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This chapter focuses on factors that facilitate community-based projects for providing effective and sustainable responses to the challenges faced by young people Not in Employment, Education, or Training (NEETs) in rural areas and more specifically to promote their quality of life and social inclusion. In line with Bronfenbrenner’s bioecological model (1977, 1979) and considering community-based projects as part of the exosystem, we aim to identify the barriers and constraints faced by projects targeting young NEETs in rural areas. As part of the collaborative research developed by the members of the “WG1—Rural NEETs Social Networks and Social Inclusion” of the Rural NEET Youth Network, we identified five promising community-based projects in Portugal, Italy, Sweden, North Macedonia, and Lithuania and conducted semi-structured interviews with the project coordinators. Our analysis showed that the identified projects take into account the different levels of the bioecological model and the need to involve how young people and local communities. Both these factors are crucial for their success and sustainability over time.

Background: The COVID-19 pandemic prompted varied policy responses globally, with LatinAmerica facing unique challenges. A detailed examination of these policies’ impacts on healthsystems is crucial, particularly in Bolivia, where information about policy implementation andoutcomes is limited.

Objective: To describe the COVID-19 testing trends and evaluate the effects of quarantinemeasures on these trends in Cochabamba, Bolivia.

Methods: Utilizing COVID-19 testing data from the Cochabamba Department Health Servicefor the 2020–2022 period. Stratified testing rates in the health system sectors were firstestimated followed by an interrupted time series analysis using a quasi-Poisson regressionmodel for assessing the quarantine effects on the mitigation of cases during surge periods.

Results: The public sector reported the larger percentage of tests (65%), followed by theprivate sector (23%) with almost double as many tests as the public-social security sector(11%). In the time series analysis, a correlation between the implementation of quarantinepolicies and a decrease in the slope of positive rates of COVID-19 cases was observedcompared to periods without or with reduced quarantine policies.

Conclusion: This research underscores the local health system disparities and the effective-ness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabambaregion. The findings stress the importance of the measures’ intensity and duration, providingvaluable lessons for Bolivia and beyond. As the global community learns from the pandemic,these insights are critical for shaping resilient and effective health policy responses.

This study explores the experiences of young people who are not in education, employment, or training (NEET) within the context of the COVID-19 pandemic in Sweden, using resonance theory as an analytical lens. It contributes knowledge about the importance of school and work (or lack thereof) for these youths during a time of uncertainty and gives insight into their quality of life and well-being from a social and relational perspective. The findings shed light on how the COVID-19 pandemic aggravated an already strained situation for this group while highlighting the importance of relationships, not only with friends and family, but with society as a whole. Adopting a non-materialistic approach to NEET situated young people's quality of life and well-being allowed resonant experiences to become evident in various aspects of their lives, which may be overlooked if the norms of an educationally underpinned work-centrism are in focus. The study calls for a broadened view on what constitutes or characterizes a good life for young people at the margins of the labor market and education system, while emphasizing the need to move beyond narrow concerns about integration into education or employment, towards focusing on their well-being.

The aim of this study was to understand how and why relational welfare works to support young people who are not in employment, education or training (NEET). It builds on research discussing the limitations of work-first and human capital strategies in social policy while responding to calls for theory-driven insights into initiatives that move beyond employability and rapid employment. The material for this realist evaluation includes programme documents, fieldnotes and 75 interviews with practitioners and participants in community-based multicomponent initiatives delivered by Swedish municipalities. These data were scrutinised against programme theories while integrating literature on relational welfare as underpinned by co-creation and capability approaches. The results illustrate how flexible, challenging and coordinated programming strengthen beings and doings of young people in NEET situations while improving their wellbeing by overcoming isolation and forming a future orientation. The study provides guidance for supporting NEET-situated young people through a relational approach to welfare. It also offers a model against which local initiatives provided to a youth group high on the policy agenda can be mapped.

Background: In the context of a broader vision for primary healthcare (PHC) informed health systems, Sweden is following international trends by introducing the national "Good Quality and Local Health Care" reform. This reform seeks to establish a health system with primary care (PC) at the centre by emphasising aspects such as interorganisational collaboration and e-Health innovation. Since translating policy into practice may be challenging in rural areas due to resource constrains and normatively urban perspectives in national policy-making, this study explores how rural PC actors navigate the PHC vision in the context of a sparsely populated area of the Swedish north.

Methods: This was a single case study, focusing on a rural municipality in northern Sweden. Thematic analysis was applied to data collected through interviews and observations, resulting in the development of three themes.

Results: The results indicate that the policies were suboptimally aligned with the needs of the rural municipality. The results highlighted enduring collaborations that predated the reform. These local alliances led to a resource allocation challenge, rendering the existing networks and reform efforts concurrently understaffed. Moreover, the reform's efforts to digitise healthcare faced impediments due to challenges associated with scaling up e-Health technology. Although key reform concepts such as person-centeredness and integrated care had already been put into practice, they were insufficiently acknowledged as such by external stakeholders.

Conclusion: Subjecting national health policy-making to scrutiny by different stakeholders through the use of rural proofing can lead to a more deliberate and impactful implementation of policies. Rural proofing facilitates the pre-emptive identification of potential shortcomings, thereby enabling the formulation of necessary adjustments that resonate with local needs. This study shows apparent misalignments between the national vision and the practical reality in rural areas, therefore calling for greater efforts to include rural perspectives in national policy-making.

Introduction: While co-creation has emerged as a promising approach to address complex problems in health and care systems, few examples exist where scholars have examined what separate stakeholder groups do to enhance their potential to engage in collaborative processes of joint problem-solving. The current study seeks to bridge this knowledge gap by providing empirical insights into the challenges of one stakeholder enacting ‘pre-creation’ to reform care services for older adults in the rural Swedish north through the Storuman Cares 2050 initiative.

Methods: This case study draws upon data collected through extensive notetaking of 23 core group meetings within Storuman Cares 2050. The notes were summarized into a database, which also included reflections on how previous experiences with other projects should inform progress as well as deliberations on engagement with co-creation partners. The data was thematically analyzed with themes developed through an inductive approach.

Results: Three themes were developed. The first one, ‘getting our house in order’, makes explicit the values, principles, and approaches that a stakeholder might bring to a co-creation process. The second theme, ‘starting close to home’, describes the value of supporting and stimulating internal engagements through demonstrating a commitment and capacity for change. The third theme, ‘reaching out’, details the importance of, but challenges to, engaging with external stakeholders.

Conclusion: This case study bridges an important knowledge gap by detailing how one stakeholder navigated past experiences and the history of relationships with diverse stakeholders while trying to support internal engagements and other local voices when aspiring to co-create. By introducing the concept of ‘pre-creation’ as encompassing the enhancement of an organization’s potential to engage in complex processes of joint problem-solving, the findings provide a stimulus for scholars to further explore what separate stakeholder groups do to enable them to co-create.

Introducción: Aunque la co-creación ha surgido como un enfoque prometedor para abordar problemas complejos en los sistemas sanitarios y asistenciales, existen pocos ejemplos en los que los estudiosos hayan examinado qué hacen los grupos de partes interesadas por separado para mejorar su potencial para participar en procesos colaborativos de resolución conjunta de problemas. El presente estudio pretende colmar esta laguna de conocimiento proporcionando una visión empírica delos retos de una de las partes interesadas que promulga la ”pre-creación” para reformar los servicios de atención a los adultos mayores en el norte rural de Suecia a través de la iniciativa Storuman Cares 2050.

Métodos: Este estudio de caso se basa en los datos recogidos mediante una amplia toma de notas de 23 reuniones del grupo central de Storuman Cares 2050. Las notas se resumieron en una basede datos, que también incluía reflexiones sobre cómo las experiencias previas con otros proyectos deberían informar el progreso, así como deliberaciones sobre el compromiso con los socios de co-creación. Los datos se analizaron temáticamente con temas desarrollados mediante un enfoque inductivo.

Resultados: Se desarrollaron tres temas. El primero, ”poner la casa en orden”, explicita los valores, principios y enfoques que una parte interesada puede aportar a un proceso de co-creación. El segundo tema, ”empezar cerca de casa”, describe el valor de apoyar y estimular los compromisos internos demostrando el compromiso y la capacidad de cambio. El tercer tema, ”tender la mano”, detalla la importancia y los retos de la participación de las partes interesadas externas.

Conclusiones: Este estudio de caso cubre una importante laguna de conocimiento al detallar cómo una parte interesada navegó por experiencias pasadas y la historia de las relaciones con diversas partes interesadas mientras trataba de apoyar los compromisos internos y otras voces locales cuando aspiraba a co-crear. Al introducir el concepto de ”pre-creación”, que engloba la mejora del potencial de una organización para participar en procesos complejos de resolución conjunta de problemas, las conclusiones estimulan a los estudiosos a seguir explorando qué hacen los distintos grupos de interesados para poder co-crear.

Aims: The aim of this study was to identify and evaluate critical components within social prescribing programmes that can impact loneliness, health, or well-being among older adults.

Methods: A systematic review with a narrative synthesis was conducted by systematically searching five databases. A total of 1193 hits were identified, screened, and assessed. Twelve studies were included, with data being extracted and deductively analysed in an iterative manner and then tabulated together with outcomes in order to find common narratives.

Results: Three critical components were identified: Assessment before prescription, matching participants with relevant activities, and individualised support from link worker. These critical components seemed important for the success of social prescribing programmes since they had an impact on loneliness, health, and well-being. All together, these results highlight the importance of person-centeredness in the prescribing process.

Conclusions: The three critical components identified may prove useful in further research, evaluation, or implementation of social prescribing programmes. Important aspects for further evaluation are discussed.

BACKGROUND: In line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports.

METHODS: Based on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi's "What's the Problem Represented to be?" (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four.

RESULTS: The three problem representations connected the Swedish health system "problem" to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources.

CONCLUSION: The results from this study indicate that as discursively framed within concrete proposals, government official reports in Sweden represent the health system problem in particular ways and with these problem representations overlooking several aspects that are central to a health system characterized by PHC principles and functions. In the continued reorientation towards good quality and local health care, these silences might need to be acknowledged.