this qualitative follow-up study. The study population (N = 44) was primary healthcare staff and migrants, most of whom had participated in RESTORE. INTERVENTION; MAIN OUTCOME MEASURES: PLA-style focus groups and interviews explored routine practice during consultations with migrants. Etic cards based on the effects of RESTORE stimulated the discussion. Deductive framework analysis was performed in each country followed by comparative data analysis and synthesis. RESULTS: Changes in knowledge, attitudes and behaviour with regard to consultations with migrants were sustained and migrants felt empowered by their participation in RESTORE. There were ongoing concerns about macro level factors, like the political climate and financial policies, negatively affecting migrant healthcare. CONCLUSION: There were sustained effects in clinical settings, and additional unanticipated positive ripple effects, due in part, from the participatory approach employed.

'Very brief advice' (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user's perspective.

BACKGROUND: Very Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients' motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA. METHODS: Semi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data. RESULTS: The majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP's VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports. CONCLUSIONS: VBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient's motivation to make an aided quit attempt.

Material practices for meaningful engagement: An analysis of participatory learning and action research techniques for data generation and analysis in a health research partnership.

BACKGROUND: The material practices which researchers use in research partnerships may enable or constrain the nature of engagement with stakeholder groups. Participatory learning and action (PLA) research approaches show promise, but there has been no detailed analysis of stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. OBJECTIVES: To explore stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. DESIGN: The EU RESTORE implementation science project employed a participatory approach to investigate and support the implementation of guidelines and training initiatives (GTIs) to enhance communication in cross-cultural primary care consultations. We developed a purposeful sample of 78 stakeholders (migrants, general practice staff, community interpreters, service providers, service planners) from primary care settings in Austria, England, Greece, Ireland and The Netherlands. We used speed evaluations and participatory evaluations to explore their experiences of two PLA techniques-Commentary Charts and Direct Ranking-which were intended to generate data for co-analysis by stakeholders about the GTIs under analysis. We evaluated 16 RESTORE researchers' experiences using interviews. We conducted thematic and content analysis of all evaluation data. RESULTS: PLA Commentary Charts and Direct Ranking techniques, with their visual, verbal and tangible nature and inherent analytical capabilities, were found to be powerful tools for involving stakeholders in a collaborative analysis of GTIs. Stakeholders had few negative experiences and numerous multifaceted positive experiences of meaningful engagement, which resonated with researchers' accounts. CONCLUSION: PLA techniques and approaches are valuable as material practices in health research partnerships.

Guidelines and training initiatives that support communication in cross-cultural primary-care settings: appraising their implementability using Normalization Process Theory.

BACKGROUND: Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their implementation and identify G/TIs likely to be successfully implemented in practice. OBJECTIVE: To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT). METHODS: RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT. RESULTS: 20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT. CONCLUSIONS: NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.

A systematic review of training interventions addressing sexual violence against marginalized at-risk groups of women.

Women from marginalized groups working in occupations such as domestic work are at increased risk for sexual violence. Scarce evidence exists about training interventions targeting such groups. The article aims to identify community and workplace-based training interventions aiming to increase capacity among marginalized at-risk women to deal with sexual violence. A systematic review was applied. Inclusion criteria were English language published between 2003 and 2013; reporting on delivery and/or evaluation; focusing on any form of sexual violence; delivered to professionals, affected or at-risk women; targeting migrant, at-risk women or domestic workers. Data were extracted on the setting, content, evaluation process and target population. Four studies which focused on prevention or responding to sexual violence were included. One study provided sexual violence training to vulnerable female and one provided a HIV prevention intervention to marginalized women. Learning objectives included increasing knowledge around issues of sexual violence and/or gender and human rights, prevention and response strategies. Two studies aimed to train trainers. All studies conducted an outcome evaluation and two a process evaluation. It seems there is a gap on participatory empowerment training for marginalized women. Community train-the-trainer interventions are imperative to protect themselves and deal with the risk of sexual violence.

Prevalence and correlates of young people's sexual aggression perpetration and victimisation in 10 European countries: a multi-level analysis.

Data are presented on young people's sexual victimisation and perpetration from 10 European countries (Austria, Belgium, Cyprus, Greece, Lithuania, the Netherlands, Poland, Portugal, Slovakia and Spain) using a shared measurement tool (N = 3480 participants, aged between 18 and 27 years). Between 19.7 and 52.2% of female and between 10.1 and 55.8% of male respondents reported having experienced at least one incident of sexual victimisation since the age of consent. In two countries, victimisation rates were significantly higher for men than for women. Between 5.5 and 48.7% of male and 2.6 and 14.8% of female participants reported having engaged in a least one act of sexual aggression perpetration, with higher rates for men than for women in all countries. Victimisation rates correlated negatively with sexual assertiveness and positively with alcohol use in sexual encounters. Perpetration rates correlated positively with attitudes condoning physical dating violence and with alcohol use in men, and negatively with sexual assertiveness in women. At the country level, lower gender equality in economic power and in the work domain was related to higher male perpetration rates. Lower gender equality in political power and higher sexual assertiveness in women relative to men were linked to higher male victimisation rates.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries.

BACKGROUND: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. METHODS: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. RESULTS: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. CONCLUSIONS: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

The Silver Lining of Posttraumatic Growth around the Dark Side of the COVID-19 Pandemic: A School-Based Intervention with Mindfulness and Character Strengths Practices among Children.

The theory of posttraumatic growth (PTG) proposes that from life difficulties positive changes can happen, such as deepened personal relationships and an awareness of new possibilities in life. PTG can occur naturally or can be facilitated. This study aimed to promote PTG through a school-based intervention of eight sessions of 45 min each with mindfulness and character strengths practices (the so-called "The exploration of happiness during the COVID-19 pandemic"). The study conducted assessments at baseline, post-intervention, and follow-up (i.e., one month after the intervention). The post-intervention results showed that the participants in the intervention group experienced an improvement in PTG, well-being, mindfulness, strengths use, and PTS symptoms compared to the children in the control group. Furthermore, these positive changes were sustained at follow-up. The findings of this study highlight that mindfulness-based strengths practices can increase positive outcomes (i.e., well-being, posttraumatic growth) and reduce negative psychological symptoms (PTS) among children. The implications for theory and practice are discussed, and detailed appendices for practitioners are provided.

Measuring the effectiveness of an intensive IPV training program offered to Greek general practitioners and residents of general practice.

BACKGROUND: The need for effective training of primary care physicians in the prevention, detection and handling of intimate partner violence (IPV) has been widely acknowledged, given its frequency in daily practice. The current intervention study aimed to measure changes in the actual IPV knowledge, perceived knowledge, perceived preparedness and detection ability of practicing general practitioners (GPs) and general practice residents, following an intensive IPV training program. METHODS: A pre/post-test design with a control group was employed to compare changes in baseline measures of IPV at the post intervention stage and at 12 months. A total of 40 participants provided full data; 25 GPs (11 in the intervention and 14 in the control) and 15 residents (intervention only). Three scales of the PREMIS survey were used to draw information on the study outcomes. RESULTS: The training program met high acceptance by both groups of participants and high practicality in clinical practice. The GPs in the intervention group performed better than the GPs in the control group on "Perceived preparedness" and "Perceived knowledge" in both the post-intervention (p= .012, r= .50 and p= .001, r= .68) and the 12-month follow-up (p= .024, r= .45 and p= .007, r= .54) as well as better than the residents in "Perceived preparedness" at post-intervention level (p= .037, r= .41). Residents on the other hand, performed better than the GPs in the intervention group on "Actual knowledge" at the 12-month follow-up (p= .012, r= .49). No significant improvements or between group differences were found in terms of the self-reported detection of IPV cases. CONCLUSION: Further studies are needed to decide whether residency training could serve as an early intervention stage for IPV training.

Depression and Driving.

We have recently published an article in the International Journal of Environmental Research and Public Health presenting the results of our study on the driving behaviour of patients with depression.1 This is the first study conducted on the Greek population assessing the fitness-to-drive of patients with psychiatric disorders through the use of questionnaires and driving simulator. Similar studies in Greece have only been performed among patients with neurological conditions such as Parkinson's disease and mild cognitive impairment.2,3 The aim of the present communication is to discuss our findings in the light of the Greek law and regulations on driving licensure and on the evaluation of driving ability. The main findings of our study add evidence in this discussion by indicating that patients with depression (N=39) do not differ from controls (N=30) regarding their scores on the self-report questionnaires Driver Stress Inventory and Driver Behaviour Questionnaire. The DSI assesses the propensity to develop stress reactions while driving and consists of subscales for driving aggression, dislike of driving, hazard monitoring, thrill seeking, and proneness to fatigue. The DBQ assesses driving behaviour by the subscales of driving errors, traffic violations, and attention lapses. Driving simulator results showed very few differences between patients and controls in terms of their performance on the three selected driving scenarios. The sole difference found between patients and controls was that the former exhibited lower ability to maintain a stable track of the vehicle (measured as the standard deviation of lateral position) only in the rural road scenario. On the other hand, safety distance from the preceding vehicle was found to be higher in patients than in controls, indicating that patients, possibly aware of their somewhat impaired driving ability, tend to drive more carefully.1 These findings provide a plausible explanation for existing conflicting study results, which do not clearly show depression to be associated with susceptibility to traffic accidents and increased crash risk .4-6 International guidelines do not suggest a blanket restriction on the driving licensure of individuals with psychiatric disorders. Instead, there are recommendations for an approach based on the severity of the disorder, insight, adherence to treatment, level of cognitive impairment, and period of stability.7,8 Regulations in Greece are more restrictive, guided by laws 148/08.08.2016 and 5703/09.12.2021, which define the minimum requirements for licensure in certain medical conditions. A psychiatric examination is requested by internists, upon suspicion of a mental health issue and the psychiatric diagnosis assigns a competence level to the patient ("competent" or "non-competent"). The condition can be re-evaluated upon the patient's request after the lapse of one year from the initial examination; in certain conditions, renewal of driving licensure is permitted after a three-year interval in euthymia for individuals manifesting good functionality and social adjustment, provided that no sedative medication is prescribed. There is a need, therefore, for the Greek government to reconsider the minimum requirements for the licensure of patients with depression and the time intervals for evaluation of driving competence, which are not supported by research evidence. Setting a minimum time restriction of 1 year, unconditionally for all patients, does not seem to contribute to risk reduction, while on the contrary, it reduces patient autonomy and social connectivity, increases stigma, and may result in social exclusion, isolation, and the development of depression.9 Thus, it is important for the law to introduce an individualised approach with pros and cons being weighed per case, based on the existing scientific knowledge regarding the contribution of each disease to the risk of road traffic collisions and the clinical status of the patient at the time of the assessment.

Design, Implementation and Evaluation of an Innovative Pilot Intervention to Improve the Family Quality of Life of Children with Specific Learning Disabilities-A Randomized Controlled Trial.

Background: The high prevalence of learning disabilities among children confirm that learning disabilities are surprisingly common. In the absence of routine screening, many children still go undetected with a huge individual and family burden, while at the same time, the findings of existing interventions are conflicting. This study reports on the design, implementation and evaluation of an innovative pilot intervention aiming at improving the quality of life of the family of children with specific learning disabilities. Method: For the purposes of this study, we ran a randomized controlled trial employing an experimental research design with two groups (intervention and control). The study population comprised parents of children with specific learning disabilities. Out of the 71 individuals that were eligible for randomization, 42 were allocated to the intervention, and 29 to the control group. A brief parenting intervention model was employed, aiming at improving parenting skills through a stepwise process. The intervention included four skill building sessions conducted over a period of 6 weeks. "Parenting style" (including three dimensions: "Authoritative", "Authoritarian" and "Permissive") and "Family Quality of life" (including five dimensions: "Family Interaction", "Parenting", "Emotional Well-being", "Physical/Material Wellbeing" and "Disability-Related Support") were employed as the outcome measures of this study. Two validated questionnaires were used to measure the study outcomes: "the Parenting Style Questionnaire" and the "Family Quality of Life Scale (FQOL) Questionnaire". The questionnaires were applied at the pre- and post-intervention level. Findings: An analysis showed that except for the "permissive parenting style", the intervention and control group had statistically significant differences in all the "Parenting style" and the "Quality of life" dimensions at the post-intervention level. In the intervention group, none of the study dimensions improved at a statistically significant level at the post-intervention level compared to pre-intervention level. According to the cluster analysis, which re-examined successful vs. unsuccessful cases, the intervention was found to have an effect on the average values of all the "quality of life" and "parenting style" dimensions, except for the "Authoritarian Parenting Style". Conclusions: The study offers evidence on the dimensions of parenting and quality of life mostly affected by a brief intervention as well as on the feasibility, practicality and acceptance of such interventions in local communities.

Driving Behaviour in Depression Based on Subjective Evaluation and Data from a Driving Simulator.

Road traffic collisions are a major issue for public health. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Patients with depression (N = 39) and healthy controls (N = 30) were asked to complete questionnaires and to drive on a driving simulator in different scenarios. Driving simulator data included speed, safety distance from the preceding vehicle and lateral position. Demographic and medical information, insomnia (Athens Insomnia Scale, AIS), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Fatigue Severity Scale, FSS), symptoms of sleep apnoea (StopBang Questionnaire) and driving (Driver Stress Inventory, DSI and Driver Behaviour Questionnaire, DBQ) were assessed. Gender and age influenced almost all variables. The group of patients with depression did not differ from controls regarding driving behaviour as assessed through questionnaires; on the driving simulator, patients kept a longer safety distance. Subjective fatigue was positively associated with aggression, dislike of driving, hazard monitoring and violations as assessed by questionnaires. ESS and AIS scores were positively associated with keeping a longer safety distance and with Lateral Position Standard Deviation (LPSD), denoting lower ability to keep a stable position. It seems that, although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, patients drive more carefully eliminating, thus, their impact.

Perceived Knowledge and Attitudes of Faculty Members towards Inclusive Education for Students with Disabilities: Evidence from a Greek University.

The current paper aimed at investigating factors affecting the perceptions and attitudes of faculty members towards inclusive education for students with disabilities in a Greek University. A questionnaire, based on the "Expanding Cultural Awareness of Exceptional Learners-ExCEL" was distributed online to 311 faculty members, during the first semester of 2020. The questionnaire explored participants' sociodemographic and academic background, prior training and personal experience with disability, perceived knowledge, beliefs and attitudes towards inclusive education practices. A total of 80 questionnaires were completed (males 56.3%; aged 41-50 years 43.7%; working experience > 16 years 52.4%; prior training on disability 77.5%). Factor analysis identified four constructs relevant to: (a) perceived knowledge regarding the legal framework ("Perceived Knowledge"), (b) intention towards the provision of general accommodations in class ("Help in Class"), (c) intention towards resource provision ("Material Offer"), and (d) beliefs about the provision of accommodations to students with disabilities ("Negative Attitude"). Gender, faculty subject and prior training on disability were shown to affect the participants' "Perceived Knowledge", while working position was shown to affect "Material Offer". Age, working experience, and personal experience with disability did not reveal any significant effect. More research is needed to investigate the attitudinal and practical barriers of faculty members towards meeting students' educational needs.

Overestimation of Relative Risk and Prevalence Ratio: Misuse of Logistic Modeling.

The extensive use of logistic regression models in analytical epidemiology as well as in randomized clinical trials, often creates inflated estimates of the relative risk (RR). Particularly, in cases where a binary outcome has a high or moderate incidence in the studied population (>10%), the bias in assessing the relative risk may be very high. Meta-analysis studies have estimated that about 40% of the relative risk estimates in prospective investigations, through binary logistic models, lead to extensive bias of the population parameters. The problem of risk inflation also appears in cross-sectional studies with binary outcomes, where the parameter of interest is the prevalence ratio. As an alternative to the use of logistic regression models in both longitudinal and cross-sectional studies, the modified Poisson regression model is proposed.

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece.

BACKGROUND: Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. METHODS: The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). RESULTS: The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). CONCLUSIONS: The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

Involving migrants in the adaptation of primary care services in a 'newly' diverse urban area in Ireland: The tension between agency and structure.

In line with World Health Organization policy (WHO, 2016; 2019), primary care services need to be adapted to effectively meet the needs of diverse patient populations. Drawing from a European participatory implementation study, we present an Irish case study. In a hybrid participatory space, migrants, general practice staff and service planners (n = 11) engaged in a project to implement the use of trained interpreters in primary care over 17 months. We used Normalisation Process Theory to analyse data from 15 Participatory Learning and Action research focus groups and related sources. While stakeholders' agency and expertise produced relevant positive results for the introduction of changes in a general practice setting, structural factors limited the range and scope for sustained changes in day-to-day practice.

Seeking for risk factors of Intimate Partner Violence (IPV) in a Greek national sample: the role of self-esteem.

The objective of this article is to gain a better understanding of the magnitude of intimate partner violence (IPV) in Greece and to explore factors associated with increased risk of IPV prevalence. A cross-sectional study was undertaken among 1,122 men and women, aged 18 to 65, who are residents of urban areas of Greece. The questionnaire used included 3 sections and 39 items that examined the sociodemographic characteristics of the participants, rate of IPV victimization and perpetration (physical, sexual, emotional), childhood experience of violence, and level of self-esteem. Statistical analysis showed self-esteem to be significantly associated with physical violence victimization and perpetration (odds ratio [OR] = .975, confidence interval [CI] = .955-.996; OR = .972, CI = .951-.993, respectively), whereas experience of abuse during childhood was shown to be a strong predictor in all six models of IPV victimization and perpetration (p < .001). Finally, gender, age and years of cohabitation were some sociodemographic and background characteristics found to increase the risk of specific forms of IPV. Conclusions drawn from the current study should be taken into account in attempts aiming at preventing or ameliorating the problem.

Women, healthcare leadership and societal culture: a qualitative study.

PURPOSE: Women leaders encounter societal and cultural challenges that define and diminish their career potential. This occurs across several professions including healthcare. Scant attention has been drawn to the discursive dynamics among gender, healthcare leadership and societal culture. The aim of this study is to assess empirically gendered barriers to women's leadership in healthcare through the lens of sociocultural characteristics. The comparative study was conducted in Greece and Malta. The interest in these countries stems from their poor performance in the gender employment gap and the rapid sociocultural and economic changes occurring in the European-Mediterranean region. SUBJECTS AND METHODS: Thirty-six individual in-depth interviews were conducted with health-care leaders, including both women and men (18 women and 18 men). Directed content analysis was used to identify and analyze themes against the coding scheme of the Barriers Thematic Map to women's leadership. Summative content analysis was applied to quantify the usage of themes, while qualitative meta-summative method was used to interpret and contextualize the findings. RESULTS: Twenty and twenty-one barriers to women's leadership were identified within the Greek and Maltese healthcare settings, respectively. Prevailing barriers included work/life balance, lack of family (spousal) support, culture, stereotypes, gender bias and lack of social support. Inter-country similarities and differences in prevalence of the identified barriers were observed. CONCLUSION: The study appraised empirically the gendered barriers that women encounter in healthcare leadership through the lens of national sociocultural specificities. Findings unveiled underlying interactions among gender, leadership and countries' sociocultural contexts, which may elucidate the varying degrees of strength of norms and barriers embedded in a society's egalitarian practices. Cultural tightness has been found to be experienced by societal dividends as an alibi or barrier against sociocultural transformation. Findings informed a conceptual framework proposed to advance research in the area of women's leadership.

Addressing mental health issues among migrant and refugee pregnant women: A call for action.

Migrant and refugee pregnant women constitute a highly vulnerable group to mental disorders. The rates of mental illness of migrants and refugees are higher than those of host populations, with migrant women being more likely to suffer from prenatal depression. A Policy Paper was developed based on a literature review conducted in Medline, Scopus and Google Scholar. Filtering criteria were: year of publication (2002-2017), study topic relevance, and English language. A total of 63 documents were identified. Most of the documents were scientific papers while a large number of documents were reports of EU committees and networks on migrant issues or annual reports of international bodies. From the analysis of existing evidence, four major topics emerged for the perinatal health of migrant women: 1) Prevalence and risk factors for antenatal mental disorders, 2) Assessment of mental disorders, 3) Healthcare professionals' training on supporting migrant and refugee pregnant women, and 4) Interventions for the mental health of migrant women. Midwives and other members of interdisciplinary teams have to be trained and culturally competent to successfully meet the needs of migrant and refugee pregnant women.