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The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants. [ABSTRACT FROM AUTHOR]

Aim: Non-pharmaceutical interventions such as lockdowns have played a critical role in preventing the spread of the Covid-19 pandemic, but may increase psychological burden. This study sought to examine emotions reflected in social media discourse following the introduction of social contact restrictions in Central Europe. Subjects and methods: German-language Twitter posts containing '#corona' and '#covid-19' were collected between 2020/03/18 – 2020/04/24. A total of 79,760 tweets were included in the final analysis. Rates of expressions of positive emotion, anxiety, sadness and anger were compared over time. Bi-term topic models were applied to extract topics of discussion and examine association with emotions. Results: Rates of anxiety, sadness and positive emotion decreased in the period following the introduction of social contact restrictions. A total of 16 topics were associated with emotions, which related to four general themes: social contact restrictions, life during lockdown, infection-related issues, and impact of the pandemic on public and private life. Several unique patterns of association between topics and emotions emerged. Conclusion: Results suggest decreasing polarity of emotions among the public following the introduction of social contact restrictions. Monitoring of social media activity may prove beneficial for an adaptive understanding of changing public concerns during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi‐structured in‐depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross‐national analysis. Overall, analysis of the in‐depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease‐related factors and system‐related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care‐giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision‐making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified. [ABSTRACT FROM AUTHOR]

There is overwhelming consensus among policy makers, academics, and professionals about the need to support families in their childrearing tasks. Consequently, European countries have been encouraged to develop family support interventions aimed at guaranteeing children's rights, targeting particularly those children in situations of psychosocial risk. While a certain amount of evidence exists regarding how family support is generally delivered in certain European countries, with a particular focus on parenting initiatives, this paper aims to take existing evidence one step further by providing an updated review focusing on two core components of the Council of Europe's Recommendation on Positive Parenting: families at psychosocial risk as the target population, and family education and support initiatives as the delivery format. The scope of the study was therefore broad, in both geographical and conceptual terms. An online survey was conducted with experts from 19 European countries to gather information regarding how they perceive family education and support initiatives for families at psychosocial risk. Both quantitative and qualitative data were analysed by computing frequencies/percentages and by following a thematic synthesis method, respectively. The results revealed both similarities and disparities as regards provider profiles, intervention characteristics, and quality standards. Practical implications are discussed, such as the need to diversify initiatives for at‐risk families in accordance with the tenets of progressive universalism, the ongoing need for an evidence‐based, pluralistic approach to programmes, and the skills and qualifications required in the family support workforce. This study constitutes a first step towards building a common family support framework at a European level, which would encompass family support and parenting policies aimed at families at psychosocial risk. [ABSTRACT FROM AUTHOR]

Background: Small and medium-sized enterprises (SMEs) face major financial losses due to mental health issues affecting employees at all levels but seldom apply programs to promote wellbeing and prevent mental health issues among employees. To support the development of a multi-country workplace-based mental health intervention for SMEs (MENTUPP), a multinational consultation study was conducted. The study aimed to examine the experiences and needs of SMEs concerning the promotion of employee wellbeing, and the prevention and management of non-clinical mental health problems in workplaces. Methods: A survey consisting of open and closed questions was designed to assess key informants' opinion about the acceptability, the use, and the implementation of interventions to promote wellbeing and prevent mental health issues in the workplace. Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations across the nine MENTUPP intervention countries (eight European countries and Australia) were invited to complete the survey. Data were collected via the online platform Qualtrics. Sixty-five of 146 informants responded, representing a 44.5% response rate. Descriptive statistics were used to analyse the quantitative data and qualitative data were analysed through thematic analysis. Results: Measures to create mentally healthy workplaces were most used in SMEs, while more specific mental health interventions, such as training staff on how to promote wellbeing, were hardly used. Managers lack resources to implement mental health interventions and are concerned about employees spending too much time on these interventions during working hours. Receiving information about the economic benefits of mental health interventions and hearing successful testimonials from other SMEs can persuade managers otherwise. Employees have concerns about confidentiality, discrimination and stigma, and career opportunities when using such interventions. Conclusions: The study identifies a variety of challenges, needs and possibilities related to implementing mental health interventions in SMEs. Employers need to be convinced that investing in mental health in the workplace is worth their time and money. This requires more studies on the (cost-)effectiveness of mental health interventions. Once employers are engaged, their knowledge and competencies about how to implement such interventions should be increased and privacy concerns of employees to participate in them should be addressed. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Introduction: Data and digital infrastructure drive collaboration and help develop integrated healthcare systems and services. COVID-19 induced changes to collaboration between healthcare organisations, which previously often happened in fragmented and competitive ways. New collaborative practices relied on data and were crucial in managing coordinated responses to the pandemic. In this study, we explored datadriven collaboration between European hospitals and other healthcare organisations in 2021 by identifying common themes, lessons learned and implications going forward. Methods: Study participants were recruited from an existing Europe-wide community of mid-level hospital managers. For data collection, we ran an online survey, conducted multi-case study interviews and organised webinars. Data were analysed using descriptive statistics, thematic analysis and cross-case synthesis. Results: Mid-level hospital managers from 18 European countries reported an increase in data exchange between healthcare organisations during the COVID-19 pandemic. Data-driven collaborative practices were goal-oriented and focused on the optimisation of hospitals’ governance functions, innovation in organisational models and improvements to data infrastructure. This was often made possible by temporarily overcoming system complexities, which would otherwise hinder collaboration and innovation. Sustainability of these developments remains a challenge. Discussion: Mid-level hospital managers form a huge potential of reacting and collaborating when needed, including rapidly setting up novel partnerships and redefining established processes. Major post-COVID unmet medical needs are linked to hospital care provision, including diagnostic and therapeutic backlogs. Tackling these will require rethinking of the position of hospitals within healthcare systems, including their role in care integration. Conclusion: Learning from COVID-19-induced developments in data-driven collaboration between hospitals and other healthcare organisations is important to address systemic barriers, sustain resilience and further build transformative capacity to help build better integrated healthcare systems. [ABSTRACT FROM AUTHOR]

Purpose Return to work is a complex and challenging process which takes various forms in different contexts. The aim of this study is to explore and compare cross-country differences in stakeholders' experiences and views on actors, policies and practices relevant for return to work after long-term sickness absence. The comparative exploration is done in six countries with various legislative backgrounds, welfare and social dialogue systems. Methods Using a purposive sample, six multidisciplinary stakeholders group discussions were conducted in six countries: Belgium, Estonia, Ireland, Italy, Romania and Slovakia. A total of 51 individuals comprised of social partners, policymakers or representatives of public bodies and patient associations participated. An interpretative phenomenological analysis was employed to derive the most important themes in the discussions. Results Five major themes emerged from the group discussions. A graphic model is proposed to emphasize the variety of frameworks and processes across countries. Conclusions The core part of the return to work process is the dynamic relation between legislation, stakeholders and practices, which is influenced by broader national and societal factors. The cross-country variation in legislations, stakeholders and practices can be understood as a continuum, from low to high structuring, development and comprehensiveness. Although social dialogue appears to have a role in return to work process with variation across countries, it is not always on top of the agenda of social partners. [ABSTRACT FROM AUTHOR]

The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants—adults and young people over the age of 11—and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants' health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition—global, local and non-ethno-national—of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants' social inclusion, as intercultural relations between migrants and newcomers are promoted. [ABSTRACT FROM AUTHOR]

Culture change is common in healthcare organisations worldwide today, and change agents are key persons in the process of change. It is therefore of vital importance to deepen the knowledge about change agents’ experiences. The aim of the study was to illuminate meanings of being a change agent to improve home care services. Ten change agents were interviewed individually using open-ended questions. The interviews were analysed with phenomenological hermeneutics. The design of the study followed the COREQ guidelines. Three themes were revealed in the analysis: ‘Being confirmed by the opportunity to make quality improvements’; ‘Pushing oneself to transfer the message’; and ‘Being strengthened by achievements but wishing for better conditions’. In order to prepare co-workers, change agents need training before their mission begins and during the change process. [ABSTRACT FROM AUTHOR]

Aims: To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design: A qualitative focused mixed methods design was used. Methods: In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven‐phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results: Three clusters of caregivers were identified: spouses, adult children and non‐family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions: Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real‐world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi‐dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non‐family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution: Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure. [ABSTRACT FROM AUTHOR]

In Europe, the widespread transition from the Traditional Staircase (TS) model to the Housing First (HF) model is transforming the way social service providers work with people experiencing homelessness. This study examined social service providers' perspectives in both models regarding factors that facilitate or hinder their work. Data were collected through 17 photovoice projects involving 81 social service providers from eight European countries. The results show factors affecting social service providers' work at three levels: systemic, organizational, and individual. Professionals in TS and HF identified similar topics; however, TS providers discussed more obstacles to work. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study higlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals' healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands. [ABSTRACT FROM AUTHOR]

Many people with scleroderma rely on peer-led support groups as a coping resource. Reasons for not attending support groups in scleroderma have been investigated only in North American participants. This study assesses reasons for nonattendance in European countries and compares results with previously published North American findings. The same 21-item survey as used in the North American sample assessed possible reasons for not attending scleroderma support groups. Proportions of items rated Important or Very Important were compared between samples. Consistent with the North American survey findings (N = 242), the two items most commonly rated as (Very) Important reasons for nonattendance among 228 European participants were (1) already having enough support (57%), and (2) not knowing of any local scleroderma support groups (58%). Compared to North American non-attenders, European patients were significantly more likely to rate not knowing enough about what happens at support groups (46% vs 19%), not having reliable ways to get to meetings (35% vs 17%), and being uncomfortable sharing experiences with a group (22% vs 11%) as (Very) Important reasons for nonattendance. Improving access to European support groups, providing education about support groups and group leader training may encourage participation. Rehabilitation professionals might help develop local support groups for people with systemic sclerosis (scleroderma) to address the lack of access to these groups for many patients. The need for transportation and limited local accessibility may also be addressed by implementing online systemic sclerosis support groups. Professionals in the field of rehabilitation may work with people with systemic sclerosis and patient organizations to provide education about support groups to improve support group attendance in Europe. [ABSTRACT FROM AUTHOR]

The economic, social, and health costs of mental distress are increasingly burdening individuals and societies in Europe. Yet, overmedicalization of mild symptoms is also well documented. This accumulates in more pressures and demands on health care systems. In this article, I explore how the process of help seeking in mental distress might be shaped by health system design and functioning in one of the South European societies—Spain. Employing Bourdieu's theoretical lens, in-depth interviews with health care providers and users of services are analyzed. I reveal how the logic of the mental health care field, which is reinforced by the market, the state, and the media, may result in medicalization of mild distress while severe mental illness remains undertreated. I also show how mental help-seeking practices could gradually influence the functioning of the treatment system. Nevertheless, points of resistance to medicalization can also be identified. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay. Background: Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information. Design and methods: The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi‐structured interviews. Six mother–nurse interactions were observed, and eight nurses' experiences were explored through focus‐group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character. Results: Interpreters were present during the consultations with the physicians, but rarely during the daily nurse‐mother interactions. Nurses focused on daily routines, infant care guidance and mother–infant attachment. The mothers learned through demonstrations and hands‐on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother–nurse conversation. Conclusion: Body language, simple words, guesswork, trial and error characterised the nurse–mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used during meetings with physicians, but not during daily bedside guidance and information giving by nurses. Relevance to clinical practice: Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers. [ABSTRACT FROM AUTHOR]

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Immigrant men who have sex with men (MSM) are vulnerable to HIV. In the last decade, several rapid HIV-testing facilities targeting MSM have been established around the world and seem popular among immigrants. This study analyzes factors contributing to immigrant MSM's use of Actuel sur Rue (AsR), a community-based rapid HIV-testing site in Montreal's gay village, where 31% of clients are immigrants. From October 2013 to January 2014, AsR staff compiled a list of new clients born outside of Canada. With their consent, 40 immigrant MSM were reached among these new clients for a 15-minute phone survey entailing open-ended and multiple-choice questions. The survey sought immigrant MSM's reasons for visiting AsR; satisfaction with service and staff; and open comments. An inductive thematic analysis was conducted with the qualitative data, and descriptive statistics were produced with the quantitative data. The qualitative findings indicate that the main reasons for seeking an HIV test were a recent risk, routine testing, or being in a new relationship. Clients chose AsR mainly because it is easily accessible, service is fast or they heard about it from a friend. The quantitative findings indicate that rates of satisfaction were high (over 90% were satisfied about all aspects except for openings hours) and more than 80% felt comfortable while receiving services at AsR. Nevertheless, this study's findings have implications for improving services. They stress the importance of offering rapid yet comprehensive service and of taking into account immigrant MSM's concerns for confidentiality. [ABSTRACT FROM AUTHOR]

Aims: The IATPAD (Improvement in Access to Treatment for People with Alcohol and Drug Related Problems) study explored barriers and facilitators to accessing alcohol and drug treatment services in eight European countries. Methods: Results from individual interviews and focus group discussions with 246 service users who had experienced alcohol and drug treatment in Bulgaria, Greece, Italy, Poland, Slovakia, Slovenia, Spain and Scotland are described. Thematic analysis was used to interpret the data. Results: The study identified a number of consistent facilitating factors and barriers across all eight European countries, despite different health care systems. The results suggest that five main factors were implicated in the help-seeking behaviour of the service users interviewed. These were: information, service organisation, staff attitudes, significant others and personal disposition. All these factors could be viewed as both facilitators and barriers. Conclusions: To enhance access to alcohol and drug treatment, local, non-stigmatising and available services are required alongside support from significant others which should increase motivation and skills of potential service users. [ABSTRACT FROM AUTHOR]