[How to improve community engagement in health: Analysis of proposed actions following the implementation of a community engagement assessment tool]. / ¿Cómo mejoramos la participación comunitaria en salud? Análisis de las acciones propuestas tras la aplicación de una herramienta de evaluación.

OBJECTIVE: To analyse the lines of action identified in the health promotion projects participating in the EvaluA GPS research, and their relationship with the scores assigned in EvalGuia, a tool for evaluating evidence-based community participation. DESIGN: Qualitative-quantitative multicentre study. SETTING: Primary care or intersectoral network of primary care and municipalities in five autonomous communities in Spain. PARTICIPANTS: Participants of 10 health promotion projects, selected with convenience sampling, following inclusion criteria (projects with a minimum of community engagement and centred on community health). METHOD: Data were collected through questionnaires (EvalGuía tool) and participatory workshops. Quantitative data were analysed with descriptive statistics, qualitative data were analysed using matrix analysis. RESULTS: After implementing the EvalGuide tool, the lowest scores were assigned in outcome evaluation, knowledge of policies related to community participation, diversity in the core working group, inclusivity policies, financial resources and diffusion of results. The lines of action proposed were heterogeneous and did not always match with those prioritised as lower score. The prioritised lines revolved around project organisation and communication. CONCLUSIONS: The EvalGuide tool can be helpful to design action plans in Health Promotion projects. The implementation of measures in 12 months to increase the diversity of the core working group, to incorporate work-life balance measures or to improve evaluation is difficult. More time is needed to implement such measures.

Evaluating the implementation of community engagement guidelines (EVALUA GPS project): a study protocol.

INTRODUCTION: The EVALUA GPS project aims to evaluate the impact of the implementation of the National Institute for Health Care and Excellence (NICE) guideline 'Community engagement: improving health and well-being and reducing health inequalities' adapted to the Spanish context. METHODS AND ANALYSIS: Phase I: A tool will be designed to evaluate the impact of implementing the recommendations of the adapted NICE guideline. The tool will be developed through a review of the literature on implementation of public health guidelines between 2000 and 2021 and an expert's panel consensus. PHASE II: The developed tool will be implemented in 16 community-based programmes, acting as intervention sites, and 4 controls through a quasi-experimental pre-post study. Phase III: A final online web tool, based on all previously collected information, will be developed to support the implementation of the adapted NICE guidelines recommendations in other contexts and programmes. DATA COLLECTION AND ANALYSIS: Data will be collected through surveys and semistructured interviews. Quantitative and qualitative data will be analysed to identify implementation scenarios, changes in community engagement approaches, and barriers and facilitators to the implementation of the recommendations. All this information will be further synthesised to develop the online tool. ETHICS AND DISSEMINATION: The proposed research has been approved by the Clinical Research Ethics Committee of Aragon. Results will be presented at national and international conferences and published in peer-reviewed open access journals. The interactive online tool (phase III) will include examples of its application from the fieldwork.

[Analysis of community agendas in primary care and factors associated with their implementation]. / Análisis de las agendas comunitarias en atención primaria y factores asociados a su implantación.

OBJECTIVE: To describe the community agendas created by the Aragonese Primary Care Teams (PCT), to analyze the characteristics of said PCT, and to explore factors related to their implementation. METHOD: Descriptive observational study of the community agendas and the Aragonese PCT that have created them since the implementation of the Aragonese Community Care Strategy (ACCS) in 2016 until March 2021. Bivariate and multivariate analysis of the characteristics of these PCT that have created the agenda with respect to those who have not developed it. RESULTS: 75 of the 123 Aragonese PCT (61%) have created the community agenda. 74.7% of them also have an active Health Council. 45 of the 75 agendas are of the advanced type, with 41 PCT that had carried out the zone health diagnosis and 28 PCT that made asset recommendations. It was observed how the creation of the community agenda is related to being a PCT belonging to a semi-urban basic health zone (odds ratio [OR]: 3.02; 95% confidence interval [95% CI]: 1.22-7.47; p=0.017) and that at least one professional would have received specific training (OR: 5.29; 95% CI: 1.09-25.72; p=0.039). CONCLUSIONS: The community agenda is a tool that supports the development of community care for PCT. The training provided by the ACCS has been shown to be key to the development of the agendas, and this work must continue, with special emphasis on the PCT belonging to rural or urban basic health zones, since they are the ones that are experiencing the greatest difficulties.

Análisis de las agendas comunitarias en atención primaria y factores asociados a su implantación / Analysis of community agendas in primary care and factors associated with their implementation

Objetivo: Describir las agendas comunitarias creadas por los equipos de atención primaria (EAP) aragoneses, analizar las características de dichos EAP y explorar factores relacionados con la puesta en marcha de las agendas. Método: Estudio observacional descriptivo de las agendas comunitarias y los EAP aragoneses que las han creado desde la implantación de la Estrategia de Atención Comunitaria Aragón (EACA) en 2016 hasta marzo de 2021. Análisis bivariante y multivariante de las características de estos EAP que han creado una agenda con respecto a los que no la han desarrollado. Resultados: De los 123 EAP aragoneses, 75 (61%) han creado la agenda comunitaria. El 74,7% de ellos tienen también activo el Consejo de Salud de zona. De las 75 agendas, 45 son de tipo avanzado, con 41 EAP que tenían realizado el diagnóstico de salud de zona y 28 EAP que realizaban recomendación de activos. Se observó que la creación de la agenda comunitaria está relacionada con ser un EAP perteneciente a una zona básica de salud semiurbana (odds ratio [OR]: 3,02; intervalo de confianza del 95% [IC95%]: 1,22-7,47; p = 0,017) y que al menos un profesional del EAP hubiera recibido formación específica (OR: 5,29; IC95%: 1,09-25,72; p = 0,039). Conclusiones: La agenda comunitaria es una herramienta que apoya el desarrollo de la atención comunitaria de los EAP. La formación impartida desde la EACA se ha demostrado clave para el desarrollo de las agendas, debiendo continuar con este trabajo y haciendo especial énfasis en los EAP pertenecientes a zonas básicas de salud rurales o urbanas, pues son los que están teniendo mayores dificultades. (AU)

Objective: To describe the community agendas created by the Aragonese Primary Care Teams (PCT), to analyze the characteristics of said PCT, and to explore factors related to their implementation. Method: Descriptive observational study of the community agendas and the Aragonese PCT that have created them since the implementation of the Aragonese Community Care Strategy (ACCS) in 2016 until March 2021. Bivariate and multivariate analysis of the characteristics of these PCT that have created the agenda with respect to those who have not developed it. Results: 75 of the 123 Aragonese PCT (61%) have created the community agenda. 74.7% of them also have an active Health Council. 45 of the 75 agendas are of the advanced type, with 41 PCT that had carried out the zone health diagnosis and 28 PCT that made asset recommendations. It was observed how the creation of the community agenda is related to being a PCT belonging to a semi-urban basic health zone (odds ratio [OR]: 3.02; 95% confidence interval [95% CI]: 1.22–7.47; p = 0.017) and that at least one professional would have received specific training (OR: 5.29; 95% CI: 1.09–25.72; p = 0.039). Conclusions: The community agenda is a tool that supports the development of community care for PCT. The training provided by the ACCS has been shown to be key to the development of the agendas, and this work must continue, with special emphasis on the PCT belonging to rural or urban basic health zones, since they are the ones that are experiencing the greatest difficulties. (AU)

Implementación de un protocolo de recomendación formal de activos para la salud en los equipos de atención primaria aragoneses / Implementation of a social prescribing protocol in Aragon's primary care teams

Objetivo: Analizar la implementación de la «Guía de recomendación de activos para la salud en atención primaria Aragón». Diseño: Estudio observacional, descriptivo, transversal. Emplazamiento: Ciento veintitrés equipos de atención primaria aragoneses. Participantes: Recomendaciones de Activos para la Salud realizadas con el protocolo «Recomendación Activos-AP» de historia clínica electrónica de atención primaria Aragón desde septiembre de 2018 a marzo de 2021. Mediciones principales: Se describieron las variables más relevantes del protocolo: edad, sexo, provincia, sector sanitario, zona básica de salud, problema de salud, aspecto a potenciar, activo para la salud recomendado, tipo de profesional, grado de asistencia, satisfacción y mejoría. Resultados: El protocolo fue utilizado 2.109 veces y se realizaron 1.482 recomendaciones y 428 seguimientos. El uso del protocolo fue aumentando progresivamente hasta marzo de 2020. A 1.431 personas se les realizó una recomendación y a 51 más de una. La edad media de las personas beneficiarias fue de 67,9años. El 74,8% de recomendaciones se dirigieron a mujeres. Diagnósticos relacionados con problemas sociales y psicológicos fueron los más vinculados a recomendaciones, y la esfera física fue el aspecto más potenciado. Los activos más recomendados se vinculaban con actividad física y recursos de promoción de la autonomía personal. Más del 90% de las personas asistieron con regularidad al activo. La satisfacción media fue de 4,8 (0/5) y el grado de mejoría de 4,3 (0/5). Conclusiones: La implementación de recomendación de activos para la salud dentro la Estrategia de Atención Comunitaria Aragón está funcionando. Sin embargo, es necesario revisar algunos aspectos. Es preciso continuar generando evidencia para poder adecuar y hacer más eficiente este proceso.(AU)

Objective: To analyze the implementation of social prescribing guideline in primary care Aragón. Design: Observational, descriptive, cross-sectional study. Location: One hundred twenty-three primary care teams of Aragón. Participants: Social prescribing made with the protocol «Recomendación Activos - AP» of electronic health record of primary care Aragón from September 2018 to March 2021. Main measurements: The most relevant variables of the protocol were described: age, sex, province, health sector, basic health area, health problem, aspect to be enhanced, asset for health recommended, type of professional, degree of assistance, satisfaction and improvement. Results: The protocol was used 2109 times, 1482 recommendations were made and 428 follow-ups were performed. The use of the protocol increased progressively until March 2020. A total of 1431 people received one recommendation and 51 received more than one recommendation. The average age of the beneficiaries was 67.9years. 74.8% of recommendations were addressed to women. Diagnoses related to social and psychological problems were the most frequently recommended, and the physical sphere was the aspect most promoted. Most social prescribing was linked to physical activity and resources for the promotion of personal autonomy. More than 90% of the people regularly attended the activity, the average satisfaction was 4.8 (0/5) and the degree of improvement 4.3 (0/5). Conclusions: The implementation of asset for health recommended within the Aragon community care strategy is working, however, some aspects need to be reviewed. It is necessary to continue generating evidence to be able to adapt and make this process more efficient.(AU)

[Implementation of a social prescribing protocol in Aragon's primary care teams]. / Implementación de un protocolo de recomendación formal de activos para la salud en los equipos de atención primaria aragoneses.

OBJECTIVE: To analyze the implementation of social prescribing guideline in primary care Aragón. DESIGN: Observational, descriptive, cross-sectional study. LOCATION: One hundred twenty-three primary care teams of Aragón. PARTICIPANTS: Social prescribing made with the protocol «Recomendación Activos - AP¼ of electronic health record of primary care Aragón from September 2018 to March 2021. MAIN MEASUREMENTS: The most relevant variables of the protocol were described: age, sex, province, health sector, basic health area, health problem, aspect to be enhanced, asset for health recommended, type of professional, degree of assistance, satisfaction and improvement. RESULTS: The protocol was used 2109 times, 1482 recommendations were made and 428 follow-ups were performed. The use of the protocol increased progressively until March 2020. A total of 1431 people received one recommendation and 51 received more than one recommendation. The average age of the beneficiaries was 67.9years. 74.8% of recommendations were addressed to women. Diagnoses related to social and psychological problems were the most frequently recommended, and the physical sphere was the aspect most promoted. Most social prescribing was linked to physical activity and resources for the promotion of personal autonomy. More than 90% of the people regularly attended the activity, the average satisfaction was 4.8 (0/5) and the degree of improvement 4.3 (0/5). CONCLUSIONS: The implementation of asset for health recommended within the Aragon community care strategy is working, however, some aspects need to be reviewed. It is necessary to continue generating evidence to be able to adapt and make this process more efficient.

Aproximación a la respuesta comunitaria a la pandemia por COVID-19 de los equipos de Atención Primaria de Salud aragoneses / Approach to the community response to the COVID-19 pandemic of Aragonese Primary Healthcare Teams

INTRODUCCIÓN: ¿cómo seguir trabajando la orientación y participación comunitaria en Atención Primaria durante la pandemia por COVID-19?. OBJETIVOS Y MÉTODOS: observar, describir, reflexionar y documentar aspectos relativos a la atención comunitaria en el momento actual de pandemia por COVID-19 en los equipos de Atención Primaria (EAP) de Aragón. Estudio exploratorio-descriptivo observacional transversal con enfoque cualitativo, con dos fases. 1ª: recopilación de experiencias comunitarias y localización de informantes clave. 2ª: descripción de acciones comunitarias. Análisis descriptivo y tipo DAFO. RESULTADOS: se detectaron 47 iniciativas. Participaron 11 expertas y 54 informantes clave. El 66,6% consideró el rol de los EAP como consultores/colaboradores. El 64,9% de las iniciativas contempló la diversidad. El 49,1% no sabía si valoraron diferencias por género. Destacaron la importancia de lo comunitario para superar la crisis y la cooperación y coordinación con la comunidad e instituciones locales. DISCUSIÓN: protocolos con orientación biomédica, miedo e incertidumbre por la COVID-19 dificultaron el desarrollo de iniciativas comunitarias; frente a esto, fue clave la trayectoria comunitaria previa de los EAP, el trabajo en equipo, con especial relevancia el de las trabajadoras sociales, y su motivación. La participación del EAP como colaborador refuerza la importancia del liderazgo compartido. Son necesarios espacios colaborativos, apoyo institucional y coordinación intersectorial. CONCLUSIÓN: durante la pandemia, las comunidades deben ser parte de la respuesta; la orientación comunitaria de los EAP es clave. Es preciso visibilizar, acompañar y reforzar el trabajo comunitario y estimular la coordinación con Salud Pública

INTRODUCTION: How to continue working on community guidance and participation in Primary Care during the COVID-19 pandemic?. OJECTIVES AND METHODS: To observe, report, reflect and document autonomous community experiences of Aragonese Primary Care Teams (PCT) during the COVID-19 pandemic. A two-phase exploratory-descriptive observational, cross-sectional study with a qualitative approach. Phase 1: compilation of experiences in community health and location of key informants. Phase 2: description of community actions. Descriptive and SWOT analysis. RESULTS: A total of 47 initiatives were detected; 11 experts and 54 key informants took part. A total of 66.6% considered the role of the PCT as consultants or collaborators; 64.9% of initiatives considered diversity. A total of 49.1% did not know whether they evaluated differences by sex. They highlighted the importance of the community to overcome the crisis, and cooperation and coordination with community and local institutions. DISCUSSION: Protocols with biomedical guidance, fear and uncertainty due to COVID-19 hindered development of community initiatives. In light of this, the previous community trajectory of PCTs, teamwork with special relevance of social workers and their motivation were fundamental. PCT involvement as a partner strengthens the importance of shared leadership. Collaborative spaces, institutional support and intersectoral coordination are all necessary. CONCLUSION: During the pandemic, communities must be part of the response; PCT community guidance is essential. Visibility, working alongside and strengthening community work and stimulating public health coordination are all necessary requirements

¿Qué hacemos y qué podríamos hacer desde el sistema sanitario en salud comunitaria? Informe SESPAS 2018 / What are we doing and what could we do from the health system in community health? SESPAS Report 2018

La salud es el bienestar individual y colectivo determinado por factores que trascienden el sistema sanitario. Si este quiere abordar la dimensión colectiva de la salud es preciso cambiar su orientación. La salud comunitaria está incluida teóricamente en la legislación, la formación, la coordinación y la planificación, y cuenta con marcos estratégicos que implican la coordinación y la participación de instituciones, servicios sanitarios y ciudadanía. Se presenta un artículo de diálogo en el que cinco personas reflexionan sobre la situación, las barreras, las fortalezas y las oportunidades de acción del sistema sanitario en relación con la salud comunitaria. Se precisan cambios en las acciones del sistema sanitario en relación con la salud comunitaria y su abordaje para ser capaces de afrontar los problemas de salud de las comunidades en la situación socioeconómica actual. Desde lo esencial del derecho a la salud reorientemos la acción teniendo presente la participación, la equidad, la orientación social, la intersectorialidad, el abordaje integral, la justicia social o la salud en todas las políticas, para poder tener presente la salud comunitaria en nuestro sistema de salud

Health means individual and collective well-being determined by factors that transcend the health services. If the health services want to address the collective dimension of health, a change of approach is required. Community health is theoretically included in legislation, training, coordination and planning with strategic frameworks that involve the coordination and participation of institutions, health services and citizenship. We present a discussion article in which five authors reflect on the situation, barriers, strengths and opportunities for action of the health services in relation to community health. Changes are needed in the actions of the health services in relation to community health and the way they approach it to address the health problems faced by the communities in the current socioeconomic situation. Given that health is an essential right, we will make a shift in action towards participation, equity, social orientation, intersectorality, comprehensive approach, social justice, and health in all policies, so that community health is taken into account in our health system

[What are we doing and what could we do from the health system in community health? SESPAS Report 2018]. / ¿Qué hacemos y qué podríamos hacer desde el sistema sanitario en salud comunitaria? Informe SESPAS 2018.

Health means individual and collective well-being determined by factors that transcend the health services. If the health services want to address the collective dimension of health, a change of approach is required. Community health is theoretically included in legislation, training, coordination and planning with strategic frameworks that involve the coordination and participation of institutions, health services and citizenship. We present a discussion article in which five authors reflect on the situation, barriers, strengths and opportunities for action of the health services in relation to community health. Changes are needed in the actions of the health services in relation to community health and the way they approach it to address the health problems faced by the communities in the current socioeconomic situation. Given that health is an essential right, we will make a shift in action towards participation, equity, social orientation, intersectorality, comprehensive approach, social justice, and health in all policies, so that community health is taken into account in our health system.

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.

[Networks of experiences on community health as an information system in health promotion: lessons learned in Aragon (Spain)]. / Las redes de experiencias de salud comunitaria como sistema de información en promoción de la salud: la trayectoria en Aragón.

Networks of community health experiences promote interaction and knowledge management in health promotion among their participants. These networks integrate both professionals and social agents who work directly on the ground in small environments, with defined objectives and inclusion criteria and voluntary participation. In this article, networks in Aragon (Spain) are reviewed in order to analyse their role as an information system. The Health Promotion Projects Network of Aragon (Red Aragonesa de Proyectos de Promoción de la Salud, RAPPS) was launched in 1996 and currently includes 73 projects. The average duration of projects is 12.7 years. RAPPS interdisciplinary teams involve 701 people, of which 89.6% are professionals and 10.6% are social agents. The Aragon Health Promoting Schools Network (Red Aragonesa de Escuelas Promotoras de Salud, RAEPS) integrates 134 schools (24.9% of Aragon). The schools teams involve 829 teachers and members of the school community, students (35.2%), families (26.2%) and primary care health professionals (9.8%). Experiences Networks boost citizen participation, have an influence in changing social determinants and contribute to the formulation of plans and regional strategies. Networks can provide indicators for a health promotion information and monitoring system on: capacity building services in the territory, identifying assets and models of good practice, cross-sectoral and equity initiatives. Experiences Networks represent an opportunity to create a health promotion information system, systematising available information and establishing quality criteria for initiatives.

¿Qué hacemos en el barrio? Descripción de las actividades comunitarias de promoción de la salud en atención primaria: Proyecto frAC / What are we doing in neighborhoods? Description of health-promoting community activities in primary care: The FrAC Project

Objetivos: Describir las actividades comunitarias de promoción de la salud realizadas en atención primaria, y comparar los tipos y formas de llevarse a cabo en las distintas comunidades autónomas. Métodos: Estudio multicéntrico descriptivo realizado en atención primaria de cinco comunidades autónomas. Se incluyeron actividades comunitarias no puntuales, realizadas en el año previo, con participación del equipo de atención primaria, en las que la comunidad participaba activamente o era una actividad intersectorial. Responsables de 194 equipos respondieron sobre participación en actividades comunitarias. En caso afirmativo, se completaba un cuestionario. Variables: tema abordado, población diana, profesionales implicados, tiempo y ámbito de realización, evaluación, perspectivas teóricas, inscripción en redes, participación de la comunidad y otros agentes, y valoración de estas participaciones. Análisis: descriptivo estratificado por comunidades autónomas. Resultados: Se identificaron 183 actividades comunitarias en 104 equipos. Aunque varían entre las comunidades autónomas, destacan las actividades de salud general, alimentación y salud afectiva-sexual, dirigidas a población general, infancia o progenitores, y desarrolladas en centros educativos o de salud. La mediana de trayectoria es de 4 años y con 2,8 profesionales implicados. El 72,5% se realizan en horario laboral, el 75% son evaluadas y el 70% apoyadas en perspectivas teórico-metodológicas. En el 65% participan sectores no sanitarios, en el 60% la administración y en el 58,5% entidades cívicas. En el 85,8% participaba personal de enfermería, en el 38,5% de medicina y en el 35% de trabajo social. Hay variabilidad entre comunidades autónomas. Discusión Se aprecia variabilidad entre comunidades autónomas en los tipos y formas de aplicación de las actividades comunitarias realizadas por atención primaria, así como en el reconocimiento institucional y la implicación comunitaria en el desarrollo y la evaluación de la actividad (AU)

Objective: To describe the health-promoting community activities developed in primary health care and compare types of activities and how they are performed among autonomous regions. Methods: A descriptive multicenter study was carried out in primary care in 5 Spanish regions. We included community activities consisting of non-sporadic activities, carried out in the previous year, with the participation of the primary care team, and the active participation of the community or as a cross-sector activity. The persons responsible for each of the 194 teams were asked if the team participated in community activities and, if so, a questionnaire was completed by the person responsible for each activity. The variables consisted of the topic addressed, the target population, the professionals involved, the time and scope of implementation, evaluation, theoretical perspectives, network registration, the involvement of the community and other agents, and evaluation of this involvement. A descriptive analysis was performed, stratified by region. Results: We identified 183 community activities in 104 teams. Although there was wide variability among regions, most activities were related to general health, nutrition and emotional-sexual health and targeted the general population, children or parents and were carried out in educational or health centers. Participating professionals had a median of 4 years of experience and a median of 2.8 professionals were involved in each activity. A total of 72.5% of the activities were performed during working hours, 75% were evaluated, and 70% were supported by theoretical and methodological perspectives. Non-health sectors were involved in 65%, local government in 60%, and nongovernmental organizations in 58.5%. Nurses were involved in 85.8% of the activities, physicians in 38.5%, and social workers in 35%. Substantial variability was detected among regions. Discussion Wide variability was found in the types of activities and their application among the community activities developed by primary care, as well as in institutional recognition and community involvement in the development and evaluation of these activities (AU)

[What are we doing in neighborhoods? Description of health-promoting community activities in primary care: the FrAC Project]. / ¿Qué hacemos en el barrio? Descripción de las actividades comunitarias de promoción de la salud en atención primaria: Proyecto frAC.

OBJECTIVE: To describe the health-promoting community activities developed in primary health care and compare types of activities and how they are performed among autonomous regions. METHODS: A descriptive multicenter study was carried out in primary care in 5 Spanish regions. We included community activities consisting of non-sporadic activities, carried out in the previous year, with the participation of the primary care team, and the active participation of the community or as a cross-sector activity. The persons responsible for each of the 194 teams were asked if the team participated in community activities and, if so, a questionnaire was completed by the person responsible for each activity. The variables consisted of the topic addressed, the target population, the professionals involved, the time and scope of implementation, evaluation, theoretical perspectives, network registration, the involvement of the community and other agents, and evaluation of this involvement. A descriptive analysis was performed, stratified by region. RESULTS: We identified 183 community activities in 104 teams. Although there was wide variability among regions, most activities were related to general health, nutrition and emotional-sexual health and targeted the general population, children or parents and were carried out in educational or health centers. Participating professionals had a median of 4 years of experience and a median of 2.8 professionals were involved in each activity. A total of 72.5% of the activities were performed during working hours, 75% were evaluated, and 70% were supported by theoretical and methodological perspectives. Non-health sectors were involved in 65%, local government in 60%, and nongovernmental organizations in 58.5%. Nurses were involved in 85.8% of the activities, physicians in 38.5%, and social workers in 35%. Substantial variability was detected among regions. DISCUSSION: Wide variability was found in the types of activities and their application among the community activities developed by primary care, as well as in institutional recognition and community involvement in the development and evaluation of these activities.

Observational study on factors related to health-promoting community activity development in primary care (frAC Project): a study protocol.

INTRODUCTION: According to Spanish health regulations, primary care professionals have the responsibility to carry out health-promoting community activities (CAs). However, in practice, their implementation is not as widespread as it should be. The aims of this study were to identify factors within the team, the community and the professionals that influence the development of these activities and to describe the community interventions in progress. METHODS AND ANALYSIS: This study is an observational analytical retrospective study. The information will be collected from five Spanish regions: Catalonia, Madrid, the Balearic Islands, Navarra and Aragón. The authors will contact primary care teams (PCTs) and identify the CAs from the previous year. The research team will conduct a peer review whether the inclusion criteria are met. In the health centres where CAs are implemented, the authors will select professionals carrying them out and randomly select an identical number of professionals not doing these activities. In the centres where no CA is implemented, three professionals will be randomly selected. The selected professionals will complete the questionnaires for individual-level variables. Information about the registered population and the PCTs will be collected through questionnaires and secondary sources. OUTCOMES: Variables will be collected from the community, the PCTs, the individual professionals and CAs. ANALYSIS: A descriptive analysis of all the variables will be carried out, along with a bivariate and a logistic regression analysis, with CAs being the primary outcome. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Jordi Gol y Gurina Foundation in Barcelona and area 11 in Madrid. The questionnaire distributed to the professionals will be anonymous.