Configuring Secretarial Workflows in the Epic EHR Suite.

The primary goal of large-scale electronic health record (EHR) suites is to meet the needs of a broad range of users in healthcare institutions. EHR suites are extensively configurable, which makes it possible to tailor them to diverse professional practices and users. However, while users such as physicians and nurses may have clearly defined responsibilities, clerical personnel (i.e. secretaries) conduct "in-between" or invisible work that is not as easily defined. Therefore, it may be more difficult to tailor EHR suites to their needs. Moreover, because secretaries are quite low in the hospital hierarchy, it is difficult for them to obtain satisfactory solutions. In this paper, we explore the challenges of configuring the EHR suite for secretary workflows in the Health Platform program in central Norway.

Co-creating public health measures with adolescents in municipalities: municipal actors' views on inhibitors and promoters for adolescent involvement.

AIM: To explore what municipal actors consider as inhibiting and promoting adolescents' involvement in public health measures in municipalities. METHODS: A qualitative study with individual and group interviews was conducted among 15 municipal actors who were central in involving adolescents from five Norwegian municipalities participating in the National Programme for Public Health Work in Municipalities (2017-2027). In addition, participatory observation of project activities was done in two municipalities. A data-driven thematic analysis was applied to analyse data. RESULTS: In the analysis, we developed four themes, including both inhibitors and promoters for adolescent involvement: (a) Timeframe challenges in adolescent involvement; (b) Lack of necessary knowledge and awareness among adolescents; (c) Limited competencies and resources in the project groups; and (d) Facilitators' attitudes on and perceptions of adolescent involvement. CONCLUSIONS: This study reports factors that are important to consider when facilitating involvement processes with young people. Findings suggest that further work should be done to ensure involvement of adolescents in public health measures in municipalities, and actors involving adolescents must be provided with competence and resources to ensure such participation.

Obstacles of eHealth Capacity Building and Innovation Promotion Initiative in African Countries.

eHealth applications and tools have the potential to improve coordination, knowledge, and information sharing between health professionals as well as continuity of care. One of the main obstacles hindering its full integration and use, particularly in the healthcare sector in developing and low and middle-income countries is the lack of qualified staff and healthcare personnel. To explore obstacles that hinder capacity and innovation promotion initiatives, a survey was conducted among BETTEReHEALTH partners. A questionnaire was used to collect quantitative data from 37 organizations. Although there are different buckets of capacity-building and innovation promotion activities going on, the findings showed very few targeting policymakers and eHealth specialists. The findings found that obstacles to capacity building and innovation promotion include lack of finance, poor infrastructure, poor leadership, and governance, and these obstacles are context or region specific. Findings from our study concur with those from previous research on the need to identify practical solutions and simple interventions to address eHealth obstacles to capacity building in developing countries. As measures to mitigate these obstacles, our study proposed the need for adequate policies, strong political commitment, the development of academic modules to be integrated into existing educational programs, and the creation of more in-country and on-site capacity-building activities. While this study contributes to the discourse on eHealth capacity-building and innovation promotion initiatives among healthcare and public health professionals, the study has a limitation as data was collected only from BETTEReHEALTH partners.

Reablement in a small municipality, a survival analysis.

BACKGROUND: Reablement is a municipal service given to patients at home. The purpose of the service is to assist recovery after hospital discharges or other sudden changes in a patient's functional level. The service is often provided by a team of nurses, physiotherapists, and occupational therapists. The purpose of this paper is to compare users of this service to users who receive traditional home care services. Outcomes to be measured are risk of long-term care and mortality. METHODS: All users of health and care services in a Norwegian municipality were eligible for inclusion. Data was extracted from the local user administrative database. Users were divided in two groups: those who received reablement and those home care users who did not receive reablement service. Propensity score matching was used to match users based on age, sex, and level of functioning in activities of daily living (ADL). Survival analysis was deployed to test if the reablement users had different risk of becoming long-term care users, and whether the mortality rate differed for this group. RESULTS: 153 reablement users were included in the study. These were matched to 153 non-reablement home care users. The groups had similar distributions of age, sex, and level of functioning when starting their service trajectories. Regressions showed that reablement users had lower risk of using long-term care services in the study period (time at risk up to 4 years), and lower mortality. However, none of these estimates were statistically significant. CONCLUSIONS: The study indicates that the reablement users in one municipality had lower use of long -term care and lower mortality when properly estimated, but numbers were too small for statistical significance to be found.

Effective interventions targeting the mental health of children and young adults: A scoping review.

Aims: Children and young adults are in general characterised by good health, but evidence shows increasing mental-health problems. Numerous interventions have been developed to target their mental health, but the effectiveness of these interventions remains varied. In this scoping review, we investigated factors associated with the effectiveness of interventions. Methods: A scoping review based on a three-block search strategy was performed to review the current literature of effective interventions. Each block (interventions, mental health and children and young adults) were operationalised to search terms. Systematic searches were conducted in three electronic databases and supplemented with citation searches, resulting in 51 studies in total. All studies were critically analysed, and a standardised extraction chart was used to systemise the data. Results: Our scoping review revealed a range of factors influencing the effectiveness of interventions. These factors were (a) characteristics of the target group (age, sex and level of baseline symptoms), (b) factors linked to implementation (use of manuals, training of implementers and context) and (c) characteristics of the interventions (universal versus indicated delivery, multiple-domain approaches, level of theory and adjustment to age and socio-economic status). Elements are discussed for each factor. Conclusions: Based on this review, it can be concluded that the use of stepwise, multi-domain approaches incorporating the social networks of the target group, adjusting activities to specific age groups and the social context, training implementers well and using stringent implementation manuals will improve the effectiveness of interventions targeting the mental health of children and young adults.

Encouraging and Enabling Lifestyles and Behaviours to Simultaneously Promote Environmental Sustainability, Health and Equity: Key Policy Messages from INHERIT.

Human consumption and activity are damaging the global ecosystem and the resources on which we rely for health, well-being and survival. The COVID-19 crisis is yet another manifestation of the urgent need to transition to more sustainable societies, further exposing the weaknesses in health systems and the injustice in our societies. It also underlines that many of the factors leading to environmental degradation, ill health and social and health inequities are interlinked. The current situation provides an unprecedented opportunity to invest in initiatives that address these common factors and encourage people to live more healthily and sustainably. Such initiatives can generate the positive feedback loops needed to change the systems and structures that shape our lives. INHERIT (January 2016-December 2019), an ambitious, multisectoral and transnational research project that involved 18 organisations across Europe, funded by the European Commission, explored such solutions. It identified, defined and analysed promising inter-sectoral policies, practices and approaches to simultaneously promote environmental sustainability, protect and promote health and contribute to health equity (the INHERIT "triple-win") and that can encourage and enable people to live, move and consume more healthfully and sustainably. It also explored the facilitators and barriers to working across sectors and in public private cooperation. The insights were brought together in guidelines setting out how policy makers can help instigate and support local "triple-win" initiatives that influence behaviours as an approach to contributing to the change that is so urgently needed to stem environmental degradation and the interlinked threats to health and wellbeing. This article sets out this guidance, providing timely insights on how to "build back better" in the post pandemic era.

Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health From 2014 to 2018: A Repeated Cross-Sectional Study.

BACKGROUND: Adolescents' mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents' mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014-2018. METHODS: The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014-2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014-2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period. CONCLUSION: Rising rates of adolescents' psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents' mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts.

Addressing Inequity: Evaluation of an Intervention to Improve Accessibility and Quality of a Green Space.

Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015-2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.

Ten Lessons for Good Practice for the INHERIT Triple Win: Health, Equity, and Environmental Sustainability.

The world's challenges of climate change, damage to ecosystems, and social and health inequalities require changes in human behaviours at every level of organisation, among governments, business, communities, and individuals. An important question is how behaviour change can be enabled and supported at the scale and speed required. The research reported in this paper describes important lessons for good practice in changing contexts to modify behaviours for a triple win for health, equity and environmental sustainability. Authors synthesised learning from qualitative, quantitative and cost benefit evaluations of 15 case studies conducted in 12 countries in Europe. The case studies address ways of living (green spaces and energy efficient housing), moving (active transport) and consuming (healthy and sustainable diets) that support the triple win. Ten lessons for good practice were identified. These include bringing a triple win mindset to policy and practice in planning interventions, with potential to improve environmental sustainability, health and equity at the same time. The lessons for good practice are intended to support governmental and non-governmental actors, practitioners and researchers planning to work across sectors to achieve mutual benefits for health and environmental sustainability and in particular to benefit poorer and more socio-economically disadvantaged groups.

Governance for public health and health equity: The Tröndelag model for public health work.

BACKGROUND: Multi-sectoral governance of population health is linked to the realization that health is the property of many societal systems. This study aims to contribute knowledge and methods that can strengthen the capacities of municipalities regarding how to work more systematically, knowledge-based and multi-sectoral in promoting health and health equity in the population. METHODS: Process evaluation was conducted, applying a mixed-methods research design, combining qualitative and quantitative data collection methods. RESULTS: Processes strengthening systematic and multi-sectoral development, implementation and evaluation of research-based measures to promote health, quality of life, and health equity in, for and with municipalities were revealed. A step-by-step model, that emphasizes the promotion of knowledge-based, systematic, multi-sectoral public health work, as well as joint ownership of local resources, initiatives and policies has been developed. CONCLUSIONS: Implementation of systematic, knowledge-based and multi-sectoral governance of public health measures in municipalities demand shared understanding of the challenges, updated overview of the population health and impact factors, anchoring in plans, new skills and methods for selection and implementation of measures, as well as development of trust, ownership, shared ethics and goals among those involved.