Youth health promotion in countries affected by forced migration: The role of mHealth technologies

Abstract Issue/problem Young refugees often face barriers in accessing youth-friendly health information and care. Differing cultural norms, languages, laws, financial difficulties, gender disparities, and stigma pose additional challenges for youth in forced migration settings. Description of the practice REACH is a regional initiative of Columbia University, which aims to bridge the gap in health literacy and health care access among refugee and disadvantaged youth in Turkey, Lebanon, and Jordan, which are heavily affected by the Syrian conflict. Supported by TaiwanICDF, Blue Chip Foundation, and Columbia University, the REACH Project uses a community-based participatory action research approach and aims to assess the impact of mHealth technologies on improving health literacy and health care access among youth in host countries. With a strong adult-youth partnership, the project includes stakeholder meetings, mixed-methods studies with youth, health service providers and policy makers, in addition to health advocacy, communication and dissemination activities such as photo exhibitions, panels, and production of policy briefs and scientific publications. REACH has been working with youth, software developers, health professionals, academia, and I/NGOs to develop the multilingual and freely available REACH4Health app to promote youth health. Results Findings from three countries show that mHealth technologies have the potential to provide innovative, youth-friendly and widely used solutions to address the health education, health communication, and health care needs of disadvantaged and marginalized youth. Lessons Youth-adult partnerships, working with mixed groups of refugee and local youth, using community-based participatory research, peer-to-peer methodologies, and co-design approaches, as well as using social media tools contribute to the overall success of mHealth and health promotion interventions for disadvantaged youth in countries affected by forced migration. Key messages • mHealth technologies have a strong potential to improve health literacy and health care access of refugee and disadvantaged youth in countries affected by forced migration. • Youth-adult partnerships, working with mixed groups of refugee and local youth, using participatory approaches and peer-to-peer methodologies significantly contribute to youth health interventions.


Aim:
Cesarean section has negative impacts on breastfeeding rates. This study is to evaluate the effect of a mobile application on breastfeeding outcomes among mothers who had cesarean section using a randomized control trial in Vietnam in 2020 -2022.

Methods:
A triple-blinded randomized trial of a mobile application was conducted. The mobile application was tailored to Vietnamese culture with two separate versions for the intervention and the control group. The intervention version auto-generated three messages per week and linked the information in the library content to improve breastfeeding while the control version sent messages on maternal and child health care. Pregnant mothers were recruited during their antenatal visits and randomly assigned to two groups. Outcomes of interest included early initiation of breastfeeding and exclusive breastfeeding rates.

Results:
A total of 275 mothers in the control and 293 in the intervention group who had undergone a cesarean section were included in the analyses. Significant increases were observed for early initiated breastfeeding within two hours (aOR = 1.51, 95%CI: 1.01 to 2.27) and exclusive breastfeeding during hospital stay (aOR = 1.59, 95%CI: 1.02 to 2.49).

Conclusions:
Our results support the use of a theory-based design mobile phone application as a part of a promising intervention to improve breastfeeding outcomes.

Key messages:
A mobile phone application could be a widely accessible, acceptable, and effective intervention to improve breastfeeding outcomes.
To improve exclusive breastfeeding rates, comprehensive interventions at different levels of sociocultural and market contexts, settings, and individuals are needed.

Background:
Little is known how Lithuanian mothers use social networks to seek information about preschool children's health. This study aimed to identify health topics of the posts, characteristics of the most engaging posts, and practices shared in the comments.

Methods:
This study included all accessible posts published in 2021 on one Facebook group with more than 21 000 Lithuanian mothers. In total, 1674 posts and 3192 comments on the most engaged group of posts (gastrointestinal disorders) were analysed. Number and type of reactions to posts, categories of health topics, aim, form, tone, and structure of the posts, also practice type on comment were registered.

Results:
Among all posts, 72.9% were related to children's health. The most common health topics included injuries (17.1%), healthcare (15.1%), gastrointestinal disorders (9.7%), allergies and skin diseases (9.7%), nutrition, physical activity and health promotion (9.3%), nurture (8.9%). The most common form was text only (48.7%), repetitive aim was to ask about personal experience (47.5%), and recommendations (35.5%). Larger numbers of reactions achieved posts with sensitive tone, including appeal, child's health description, gratitude in advance, and written in Lithuanian (p < 0.05). Comments with healthy lifestyle recommendations, recommendations for medication, also recommendations to treat children by themselves, to visit physicians accounted for 73.6%, 26.4%, 36.0% and 10.8% respectively.

Conclusions:
Main topics of children's health on Facebook for Lithuanian mothers are injuries, healthcare, gastrointestinal disorders, allergies, skin diseases, nutrition, physical activity, health promotion, nurture. Posts with sensitive tone, appeal, situation description, gratitude, written in Lithuanian achieve the largest number of reactions. Comments most frequently include advices to treat children at home, also healthy lifestyle recommendations.

Key messages:
Lithuanian mothers most frequently seek advices regarding preschool children's injuries, healthcare, gastrointestinal issues, allergies and skin diseases, and nurture. Publication of posts including text only, sensitive tone, greetings, situation description, and gratitude might help to promote health more effectively.
Issue/problem: Young refugees often face barriers in accessing youth-friendly health information and care. Differing cultural norms, languages, laws, financial difficulties, gender disparities, and stigma pose additional challenges for youth in forced migration settings. Description of the practice: REACH is a regional initiative of Columbia University, which aims to bridge the gap in health literacy and health care access among refugee and disadvantaged youth in Turkey, Lebanon, and Jordan, which are heavily affected by the Syrian conflict. Supported by TaiwanICDF, Blue Chip Foundation, and Columbia University, the REACH Project uses a communitybased participatory action research approach and aims to assess the impact of mHealth technologies on improving health literacy and health care access among youth in host countries. With a strong adult-youth partnership, the project includes stakeholder meetings, mixed-methods studies with youth, health service providers and policy makers, in addition to health advocacy, communication and dissemination iii232 European Journal of Public Health, Volume 32 Supplement 3, 2022