Equity impacts of interventions to increase physical activity among older adults: a quantitative health impact assessment.

BACKGROUND: Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany. METHODS: We created six intervention scenarios targeting the elderly population: Scenarios #1-#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity. RESULTS: Under scenarios #1-#4, approximately 3589-5829 incident disease cases and 6248-10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381-7163 disease cases and 6914-12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6. CONCLUSIONS: This study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.

Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU).

BACKGROUND: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. M ETHODS: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. R ESULTS: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. DISCUSSION: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

Sociodemographic and health-(care-)related characteristics of online health information seekers: a cross-sectional German study.

BACKGROUND: Although the increasing dissemination and use of health-related information on the Internet has the potential to empower citizens and patients, several studies have detected disparities in the use of online health information. This is due to several factors. So far, only a few studies have examined the impact of socio-economic status (SES) on health information seeking on the Internet. This study was designed to identify sociodemographic and health-(care-)related differences between users and non-users of health information gleaned from the Internet with the aim of detecting hard-to-reach target groups. METHODS: This study analyzed data from the NRW Health Survey LZG.NRW 2011 (n = 2,000; conducted in North Rhine-Westphalia, Germany, via telephone interviews). Logistic regression analysis was used to examine the determinants of online health information seeking behavior. RESULTS: 68% of Internet users refer to the Internet for health-related purposes. Of the independent variables tested, SES proved to exert the strongest influence on searching the Internet for health information. The final multivariate regression model shows that people from the middle (OR: 2.2, 95% CI: 1.6-3.2) and upper (OR: 4.0, 95% CI: 2.7-6.2) social classes are more likely to seek health information on the Internet than those from the lower class. Also, women are more likely to look for health information on the Internet than men (OR: 1.5, 95% CI: 1.1-2.1). Individuals with a migration background are less likely to conduct health searches on the Internet (OR: 0.6, 95% CI: 0.4-0.8). Married people or individuals in a stable relationship search the Internet more often for health information than do singles (OR: 1.9, 95% CI: 1.2-2.9). Also, heavy use of health-care services compared to non-use is associated with a higher likelihood of using the Internet for health-related matters (OR: 1.7, 95% CI: 1.2-2.5). CONCLUSIONS: In order to achieve equity in health, health-related Internet use by the socially deprived should be promoted through measures to increase their level of e-health literacy. Furthermore, longitudinal studies are needed in order to gain reliable data/results on determinants of health-related Internet use.

Specific health status has an impact on the willingness to use telemonitoring: data from a 2009 health survey in north rhine-westphalia, Germany.

OBJECTIVE: Demographic changes in Germany are expected to cause a rising need for medical care and therapy while capacities are declining. Telemedicine offers the option of minimizing some aspects of these problems, but so far, many telemedicine projects in Germany (including telemonitoring projects) are not applied to the clinical routine. This study was done to assess the influence of health factors on potential willingness to use telemonitoring devices at home. MATERIALS AND METHODS: Health status and other health-relevant factors were determined using individual and medical factors (e.g., reported diseases). Principal-component analysis was used to identify groups with a specific response behavior. This study was based on a representative telephone survey conducted in the German state of North Rhine-Westphalia in 2009. RESULTS: Willingness to use telemonitoring was high in North Rhine-Westphalia but decreased with age. Men showed a significantly greater willingness to use telemonitoring than did women. Also, there was an effect associated with the subjects' health status (e.g., cardiovascular diseases caused a decrease of 9.7% in the level of acceptance, whereas musculoskeletal disorders caused a decrease of 5.1%). CONCLUSIONS: The target groups for telemonitoring consisted mainly of elderly persons and those with certain diseases. This study showed that being diseased lowered the willingness to use telemonitoring. People need to understand better how telemonitoring can help to improve controlling their health status and coping with the disease. It is necessary to reflect on these specific needs if telemonitoring is to become routine in the German healthcare system.

Is telemonitoring an option against shortage of physicians in rural regions? Attitude towards telemedical devices in the North Rhine-Westphalian health survey, Germany.

BACKGROUND: General practitioners (GP) in rural areas of Germany are struggling to find successors for their private practices. Telemonitoring at home offers an option to support remaining GPs and specialists in ambulatory care. METHODS: We assessed the knowledge and attitude towards telemedicine in the population of North Rhine-Westphalia (NRW), Germany, in a population-based telephone survey. RESULTS: Out of 2,006 participants, 734 (36.6%) reported an awareness of telemedical devices. Only 37 participants (1.8%) have experience in using them. The majority of participants were in favour of using them in case of illness (72.2%). However, this approval declined with age. These findings were similar in rural and urban areas. Participants who were in favour of telemedicine (n = 1,480) strongly agreed that they would have to see their doctor less often, and that the doctor would recognize earlier relevant changes in their vital status. Participants who disliked to be monitored by telemedical devices preferred to receive immediate feedback from their physician. Especially, the elderly fear the loss of personal contact with their physician. They need the direct patient-physician communication. CONCLUSIONS: The fear of being left alone with the technique needs to be compensated for today's elderly patients to enhance acceptance of home telemonitoring as support for remaining doctors either in the rural areas or cities.

[Evaluation of the public-health intervention "Healthy Lower Rhine ... against Stroke" by phone surveys. A comparison of community knowledge of stroke by two surveys in the Lower Rhine Region, district of Wesel, Germany, 2002 and 2008]. / Evaluation der Public-Health-Intervention "Gesunder Niederrhein ... gegen den Schlaganfall" durch Telefonbefragungen: Vergleich des Schlaganfallwissens der Erwachsenenbevölkerung am Niederrhein, Kreis Wesel, 2002 und 2008.

BACKGROUND AND PURPOSE: From 2003 to 2008, the program "Healthy Lower Rhine ... against Stroke" was carried out by the Healthy Lower Rhine Network consisting of Health-Conference agencies of six neighboring districts and municipalities. The initiative aims primarily at improving public knowledge on stroke with regard to proper action - "A stroke is a medical emergency, so phone the emergency number 112 immediately!" - and stroke warning signs and symptoms. The campaign is designed to eventually reduce prehospital time, i.e., delays from onset of symptoms to hospital delivery. In the Wesel district (North Rhine-Westphalia [NRW]) the local Health Conference commissioned two representative telephone surveys with a T(0) survey before the start of the program in 2003 and T(1) in 2008 prior to the end of the 5 years' runtime. METHODS: The telephone survey was carried out by the CATI Laboratory (Computer-Assisted Telephone Interviews) of the Survey Center for Social Science (SUZ) in Duisburg in collaboration with the Institute of Health and Work NRW (LIGA.NRW) and the Health-Conference agency of the Wesel district. The study population was the adult community with about 385,000 inhabitants. The random sample comprised 1,089 persons for the T(0) survey (02/18/02-03/28/02) and 1,104 persons were interviewed for the T(1) poll (03/18/08-04/05/08). RESULTS: While in 2002 a proportion of 31.9% of the interviewed persons knew not a single correct stroke symptom, in 2008 this portion amounted to 27.3%. Three or more correct signs were mentioned by 18.6% in the T0 survey versus 25.5% in 2008 (T(1) survey). Symptoms which were mentioned significantly more frequently in 2008 than in 2002 were hemiplegia and dropping corner of the mouth (+5.3%), respectively, numbness/paresthesia (+17.9%), trouble speaking or understanding (+6.1%), and trouble seeing/visual impairment (+4.3%). When being asked: "What would you do in case of stroke?", 69% of the answers in 2008 were correct (call emergency number 112). There were no significant differences in knowledge of risk factors. About 25% of participants in 2008 stated, that they remembered the stroke awareness campaign or related events. CONCLUSION: The present study shows a moderate improvement of community knowledge about stroke with respect to symptoms and proper action in the course of the 5 years' public-health intervention. In comparison to similar surveys performed in 2000 and 2004, especially knowledge of correct action in case of emergency (stroke = medical emergency = call 112) improved. Still, there are persisting gaps in knowledge about stroke in the community, which make further efforts of improving this knowledge recommendable.

["Medical Emergency Services as Seen by Consumers". Health services research by CATI survey of the community]. / "Medizinische Notfalldienste aus Nutzersicht" Ein Beitrag zur Versorgungsforschung durch CATI-Befragung der Bevölkerung.

BACKGROUND: In the Wesel district (North Rhine-Westphalia), emergency ambulances have been called out with increasing frequency and hospitals report that their emergency departments (ED) are more and more being used outside consultation hours of panel doctors. Therefore, the district health conference put this issue on its agenda. PURPOSE: The aim was to obtain data on the following questions: * What do people do when they need medical help outside consultation hours of panel doctors? * Do people know that there is an on-call duty by panel doctors? Do they know how to contact this service? Do people know the Emergency Medical Service and phone number 112 and the new phone number 19222 for Patient Transport Ambulances? MATERIAL AND METHODS: The study population was defined as comprising all residents in the district of Wesel between 18 and 87 years of age (approximately 385,000 people). The sample contained 1,089 persons drawn in accordance with the Gabler-Häder method and in a second step the "birthday method" was used. The survey was carried out by the CATI Laboratory (Computer-Assisted Telephone Interviews) at the Institute of Public Health (lögd, Bielefeld, Germany) between February 18 and March 28, 2002. RESULTS: (1) Being asked: "How would you act in case of a non-life-threatening disease outside consultation hours of panel doctors?", 52.6% of the respondents gave at least one correct answer; 48.6 % of all given answers were "correct" (i. e., on-call duty of Statutory Health Insurance [SHI]-accredited physicians), the others were "incorrect", i. e., "I go to the hospital/emergency department" (24.3%) or "I call the phone number 112" (13%). (2) About 80% of respondents said they heard about the on-call duty of SHI physicians. (3) 95.6% of respondents stated they knew the emergency call of the fire department; 86% of these participants were able to name the correct phone number 112. (4) About 4% of the respondents said they knew the nationwide telephone number for patient transports, and 58% of these respondents mentioned the correct number 19222. CONCLUSION: A) The tiered medical emergency system should be used adequately; this aim could be attained by (1) information of the public about the "24-h" on-call service of panel doctors; information about the fact that the majority of medical conditions can be treated by panel doctors and that in severe cases a professional and quick referral will be done; information about the fact that self-referral to hospitals may reduce or even obstruct professional resources for the treatment of "real" emergency patients. Target groups are men, younger age groups and people with a higher level of education. (2) information of target groups (elderly people) about the emergency call number 112. (3) information of the public about the national phone number 19222 for patient transports. B) Structural measures such as (1) specific on-call services, (2) improvement of the transparency and reach-ability of panel doctors' on-call services.