Exploring the Viability and Acceptance of Nudge in Public Policies for Health Promotion.

BACKGROUND: Behaviorally informed interventions, such as nudging, encourage actions intended to promote longer and healthier lives. Holding significant potential for influencing health policies and healthcare practices, these interventions are partaking of a shift in governance and public health policymaking. However, a substantial knowledge gap remains regarding the feasibility and appropriateness of implementing policies that draw on nudge. METHODS: Ae survey on nudge's acceptability) was adapted to the Portuguese context to access attitudes towards 16 nudge measures. The research focused on evaluating attitudes among political science and public administration BSc and MSc students from nine Portuguese universities, and analyzing the relationship between these attitudes, sociodemographic characteristics, and sociopolitical attitudes. The data analysis involved the application of descriptive and inferential statistics. RESULTS: The participants exhibited a moderate-to-high level of approval for various nudge measures, particularly those related to nutrition and public education/awareness raising. The study identified a nuanced relationship between the level of intrusiveness of nudges and their public approval, indicating that interventions preserving the architecture of choice gathered higher acceptance compared to more intrusive approaches. Notably, approval was associated with a high level of trust in social groups and a low propensity for risk-taking and alcohol consumption. CONCLUSIONS: This study not only sheds light on the types of nudge measures that are likely to be more acceptable for promoting healthy behaviors, but also establishes a crucial link between behavioral interventions and healthcare policies. Understanding the nuanced factors influencing the public acceptance of nudges contributes to the discourse on the implementation of behaviorally informed health policies and emphasizes the importance of tailoring interventions to align with public values and preferences.

Unlocking the WHO's Age-Friendly Healthcare Principles: Portugal's Quest and Recommendations.

Countries worldwide are grappling with a pressing demographic challenge characterized by a growing older population. This poses a significant healthcare dilemma, presenting challenges for healthcare systems and providers. To address these challenges, the World Health Organization (WHO) has devised a set of Age-Friendly Principles, aimed at optimizing healthcare provision for older people. This article delves into the current state of healthcare adaptation for older adults in Portugal and assesses the implementation of the WHO Principles. Case studies were conducted in three distinct regions of Portugal, involving semistructured interviews with key decision makers from both the healthcare sector and organizations wielding direct influence over health policies (n = 11). A comprehensive content analysis was conducted employing the webQDA software. The findings unveiled a noteworthy trend in which most interviewees displayed limited familiarity with the WHO Principles. Nevertheless, all interviewees acknowledged the need to adapt the healthcare system accordingly. Strengths were identified, primarily within the healthcare management system, but noteworthy gaps were also revealed, particularly in terms of facility preparedness and professional training. Interviewees proposed various interventions to enhance age-friendly healthcare provision; however, they concurrently pinpointed challenges related to human resources, infrastructure, and financial management. In their concluding recommendations, interviewees underscored the development of tools to facilitate the application and evaluation of the WHO Principles, as well as the development by the WHO of an accreditation system to encourage the application of the principles in healthcare providers across the world.

Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal.

Demographic ageing has emphasized the need to adapt current healthcare systems to the comorbidity profile of older adults. In 2004, the World Health Organization (WHO) developed the Age-Friendly Principles, but the approach to their implementation in the health systems still remains uncertain. This article intends to address this gap by assessing how the Principles are perceived and implemented in the Portuguese National Health Service (NHS), where this topic has recently been placed on the political agenda. A questionnaire survey was administered to primary care directors and hospital administrators, covering a total of 173 health units. Findings show that most respondents are unaware of the WHO Principles (71%) and do not identify the current organizational structure of care as a problem for the provision of care (80%). However, the implementation of the WHO Principles is lower than desired, especially regarding professional training and the management system (50% and 28% of the criteria are implemented, respectively). These criteria defined by the WHO are implemented in a reduced number of health units, as opposed to the physical environment where implementation is more widespread (64%). Accordingly, further dissemination and implementation support in the national territory are needed in order to improve the health outcomes of older adults and increase the performance of health units.

Designing a Health Strategy at Local Level: A Conceptual Framework for Local Governments.

This article addresses a gap in the literature regarding the design and implementation of health and well-being strategies by local governments. It presents a conceptual framework that can help local governments to include health and well-being among their political priorities by promoting the participation of local stakeholders and the community in general. The article also highlights the important role that local governments play in public health, especially in times of crisis, such as the COVID-19 pandemic. To demonstrate the approach, the manuscript explores the recent shift toward decentralization in Portugal and the resulting emphasis on local governments leading new approaches to health governance. The planning process for Arouca's Health Strategy, an inland municipality, is used as a case study to demonstrate the approach, which emphasizes the meaningful participation of the entire local community. The article concludes by noting that there is still significant room for improvement in all areas related to health and well-being and a need to adopt new multistakeholder governance arrangements to sustain the institutional capacity for upcoming strategies.

Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist.

BACKGROUND: Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards. OBJECTIVE: The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies. METHODS: A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70% or more experienced participants scored an item 7 to 9 and less than 15% of participants scored the same item 1 to 3. RESULTS: A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation-related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82%) of the procedures related to usability evaluation involving users and for 7 (70%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies. CONCLUSIONS: This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions.

Perceptions on Extending the Use of Technology after the COVID-19 Pandemic Resolves: A Qualitative Study with Older Adults.

The COVID-19 pandemic of the last two years has affected the lives of many individuals, especially the most vulnerable and at-risk population groups, e.g., older adults. While social distancing and isolation are shown to be effective at decreasing the transmission of the virus, these actions have also increased loneliness and social isolation. To combat social distancing from family and friends, older adults have turned to technology for help. In the health sector, these individuals also had a variety of options that strengthened eHealth care services. This study analyzed the technologies used during the COVID-19 pandemic by a group of older people, as well as explored their expectations of use after the pandemic period. Qualitative and ethnographic interviews were conducted with 10 Portuguese older adults, and data were collected over a period of seven months between 2020 and 2021. The research demonstrated that the use of current and new technologies in the post-pandemic future is likely to be related to overcoming: (i) insecurity regarding privacy issues; (ii) difficulties in using technologies due to the level of use of digital technology; and (iii) the human distancing and impersonal consequences of using these technologies.

Defining Recommendations to Guide User Interface Design: Multimethod Approach.

BACKGROUND: For the development of digital solutions, different aspects of user interface design must be taken into consideration. Different technologies, interaction paradigms, user characteristics and needs, and interface design components are some of the aspects that designers and developers should pay attention to when designing a solution. Many user interface design recommendations for different digital solutions and user profiles are found in the literature, but these recommendations have numerous similarities, contradictions, and different levels of detail. A detailed critical analysis is needed that compares, evaluates, and validates existing recommendations and allows the definition of a practical set of recommendations. OBJECTIVE: This study aimed to analyze and synthesize existing user interface design recommendations and propose a practical set of recommendations that guide the development of different technologies. METHODS: Based on previous studies, a set of recommendations on user interface design was generated following 4 steps: (1) interview with user interface design experts; (2) analysis of the experts' feedback and drafting of a set of recommendations; (3) reanalysis of the shorter list of recommendations by a group of experts; and (4) refining and finalizing the list. RESULTS: The findings allowed us to define a set of 174 recommendations divided into 12 categories, according to usability principles, and organized into 2 levels of hierarchy: generic (69 recommendations) and specific (105 recommendations). CONCLUSIONS: This study shows that user interface design recommendations can be divided according to usability principles and organized into levels of detail. Moreover, this study reveals that some recommendations, as they address different technologies and interaction paradigms, need further work.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review.

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Public Service Motivation and Determining Factors to Attract and Retain Health Professionals in the Public Sector: A Systematic Review.

(1) Background: The motivational determinants of health professionals to choose and remain in the public sector have been increasingly addressed, including the customized approach of Public Service Motivation (PSM). However, to date, no systematic research overview has been performed in this domain, leaving the body of literature unstructured. This article fills this gap by assessing the motivational factors of choice for the public sector in the health field, and the conceptual and methodological trends of this research stream. (2) Methods: This study follows the PRISMA protocol to ascertain patterns in past research and inform researchers, practitioners, and policymakers. Eighty-nine documents published between 1998 and 2021 were retained after selecting them according to their theme and outlined goals. (3) Results: Common motivational determinants are remuneration, available resources, work conditions, and frequency of contact and interaction with patients. The PSM construct and scale are often employed as main frameworks, but there is also a concern in assessing motivation drawing on psychological constructs that reflect the challenging line of work and environment that is health care, such as presenteeism, stress, and perception of hindrances. (4) Conclusions: By focusing on health professionals' motivation, this study contributes to a timely systematization in challenging times for health institutions and their human resources.

Contextual Factors Influencing Young Athletes' Decision to Do Physical Activity and Choose a Sports' Club: The Case of Portugal.

Physical activity and sports are a central part of individuals' lives throughout the life cycle. During adolescence, its regular practice may contribute to the development of healthy adult lifestyles, decreasing chronic disease incidence. Therefore, the reasons that drive adolescents to start practicing sports in a certain club may be multiple and understanding such causes can be important to design and implement public policies to promote active lifestyles for everyone. In this article, we report the core findings of a research on why young athletes do sports, how they choose their team-training club and how COVID-19 has had an impact on their routines. From a methodological viewpoint, a questionnaire was developed and sent to sport clubs located in NUTS2 Centro Region, Portugal, and results were analyzed through the use of geographic information systems and statistical analysis, namely association tests (Chi-square test), difference tests (Mann-Whitney test and Kruskal-Wallis test), logistic regression and descriptive analysis. Findings show that family, age group, friends, proximity to sports facilities, teammates, and club conditions are the factors that influence adolescents the most. In short, external factors have a significant preponderance to practice physical activity and choose a sports' club. These findings can provide useful insights for clubs, coaches and policy-makers to become more aware of the relationship between sports practice and accessibility to sports halls, as well as the athletes' behavior and their connection with the club and basketball practice. As such, these findings can motivate the design of initiatives and strategies to boost sports practice and to find ways for clubs to attract more adolescents.

The COVID-19 Pandemic Strain: Teleworking and Health Behavior Changes in the Portuguese Context.

The COVID-19 pandemic has forced a societal essay, based on thorough measures of individual and communitarian protection, ranging from compulsory social distancing to quarantine. Following WHO recommendations, more or less strict policies were adopted by governments worldwide in order to mitigate public health risks. In Portugal, the first state of emergency was declared on 18 March 2020 and renewed until 2 May 2020. During this time, most citizens stayed in quarantine with practical implications regarding their work and daily activities. This exploratory study, conducted within the pandemic crisis context in Portugal, intends to grasp specificities of the adaptation to the lock down and social isolation/distancing measures, concerning, specifically, teleworking conditions and physical activity practice. Data was collected from March to May 2020 through an online survey from 1148 participants of different age groups and literacy. Considering that COVID-19 features a mutual feedback loop of disease and social dynamics-governmental measures, civic adjustments, and individual coping-to know more about what was featured, the first wave may provide some cues to ensure a more efficient co-operation among social actors and, ultimately, tailor better public policies towards teleworking, online distance learning, and the promotion of healthy behaviours.

Active Aging Governance and Challenges at the Local Level.

International and national guidelines have been promoting active aging while creating the necessary means for decision-makers and other relevant actors to work together (governance mechanisms) to implement local and active aging policies. This is especially important in the present COVID-19 pandemic context, posing greater challenges on older people who tend to be self-isolated. How are local actors conceptualizing active aging? What are their priorities related to a healthy life for older people? Which governance mechanisms are used to implement such policies? These are some of the questions addressed in this paper, targeting Portugal, a southern European country. A mixed-methods sequential explanatory design combining a survey conducted at a national level and interviews with key actors in the NUTS III Aveiro Region was employed to identify and understand the underpinning governance mechanisms. Findings confirm the 'passive organization type' in which European politico-territorial studies tend to place Portugal, as there are gaps in the way policies are formulated, implemented and evaluated, as well as a lack of coordination. Results of this study have important impacts on the way local governments and other stakeholders will prepare themselves in the post-pandemic period to design and implement policies addressing active aging.

Collaborative place-based health governance systems: stakeholders' perceptions in the Portuguese Baixo Vouga sub-region.

This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.

Mapping health vulnerabilities: exploring territorial profiles to support health policies.

Vulnerability processes and effects, albeit of great importance to cohesion and territorial policies, are nonetheless still underexplored and narrowly operationalized in scientific research. In particular, most assessments rely on economic indicators and a limited territorial scale, which do not have the same analytic potential of a broader view at a national level with regional/municipal similarities, specificities, and inter-connections. This gap also applies to health-related vulnerabilities, which, stemming from a lack of socioeconomic and environmental resources, has increased during and after the economic crisis of the past decade. This paper aims to analyze the health vulnerability phenomena in Portugal from a spatial perspective. Following a Multiple Correspondence Analysis, different territorial profiles of social vulnerability associated with the population health condition and access to and use of "health services" are identified. We conclude by outlining the importance of adding the spatial context to health policies addressing vulnerabilities and suggest avenues for future research.

Collaborative place-based health governance systems: stakeholders' perceptions in the Portuguese Baixo Vouga sub-region / Governança colaborativa de base local em sistemas de saúde: percepções dos stakeholders na sub-região do Baixo Vouga português

Abstract This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.

Resumo Esta investigação tem como objetivo avaliar estas dimensões no sistema de governança da Região de Aveiro (RA) Portugal, através de 15 entrevistas feitas aos responsáveis máximos de instituições que decidem e que prestam cuidados. Na análise das entrevistas, aplicaram-se me- todologias de análise de conteúdo. Para o efeito, criaram-se matrizes por casos, sub-categorias, sucategorias e indicadores. Das gravações das entrevistas, extraíram-se unidades de registo para cada indicador. Propomos um referencial de governança colaborativa de base local que sistematiza definições operativas de governança colaborativa, servindo, depois, de referencial para o exercício de avaliação. O sistema de governança da sub-região do Baixo Vouga é colaborativo porque assenta numa estrutura partilhada de princípios transposta para o modo como os serviços são prestados. Apresenta colaboração multinível e multissetorial e capacidade de construir decisões partilhadas. Reforçar-se-iam estas dimensões com mais participação, autonomia, subsidiariedade e se se recorresse mais à informação e a conhe- cimento prático, localizado. Também beneficiaria com a adoção extensiva de metodologias de base local na formulação e na implementação de políticas.

Mapping health vulnerabilities: exploring territorial profiles to support health policies / Mapeamento de vulnerabilidades de saúde: explorando perfis territoriais para apoiar políticas de saúde

Abstract Vulnerability processes and effects, albeit of great importance to cohesion and territorial policies, are nonetheless still underexplored and narrowly operationalized in scientific research. In particular, most assessments rely on economic indicators and a limited territorial scale, which do not have the same analytic potential of a broader view at a national level with regional/municipal similarities, specificities, and inter-connections. This gap also applies to health-related vulnerabilities, which, stemming from a lack of socioeconomic and environmental resources, has increased during and after the economic crisis of the past decade. This paper aims to analyze the health vulnerability phenomena in Portugal from a spatial perspective. Following a Multiple Correspondence Analysis, different territorial profiles of social vulnerability associated with the population health condition and access to and use of "health services" are identified. We conclude by outlining the importance of adding the spatial context to health policies addressing vulnerabilities and suggest avenues for future research.

Resumo Os processos e os efeitos da vulnerabilidade, embora de grande importância para a coesão e políticas territoriais, ainda são pouco explorados e operacionalizados do ponto de vista científico. Na verdade, a maioria das avaliações baseia-se em indicadores económicos e em contextos territoriais muito específicos, não explorando o potencial analítico de uma visão mais ampla ao nível nacional, tendo por base as especificidades e as interconexões regionais / municipais. Essa lacuna é visível nas vulnerabilidades relacionadas com a saúde, que, decorrentes da falta de recursos sociais, económicos e ambientais, aumentaram durante e após a crise económica iniciada na década passada. O principal objetivo deste artigo consiste em analisar os fenómenos de vulnerabilidade associados à saúde em Portugal numa ótica territorial. Através da realização de uma Análise de Correspondência Múltipla, são identificados diferentes perfis territoriais de vulnerabilidade social associados ao "estado de saúde" dos indivíduos e ao acesso e uso de "serviços de saúde". Na conclusão do artigo, sublinha-se a importância de adicionar o contexto territorial às políticas de saúde que procuram encontrar respostas para fazer face aos desafios decorrentes de vulnerabilidades sociais e sugerem-se pistas para investigação futura.

Age-Friendly Health Care: A Systematic Review.

BACKGROUND: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. METHODS: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. RESULTS: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. CONCLUSIONS: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.

Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults.

BACKGROUND: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. OBJECTIVE: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. METHODS: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. RESULTS: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. CONCLUSIONS: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations.