Janine de Zeeuw

Background: Human Papillomavirus (HPV) vaccine coverage is low among migrant populations, for example people with a Turkish and Moroccan migration background living in the Netherlands. This may relate to the use of media information during their vaccination decision-making process. We explored the self-perceived attitude, social influence, self-efficacy and (intended) use of media information in the HPV vaccination decision-making process of female adolescents and (grand)parents with Turkish and Moroccan migration backgrounds in the Netherlands.Methods: In this qualitative study, we obtained data from female adolescents aged 12-18 years, parents, and grandparents with Turkish and Moroccan backgrounds. We performed semi-structured interviews using a topic guide structured with the World Health Organization (WHO) Health Systems framework and the Attitudes, Social influence, self-Efficacy (ASE) model. For the analysis, we coded interview data and organized the codes along the corresponding ASE items attitude, social influence, self-efficacy, and (intended) behaviour.Results: We interviewed nine female adolescents, eleven parents, and two grandparents. Participants expressed a positive attitude and (intended) use of off- and online media information in HPV vaccination decision-making, thereby preferring reliable and online information, optionally in their mother tongue. Participants experienced high self-efficacy in obtaining and using media information but used unfocused search strategies. They also perceived an influence of social media on vaccination decision-making in society.Conclusion: Individuals with Turkish and Moroccan backgrounds living in the Netherlands have a positive attitude towards and (intention to) use media information regarding HPV vaccination. Despite their perceived high self-efficacy, they use unfocused search strategies. These findings point to a shared responsibility of healthcare professionals, parents, and public health agencies in supporting health media literacy, and reinforce the need to ensure reliable HPV vaccination media information.

The high-risk human papillomavirus (hrHPV)-based screening recommended by the World Health Organization is expected to lead to worldwide reduction of the cervical cancer burden, but the countries burdened most by cervical cancer also struggle with the costs of transitioning to this approach. Country-specific evaluations are needed to inform policymakers on implementation of hrHPV-based screening for their setting. Following initial implementation in Uganda, Bangladesh and Slovakia focused on underscreened women in the PRESCRIP-TEC project, we investigated the potential cost-effectiveness and affordability of hrHPV-based screening strategies. Country-specific model-based cost-effectiveness and budget impact analyses were conducted for the three countries, comparing the PRESCRIP-TEC strategy with the existing screening strategy in each setting. Data from initial project implementation informed the relevant model parameters. The PRESCRIP-TEC strategy resulted in disability-adjusted life year (DALY) gains in all three countries. The cervical cancer incidence rate was reduced by a third for Uganda, 15% for Bangladesh and 11% for Slovakia. The incremental cost-effectiveness ratios were UGX 0.56 million per DALY for Uganda (I$ 475), BDT 76 thousand per DALY for Bangladesh (I$ 1698) and EUR 1782 (I$ 3637) per DALY for Slovakia. Substantial additional funding will be required to enable implementation, particularly in relation to the initial start-up costs. The provided estimates can serve to inform policymakers and researchers in the context of implementing hrHPV-based screening in diverse settings.

Objective To examine existing literature regarding health literacy levels and their association with multimorbidity and the potential underlying mechanisms behind the said association. Design Systematic review and meta-analysis. Data sources The databases MEDLINE, EMBASE, CINAHL and Science Direct were searched for articles published between 1 January 2000 and 31 October 2023 using a systematic search strategy. Eligibility criteria Included were all primary studies conducted in people over 18 years old with data on health literacy levels and the presence of multimorbidity. No language restrictions were used. Data extraction and synthesis Two authors independently extracted data and assessed the bias using the Joanna Briggs Institute critical appraisal tools. Results We included a total of 39 studies (36 quantitative, two qualitative and one mixed-method), representing 154 337 participants. We found a 32% proportion of limited health literacy among individuals with multimorbidity. Analysis of three articles using the Health Literacy Questionnaire tool (n=31 228) (Pooled OR 2.88 (95% CI 1.92 to 4.31)) and three articles using the Health Literacy Survey Questionnaire–European Union tool (n=35 358) (OR 1.16 (95% CI 1.07 to 1.25)) indicated that people with limited health literacy were likely to have multiple conditions. One of three articles studying underlying mechanisms reported that self-efficacy mediates the association between health literacy and multimorbidity. Additionally, substantial literature identified education and income as the most consistent determinants of health literacy among individuals with multimorbidity. Of the only two articles studying the effectiveness of health literacy-related interventions, both reported an improvement in clinical outcomes after the intervention. Conclusions Our review demonstrated a consistent association between health literacy and multimorbidity, indicating that people with lower health literacy levels are more likely to have multimorbidity. More evidence is needed regarding the effect of health literacy interventions on multimorbidity. PROSPERO registration number CRD42022301369.

Background: People with a Turkish or Moroccan migration background in the Netherlands have low HPV vaccination uptake. Health system barriers, including a lack of awareness raising initiatives on HPV, health care professionals being insufficiently trained to provide tailored care and insufficient delivery of HPV (vaccination) information, contribute to low uptake. To understand which promising interventions could be transferred, the interventions were discussed with a variety of stakeholders including community members. Methods: By interviews and focus groups 33 key stakeholders were engaged to discuss on the promising evidence-based interventions. The interventions were extensively discussed on their effectiveness, cultural appropriateness, and potential transferability for which the Population-Intervention-Environment-Transfer Model of Transferability (PIET-T) model was used. Results: Two interventions will be implemented of which one is focusing on the use of health promotors (trusted community members) who will provide parents of vaccine-eligible children with information on HPV and HPV vaccination. The educational sessions will be held together with health professionals in, for example, community centers or at schools. The other intervention focuses on training of healthcare professionals. Conclusions: By engagement of key stakeholders including community members following the PIET-T model, final interventions could be developed that are tailored to the specific needs and contexts of people with a Turkish or Moroccan migration background in the Netherlands.

Background: Mental health as a public health issue warrants a comprehensive prevention-oriented approach whereby capacity building as well as a multisectoral and life-course approach are crucial. The ‘Capacity-building on mental health: multidisciplinary training programme and exchange programme for health professionals,’ project enhances and improves the capacity of professionals across Europe in the field of mental health. Various professionals are targeted 1) health professionals working in the mental health sector, 2) teachers and educators working in the educational setting, 3) social workers working in various community settings and 4) prison staff. Objectives: To understand the needs, gaps, obstacles in capacities, competencies, and to build upon existing programmes a mixed methods study, adopting a convergent parallel design is conducted to design and develop the programme. First, a literature review is conducted complemented with interviews, focus group discussions and a survey among various stakeholders to enrich the data. The training will be piloted in The Netherlands, Spain, Czech Republic, Croatia, Finland and Austria. Thereafter it will be rolled out in the 21 remaining EU countries as well as in Norway, Iceland and Ukraine. Results: Various gaps and competencies identified from different perspectives build a solid fundament for a comprehensive multidisciplinary training programme tailored to the needs of various professionals within the mental health arena. Preliminary results show that 98 multidisciplinary training programmes exist, with about half containing training materials and limited reports on evaluation. Conclusions: The comprehensive needs assessment will assure a multidisciplinary training programme is suitable and relevant for various professionals to ensure a well-designed capacity-building programme. Key messages: • Various gaps and needs among various professionals exist. • A comprehensive study strengthens alignment of training to needs and gaps among various professionals.

Cervical cancer is the fourth most common cancer in women globally, with an estimated 604 127 cases and 341 831 deaths in 2020 [1]. Low- and middle-income countries (LMICs) are disproportionately affected, accounting for more than 90% of cervical cancer mortality [2]. Compared to other cancers, the burden of cervical cancer has the largest inequity between high-income […]

Background: In the Netherlands, females with a Turkish or Moroccan migration background are among underserved communities with low HPV vaccine uptake. To target health system barriers related to uptake, the RIVER-EU project will identify and adjust promising evidence-based HPV interventions in collaboration with key stakeholders. Methods: Participatory Action Research (PAR) was applied to engage and collaborate with key stakeholders, including community members to discuss on transferability of promising evidence-based HPV vaccination interventions. Focus group discussions and semi-structured interviews were conducted for which topic guides were developed. Results: Key stakeholders included community members (parents and daughters), non-governmental organizations, healthcare providers, and policymakers. To engage community members, we build upon the relationship we had built during the first phase of RIVER-EU, and we reached out to organizations working with the communities. To build relationships and trust intensive physical and clear communication with communities was helpful. It required time and efforts to engage with general practitioners due to work overload. We could establish successful engagement of all key stakeholders by the application of various strategies. Conclusions: The PAR approach supported the meaningful discussion on identification of the facilitators and barriers related to the transfer and implementation of HPV interventions. All key stakeholders could provide their valuable insights needed to ensure successful understanding of the variety of perspectives needed for successful transfer.

Background: HPV vaccine uptake in female adolescents with a Turkish or Moroccan migration background in the Netherlands is lower as compared to the national average. This study aimed to study health system barriers for HPV vaccine uptake in these groups. Methods: Semi-structured interviews with Turkish/Moroccan (2nd and 3rd degree migrants) female adolescents (12-18 years old), their parents and grandparents were conducted. In addition a focus group discussion with healthcare providers with particular experience with HPV immunization and the target groups was organized. Data was collected between November 2021-April 2022. Results: 22 interviews were conducted among twenty-three individual participants. Sixteen participants with a Turkish migration background were recruited and seven participants were having a Moroccan migration background. In thirteen cases young women in the families did not receive an HPV vaccination. Health system barriers identified were: language barriers in the information provided, focus on HPV being a sexually transmitted disease in information campaigns, lack of knowledge and awareness on HPV among participants and healthcare providers and inability to reach the target groups with tailored immunization programs. Similar health system barriers were mentioned by the healthcare providers, but also included a lack of trust in the government and healthcare institutions, insufficient coordination and collaboration between different healthcare providers. National immunization programs with mass campaign vaccination is mentioned as a barrier to reach families with a Turkish/Moroccan migration background. Conclusions: Various health system barriers were addressed to be related to HPV vaccine uptake in females with a Turkish/Moroccan migration background in the Netherlands. Despite similarities concerning health system barriers among community members and healthcare providers, different health system barriers were also mentioned.

Purpose Psychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP), that is the time period between onset of symptoms until initiation of appropriate treatment by a healthcare professional, is one of the main determinants for successful treatment in western settings. This study aims to explore the factors related to the DUP among Surinamese patients using the perspectives from patients, their families and first-line healthcare professionals in Suriname. Methods Semi-structured interviews were conducted with patients having a history of psychosis, family members and general practitioners between February 2019 and April 2019 in Suriname. Interviews were tape-recorded and transcribed verbatim. Data were analysed using a thematic analysis for which an inductive and deductive approach was applied. Results In total, 28 patients, 13 family members and 8 general practitioners were interviewed. Five patients were excluded from the study. A median DUP of 4 months was found (IQR 1–36). Identified themes related to DUP included presentation of symptoms and illness awareness, help-seeking behaviour and alternative medicine, social support and stigma, financial and practical factors. Conclusion Multiple factors were related to DUP, of which poor illness awareness, traditional medicine, stigma and social support were predominant. Poor illness awareness and use of alternative medicine were related to a longer DUP. Stigma was often an obstacle for patients and their families. Social and family support was important in helping patients to get medical help sooner. Other explored factors including financial and practical factors did not contribute to DUP.