A competency framework on simulation modelling-supported decision-making for Master of Public Health graduates.

BACKGROUND: Simulation models are increasingly important for supporting decision-making in public health. However, due to lack of training, many public health professionals remain unfamiliar with constructing simulation models and using their outputs for decision-making. This study contributes to filling this gap by developing a competency framework on simulation model-supported decision-making targeting Master of Public Health education. METHODS: The study combined a literature review, a two-stage online Delphi survey and an online consensus workshop. A draft competency framework was developed based on 28 peer-reviewed publications. A two-stage online Delphi survey involving 15 experts was conducted to refine the framework. Finally, an online consensus workshop, including six experts, evaluated the competency framework and discussed its implementation. RESULTS: The competency framework identified 20 competencies related to stakeholder engagement, problem definition, evidence identification, participatory system mapping, model creation and calibration and the interpretation and dissemination of model results. The expert evaluation recommended differentiating professional profiles and levels of expertise and synergizing with existing course contents to support its implementation. CONCLUSIONS: The competency framework developed in this study is instrumental to including simulation model-supported decision-making in public health training. Future research is required to differentiate expertise levels and develop implementation strategies.

Training needs assessment tools for the public health workforce at an institutional and individual level: a review.

BACKGROUND: The public health workforce (PHW) needs to have the necessary capacities to provide healthcare services and public health services. Training needs assessments (TNA) is necessary to assess and understand PHW and their capacities to provide services. This review attempts to identify and describe published studies on tools and methodologies for TNA of the workforce used in public health and health-related fields. METHODS: A systematized review of literature was carried out in February 2022. Cochrane Handbook for systematic review version 5.2.0 and PRISMA 2020 statement were used to guide reporting. This review includes original research, reports and grey literature from the websites of public health organizations in English. RESULTS: This review included 38 documents for evidence synthesis. Twenty-seven documents were indexed literature (71%) and 11 were grey documents (29%). TNA documents were published between 1999 and 2022. TNA was performed in many countries around the world. The organizations used either a validated questionnaire or created their own tools to perform organizational and individual self-assessments. The TNA tools were developed using different methods such as expert panels, literature reviews, stakeholder interviews and quantitative surveys. CONCLUSION: TNA is useful for defining and characterizing the public health workforce in every organization. Workforces consist of individuals who have their own training needs to fulfill their tasks. Therefore, individual and organizational TNA should be combined to study the public health workforce and their capacities.

Professionalization of the public health workforce: scoping review and call to action.

BACKGROUND: The 'WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region' provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration. It was based on a literature review till 2016. This scoping review aims to explore how the professionalization was documented in the literature between 2016 and 2022. METHODS: Following the Joanna Briggs Institute guidelines, we searched Medline via PubMed, Web of Science, ERIC via EBSCO and Google Scholar and included studies on professionalization levers. Four critical appraisal tools were used to assess qualitative, quantitative, mixed methods studies and grey literature. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting. RESULTS: Eleven articles included in this review spanned 61 countries, targeting undergraduate, master's, doctoral degrees and continuing professional development. Most of these documents were reviews. About half provided a definition of the public health workforce; more than half covered the taxonomy and included information about competences, but the use of frameworks was sporadic and inconsistent. Formal organization and the necessity of a code of conduct for the public health workforce were acknowledged in only two studies. CONCLUSIONS: In spite of some efforts to professionalize the public health workforce, this process is fragmented and not fully recognized and supported. There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the public health workforce worldwide.

What is context in knowledge translation? Results of a systematic scoping review.

Knowledge Translation (KT) aims to convey novel ideas to relevant stakeholders, motivating their response or action to improve people's health. Initially, the KT literature focused on evidence-based medicine, applying findings from laboratory and clinical research to disease diagnosis and treatment. Since the early 2000s, the scope of KT has expanded to include decision-making with health policy implications.This systematic scoping review aims to assess the evolving knowledge-to-policy concepts, that is, macro-level KT theories, models and frameworks (KT TMFs). While significant attention has been devoted to transferring knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level), the definition of 'context' in the realm of health policymaking at the macro-level remains underexplored in the KT literature. This study aims to close the gap.A total of 32 macro-level KT TMFs were identified, with only a limited subset of them offering detailed insights into contextual factors that matter in health policymaking. Notably, the majority of these studies prompt policy changes in low- and middle-income countries and received support from international organisations, the European Union, development agencies or philanthropic entities.

Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays.

BACKGROUND: Despite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates. METHODS: The study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework's steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. FINDINGS: The inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course. CONCLUSION: Integrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.

Critical route for development of medical student leadership competencies in 35 Pan American Health Organization member states: A scoping review and thematic analysis.

The Pan American Health Organization has been committed to training physicians in leadership competencies since 2008. However, four reviews on teaching leadership using competency-based education in undergraduate medical education (UME) identified only two of 35 MS: Canada and the USA. Previous reviews did not use a systemic approach or qualitative methodology to explore factors influencing leadership education. Therefore, this review aims to identify facilitating and inhibiting factors in teaching leadership in UME using a scoping review and thematic analysis. Six databases containing grey and indexed literature in English, Spanish, and Portuguese were searched, including a hand search and authors' consultations. Forty-eight documents out of 7849 were selected based on eligibility criteria. Braun and Clarke's thematic analysis guide was used, identifying eight themes: curriculum, intended learning outcomes, teaching methods, assessment, addressing barriers, supporting organisational change, building networks, and developing expertise. Considering these themes, the authors propose a critical route for teaching leadership in UME in the Americas. First, institutional design should consider governance gaps, such as having national and international policies for leadership training in UME with inter-professional, trans-professional, and citizen-focused approaches. There is a pressing need to provide leadership training for physicians and other professionals from government, academia, non-governmental organisations, hospitals, and national and international organisations whose missions are related to health or education. Networking opportunities for stakeholders in leadership education and teacher training is also essential. Second, instructional design reveals knowledge-do gaps in member states (MS) when incorporating leadership into the medical curriculum. This includes using leadership frameworks, defining learning outcomes, and employing assessment and monitoring tools for leadership education. Mechanisms to reduce these gaps in MS include the Equator Network and Evidence-Informed Policy Networks fostering knowledge translation and governance.

Core competencies in applied infectious disease epidemiology: a framework for countries in Europe.

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency framework to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competencies across international boundaries, specifically for infectious diseases. This perspective presents the process to update the competency framework for applied infectious disease epidemiology, highlighting ECDC's efforts to support countries with using the framework. ECDC commissioned the Association of Schools of Public Health in the European Region (ASPHER) to update the framework through publication and dissemination of a technical report and a self-assessment tool linked to training resources. A mixed methods approach to gather input from experts in relevant specialities included qualitative interviews with 42 experts, workshops with ECDC Technical Advisory Group and an online survey of 212 public health professionals across Europe and beyond. Modifications resulted in 157 core competencies in 23 domains, each mapping to one of six subject areas of importance in applied infectious disease epidemiology. The framework serves as a basis to update the curriculum of the ECDC Fellowship programme with two alternative paths: intervention epidemiology or public health microbiology.

Associations between COVID-19 pandemic impact, dimensions of behavior and eating disorders: A longitudinal UK-based study.

BACKGROUND: There is growing concern about how people with eating disorders are impacted by the widespread societal restructuring during the COVID-19 crisis. AIMS: We aimed to examine how factors relating to the impact of the pandemic associate with eating disorders and quantify this relationship while adjusting for concurrent and longitudinal parameters of risk. METHODS: We gathered demographic, behavioral and clinical data pre- and mid-pandemic as well as childhood trauma history from a longitudinal online survey of 489 adults (mean age 23.4 years) recruited from the Neuroscience in Psychiatry Network (NSPN). Using pre-pandemic (T1) and concurrent (T2) data we aimed to predict eating disorders at mid-pandemic (T2). We deployed hierarchical generalized logistic regression to ascertain the strength of longitudinal and concurrent associations. RESULTS: Pre-pandemic eating disorder scores strongly associated with concurrent eating disorder (z = 5.93). More conflict at home mid-pandemic (z = 2.03), pre- (lower sensation seeking z = -2.58) and mid-pandemic (higher lack of perseverance z = 2.33) impulsivity traits also associated with mid-pandemic eating disorder. CONCLUSION: Conflict at home mid-pandemic and specific aspects of impulsiveness significantly associated with concurrent eating disorder when adjusted for pre-pandemic eating disorder symptoms, baseline demographics, behavioral traits, history of traumatic experiences and concurrent psychopathology. These results provide insight into the struggles of those suffering with eating disorders during the COVID-19 pandemic and highlight the importance of impulsiveness traits and the immediate family environment in their experience of illness during the pandemic.

Leadership Competencies for Knowledge Translation in Public Health: A consensus study.

BACKGROUND: In 2010, 240 billion US dollars was invested worldwide to conduct research for health; unfortunately, 200 billion was misused in the production and reporting of the evidence researched. Universities could facilitate students to acquire leadership competencies to move well-conducted research findings into practical use; this could be an essential move to reduce the misuse of investment. METHODS: A literature review was done based on the Equator Network and Cochrane guidelines, followed by three Delphi rounds to select competencies. RESULTS: Eleven papers were analysed out of 1121 items and 39/78 identified competencies were prioritized to be presented in the Delphi. Four out of 12 participants accepted to be involved in this project, and 22 competencies reached consensus and stability after three rounds. This framework conceptualizes competencies as the knowledge, skills, attitudes and values. The competencies were framed in four domains: knowledge management, engage diverse others in public health initiatives, training and capacity building/change management and communication. CONCLUSION: This framework offers guidance to universities when instructing students with leadership competencies for KT. This project emphasizes that effective leadership should include personal conscience and self-determination values.

Public health competences through the lens of the COVID-19 pandemic: what matters for health workforce preparedness for global health emergencies.

The COVID-19 pandemic is raising new questions on public health competences and leadership and on health workforce preparedness for global public health emergencies. The present commentary aims to highlight demand and opportunities for innovation through the disruptions caused by the COVID-19 crisis. We review the public health competency framework recently launched by WHO and ASPHER through the lens of COVID-19. The framework provides guidance for aligning public health and global health competences across sectors and professional groups. Five critical competency areas can be identified in relation to public health emergencies: (1) flexibility, adaptation, motivation, communication, (2) research, analytical sensitivity, ethics, diversity, (3) epidemiology, (4) preparedness and (5) employability. However, this may not be enough. New models of public health leadership and changes in the health workforce are needed, which transform the silos of professions and policy. Such transformations would include learning, working, leading and governing differently and must stretch far beyond the public health workforce. To achieve transformative capacity, critical public health competences must be considered for all healthcare workers on all levels of policymaking, thus becoming the 'heart' of health workforce resilience and pandemic preparedness.

Labour market competition for public health graduates in the United States: A comparison of workforce taxonomies with job postings before and during the COVID-19 pandemic.

A strong public health workforce (PHW) is needed to respond to COVID-19 and public health (PH) issues worldwide. However, classifying, enumerating, and planning the PHW is challenging. Existing PHW taxonomies and enumerations focus on the existing workforce, and largely ignore workforce competition for public health graduates (PHGs). Such efforts also do not utilize real time data to assess rapid changes to the employment landscape, like those caused by COVID-19. A job postings analysis can inform workforce planning and educational program design alike. To identify occupations and industries currently seeking PHGs and contrast them with existing taxonomies, authors matched existing PHW taxonomies to standardized occupational classification codes, then compared this with 38,533 coded, US job postings from employers seeking Master's level PHGs from 1 July 2019 to 30 June 2020. Authors also analysed 24,516 postings from March 2019 to October 2019 and compared them with 24,845 postings from March 2020 to October 2020 to assess changing employer demands associated with COVID-19. We also performed schema matching to align various occupational classification systems. Job postings pre-COVID and during COVID show considerable but changing demand for PHGs in the US, with 16%-28% of postings outside existing PHW taxonomies, suggesting labour market competition which may compound PHW recruitment and retention challenges.

Employment outcomes and job satisfaction of international public health professionals: What lessons for public health and COVID-19 pandemic preparedness? Employment outcomes of public health graduates.

The profile of public health professionals (PHPs) and COVID-19 preparedness is assessed against the employment outcomes (EO), precarious employment (PE), and job satisfaction (JS) of the European Public Health Master programme alumni. The study is descriptive, cross-sectional, conducted from May-October 2020. A survey was developed to assess the EO, PE and JS. Participants were recruited by email. SPSS statistics 26 version was used to perform descriptive analysis. A total of 189 PHPs participated (65% response) with majority women (66%), the mean age was 36 years. Participants were employed (80%), in non-governmental organisations (20%), and academia (19%). Common employment positions were managerial (37%) and consultancy (18%). Majority of PHPs were exposed to PE (81%), the most frequent elements were 'temporary employment' (54%), and 'the lack of labour union' (53%). The JS of PHPs was 'satisfied'. A blend of scientific public health knowledge and interpersonal competencies, reforms in current employment conditions, development of professional entities to safeguard PHPs' rights, and continuous investment in public health is necessary for PHPs to strengthen COVID-19 pandemic preparedness. Furthermore, monitoring and evaluation of EO and JS are crucial to prepare PHPs according to the needs of the employment market and to be aware of PHPs' needs.

Education and training in public health: is there progress in the European region?

BACKGROUND: The Association of Schools of Public Health in the European Region (ASPHER) is confronted with challenges to improve education for public health professionals. In this article, we attempt to answer the question: Did ASPHER members improve their organization and programmes to enable their graduates to acquire the competences to tackle the diverse areas of public health defined in the Ten Essential Public Health Operations (EPHOs)? METHODS: ASPHER run two surveys among its membership: In 2011, 66 Schools and Departments of Public Health (SDPHs) took part (82.5%), while in 2015-16, 78 SDPHs (81.3%). The performance of graduates was estimated using a Likert scale. RESULTS: In 2015-16, the SDPHs delivered 169 academic programmes (2.2 on average per SDPH). Among the SDPHs participating in both surveys, significant differences could not be determined, neither for the organization (except increasingly using social media) nor for teaching areas. The performance of graduates did not show significant differences except for the deterioration of EPHO-8 ('assuring sustainable organizational structures and financing'). However, the qualitative data revealed progressive dynamics regarding innovations in the organizational set-up, digitalization, teaching/training, introduction of new modules and research. CONCLUSIONS: The results generated do not allow us to state that the innovative elements introduced after the first survey in 2011 have had a clear impact reflected in the second survey carried out in 2015-16, but perhaps this is due to the need for a broader follow-up in order to objectify the potential consequences derived from the boost generated by the changes introduced.

Autism and education-international policy in small EU states: policy mapping in Malta, Cyprus, Luxembourg and Slovenia.

BACKGROUND: Special education provides an array of support that can advantageously meet special education needs (SEN) of children with autism. This report maps autism and SEN policies, and tension of international legislation in Malta, Cyprus, Luxembourg and Slovenia. METHODS: A policy path analysis was performed using a scoping review as fundamental methodological framework. RESULTS: Education for children with SEN developed from limited education towards segregation, and further to integration, and inclusion in mainstream education. International policy has greatly influenced the education systems under study. The rights to education and to have SEN addressed have been adopted in all countries. Inclusion is seen to be gradually incorporated by Malta, Cyprus and Luxembourg-closely following values of international documents through concise SEN policies. Slovenia's education system remains segregated, indicating potential tension. CONCLUSIONS: It appears that mainstream schools offer SEN services until no longer feasible for the child in the majority of investigated countries. Inclusion has become a guiding principle for most education systems under study. Finally, small states either commit to the implementation of inclusion or delay it and attempt to improve the education system for children with SEN in different ways.

[Rational Use of Antibiotics Among Turkish Migrants In Germany: Knowledge, Attitudes and Interaction With Physicians and Pharmacists]. / Antibiotikanutzung bei Menschen mit türkischem Migrationshintergrund ­ Wissen, Einstellungen und Interaktion mit ÄrztInnen und ApothekerInnen.

OBJECTIVES: Due to strong transnational ties, the use of and demand for antibiotics among Turkish migrants in Germany may be influenced by cultural aspects of antibiotic use in Turkey. Research on the use of antibiotics among Turkish migrants in Germany, however, is scarce. The aim of this study was to find out how Turkish migrants in Germany use antibiotics, whether and how knowledge, underlying motives and attitudes influence demand and how Turkish migrants interact with medical professionals. MATERIALS AND METHODS: Using a qualitative approach, behavioural patterns and logic of action of adult Turkish migrants were identified. We carried out semi-structured focus group interviews with adults of Turkish origin residing in Germany and expert interviews with family physicians and pharmacists. The interviews were analysed by means of content analysis. RESULTS: While younger migrants had a generally positive, but cautious attitude towards the use of antibiotics, older migrants often showed exaggerated, unrealistic expectations resulting from a lack of factual knowledge. Overall, participants adopted a passive role in the patient-provider relationship. This led to a perpetuation of significant knowledge gaps. CONCLUSIONS: Older Turkish migrants who have less factual knowledge show exaggerated expectations concerning the effectiveness of antibiotics. In conjunction with a passive patient role, resulting in information needs not being satisfied, this can affect the patient-provider relationship. A more active communication by physicians and information materials sensitive to the needs of migrants can positively influence the interaction between migrant patients and medical professionals.

Is there a golden recipe? A scoping review of public health workforce development.

BACKGROUND: This study intended to design a suitable and comprehensive approach for a public health workforce development plan with the ultimate goal of meeting the health objectives in different European Region countries. METHODS: We performed a scoping review, including an accurate and exhaustive country-specific hand-search process, mapping the key concepts and practices used in public health workforce development based on the available evidence worldwide. RESULTS: We identified nine comparative measures, based on common features from a scoping literature review, for the assessment of public health workforce development plans available in selected countries. This list of nine comparative measures includes: (i) Alignment between the 10 Essential Public Health Operations (EPHOs) or core public health functions and organizational resources and public health priority areas; (ii) Regulations and Norms; (iii) Capacity Assessment; (iv) Datasets and Databases; (v) Workforce Development Strategies, Planning and Management; (vi) Education, Training, Core Competencies and Models; (vii) Licensing, Accreditation and Credentialing; (viii) Forecasting Strategies for Enumerating and Quotas and (ix) Ethical and Professional Codes of Conduct. These measures are essential to develop, sustain and modernize the public health workforce effectively. CONCLUSION: We propose a well-balanced set of measures for countries aiming to improve or develop their public health workforce based on instruments that are successfully used and applied in a wide range of countries with different public health systems. However, the implementation should be tailored and adopted according to the specific country context and available recourses.

Application of EASY-Care Standard 2010 instrument in a population-based survey in transitional Kosovo.

BACKGROUND: The aim of this study was to assess the health needs and priorities of older people in Kosovo, the newest state in Europe striving for a functional democracy after the breakdown of former Yugoslavia and the following war in the region. METHODS: A cross-sectional study was conducted in Kosovo in 2011 including a nationwide representative sample of 1890 individuals aged ≥65 years (949 men, mean age: 73 ± 6 years; 941 women, mean age: 74 ± 7 years; overall response rate: 84%). All individuals were administered the full version of EASY-Care Standard 2010 instrument, inquiring about the need for support in activities of daily living ('independence'), the 'risk of breakdown in care' (leading to emergency admission to hospital) and the 'risk of falls'. RESULTS: The degree of 'independence' was lower, whereas the 'risk of breakdown in care' and the 'risk of falls' were significantly higher in: older women; the oldest individuals (≥85 years); rural residents; participants living alone; those perceiving themselves as poor; participants who could not access medical care; those who perceived their general health status as poor; and older people who reported at least one chronic condition. CONCLUSIONS: This is one of the very few reports from Southeast European region informing about the health needs and priorities of older people in a large and representative population-based sample of older men and women. The poor health status of older people, especially evident in the socio-demographic disadvantaged categories, should raise the awareness of policymakers and decision-makers for appropriate health and social care of elderly in Kosovo and in other European countries.

Breast cancer screening and migrants: exploring targeted messages for Moroccan migrant women in Brussels.

Objectives: This study explored views of Moroccan migrant women on barriers and facilitators to the organized breast cancer screening program in Brussels (Belgium), and the potential of targeted printed invitations to increase this population's attendance to the program. Methods: We conducted one expert interview with the breast cancer screening program coordinator on current practices and challenges with regards to inviting Moroccan migrant women in Brussels for screening. Secondly, we held focus groups with Moroccan women aged 26-66. Sessions focused on perspectives on breast cancer screening and the existing generic program invitations. Directed content analysis of transcripts was based on the Health Belief Model. Alternative communication packages were developed based on barriers and suggestions from the focus groups. A second round of focus groups looked at the alternative communication packages and their potential to encourage Moroccan migrant women in Brussels to participate in the organized breast cancer screening program. Results: Alternative packages were appreciated by some, but a number of adjustments did not catch participants' attention. Printed communication delivered by post does not appear to be the preferred means of communication to encourage breast cancer screening for Moroccan migrant women in Brussels, nor does it seem appropriate to address the barriers to screening found in this study. Conclusions: The benefit of targeted postal invitation packages for Moroccan migrant women in Brussels seems limited for a variety of reasons. For future research, a large-scale study analyzing the topic in a cross-cultural perspective is warranted.

Europeanization process impacts the patterns of alcohol consumption in the Western Balkans.

Background: Western Balkan countries exhibit high levels of alcohol consumption, which constitutes a serious public health concern. We aimed to quantitatively assess the influence of the Europeanization process on levels of alcohol consumption in Western Balkans, an issue that has been under-researched. Methods: The process of Europeanization was defined as the penetration of European dimension, procedures, policy paradigms, beliefs and norms in national arenas of politics and policy development. Data about alcohol consumption in six Western Balkan countries from 1991 to 2011 were gathered from the World Bank and World Health Organization databases. Azerbaijan and Georgia were considered control countries. A difference-in-differences approach was used to assess the impact of Europeanization process on levels of alcohol consumption. Results: The Europeanization process impacts alcohol consumption in Western Balkan countries through the European Union directives and tax policies. After starting the Europeanization process, the spirits consumption in Croatia and The Former Yugoslav Republic of Macedonia decreased by 1.06 litter per capita (95% CI: from -1.63 to - 0.49) and 1.02 litter per capita in Serbia (95% CI: from -1.9 to - 0.1). Conclusion: Our analysis provides useful evidence about the possible influence of Europeanization process especially on spirits consumption levels in Western Balkans. These findings draw attention to the need to implement new policies in order to prevent alcohol health-related harm due to the possible increase of wine and beer consumption.