Colorectal cancer: a qualitative study of coping strategies used by survivors, with associated social determinants.

BACKGROUND: Colorectal cancer survivors have to develop coping strategies during the diagnosis and survivorship period. This study aims to identify coping strategies in patients with colorectal cancer, in particular the differences between coping strategies during the disease and throughout survival. It also aims to investigate the impact of some social determinants on coping strategies and critically reflect on the influence of positive psychology. METHODS: Qualitative study with in-depth interviews of a purposive sample of 21 colorectal cancer survivors in Majorca (Spain), developed between 2017-2019. Data was analysed using interpretive thematic analysis. RESULTS: We observed different coping strategies during the stages of disease and survival. However, striving toward acceptance and adaptation when facing difficulties and uncertainty, predominate in both stages. Confrontational attitudes are also considered important, as well as encouraging positive rather than negative feelings, which are considered unhelpful and to be avoided. CONCLUSIONS: Although coping during illness and survival can be classified into common categories (problem and emotion-centred strategies), the challenges of these stages are faced differently. Age, gender and the cultural influence of positive psychology strongly influence both stages and strategies.

Impact of COVID-19 Confinement on the Health-Related Habits of People at High Risk of Type 2 Diabetes.

The general lockdown decreed in Spain due to the COVID-19 pandemic interrupted the ALAS health promotion intervention aimed at the population at high risk of suffering from type 2 diabetes. We conducted a descriptive study in 2020 through a telephone survey and a comparison with baseline data to determine the impact of confinement on the lifestyles of the participants. We collected sociodemographic variables and conducted assessments before/after confinement on general health status and lifestyle (sleep, physical activity and diet). Additionally, weight, BMI and adherence to a Mediterranean diet were assessed. Descriptive statistical analyses, comparisons of pre-post confinement data and logistic regression were carried out. A total of 387 individuals responded. Among them, 31.8% reported a worse perception of health after confinement, and 63,1% reported no change. Regarding exercise, 61.1% reduced their weekly physical activity time. Regarding diet, 34,4% perceived worse quality, and 53.4% reported no change, despite the fact that 89.4% declared changes in their eating practices. Weight and BMI decreased by 3,1%, and adherence to the Mediterranean diet improved from baseline. Confinement had a negative impact on the general health, diet, sleep and physical activity of this population (at risk of diabetes); however, weight and BMI decreased, and adherence to a Mediterranean diet improved.

Evaluation under real-life conditions of a lifestyle intervention for diabetes prevention developed by the municipal health services of Madrid, Spain.

The Diet, Physical Activity and Health (Alimentación, Actividad física y Salud, ALAS) program is an intervention implemented by the municipal health services of Madrid with the objective of reducing weight and preventing diabetes in high-risk population by improving diet and physical activity. The ALAS program combines individual visits with a 10-session group workshop that takes place over a 6-month period. This study evaluated the effectiveness of the ALAS intervention implemented under real-life conditions between 2016 and 2019. The intervention was evaluated with a pre- and post-intervention study with follow-up performed 6 and 12 months from the start of the program. The analyzed outcomes were a 5-10% reduction in the initial weight, body mass index (BMI), waist circumference and a change in glycemic status in prediabetic participants. Statistical models were adjusted by sociodemographic variables. The participants were recruited from municipal community health centers or referred by municipal occupational health services. Between 2016 and 2019, 1629 people participated in the program. At 6 months, 85% of the participants had lost weight; 43% had lost 5% or more of their initial weight, and 12% had lost 10% or more. Regarding BMI, 22.3% of participants who were initially obese were no longer obese, and 15.2% of the overweight participants achieved normal weight. A total of 35.1% of the prediabetic participants reverted to normoglycemic status. The intervention was found to be more effective for men, for those who completed the intervention and those who accessed the program through the occupational health route. Among the participants who accessed the intervention via the community, the intervention was more effective in those with a high educational level. The evaluation demonstrated the effectiveness of the ALAS program for reducing weight and the risk of developing Type 2 diabetes when applied under real-life conditions. The effectiveness of the intervention differed according to gender, access route and educational level of the participants.

Prospective Observational Study on the Prevalence and Diagnostic Value of General Practitioners' Gut Feelings for Cancer and Serious Diseases.

BACKGROUND: General practitioners (GPs) have recognized the presence of gut feelings in their diagnostic process. However, little is known about the frequency or determinants of gut feelings or the diagnostic value of gut feelings for cancer and other serious diseases. OBJECTIVE: To assess the prevalence of gut feelings in general practice, examine their determinants and impact on patient management, and measure their diagnostic value for cancer and other serious diseases. DESIGN: This prospective observational study was performed using the Gut Feelings Questionnaire (GFQ). PARTICIPANTS: Participants included 155 GPs and 1487 of their patients, from four Spanish provinces. MAIN MEASURES: Sociodemographic data from patients and GPs; the reasoning style of GPs; the characteristics of the consultation; the presence and kind of gut feeling; the patient's subsequent contacts with the health system; and new cancer and serious disease diagnoses reported at 2 and 6 months post-consultation. KEY RESULTS: GPs experienced a gut feeling during 97% of the consultations: a sense of reassurance in 75% of consultations and a sense of alarm in 22% of consultations. A sense of alarm was felt at higher frequency given an older patient, the presence of at least one cancer-associated symptom, or a non-urban setting. GPs took diagnostic action more frequently after a sense of alarm. After 2 months, the sense of alarm had a sensitivity of 59% for cancer and other serious diseases (95% CI 47-71), a specificity of 79% (95% CI 77-82), a positive predictive value of 12% (95% CI 9-16), and a negative predictive value of 98% (95% CI 86-98). CONCLUSIONS: Gut feelings are consistently present in primary care medicine, and they play a substantial role in a GP's clinical reasoning and timely diagnosis of serious disease. The sense of alarm must be taken seriously and used to support diagnostic evaluation in patients with a new reason for encounter.

Coping with intimate partner violence and the COVID-19 lockdown: The perspectives of service professionals in Spain.

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020-April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV.

Prevalence and diagnostic value of GPs' gut feelings for cancer and serious diseases: protocol for a prospective observational study of diagnostic validity.

INTRODUCTION: Cancer diagnosis in primary care is an important challenge for general practitioners (GPs) due to the relatively low frequency of any single type of cancer and the heterogeneous signs and symptoms that can be present. In addition to analytical reasoning, GPs may become aware of gut feelings (GFs) as they suspect that a patient may have cancer or another serious disease. We aimed to investigate the prevalence and the predictive value of GFs for the diagnosis of cancer and serious diseases. METHODS AND ANALYSIS: Prospective observational study of diagnostic validity. Participation will be offered to GPs from Majorca and Zaragoza (Spain). They will recruit all patients with a new reason for encounter during one or two workdays. GPs will complete the Gut Feelings Questionnaire (GFQ). Variables regarding patient, GP and consultation will be collected. Two and 6 months after the first visit, incident diagnoses of cancer or other serious diseases, diagnostic tests performed, referrals and new visits will be recorded. Analysis will include a descriptive analysis of the variables and prevalence of GFs, and the sensitivity, specificity, predictive values and likelihood ratios of the GFs (sense of alarm and sense of reassurance) for diagnosing cancer and other serious diseases, as measured with the GFQ. ETHICS AND DISSEMINATION: The study has obtained approval from the Majorcan Primary Care Research Committee and from the Balearic Islands Ethical Committee, with reference number IB 3210/16 PI. The results may help GPs to make more accurate decisions about which patients need further examinations to rule out or to confirm a diagnosis of cancer or a serious disease, and which ones do not. The results will be published as part of the PhD project of the first author and in open access journals, and will be presented at medical conferences.

Qualitative evaluation of a complex intervention to implement health promotion activities according to healthcare attendees and health professionals: EIRA study (phase II).

OBJECTIVE: To evaluate the implementation and development of a complex intervention on health promotion and changes in health-promoting behaviours in primary healthcare according to healthcare attendees and health professionals. DESIGN: Descriptive qualitative evaluation research conducted with 94 informants. Data collection techniques consisted of 14 semistructured individual interviews, 9 discussion groups, 1 triangular group and 6 documents. Three analysts carried out a thematic content analysis with the support of Atlas.ti software. This evaluation was modelled on Proctor and colleagues' concept of outcomes for implementation research. SETTING: 7 primary care centres from seven Spanish regions: Andalusia, Aragon, Balearic Islands, Basque Country, Castilla-La Mancha, Castilla-Leon and Catalonia. PARTICIPANTS: The study population were healthcare attendees (theoretical sampling) and health professionals (opportunistic sampling) who had participated in the exploratory trial of the EIRA intervention (2015). RESULTS: Healthcare attendees and professionals had a positive perception of the study. Healthcare attendees even reported that they would recommend participation to family and friends. Health professionals became aware of the significance of the motivational interview, especially for health promotion, and emphasised social prescribing of physical activity. They also put forward recommendations to improve recruitment, screening and retention of participants. Healthcare attendees modified behaviours and health professionals modified working practices. To achieve sustainability, health professionals believe that it is crucial to adapt agendas and involve all the staff. CONCLUSIONS: The discourses of all stakeholders on the intervention must be taken into consideration for the successful, setting-specific implementation of adequate, acceptable, equitable and sustainable strategies aimed at health promotion and well-being.

Cross-cultural translation and validation of the 'gut feelings' questionnaire into Spanish and Catalan.

BACKGROUND: The gut feelings questionnaire (GFQ) is the only tool developed to assess the presence of a 'sense of alarm' or a 'sense of reassurance' in the diagnostic process of general practitioners (GPs). It was created in Dutch and English and has validated versions in French, German and Polish. OBJECTIVES: To obtain a cross-cultural translation of the GFQ into Spanish and Catalan and to assess the structural properties of the translated versions. METHODS: A six-step procedure including forward and backward translations, consensus, and cultural and linguistic validation was performed for both languages. Internal consistency, factor structure, and content validity were assessed. RESULTS: Internal consistency was high for both questionnaires (Cronbach's alpha for GFQ-Spa = 0.94 and GFQ-Cat = 0.95). The principal component analysis identified one factor with the sense of alarm and the sense of reassurance as two opposites, explaining 76% of the total variance for the GFQ-Spa, and 77% for the GFQ-Cat. CONCLUSION: Spanish and Catalan versions of the GFQ were obtained. Both have been cross-culturally adapted and showed good structural properties.

Barriers to and discourses about breast cancer prevention among immigrant women in Spain: a qualitative study.

OBJECTIVES: To identify knowledge, barriers and discourses about breast cancer screening in Spain among female immigrants from low-income countries and native Spanish women from a low socioeconomic class. DESIGN: Qualitative interview study with thematic analysis interpreted using cultural mediators. SETTING: Mallorca, Spain. PARTICIPANTS: Thirty-six in-depth interviews, using cultural mediators, of immigrant women living in Mallorca who were 50-69 years old and were from Maghreb, Sub-Saharan Africa, Eastern Europe, Latin America, China or were native to Spain and from a low socioeconomic class. RESULTS: We analysed the interviews to assess breast cancer perceptions and beliefs, discourses about breast cancer prevention and barriers to accessing breast cancer prevention programmes. Although the women reported an association of breast cancer with death, they acknowledged the effectiveness of early detection. They also exhibited reluctance to talk about cancer. Discourses about cancer prevention tended to be proactive or fatalistic, depending on the woman's country of origin. For all women, fear of results and lack of time were barriers that limited participation in breast cancer prevention programmes. Language barriers, frequent changes of residence and fear due to status as an irregular (undocumented) immigrant were barriers specific to immigrant women. CONCLUSIONS: The culture of origin affects whether an immigrant has a fatalistic or proactive approach toward breast cancer screening. Immigrants from low-income countries and Spanish natives from a low socioeconomic class experience barriers in access to breast cancer screening. Frequently changing homes is also a barrier for immigrant women.

[Who, how and what: community health and local administration]. / Quién, cómo y qué: salud comunitaria y administración local.

The thirteenth SESPAS (Spanish society of public health and health management) report is structured in three blocks Who, How and What about community health and local governance. In the who block the main agents working in community health are described: communities, health care system, and local government; and how their relations and implication in community health have evolved; which concepts are used; what is the current situation and which challenges they have. The How block contains methodological views, oriented towards implementation of community interventions, based upon participatory tools, development of networks and review of evidence and evaluations to build a National Strategy of Health Promotion of the Spanish Ministry of Health, welfare and consumers affairs including suitable deontologic principles. Finally, the what block refers to a wide range of experiences of community health at the local level as well as training in community health, urbanism, gender, neighborhoods, healthy universities. Additionally, besides regular papers, we show dialogs including debates to further develop community health. It contains 18 papers, without taking into account this introduction, authored by 40 men and 49 women.

Quién, cómo y qué: salud comunitaria y administración local / Who, how and what: community health and local administration

El decimotercer informe bienal de SESPAS se estructura en tres bloques que corresponden a quién, cómo y qué sobre la salud comunitaria y la administración local. En el bloque del quién, se describen los agentes principales que trabajan en la salud comunitaria: la comunidad, el sistema sanitario y la administración local; y cómo ha evolucionado su relación e implicación con la salud comunitaria, qué conceptos manejan, cómo se encuentran en este momento y cuáles son sus retos futuros. El bloque del cómo recoge aportaciones más metodológicas, orientadas a la implementación práctica de las intervenciones comunitarias; desde las herramientas para promover la participación, a la creación de redes de actividades, la revisión de las evidencias o la evaluación de la puesta en marcha de la Estrategia Nacional de Promoción de la Salud, del hoy Ministerio de Salud, Consumo y Bienestar Social, incluyendo los principios deontológicos que son de aplicación. Finalmente, el del qué, hace acopio de algunas experiencias sobre aspectos determinados de la salud comunitaria en el ámbito local, así como sobre la formación en salud comunitaria, el urbanismo, el género, los barrios o las universidades saludables. Además del formato habitual se incluyen 5 diálogos en los que se plantean debates para continuar desarrollando la salud comunitaria. En resumen 18 artículos, sin contar esta presentación, firmados por 49 autoras y por 40 autores

The thirteenth SESPAS (Spanish society of public health and health management) report is structured in three blocks Who, How and What about community health and local governance. In the who block the main agents working in community health are described: communities, health care system, and local government; and how their relations and implication in community health have evolved; which concepts are used; what is the current situation and which challenges they have. The How block contains methodological views, oriented towards implementation of community interventions, based upon participatory tools, development of networks and review of evidence and evaluations to build a National Strategy of Health Promotion of the Spanish Ministry of Health, welfare and consumers affairs including suitable deontologic principles. Finally, the what block refers to a wide range of experiences of community health at the local level as well as training in community health, urbanism, gender, neighborhoods, healthy universities. Additionally, besides regular papers, we show dialogs including debates to further develop community health. It contains 18 papers, without taking into account this introduction, authored by 40 men and 49 women

Activos: de los mapas al territorio. Informe SESPAS 2018 / Assets: from maps to territory. SESPAS Report 2018

En los últimos años, los mapas de activos para la salud se están convirtiendo en herramientas cada vez más presentes en el ámbito de la promoción de la salud. Se están incorporando a la práctica diaria de muchos profesionales de la salud, tanto en la atención individualizada en las consultas (mediante la prescripción social) como en grupos o en procesos de desarrollo comunitario. Es necesario reflexionar sobre cómo se están produciendo los mapas de activos, analizando de qué manera las diferentes etapas del proceso pueden intervenir en su construcción. Tanto los formatos en que se presentan los datos obtenidos mediante la identificación de activos para la salud como los propios procesos de producción de la información, procesos participativos y evaluados, son clave para que los mapas sean útiles tanto a los profesionales como a la ciudadanía y las instituciones

In recent years, health asset maps have become increasingly important tools in the field of health promotion. They are being incorporated into the daily practice of many healthcare workers, in individualized care in consultations (through social prescription), and in groups or community development processes. It is necessary to reflect on how the asset maps are being produced, analyzing how the different stages of the process can be involved in their construction. The formats in which the data is obtained through the identification of health assets are presented, as well as the processes of production of the information, participative and evaluated processes, are crucial for the maps to be useful, for professionals as well as citizens and institutions

[Assets: from maps to territory. SESPAS Report 2018]. / Activos: de los mapas al territorio. Informe SESPAS 2018.

In recent years, health asset maps have become increasingly important tools in the field of health promotion. They are being incorporated into the daily practice of many healthcare workers, in individualized care in consultations (through social prescription), and in groups or community development processes. It is necessary to reflect on how the asset maps are being produced, analyzing how the different stages of the process can be involved in their construction. The formats in which the data is obtained through the identification of health assets are presented, as well as the processes of production of the information, participative and evaluated processes, are crucial for the maps to be useful, for professionals as well as citizens and institutions.

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

OBJECTIVE: Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN: Two case-control studies. SETTING: Performed in primary care of five Spanish regions. SUBJECTS: In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES: Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS: The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS: Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

BACKGROUND: Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. METHODS: A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. RESULTS: Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role. CONCLUSIONS: Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.

Beyond the consultation room: Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers.

BACKGROUND: Primary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities. OBJECTIVE: To identify proposals to approach HP in the context of primary care according to health-care users aged 45-75 years, key community informants and primary care centre (PCC) workers. METHODS: Descriptive-interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out. RESULTS: Participants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person-centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness. CONCLUSIONS: According to a socio-ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions.

Gut feelings in the diagnostic process of Spanish GPs: a focus group study.

OBJECTIVES: The gut feelings of doctors can act as triggers and modulators of the diagnostic process. This study explored the existence, significance, determinants and triggers of gut feelings among Spanish general practitioners. DESIGN: Qualitative study using focus groups. Thematic content analysis. SETTING: Primary healthcare centres in Majorca (Spain). PARTICIPANTS: 20 purposively sampled general practitioners working in Majorca. RESULTS: General practitioners were aware of the existence of gut feelings in their diagnostic reasoning process and recognised 2 kinds of gut feelings: a sense of alarm and a sense of reassurance. A previous physician-patient relationship and the physician's experience had a strong perceived influence on the appearance of gut feelings. The physicians attached great significance to gut feelings, and considered them as a characteristic of the primary care working style and as a tool available in their diagnostic process. The physicians thought that the notion of gut feelings and their relevance can be transmitted to students and trainees. They tended to follow their gut feelings, although they were not sure of their accuracy. CONCLUSIONS: Spanish general practitioners in our study recognise the presence and role of gut feelings in their diagnostic reasoning process. Future research should examine the diagnostic accuracy of gut feelings and how to teach about gut feelings in the training of general practitioners.

[Healthcare promotion in primary care: if Hippocrates were alive today ]. / Promoción de la salud en atención primaria: si Hipócrates levantara la cabeza .

This article argues for the need to implement community healthcare promotion initiatives in medical practice. Some of the community initiatives introduced in primary care, as well as scientific evidence and associated implementation factors are described. The need for effective coordination between primary care and public health services, working with the community, is underlined. Two specific coordination initiatives are explained by way of example. The first is a project to develop healthcare plans in health centres in the Balearic Islands, by means of a participatory process with the collaboration of citizens, local organisations and the town council (urban planning, mobility, social services, etc.). The second is the Interdepartmental Public Health Plan of Catalonia, which was established to coordinate cross-sectoral healthcare. A specific part of this plan is the COMSalud project, the purpose of which is to introduce a community perspective to health centres and which is currently being piloted in 16 health areas. We review the proposals of a 2008 research study to implement healthcare promotion in primary care, assessing its achievements and shortfalls. The Disease Prevention and Health Promotion Strategy of the Spanish Ministry of Health is recognised as an opportunity to coordinate primary and public health. It is concluded that this change of mentality will require both financial and human resources to come to fruition.

Autonomía de gestión en atención primaria: posicionamiento de los profesionales de Mallorca / Managerial autonomy in primary care: Position of health professionals in Mallorca

OBJETIVOS: Valorar los conocimientos, percepciones, expectativas y actitudes de los profesionales de Atención Primaria (AP) de Mallorca sobre la autonomía de gestión. DISEÑO: Estudio descriptivo transversal, basado en un cuestionario ad hoc, anónimo, y distribuido de forma online, durante junio-julio del 2013. Emplazamiento: AP Mallorca. PARTICIPANTES: Profesionales asistenciales de AP (n = 1.097). Mediciones: Conocimientos sobre autogestión; competencias, requisitos y escenarios de futuro de los centros con autonomía de gestión (CAG); repercusión de la autogestión; disposición a asumir compromisos y riesgos, y a incorporarse a un CAG. RESULTADOS: Tasa de respuesta: 49,8% (546/1.097). El 10,9% mostró un alto nivel de conocimientos sobre autogestión, las principales competencias de un CAG fueron: capacidad de organización interna (87,5%) y de selección del personal (81,1%). Los futuros CAG se preveían con unos profesionales motivados e implicados (72,6%), resultados eficientes (66%), mayor calidad asistencial (59,4%) y mejor formación (52,8%). Los beneficios de la autogestión se consideraron importantes para los distintos profesionales y para la mejora de la AP de Mallorca (46,8%). Los principales requisitos de los CAG fueron disponer de directores capacitados (92,6%), sistemas de asignación presupuestaria (87,5%) y contratos de gestión adecuados (86,1%). Preferían que los CAG dependieran de la Administración (62,7%), y tenían interés personal en incorporarse a un CAG (56,9%), pero sin asumir excesivos compromisos (renuncia al régimen estatutario, riesgo económico). CONCLUSIONES: Estos datos aportan una información de gran importancia, hasta ahora desconocida, que puede contribuir a planificar con una mayor racionalidad y de forma participativa la puesta en marcha de CAG en nuestro medio

OBJECTIVES: To assess the knowledge, perceptions, expectations and attitudes of Primary Care (PC) professionals in Mallorca on managerial autonomy. DESIGN: Cross-sectional study based on an ad hoc, anonymous questionnaire, distributed online, from June-July 2013. LOCATION: PC Mallorca. PARTICIPANTS: PC healthcare professionals (n = 1,097). Measurements: Knowledge of self-management skills, requirements, and future scenarios of the centers with management autonomy (CMA); impact of self-management, commitment and willingness to take risks, and to become a CMA. RESULTS: Response rate: 49.8% (546/1097), with 10.9% showing a high level of knowledge of self-management. The core competencies of a CMA were internal organizational capacity (87.5%) and selection of staff (81.1%). The CMA future was envisaged with motivated and involved professionals (72.6%), efficient results (66%), better quality of care (59.4%), and better training (52.8%). The benefits of self-management were considered important, for individual practitioners and for the improvement of PC in Mallorca (46.8%). The main requirements of the CMA were to have: trained managers (92.6%), budget allocation systems (87.5%), and appropriate management contracts (86.1%). They preferred that the CMA should depend on the Administration (62.7%), and had a personal interest in becoming a CMA (56.9%), but without taking on excessive commitments (waiving statutory regime, financial risk). CONCLUSIONS: These data provide hitherto unknown information of great importance, which could contribute to a more rational planning and participatory implementation of CMA in our midst

Adult community health-promoting interventions in primary health care: A systematic review.

OBJECTIVE: To examine evidence on the effectiveness of health-promoting community interventions carried out in primary health care. METHODS: Systematic review of originals and systematic reviews of health-promoting community interventions with the participation of primary health care. A working definition of community activities was used in the inclusion criteria. Databases searched up to 2013: PUBMED, EMBASE, CINHAL, Web of SCIENCE, IBECS, IME, and PSICODOC. No restrictions on year of publication or design. Articles were reviewed by separate researchers to identify risks of bias. RESULTS: Fifty-one articles published between 1966 and 2013 were included: 11 systematic reviews and 40 originals that described 39 community interventions. There is evidence on the effectiveness of community interventions in reducing cardiovascular risk factors, encouraging physical exercise, preventing falls and improving self-care among chronic patients compared with usual individual care. The effectiveness of some interventions increases when the community is involved in their development. Most assessments show positive results despite design limitations. CONCLUSIONS: The community approach may be more effective than the individual in usual preventive interventions in primary care. There is a lack of evidence on many community interventions in primary care and further research is needed.