Vocational training of health mediators of primary care teams improves their sense of coherence

Abstract Background A Primary Care Model Programme had been implemented in Hungary between 2013-2017 in which group practices were established that employed - among others - nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme. Methods A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales. Results Positive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-the-job vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence. Conclusions Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for disadvantaged groups but also improved the mental health of mediators themselves. Key messages • Nonprofessional health mediators are important members of primary care teams servicing disadvantaged populations. • Significant improvement in mental status during 5 years of follow-up occurred among Roma health mediators who received vocational training and were equal members of primary health care teams.

Medical rehabilitation is a valuable component to restore physical and mental health, to prevent social isolation and to ensure a return to work.Due to the demographic change and the still increasing number of Post-Covid-19 patients, the demand for rehabilitation is still increasing.Latest, the COVID-19 pandemic elucidated that especially people from lower socio-economic backgrounds are disproportionally affected by health crisis.The aim of this study was to determine the influence of socio-demographic and socioeconomic factors on quantitative exercise therapy in medical rehabilitation and to clarify the divergence of existing research findings.In our study we used data from 824.606 rehabilitation cases (German Federal Pension Insurance) and investigated the role of age and gender, marital status, social status and location towards inequalities in access to medical rehabilitation.Multiple linear regression and effect size calculation were used to show associations and to discuss the relation to clinical relevance.We were able to show a highly significant difference (P < 0.001) in access to exercise therapy in our study group.Patients aged 65+, women, single or widowed people, rehabilitants of low socioeconomic status or people located in the new federal states in Germany received shorter and less frequent exercise therapy.There are differences of up to 3.5 hours of treatment duration and 4.25 treatments per week, when disadvantaged social factors accumulate.However, despite the presented differences, the received treatments for the disadvantaged groups are still in the range of suggested minimum therapeutic requirements by the German Federal Pension Insurance.We could show a significant difference in rehabilitative therapy, which is solely based on social factors.There is an urgent need to draw special attention to the here discussed inequalities in access to medical rehabilitation for socially disadvantaged population and the overarching impact on society.

Key messages:
The social inequality in medical rehabilitation to the detriment of the socially disadvantaged population that we have identified must give rise to clear changes in order to establish social justice.
Equal opportunities and health quality assurance that address the individual needs of each patient should be the focus of socio-medical, policy development.

Background:
A Primary Care Model Programme had been implemented in Hungary between 2013-2017 in which group practices were established that employed -among others -nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups.The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme.

Methods:
A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey.

Results:
The online modality allowed to reach professionals across the country, though affected the participation in the evaluation surveys.Overall, 93 professionals participated in the training program, yet only 57 returned completed surveys.The paired analysis showed an increase in the mean knowledge scores (0-24) at baseline and follow-up (14.5 vs 15.82 (p = 0.0083).A more notable increase was detected on questions that measured knowledge of health coaching techniques (0-6) (2.76 vs 3.44 (p = 0.0052)).

Conclusions:
New knowledge and skills penetrated into daily CICT practices across Armenia.This was a good example of a quick mobilization of local and international expertise to assist the national efforts in responding to a public health emergency by utilizing evidence-based approaches and lessons learned from

Introduction:
This study aims to explore perceptions, fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives and/or co-workers and non-pharmacological preventive interventions among hospital workers.

Materials and Methods:
The research used an explorative qualitative approach.Six focus groups and ten individual interviews across multidisciplinary workers (physicians, nurses, aides, cleaners, maintenance, and security staff) were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding.

Results:
Forty professionals participated in the study.Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties.

Conclusions:
This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families.Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization.These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, in order to reduce also health inequalities.

Key messages:
Lack of pandemic preparedness increased HCW' fear of infection, which could be reduced by ensuring the availability and good use of proper PPE, and by clear guidelines on case/contact detection.The improvement on non-pharmacological preventive interventions must be underpinned by effective communication channels and/or communication staff, and should reach all workers in the institution.
The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales.
Conclusions:Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team.Employment of health mediators in primary care teams not only contributed to improving access to care for