Needs of patients with multi-morbidity and heart failure for the development of a mHealth to improve their self-management: A qualitative analysis.

Objective: To provide practical information regarding needs, preferences of content and format of an app to assist the self-management in patients with multi-morbidity and heart failure (HF). Methods: The three-phase study was conducted in Spain. Six integrative reviews, a qualitative methodology based on Van Manen's hermeneutic phenomenology through semi-structured interviews and user stories were used. Data collection continued until data saturation was reached. All data were transcribed verbatim and analysed using a framework approach. Thematic analysis technique following the methods of Braun and Clarke was used for emerging themes. Results: Integrative reviews conducted included practical recommendations to include in the content and format of the App and helped create the interview guide. Interviews revealed 15 subthemes that captured the meaning of narratives offering contextual insights into the development of the App. The main effective mechanisms of multicomponent interventions for patients with HF must contain (a) components that increase the patient's understanding of HF, (b) self-care, (c) self-efficacy and participation of the family/informal caregiver, (4) psychosocial well-being and (5) professional support and use of technology. User stories revealed that patients prioritized improvements in direct contact with health services in case of emergency (90%), nutritional information (70%), type of exercises in order to improve their physical condition (75%) and information about food and drug interaction (60%). The importance of motivation messages (60%) was highlighted by transversal way. Conclusions: The three-phase process integrating theoretical basis, evidence from integrative reviews and research findings from target users has been considered a guide for future app development.

Intervention programme to improve knowledge, attitudes, and behaviour of nursing students towards organ donation and transplantation: A randomised controlled trial.

AIM: To develop and evaluate an educational programme aimed at undergraduate training to increase and improve knowledge, attitudes and behaviour towards the organ and tissue donation and transplants (OTDT). BACKGROUND: The request for OTDT falls on the health personnel and the reduction of family refusals depends on their attitude and competence, which is vital to increase OTDT. The evidence highlights the efficacy of starting training at early stages and the implementation of educational programmes in universities is recommended to reduce family refusals. DESIGN: A randomised controlled trial. METHODS: A randomised controlled trial with an experimental group (EG) -theory class and round table- and a control group (CG) -theory class- that transitions to a delayed experimental group. A sample of 73 students was distributed in parallel randomised groups. RESULTS: The groups increased their knowledge and improved their attitude, significantly changing their behaviour in the follow-up. These changes in the experimental groups were more significant than in CG in perceived quality of information (z = -4.948; p = <0.001), level of knowledge (EG1 and CG z = -2.245; p = 0.025) (EG2 and CG z = -2.215; p = 0.027), attitude (EG1 and CG z = -2.687; p = 0.007) (EG2 and CG z = -2.198; p = 0.028) and behaviour (EG1 and CG t = 2.054; p = 0.044) (EG2 and CG z = -2.797; p = 0.005). CONCLUSIONS: The education programme has proven effective, promoting knowledge, change and entrenchment of attitudes, facilitating conversations with families, enabling willingness to donate and increasing potential donors.

Content and Clinical Validation of the Nursing Outcome "Health Literacy Behaviour": A Validation Protocol.

Health literacy (HL) is a result of health promotion and education that has been included as a nursing intervention since 2013. It was proposed, as a nursing activity, to "determine health literacy status at initiation of contact with the patient through informal and/or formal assessments". Because of that, the outcome 'Health Literacy Behaviour' has been incorporated in the sixth edition of the Nursing Outcomes Classification (NOC). It collects the patient's different HL levels and allows them to be identified and evaluated in a social and health context. Nursing outcomes are helpful and provide relevant information for the evaluation of nursing interventions. OBJECTIVES: To validate the contents of the nursing outcome 'Health Literacy Behaviour (2015)' in order to use them in nursing care plans, and to evaluate their psychometric properties, application level, and effectiveness in nursing care to detect low health literacy patients. METHODS: a methodological two-phased study: (1) an exploratory study and content validation by expert consensus, who will evaluate revised content of nursing outcomes; (2) methodological design by clinical validation. CONCLUSION: The validation of this nursing outcome in NOC will enable the generation of a helpful tool that would facilitate nurses to set individualised and efficient care interventions and identify low health literacy populations.

Self-management in heart failure using mHealth: A content validation.

AIM: To describe the development of a mobile health application -mICardiApp- designed by a multidisciplinary professional team and patients with heart failure and to evaluate its content validity. METHODS: Critical reviews of the literature, semi-structured interviews with patients, and user stories guided the development of the content of the mobile application. These contents were refined and validated through a modified Delphi process. An expert panel of healthcare and social care professionals together with patients and academics evaluated the content through two content validity indicators, relevance, and adequacy, and provided narrative feedback. The content validity of the app and each screen was determined by calculating the Content Validity Index (CVI). Similarly, the Adequacy Index (AI) was analyzed. RESULTS: The developed app is composed by 8 topics: (1) available resources, (2) cardiac rehabilitation, (3) control of signs and symptoms, (4) emotional support, (5) learning and having fun, (6) medication, (7) nutrition, and (8) physical activity. The results demonstrated high CVI of the screens and the full app. 57 of the 59 screens in the app reached an excellent CVI ≥ 0.70 for both relevance and adequacy, except for 2 screens. The CVI Average Method of the app was 0.851. CONCLUSIONS: mICardiApp is presented as an application to improve health literacy and self-management of patients with multimorbidity and heart failure, with proven validation.

Assessment of health literacy among migrant populations in Southern Spain: A cross-sectional study.

AIM: The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy. DESIGN: A cross-sectional descriptive study. METHODS: Health literacy was measured in a total of 278 immigrants using HLS-EU-Q16. An inferential descriptive and multiple regression analysis was carried out. RESULTS: 65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r = .398), age (r = .178p) and perceived social status (r = .151). Participants with shorter length of stay (ß = .405 1), without health sciences education (ß = .205) and low education level (ß = .182) had limited health literacy.

Correction: Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/35945.].

Health Literacy, Misinformation, Self-Perceived Risk and Fear, and Preventive Measures Related to COVID-19 in Spanish University Students.

The "infodemic" is one of the main obstacles in the fight against the COVID-19 pandemic. In order to face it, health literacy (HL) is essential since it allows for knowledge about COVID-19 and the practice of preventive measures to be fostered. This is especially relevant in university students due to their idiosyncrasy. This study aims to evaluate the level of HL related to COVID-19 (HLC), risk perception, misinformation, and the attitudes and behaviors adopted to prevent the spread of coronavirus in Spanish university students. An online questionnaire was administered to 499 Spanish university students. The HLC index presented a mean of 33.89 out of 50; a total of 63.8% had an inadequate level of HLC. They practiced a mean of 7.54 out of 9 preventive behaviors, and the mean knowledge score was 10.40 out of 13. The HLC showed significantly different scores for the degree, the practice of preventive measures, and some sources of information. The level of HL correlates with the adoption of preventive measures. The higher the severity and perceived susceptibility, the more preventive measures are taken by the students. Therefore, there is a need to strengthen the HL skills of university students and address the dissemination of misinformation. Although caution should be taken when generalizing these results due to the limitations inherent within a cross-sectional study and the convenience sampling, our results can guide the establishment of health education strategies and policies for the management of the infodemic in pandemic situations, according to this target population.

Measuring COVID-19 health literacy: validation of the COVID-19 HL questionnaire in Spain.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of health literacy to make informed preventive decisions. A specific COVID-19 health literacy questionnaire (CHL-Q) is included in the COVID-19 Snapshot Monitoring WHO initiative to conduct behavioral insights studies related to COVID-19. The objective was to assess the psychometric properties of a Spanish version of the COVID-19 Health Literacy Questionnaire (CHL-Q). METHODS: Data quality, acceptability, internal consistency, and construct and structural validity were analyzed. A Rasch analysis was also performed. This cross-sectional, observational study was conducted on the Spanish general population after the first wave of the pandemic and after the end of the general lockdown by an online survey agency. 1033 participants (inclusion criteria were being 18 years or older and living in Spain), was extracted from a panel of approximately 982,000 participants. The sampling was stratified matching the Spanish general population in terms of age, gender, and area of residence. The CHL-Q includes 9 items and assesses people's knowledge, motivation and competencies to access, understand, evaluate, and apply information about COVID-19 in order to make informed decisions. RESULTS: CHL-Q index presented a mean of 33.89 (SD = 9.4), and good fit to the Rasch model (χ2(32) = 34.672, p = 0.342, person separation index = 0.77), with ordered thresholds, unidimensionality, item local independence, and no item bias by sex, age or education level. The CHL-Q showed significant different scores by level of education, experience of infection, confusion related to COVID-19 information and adherence to preventive measures. We found a statistically significant correlation between the CHL-Q index and the total number of preventive measures adopted, COVID-19 knowledge, and information seeking behaviour. The Cronbach´s alpha was 0.87 and the item total corrected correlation, 0.49-0.68. CONCLUSIONS: The Spanish version of CHL-Q is a short, adequate, and reliable instrument to measure COVID-19 related health literacy in the Spanish general population. Measuring the CHL in the population can be useful to evaluate whether public authorities, media and the medical and scientific community have been able to reach the population to offer the information in the terms they need it.

Effectiveness of a multimodal intervention and the simulation flow to improve empathy and attitudes towards older adults in nursing students: A crossover randomised controlled trial.

AIM: The aims of this study were (1) to develop a multimodal intervention according to the NLN Jeffries Simulation Theory planned to improve attitudes and empathy towards older adults in undergraduate nursing students using theoretical contents, age simulation suits, and storytelling of old participants, and (2) to evaluate the influence of the simulation flow on the effectiveness of this intervention in improving attitudes and empathy towards older adults. BACKGROUND: The increase in longevity in recent decades has led to an increase in the demand for professionals linked to the care of the older adults. Some studies indicate that health care professionals lack empathy and understanding toward older adults. Therefore, it is essential to introduce innovative teaching strategies to improve attitudes and empathy toward older adults in future health professionals. DESIGN: A crossover randomised controlled trial. METHODS: A three-period crossover randomised controlled trial with an experimental group, a control group (that transitions to a delayed experimental group) was conducted on 70 nursing students after the initial 73 were allocated. A multimodal intervention was used that, in addition to geriatric nursing theory, incorporated complex age simulation suit and student-older adult interaction. Pre-test and post-test data were obtained through the Jefferson Scale of Empathy and Kogan's Attitudes towards Older People Scale. Thus, students in the experimental group 1 received the following simulation flow: Geriatric Nursing Theory + Seminar with age simulation suit + student-older adult interaction. The students in the delayed experimental group 2 received this order: Geriatric Nursing Theory +Seminar without Age simulation suit + student-older adult interaction + Age simulation suit. RESULTS: Statistically significant differences were observed in both empathy (t = 3.155, p = 0.001, d = 0.782), and attitudes (t=3.256, p=0.001, d=0.803) when comparing control group scores (who only received the theoretical contents of the seminar) and experimental group 1 scores after receiving the full multimodal simulation (i.e. a seminar wearing an age simulation suit + volunteer interaction with an older adult). Regarding the order of educational strategies in the simulation flow, there were significant differences in the empathy scores found when both groups had received the full intervention. Accordingly, training with age simulation suits followed by storytelling provides better scores in empathy than in the opposite direction (t = 2.028, p = 0.048, d = 0.54). CONCLUSIONS: The use of a multimodal intervention, implementing an age simulation suit and the narration of an older adult's life experiences (in this order), improves attitudes and empathy.

Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial.

BACKGROUND: Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL). OBJECTIVE: This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs. METHODS: This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months. RESULTS: The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months. CONCLUSIONS: The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35945.

Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) for Arabic/French-Speaking Migrants in Southern Europe.

Improving health literacy (HL) is critical for addressing health inequalities. Low literacy rates are believed to be more prevalent in ethnic minorities, which may have an impact on people's health. For measures to be implemented in this regard, HL must be evaluated to obtain specific indicators. Our aim, therefore, was to develop a version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which is recommended to be used with vulnerable populations, suited to Arabic/French-speaking migrants who reside in south-eastern Spain, and to explore its psychometric properties for assessing health literacy in this population. A cross-sectional survey was carried out in a convenient sample of 205 migrants. The structural validity was calculated by a confirmatory factorial analysis (CFA), which suggested appropriate adjustment indicators, and which indicated that the three-dimensional model is adequately adjusted to the data obtained in the study. The coefficient omega showed high internal consistency in the three HL dimensions (health care, disease prevention, and health promotion). Concurrent validity presented a significant correlation with the Newest Vital Sign test (r = 0.390; p < 0.001). The multigroup CFA showed that the heterogeneity of the sample used was not a problem for establishing the structural validity of the scale. The Arabic/French version showed good construct validity.

Effectiveness of a Multifactorial Intervention in the First 1000 Days of Life to Prevent Obesity and Overweight in Childhood: Study Protocol.

(1) Background: Obesity is a global health problem, and its prevention must be a priority goal of public health, especially considering the seriousness of the problem among children. It is known that fetal and early postnatal environments may favor the appearance of obesity in later life. In recent years, the impact of the programs to prevent obesity in childhood has been scarce. The aim of this research is to evaluate the effectiveness of an intervention based on the concept of early programming. (2) Methods: Non-randomized controlled trial design. Inclusion criteria are: two-year-old infants whose gestational period begins in the 14 months following the start of the intervention, and whose mothers have made the complete follow-up of their pregnancy in the same clinical unit of the study. The intervention will be developed over all the known factors that affect early programming, during pregnancy up to 2 years of life. Data will be collected through a data collection sheet by the paediatricians. A unibivariate and multivariate analysis of the data will be carried out. (3) Ethics and dissemination: The trial does not involve any risk to participants and their offspring. Signed informed consent is obtained from all participants. Ethical approval has been obtained. (4) Results: It is expected that this study will provide evidence on the importance of the prevention of obesity from the critical period of the first 1000 days of life, being able to establish this as a standard intervention in primary care.

Empathy training in health sciences: A systematic review.

Effective empathy training interventions based on scientific evidence becomes essential. A theoretical framework should guide the proposed interventions and be coherent with the evaluation of the dimensions taking in account that empathy is currently a multidimensional concept. The study aimed to determine, in health care professionals and/or students, what is the effectiveness of experiential versus humanistic training, in terms of improvement of empathic ability (dimensions) and maintenance over time of what has been learned, and to establish the degree of coherence between the proposed theoretical model and the trained and evaluated dimensions. A systematic review using six databases was performed. The data were synthesised, and the risk of bias was analysed using the Equator Guidelines. Twenty-three articles were selected. Further evidence of the effectiveness of experiential intervention against humanistic educational strategies was observed. Most studies were not based on a solid theoretical framework and, in these cases, inconsistency between empathic trained dimensions and those evaluated was detected. Although a better understanding of training time variable is required, middle-term interventions are recommended. Increasing the multicentre controlled trials; specifying the intervention that includes the empathy dimensions; triangulating the data from health professionals, patients, and external observers; and including monitoring, becomes a necessity.

Teaching empathy to nursing students: A randomised controlled trial.

BACKGROUND: Empathy has been reported to produce a positive effect on improving patient health outcomes, becoming a fundamental skill in any health personnel-patient relationship. OBJECTIVE: To evaluate the effectiveness of an intervention designed to improve the nursing students´ empathy, the learning perception, the improvement of the perception in the understanding of the content, and in the degree of difficulty as well as the acquisition of skills. DESIGN: Multicentre randomised controlled trial. SETTING: This research was conducted at two schools of nursing at a public university in the Southwest of Spain. PARTICIPANTS: 116 nursing students were randomly assigned to an experimental or a control group (delayed intervention group once the post-training analysis was completed) during the second semester of the 2015/2016 academic year. METHODS: Pre-test, post-test, and follow-up data were obtained for each group using a simulated clinical interview. Empathy was the primary outcome (The Consultation and Relational Empathy Measure, Jefferson Scale of Empathy student version, Reynolds Empathy Scale, and Carkhuff Scale). The students' perceived knowledge, the learning perception, the self-esteem (Rosenberg Self-Esteem Scale) and the understanding of the content and acquisition of skills (ad-hoc questions) were also analysed. RESULTS: The results were improved in all the measures conducted in the experimental groups at the different centres after the intervention. The mean post-test simulation scores were higher than the pre-test with statistically significant differences. The results were maintained in the follow-up. The student's perception of learning and the perception of understanding of the content and the acquisition of skills were improved as well. CONCLUSION: The study support that training in empathic competence is effective.

Effect of an mHealth Intervention to Improve Health Literacy in Immigrant Populations: A Quasi-experimental Study.

Health literacy is a social determinant of the basic health of populations and is especially important to enhancing and developing the empowerment of migrant populations. To evaluate the effectiveness of an mHealth intervention to improve the cognitive and social skills that enable migrants to access and use health services, we developed a quasi-experimental design to encompass a single group of enrolled immigrants (N = 93). They completed preintervention and postintervention questionnaires of the European Health Literacy Survey Questionnaire, the self-created questionnaire HL-APP-Q14 (Health Literacy App Questionnaire), and a practical simulation test. Health literacy improved significantly after the intervention, increasing from a problematic level (mean, 9.55 [SD, 4.35]) to a sufficient level (mean, 14.03 [SD, 2.68]). Differences were statistically significant for males and females as well as for participants of all nationalities, except the Chinese group. The application e_SaludAble empowered the migrant participants through the improvement of their health literacy.

Efficacy of empathy training in nursing students: A quasi-experimental study.

BACKGROUND: Empathy is a competency to be learned by nurses and a therapeutic tool in the helping relationship that has repercussions on the health of both patients and professionals. OBJECTIVES: To determine the efficacy of an experiential training for improving the empathy of nursing students in terms of capacity building, empathic performance and increased learning perception and retention of the material. DESIGN: A quasi-experimental study of a single group with pretest-posttest measurements of the educational intervention and follow-up at one month after the training. SETTINGS: Faculty of Nursing, University of Cádiz, Spain. PARTICIPANTS: Forty-eight second-year undergraduate university nursing students. METHODS: The educational intervention was conducted during a single semester, with 20h of training. The methodology of role-playing, behavior assay, and a flipped classroom was followed. Measurements of student performance were collected before and after the intervention. The Reynolds Empathy Scale was used to evaluate the student's perception of his/her performance; The Consultation and Relational Empathy Measure was used to evaluate the patient's perception of the student's behavior during the simulation; and three independent external observers assessed the student's behavior, guided by The Carkhuff Scale. Descriptive analysis and non-parametric contrast tests were performed to compare the scores before and after the training (Mann-Whitney U and Wilcoxon rank-sum). Spearman's correlation coefficient was used for the correlation between the measurements. RESULTS: The mean scores improved for all of the variables, with the differences being statistically significant. The students assessed their learning positively. CONCLUSIONS: The training was shown to be effective for improving the empathy of the university students in the study. The results are promising in terms of the students retaining the competencies adquired. Therefore, this type of experiential training is recommended for empathy training of future health professionals.

Mental Health in Immigrants Versus Native Population: A Systematic Review of the Literature.

The relationship between psychopathology and migration presents unresolved questions. OBJECTIVES: To determine whether there is a higher incidence of mental illness among immigrants, to describe the nosologic differences between immigrant and native populations, and to identify the risk factors involved of immigration. METHODS: A systematic review was conducted using the PubMed, Science Direct, ISI, Scopus, Psycinfo, Cochrane, and Cuiden databases. The search strategy was conducted using the MeSH thesaurus for the controlled terms "mental disorders," "mental health," "transients and migrants," "immigrants," and "epidemiology." The quality of the articles was analyzed by using the Equator Guidelines, following checklists according to the methodological design of the studies by two independent reviewers. RESULTS: From a total of 817 studies found, 21 met the inclusion criteria. Out of the 21 studies selected, 13 showed a higher prevalence of mental illness. CONCLUSIONS: Migration represents a major challenge, but it does not lead exclusively to mental distress. Immigrants experience more problems in depression, anxiety, and somatic disorders, pathologies related directly to the migration process and stress suffered. Resources should be oriented to primary and community care.

Percepción y experiencias en el acceso y el uso de los servicios sanitarios en población inmigrante / Perceptions and experiences of access to health services and their utilization among the immigrant population

Objetivo: Identificar y describir las necesidades y los problemas percibidos por la población inmigrante en relación con el acceso y la utilización de los servicios de salud. Método: Estudio cualitativo descriptivo de orientación fenomenológica mediante grupos focales. El ámbito de estudio fue la comarca del Campo de Gibraltar, puerta de entrada a Europa para la inmigración procedente de África. La saturación teórica determinó el tamaño final de la muestra (51 inmigrantes de 11 nacionalidades). Se llevó a cabo un análisis narrativo del contenido con el software informático QSR NVivo9. Resultados: Los discursos muestran cuatro categorías de análisis: respuesta ante un problema de salud, acceso al sistema, conocimiento de recursos sociosanitarios y necesidades de alfabetización en salud. Las respuestas desplegadas ante los problemas de salud y la forma de acceder al sistema sanitario son distintas en función de algunas características sociodemográficas (nacionalidad/cultura de origen, tiempo de estancia y estatus económico). En general utilizan principalmente la asistencia sanitaria a demanda cuando presentan problemas de salud, y quedan relegados los servicios de promoción y prevención de la salud. Las necesidades de alfabetización en salud detectadas se relacionan sobre todo con el dominio del idioma y el funcionamiento del sistema sanitario. Conclusiones: Es necesario fomentar intervenciones destinadas a potenciar la alfabetización en salud de la población inmigrante, que atiendan a la diversidad, tengan en cuenta el tiempo de estancia y partan de una metodología de acción-participación (AU)

Objective: To identify and describe the needs and problems of the immigrant population related to access and utilization of health services. Method: A descriptive, qualitative, phenomenological study was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9 software. Results: Immigrants’ discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention. The health literacy needs identified concerned language proficiency and the functioning of the health system. Conclusions: There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on an action-participation methodology (AU)

[Perceptions and experiences of access to health services and their utilization among the immigrant population]. / Percepción y experiencias en el acceso y el uso de los servicios sanitarios en población inmigrante.

OBJECTIVE: To identify and describe the needs and problems of the immigrant population related to access and utilization of health services. METHOD: A descriptive, qualitative, phenomenological study was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9 software. RESULTS: Immigrants' discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention. The health literacy needs identified concerned language proficiency and the functioning of the health system. CONCLUSIONS: There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on an action-participation methodology.

Perspectivas actuales en el tratamiento del trastorno de estrés postraumático en la población infantil: análisis bibliométrico / Current approaches to post-traumatic stress disorder among children: a biblimetric analysis

El Trastorno de Estrés Postraumático en la población pediátrica, ha sido poco investigado. Así hasta 1987 no se reconoce, en los criterios diagnósticos, que las reacciones de los niños al trauma pueden diferir de la de los adultos. Teniendo en cuenta estas diferencias en cuanto a la semiología del Trastorno de Estrés Postraumático, es lógico pensar que la evaluación e intervención de estos pacientes no puede plantearse de igual modo que en el caso de la población adulta. Por todo ello, el objetivo del presente artículo es describir la evolución de la literatura científica, en los últimos 10 años, y establecer el estado actual de la cuestión, determinando las deficiencias y necesidades a considerar para desarrollar vías de estudio en futuras investigaciones

Very little attention has been paid by researchers to post-traumatic stress disorder (PTSD)in the paediatric population. Not until 1987 the fact that child reaction to trauma may differ from adult reaction is reflected in diagnostic criteria. Bearing these differences in mind with regard to the PTSD semiology, we may think that planning of assessment and intervention must differ in the case of chifdren. Therefore, the aim af this paper is to follow the evolution of literature during the last 10 years, and to establish the current state of the art of PTSD in children. Deficiencies and needs will be remarked in order to develop future research fines