Screening intimate partner violence in the healthcare services during Covid-19 lockdowns in Israel

Abstract Background Studies have shown increased rates of intimate partner violence (IPV) during the Covid-19 lockdowns. Healthcare services (HCS) have an important role in detection and screening of women victims of IPV. These women tend to visit the HCS more frequently, which creates an opportunity to detect, screen, and inform them about relevant support services. Methods We conducted an online survey during Israel's 2nd and 3rd lockdowns (October 2020-February 2021). A self-administrated structured questionnaire was distributed in Arabic and Hebrew via social media. Eligibility criteria included women >18 years old. 519 women completed the questionnaire: Palestinian-Arab=73; non-immigrant Jew=319; and immigrant Jew=127. We asked women whether they were ever screened (ES) for IPV or received information (RI) on support services in the HCS. Results 37.2% of the women reported any IPV; Palestinian-Arab women reported higher rates of IPV (49.3%) compared to non-immigrant Jew (34.2%) and immigrant Jew (37.8%). Prevalence of ES and RI on support services were low among the total study sample (21.8%, 47% respectively). Only 12.1% reported on both (ES and RI). Among women who reported IPV, only 26.9% reported that they had been ES, 39.4% RI, and 13.5% both. Whilst Palestinian-Arab women victims of IPV reported higher ES and a lower RI (30.6%,25% respectively) non-immigrant and immigrant Jew reported the opposite -higher prevalence of RI and less ES (non-immigrant Jew 45%,25.7%. Immigrant Jew 37.5%,27%, respectively). In the multivariate analysis after adjusts, Palestinian-Arab women were less likely to RI regarding support services (OR = 0.33,90%CI=0.19-0.57), while immigrant Jew women had a greater chance to be ES in HCS (OR = 4.29, 90% CI=1.43-12.80). Conclusions To increase IPV detection in the HCS, there is a need for interventions on screening and providing information on support services specifically during emergencies where IPV is likely to increase. Key messages During emergency situations such as the Covid-19 when IPV is likely to increase, HCS should make more efforts for IPV screening and providing information on support services to women victims of IPV. Tailored intervention should consider barriers in the HCS for providing less information on support services to minority women, and less screening for immigrant women.


Background:
Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. We answered the research question: what are the short-and long-term outcomes of participation in X-Fittt 2.0 in terms of health, quality of life and societal participation? Methods: Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), 1 year (t2) and 2 years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using linear mixed-model analysis, while we used descriptive statistics for the categorical variables. Qualitative data were analysed using thematic analysis. Results: Body weight was significantly lower at all three post-initiative time points compared with t0, with a maximum of 3.8 kg difference at t2 (p < 0.05). BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks (p < 0.05). A positive trend regarding paid work was observed, participants reported increased PA levels (including sports) and a few stopped smoking or drinking alcohol. Participants felt healthier and more energetic, reported improved self-esteem and stress levels, and had become more socially active. However, barriers to being physically active included a lack of money or time, or physical or mental health problems. Conclusions: X-Fittt 2.0 improved the physical health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results.

Key messages:
Care-physical activity initiatives can improve the physical and mental health, quality of life, lifestyle and societal participation of citizens with a low socioeconomic status. It is vital to improve the accessibility of care-physical activity initiatives, for example by lowering costs, so that existing and future initiatives better suit people with low socioeconomic status.

Conclusions:
To increase IPV detection in the HCS, there is a need for interventions on screening and providing information on support services specifically during emergencies where IPV is likely to increase.

Key messages:
During emergency situations such as the Covid-19 when IPV is likely to increase, HCS should make more efforts for IPV screening and providing information on support services to women victims of IPV. Tailored intervention should consider barriers in the HCS for providing less information on support services to minority women, and less screening for immigrant women.

Introduction:
Frequent users of emergency departments (FUED; 5 ED visits in the previous 12 months) often present with somatic, psychological and substance use problems. Providing a Case Management (CM) intervention may reduce their number ED visits and improve their quality of life. However, there is limited knowledge about the implementation process of CM.

Methods:
This study aimed to introduce CM into the EDs in the French-speaking part of Switzerland and to identify the facilitators, barriers and needs encountered in this process.
Semi-structured interviews were conducted with ED involved staff. An inductive content analysis was conducted.

Results:
Among 13 invited hospitals, 8 implemented CM (62%); 23 ED staff were sampled from all participating ED: 17 nurses (74%), 5 physicians (22%) and 1 healthcare manager (4%). The average age was 48,48 years (SD = 8,64) and 74% were female. Four main facilitators emerged from the analysis: 1) Direct hierarchy support and flexibility (e.g. time management, supplemental paid hours); 2) Exchange with colleagues (e.g. debriefing, support); 3) Supervision by the research team (training and toolkit consisting of a binder and USB stick containing the study presentation and implementation procedures); and 4) Motivation (pleasure to work on an innovative project, benefit for patients and caregivers). Lack of resources was an unanimously mentioned barrier (e. g., time to identify and contact FUED medical and social support). Finally, participants identified the following needs to enable CM implementation: official and protected time for the project, a dedicated room for CM, at least two team members involved in the project since its initiation with complementary skills (e.g.: somatic, psychiatric and social).

Conclusions:
Our study suggests that successful CM implementation is a complex process that, in addition to motivated ED staff, requires significant dedicated resources, such as protected time and a devoted support team.
Key messages: Future research should establish a case management intervention with resources (time, space, teams with complementary skills) specifically dedicated to this process. In order to increase the quality of care, institutions should dedicate more funding for the implementation and sustainability of case management to enable its optimal application by caregivers.
Abstract citation ID: ckac130.010 Improving population health in Germany -lessons of a pilot study to assess health system performance Background: Improving the population health, both its level and equity, is a major goal of health systems. Health System Performance Assessment (HSPA) is a tool to evaluate the performance of different health system dimensions, e.g., population health, access, efficiency. For the first time, a systematic HSPA was piloted for Germany including the dimension population health.

Methods:
The conceptual framework for the German HSPA pilot has been developed in a previous feasibility study. The selection of indicators was based on established indicators used in other HSPA initiatives. Another inclusion criterium was data availability. The ten indicators to measure population health cover e.g., maternal and neonatal health, amenable mortality, infectious diseases, and cancer screening. The indicators are evaluated in terms of their trend over time , in international comparison (e.g., Austria, Denmark, France), and by various equity criteria (e.g., age, gender, region).

Results:
Overall, Germany's health system performs moderately regarding population health, especially when compared to selected European countries. While Germany performs very well in terms of incidence rates of infectious diseases, amenable mortality is an area with need for improvements. However, 15th European Public Health Conference 2022