Parental health literacy: from evidence to interventions

A influência dos determinantes sociais de saúde na saúde infantil é amplamente reconhecida. A literacia em saúde é apontada como uma componente essencial para melhorar a saúde infantil e reduzir as desigualdades. À semelhança do que acontece na população geral, muitos pais têm um baixo nível de literacia em saúde, que condiciona a sua capacidade para proteger a saúde da criança. Neste trabalho pretende-se descrever a relação entre literacia em saúde parental, comportamentos parentais e resultados em saúde da criança. Adicionalmente serão discutidas medidas para abordar a literacia em saúde parental. Os efeitos da literacia em saúde dos pais são abrangentes, afetando comportamentos diversos dos pais e diferentes resultados em saúde da criança, em domínios que vão desde a promoção da saúde e prevenção da doença aos cuidados na doença aguda e doença crónica. A maior parte das intervenções para a promoção da literacia em saúde dos pais assenta no aconselhamento verbal e na disponibilização de materiais escritos, seguindo a aplicação do princípio de «precauções universais» e adotando metodologias validadas. Os dados sugerem a necessidade de abordagens socioecológicas, que invistam na criação de ambientes favoráveis e não apenas na promoção de competências de literacia em saúde dos pais. Abordar a literacia em saúde dos pais de forma sustentada implica a adoção de uma abordagem centrada na família, a utilização de precauções universais e um maior alinhamento entre as exigências colocadas aos pais e as suas competências de literacia em saúde.ABSTRACT - The influence of the social determinants of health on child health is widely recognized. Health literacy is seen as a critical component to improve child health and reduce inequalities. As in the general population, many parents have a low level of health literacy, which affects their ability to protect their child’s health. In this work, we intend to describe the relationship between parental health literacy, parental behaviors, and child health outcomes. In addition, interventions to address parental health literacy will be discussed. The effects of parental health literacy are wide-ranging, affecting different parental behaviors and different child health outcomes, across the domains of health promotion, disease prevention, acute illness care, and chronic illness care. Most interventions to promote parenting health literacy are based on verbal counseling and the provision of written materials, following the application of the “universal precautions” principle and adopting validated methodologies. The data suggest the need for socio-ecological approaches, which invest in creating supporting environments along with the promotion of parents’ health literacy skills. Addressing parents’ health literacy in a sustainable way implies adopting a family-centered approach, using universal precautions and gaining a better alignment between the demands placed on parents and their health literacy skills.info:eu-repo/semantics/publishedVersio

Factors associated with motivation to avoid meeting family and friends during the COVID-19 pandemic

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Factors associated with avoidance of emergency department visits in Portugal during the pandemic

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an action-research project in primary health care

ABSTRACT – Background: Primary Health Care (PHC) is usually the first contact with the health system, and health professionals are key mediators for enabling citizens to take care of their health. In Portugal, great improvements have been achieved in the biometric indicators of maternal and child health during the last decades. Nevertheless, scant attention has been paid to the mental health dimension, in spite of the recognition of its importance, being pregnancy and early childhood crucial opportunities in the lifecycle for mental health promotion, especially in the early years of life, with a strong impact in the health of the child. The impact of early attachment between mother and baby on maternal and child health has long been recognized. This attachment can be influenced by some factors, as the mother’s emotional adjustment. Attention to these factors may facilitate implementation of both positive conditions and preventative measures. Family support during the transition to parenthood has been highlighted as an effective measure and PHC professionals are in a privileged position as information sources as well as mediators. Aims: The project we present describes an action-research process developed together among academic researchers and health professionals to embrace these issues. We intend to enable health professionals to support families in the transition to parenthood thereby promoting children’s mental health. Approach: The project is driven by a participatory approach intended to lead to reorganization of health care during pregnancy and early childhood. Effective change happens when those involved are interested and motivated, what makes their participation so important. Reflection about current practices and needs, and knowledge about evidence-based interventions have been guiding the selection of changes to introduce in clinical practice for family support and development of parenthood skills and self-confidence. Development: We summarize the main steps in development: the initial assessment and the picture taken from the community under study; the decision making process; the training programme of PHC professionals in action; the review of the protocols of maternal consultation, home visits and antenatal education; the implementation planning; the plan for evaluation the effectiveness of the changes introduced in the delivery of maternal and child health care units. The already developed work has shown that motivation, leadership and organizational issues are decisive for process development.-------------------------- RESUMO - Os Cuidados de Saúde Primários são habitualmente o primeiro contacto com o sistema de saúde e os profissionais de saúde são mediadores chave na capacitação dos cidadãos para cuidarem da sua saúde. Em Portugal, nas últimas décadas, têm-se alcançado grandes melhorias nos indicadores biométricos de saúde materno-infantil. Contudo, tem-se dedicado pouca atenção à dimensão de saúde mental, apesar do reconhecimento da sua importância. A gravidez e primeira infância têm sido apontadas como uma oportunidade crucial no ciclo de vida para a promoção da saúde mental. É dado especial enfoque aos primeiros tempos de vida, dado o forte impacto na saúde da criança. O impacte da vinculação precoce entre a mãe e o bebé na saúde da mãe e da criança há muito que é reconhecido. Esta vinculação pode ser influenciada por vários factores, nomeadamente pelo ajustamento emocional da mãe. A focalização nestes aspectos pode facilitar a criação de condições favoráveis e a implementação de medidas preventivas. O suporte familiar durante o período de transição para a parentalidade tem sido enfatizado como uma medida eficaz e os Cuidados de Saúde Primários estão numa posição privilegiada como fontes de informação e como mediadores. O projecto que apresentamos descreve um processo de investigação- acção desenvolvido em parceria entre investigadores académicos e profissionais de saúde para abordar os aspectos referidos. Pretende-se capacitar os profissionais de saúde para apoiarem as famílias na transição para a parentalidade, promovendo assim a saúde mental das crianças. O projecto baseia-se numa abordagem participativa, direccionada para a reorganização dos cuidados durante a gravidez e primeiros tempos de vida. A mudança efectiva acontece quando os envolvidos estão interessados e motivados, o que torna a sua participação tão importante. A reflexão acerca das práticas e necessidades actuais e o conhecimento acerca de intervenções baseadas na evidência têm guiado a selecção das alterações a introduzir na prática clínica, no sentido de promover o suporte familiar e o desenvolvimento de competências parentais e auto-confiança. Neste artigo, apresentamos as etapas principais do desenvolvimento do projecto: avaliação inicial da comunidade em estudo; processo de tomada de decisão; programa de formação dos profissionais dos Cuidados de Saúde Primários; revisão dos protocolos da consulta de saúde materna, visita domiciliária e educação pré-natal; planeamento da implementação; plano de avaliação da efectividade das alterações introduzidas na prestação de cuidados. O trabalho já desenvolvido tem mostrado que a motivação, liderança e aspectos organizacionais são decisivos para o processo de mudança e de criação de um novo paradigma de cuidados a prestar às famílias.publishersversionpublishe

«Papa Bem»: Investing in health literacy for childhood obesity prevention

[PT] Introdução: O projeto «Papa Bem» tem como finalidade promover a literacia em saúde, através da criação e disseminação de materiais escritos e audiovisuais acerca da obesidade infantil e formas de prevenção, desde a conceção até aos 5 anos de idade. Materiais e métodos: A elaborac¸ão do plano editorial e a produc¸ão dos materiais tiveram por base um estudo exploratório, que contou com uma revisão da literatura e com um diagnóstico ecológico e educacional numa área-piloto. Ao longo de todo o processo de produc¸ão dos materiais foram consultados peritos nas diversas áreas temáticas. A legibilidade dos materiais produzidos foi testada. Resultados: Através do estudo exploratório identificámos os fatores predisponentes, facilitadores e de reforc¸o inerentes a comportamentos relacionados com a obesidade infantil, que nortearam a produc¸ão dos materiais. Os materiais produzidos, baseados na mais recente evidência científica, demonstraram ser acessíveis para pessoas com baixos níveis de escolaridade. Conclusão: A metodologia participativa utilizada no projeto permitiu-nos compilar informação relevante quanto aos principais pontos críticos para a compreensão e prevenção da obesidade infantil. A elaborac¸ão das mensagens, com linguagem simples e organizac¸ão lógica, adequadas à populac¸ão, poderá ser facilitadora da mudanc¸a comportamental, particularmente se tiver o apoio de mediadores que as adaptem a cada contexto, reforc¸ando a abordagem socioecoló- gica na prevenc¸ão da obesidade infantilO projeto «Papa Bem» tem como finalidade promover a literacia em saúde, através da criação e disseminação de materiais escritos e audiovisuais acerca da obesidade infantil e formas de prevenção, desde a conceção até aos 5 anos de idade.[ENG] Introduction «Papa Bem» project («Eat Well») aims to promote health literacy through the production and dissemination of written and audiovisual materials concerning childhood obesity prevention. The focus is the period that goes from pregnancy to 5 years of age. Methodology The editorial plan and materials production was based on an exploratory study, which included a literature review and an ecological and educational diagnosis conducted in a pilot area. During the process of production of the materials several experts were consulted. The readability of the materials was tested. Results In the exploratory study, predisposing, enabling and reinforcement factors related to the behaviors associated with child obesity were identified to guide the materials production. Based in the most recent scientific evidence, these materials proved to be accessible to people with lower education levels. Conclusion Through the participatory methodology, it was possible to get relevant information about the main critical issues in understanding and managing the problem of child obesity. The development of simple and logically organized messages may facilitate behavior change, especially with the support of mediators who adapt them to each context, ensuring the continuity of the socio‐ecological approach required for controlling child obesity

Factors associated with the patient’s decision to avoid healthcare during the COVID-19 pandemic

Funding Information: Funding: The present publication was funded support through CHRC (UIDP/04923/2020). Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, “COVID-19 Barometer: Social Opinion”, which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen’s Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.publishersversionpublishe

Factors associated with COVID-19 vaccine hesitancy after implementation of a mass vaccination campaign

Funding Information: Funding: The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September–November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the communitybased survey, “COVID-19 Barometer: Social Opinion”. Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.publishersversionpublishe

Application of the OPtimising HEalth LIteracy and Access (Ophelia) process

APP1155125. The present publication was funded by Funda??o Ci?ncia e Tecnologia, lP national support through CHRC (UIDP/04923/2020), and NOVA National School of Public Health ? NOVA University of Lisbon. Publisher Copyright: © Copyright © 2021 Dias, Gama, Maia, Marques, Campos Fernandes, Goes, Loureiro and Osborne.The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.publishersversionpublishe

Physical distancing and mental well-being in youth population of Portugal and Brazil during the COVID-19 pandemic

Funding Information: This paper was made possible with the scholarship from FCT and to the Unidade de I&D CHRC – Comprehensive Health Research Centre (UI/BD/150908/2021). Also to CAPES (Code 001) and CNPQ (Research Productivity Scholarship Process 304483/2018-4). The databases are anonymous, guaranteeing data confidentiality. Funding Information: Fundação para a ciência e tecnologia (FCT) and the Unidade de I&D CHRC – Comprehensive Health Research Centre (UI/BD/150908/2021). Also to CAPES (Code 001) and CNPQ (Research Productivity Scholarship Process 304483/2018-4) Publisher Copyright: © 2022Background: The COVID-19 pandemic may affect youth's physical and mental well-being, partially because of the countries' rules to contain the virus from spreading. However, there is still uncertainty about the impact of physical distancing on youth's mental health. We aimed to estimate the prevalence of feeling agitated, anxious, down, sad, or low mood (FNF) due to physical distance measures and verify which factors are associated with young Portuguese and Brazilian people. Methods: We used cross-sectional data from the instrument "COVID-19 Barometer: Social Opinion"in Portugal (March 2020 and September 2021) and from "COVID-19 Social Thermometer"in Brazil (August 2020 to April 2021); these surveys included data regarding the health and socioeconomic impact on the population. The health and sociodemographic variables of the two countries were summarized as absolute and relative frequencies. A multivariable logistic regression model was fit by country to estimate the relation between FNF and selected variables of interest. Results: Approximately 36% of the sample studied reported anxiety, agitation, sadness, or low mood almost every day in Portugal and 52% in Brazil due to physical distancing. In Portugal, having more than two comorbidities represented a greater chance of experiencing FNF every day or almost every day (odds ratio [OR] = 1.51 [CI: 1.22-1.87]) than those without comorbidities. In contrast, having a university education level represented a protector factor (OR = 0.76 [CI: 0.67-0.88]). In Brazil, being unemployed increased the chance of FNF compared to students (OR = 11.2). Conclusions: Physical distancing measures have impacted the mental well-being of the young population in Portugal and Brazil. The countries must make a quick effort to attend to and protect young people's well-being and mental health in the changing context of the current pandemic.publishersversioninpres