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BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

Background: Globally, many models of care through which the way health services are delivered have been adopted withinteam-based primary health care. Although these models have aimed to solve some of the health care challenges related tophysician’s shortages in clinics and further acceptance of non-physician-led clinics, their application is usually determined by arange of factors, such as preparedness of the health care providers, preparedness of patients and support from higher authorities.

Objective: The study was designed to explore health care providers’ perceptions for changes in models of care in diabetes clinicsat primary health care in Muscat, Oman.

Methods: A total of 27 semi-structured interviews were conducted with health care providers involved in diabetes clinics atfive purposively selected primary health care centres in Muscat. The interviewees included the core members of the diabetesmanagement team and other supportive members available at the centres, and were of mixed genders, nationalities and professions.Qualitative thematic analysis was applied.

Results: The analysis resulted in one main theme, which captured positive responses towards task-sharing model, but revealedworries and requirements for complete implementation. Nurses’ competences and diabetic patients’ acceptance were among themain concerns. Health care providers revealed that for complete implementation of the model, nurses’ involvement in the teamcould be improved through updating their knowledge and through the provision of support from higher authorities, while diabeticpatients’ acceptance could be improved through understanding of their perceived knowledge towards the model which couldpromote nurse-led clinics.

Conclusion: Task-sharing within the discussed possibilities could provide many positive outcomes and a rewarding future fordiabetes clinics at primary health care centres. Omani culture could play a role in its implementation; therefore, if successfulimplementation is desired, carefully considered steps must be applied by the government and the community

AIM: The aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches.

BACKGROUND: The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines.

METHOD: A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.

FINDINGS: The study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

Objectives, setting and subjects: Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. Design: In-depth interviews with 14 individuals were analysed with qualitative content analysis. Results: Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants’ descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. Conclusions: The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care.

Background: Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients’ reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. 

Methods: In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants’ evaluation of the risk communication was assessed in the intervention group (n=1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n=714-857).

Results: The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification.

Conclusions: The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion.

Childhood obesity is increasing in Sweden. All children are offered regularly spread health visits to a school nurse. As health visits include a measure of height and weight and a health dialogue, school nurses can discover, disclose, and treat a child's weight gain. The aim of this study was to describe school nurses’ experiences and challenges in working with childhood obesity. This qualitative study collected data through focus-group discussion and semi-structured interviews with ten female school nurses from six municipalities. Data were analysed inductively using manifest qualitative content analysis. The study was reported using the COREQ guidelines. Stigmatization and lack of resources are major challenges for school nurses working with childhood obesity, and they experience frustration, powerlessness and feel that they provide unequal treatment. The present study concludes that obesity stigmatization is a widespread challenge for school nurses. They cannot alone generate all the resources needed or conquer all challenges. Evidence-based guidelines, increased knowledge, time for reflections and peer support could potentially empower school nurses, reduce frustration, and improve the quality of and equality in childhood obesity treatment.

Uppdrag: I denna rapport sammanfattas det regeringsuppdrag som Länsstyrelsen Västerbotten haft under åren 2019–2021. Syftet med uppdraget var att utveckla metoder och arbetssätt för samordning av ett regionalt arbete för en god och jämlik hälsa utifrån bestämningsfaktorerna i de åtta målområdena, med målet att skapa bättre förutsättningar för det lokala främjande och förebyggande folkhälsoarbetet i länet. 

Genomförande: Uppdraget har genomförts i nära samarbete mellan Länsstyrelsen Västerbotten, Region Västerbotten och Umeå Universitet. Tillsammans har dessa tre aktörer genomfört en omfattande och noggrann inventering av förutsättningarna för lokalt och regionalt folkhälsoarbetet i länet, vilken har legat till grund för aktiviteter som genomförts och processer som startats under pilotprojektets tid. Detta innefattar i huvudsak kommunbesök, dialoger, samverkanskonferenser, utbildning i folkhälsa och folkhälsoarbete, studiebesök till Bodö samt förankring och framtagande av en avsiktsförklaring för en god, jämlik och jämställd hälsa.

Resultat: Pilotprojektet har bidragit till goda förutsättning för att etablera en samordningsstruktur som stimulerar och förtydligar det gemensamma regionala folkhälsoarbetet, vilket i sin tur stärker det lokala folkhälsoarbetet. Arbetet med pilotprojektet har lett till ökad kunskap hos beslutsfattare och andra aktörer om betydelsen av och förutsättningarna för att bedriva ett folkhälsoarbete med fokus på jämlikhet. Pilotprojektet har även bidragit till att utveckla relationer, kunskaper, drivkrafter, engagemang och motivation hos länets folkhälsoaktörer. Med utgångspunkt i de lokala behoven har pilotprojektet utvecklat arbetssätt för samordning av lokalt och regionalt folkhälsoarbete. Detta arbetssätt kan sammanfattas i en modell som möjliggör för aktörer att bidra till, få hjälp med och samarbeta efter de egna förutsättningarna i syfte att stärka både det lokala och regionala folkhälsoarbetet. Västerbottensmodellen består av följande komponenter:

Lyssna – ett behovsorienterat förhållningssätt: Lokala perspektiv och behov styr hur samverkan fungerar och utvecklas för att olika aktörer tillsammans ska kunna bidra till ett gott folkhälsoarbete utifrån sina förutsättningar.

Lita på varandra – en tillitsbaserad arbetsprocess: Det behovsorienterade förhållningssättet karakteriserar såväl de externa som det interna arbetsprocesserna med en kontinuerlig dialog mellan lokala och regionala aktörer.

Göra – strukturerade metoder: Gemensamt utformade och väl förankrade metoder ger goda förutsättningar för att kunna etablera en samordningsstruktur för lokalt och regionalt folkhälsoarbete.

När pilotprojektet tar slut behövs en samordnade funktion som tar vid helheten av det pilotprojektet stått för, varför pilotprojektet tog initiativ till att bilda Forum för folkhälsa i Västerbotten. Intentionen är att Forum för folkhälsa i Västerbotten ska förvalta och utveckla de metoder och arbetssätt för regional samordning som pilotprojektet arbetat fram, vilka inkluderar: kunskapshöjande insatser, dialoger, överenskommelser, samverkanskonferenser och informationsspridning. Förhoppningen är att Forum för folkhälsa i Västerbotten kommer utgöra ett nav för samverkan som både främjar och stödjer dialog, informations- och erfarenhetsutbyte, utveckling och utbildning och bidrar till uppföljning av folkhälsoarbetet i länet. 

BACKGROUND: Despite various guidelines, shortcomings in lifestyle counseling in primary care have been demonstrated. Comparisons between countries may provide insight on how to improve such counseling. To the best of our knowledge, studies comparing patients' views of lifestyle counseling beween the United States (US) and European countries have not been reported.

OBJECTIVES: To quantify and compare patients' perspectives in the US and Sweden on primary care providers' counseling on weight, eating habits, physical activity, smoking, and alcohol consumption.

METHODS: In a cross-sectional study, 629 patients from Sweden and the US completed a telephone interview about their experiences after a visit to a physician in primary care. The survey focused on patients' perception of the importance of healthy lifestyle habits, their need to change, their desire to receive support from primary care, and the support they had actually received. Data were analyzed using chi-square or Fisher's exact test.

RESULTS: For three of the four lifestyle habits, the proportion saying they needed to change was higher in the US. The exception was for alcohol, where Swedish subjects indicated a greater need to change. Among those stating a need to change, the proportion saying that they would like to have support from primary care was generally above 80% in both countries. The proportion of US patients reporting that their primary care provider had initiated a discussion of lifestyle modification was, with the exception of alcohol, roughly double the level reported by the Swedish patients.

CONCLUSIONS: This study demonstrates high and quite similar patient expectations concerning lifestyle counseling in both countries, but more frequent initiation of discussions of most lifestyle issues in US primary care. Further studies, e.g. qualitative interviews with physicians, and medical record reviews, are required to better understand what can explain the differences between countries indicated by the study.