BACKGROUND AND OBJECTIVES:Population health management (PHM) is increasingly promoted as a strategy to improve health outcomes, enhance healthcare quality, reduce costs, and, more recently, support clinician well-being and advance health equity - the Quintuple Aim. However, how PHM is conceptualised within the primary care context remains unclear. This scoping review explores how PHM is conceptualised within this context. METHOD:Five databases (PubMed, Embase, CINAHL, Web of Science and Scopus) were searched to find publications that conceptually addressed PHM and its interaction with the primary care context. Data extraction focused on definitions and related terms, the bidirectional influence between PHM and general practice, and interpretations of the components 'population' and 'management'. RESULTS:27 publications were included. Definitions of PHM varied, with few explicitly addressing the primary care practice level. They highlighted the need to proactively address social determinants of health beyond clinical outcomes. Both top-down and bottom-up dynamics make general practices accountable for and increasingly involved in the identification of populations, risk stratification and impact assessment, with both clinical judgement and real-world primary care data. Management involves team-based and technology-supported care. CONCLUSION:Considering PHM within primary care highlighted the importance of general practice's accountability, its consideration of social determinants of health beyond clinical outcomes and its community alignment to enhance equity. What the potential added value of general practitioner's clinical intuition and real-world primary care data in assessing impact warrants additional exploration.

BACKGROUND:Ethiopia's Health Extension Program (HEP) aims to improve primary care access through community-based delivery of essential preventive and promotive services. Despite progress, some health outcomes remain suboptimal, underscoring the need to optimize HEP implementation. Identifying barriers of the HEP and its Health Extension Workers (HEWs) is critical for enhancing program effectiveness. This scoping review aims to identify and synthesize evidence on the barriers impacting the performance of the Ethiopian HEP and HEWs. METHODS:A comprehensive search strategy was conducted across multiple databases, including PubMed, EMBASE, Web of Science, and relevant institutional websites, as well as hand searches via Google Scholar and Google engine, to identify both published and unpublished documents (documents (government reports and policy documents (strategic plans, program reviews, annual performance reports), development partner publications, doctoral dissertations, and masters theses) related to the HEP. The review encompassed studies published since January 2003. Data extraction was performed using Atlas.ti software version 7.5.18, which facilitated the collection of verbatim excerpts and the application of thematic coding to highlight key findings. The results are organized and presented through thematic analysis, focusing on multi-dimensional barriers and challenges. RESULTS:The review reveals multi-dimensional barriers, including a misalignment between the HEP's preventive design and the community's demand for curative services, which undermines community trust and program acceptance, and gender-imbalanced workforce, which creates barriers to service delivery in certain cultural contexts. Additional barriers include a lack of training and retention strategies, and digital literacy and access gaps which further impede effectiveness of the program. Excessive workloads, non-health tasks, and poor living conditions, divert HEW's focus from their primary responsibilities. Weak community engagement, inadequate integration of Traditional Birth Attendants (TBAs), and inefficiencies in model family development limit the program's impact. Misconceptions in the community, resource constraints, fragmented stakeholder interactions, ineffective supervision, governance issues, and political interference directly impede performance. CONCLUSION:The HEP faces deeply entrenched, multi-dimensional barriers that limit its potential to achieve optimal health outcomes. Key policy recommendations include integrating curative services, ensuring a balanced gender mix in the workforce, improving working conditions and expanding community engagement. Further research is needed to quantify barriers, assess their impact, and identify key influencing factors, with stakeholder engagement and implementation research being essential for developing effective solutions.

Background The Health Extension Program (HEP) is Ethiopia’s flagship program introduced in 2003 to ensure equitable access to primary healthcare services. Recently, inefficiency in the time use patterns of staff of the HEP, including absenteeism and non-productive engagements, has been reported as a major challenge. Objective This qualitative study explored what factors influenced their time use and efficiency. Methods This is a qualitative study that was conducted in rural health posts (HPs) across Ethiopia in three rounds over a period of 12 months (17 May 2023 to 16 May 2024). Qualitative data were collected through key informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs) involving HEWs and other staffs of health posts, their supervisors, Kebele leaders, Women’s Development Army (WDA), teachers, and other community members. A total of 52 KIIs, 31 IDIs, and 28 FGDs were conducted in three rounds. Data were analyzed using ATLAS.ti 7.1.18 software. Results HEWs commonly spent their time on productive non health or non-HEP activities such as those related to community-based health insurance, agricultural and rural development and education sectors, and other political assignments. It was also noted that HEWs could be available in their workplace, but might not be productive. Factors for the inefficiencies across HPs often pertained to environmental and demographic features, community trust and engagement, local administration; human resource development and management practices, multisectoral collaboration; and underlying causes of absenteeism including motivation. Conclusion Inefficiencies are common among HEWs. Strategies need to be devised focusing on the identified modifiable factors such as improving accountability and performance management practices, introducing incentive mechanisms to keep HEWs motivated, improving accessibility to transportation services, and security conditions, workforce to population size ratio; and capacity building.

In recent years, our understanding of the various stress factors affecting the mental well-being of medical trainees during on-call work has grown. Although we have developed a general understanding, we still lack insight into the underlying interrelationships and causal effects of these factors, necessary to address and prioritize the mental health needs of young doctors. We aimed to measure the causal effects of selected stress factors related to on-call work contributing to occupational stress among General Practitioners (GPs) in training. We identified key stress factors through a literature review and group discussion. Furthermore, we built a Directed Acyclic Graph (DAG) for each identified factor to draw valid causal inferences based on data collected from an observational survey. Our analysis indicated that GPs in training experience interruptions to leisure time, fear of potential work-related errors, and anticipatory and vigilant behaviour towards potential patient complaints as key contributors to elevated stress levels during on-call work. Our study revealed the importance of psychological or emotional stressors during an on-call shift encountered by GPs in training, encouraging preventive measures. Not applicable.

INTRODUCTION:Ethiopian Health Extension Program (HEP) aims to improve access to primary care, yet suboptimal health outcomes persist, indicating the need to optimize HEP implementation. This scoping review aims is to identify and synthesize evidence on the enabling factors that influence the Ethiopian HEP and Health Extension Workers (HEWs) performance. METHODS:A comprehensive search strategy was employed across multiple databases, including PubMed, EMBASE, Web of Science, and institutional websites. The review included studies published since January 2003, encompassing quantitative, qualitative, and mixed-methods researchs. The PRISMA flow diagram guideline was utilized for reporting of a review process and JBI methodology guideline was used for data extraction. Data extraction was conducted using Atlas.ti software, capturing verbatim excerpts and applying thematic coding to illustrate key findings. RESULTS:This review identified key multidimensional enablers of the Ethiopian HEP that collectively enhance the program's performance. Motivational factors for HEWs play a critical role, encompassing intrinsic desires and extrinsic factors including opportunities for career growth and fair compensation. Additionally, the review identified the importance of continuous capacity building to enhance the skills of HEWs and program performance. The review also highlights the positive impact of diversifying HEP services including customizing the HEP services to the varied contexts and integrating male HEWs to enhance program reach and acceptance. Engaging communities through organized campaigns, stakeholder coordination, and leveraging local structures enable and strengthen the program's effectiveness. Finally, the availability of essential resources is crucial for HEWs to provide timely and appropriate care. These multidimensional enabling factors form pathways for HEWs and HEP to create supportive environment and capability that significantly enhances HEP performance. CONCLUSIONS:Intrinsic and extrinsic motivations, community engagement, clinical nurse inclusion, male HEWs participation, mentorship and improving living conditions of HEWs enhances the HEWs' effectiveness and program performance.

Background: Supporting self-management in healthcare practice is essential to improve chronic patients’ daily life experiences. Primary care professionals play an indispensable role in this. Nevertheless, supporting self-management in practice comes with many challenges. The aim of this study is to identify determinants of professionals’ supportive behaviour and develop an intervention that facilitates self-management support in primary care practice, using these determinants as building blocks. Methods: To develop the intervention, the Behaviour Change Wheel (BCW) was used which involves eight steps in three stages: (1) Understanding the behaviour using the COM-B model, (2) Identifying intervention options, and (3) Identifying content and implementation options. The theoretical underpinnings for stage 1 included data from interviews, focus groups and brainstorm sessions, incorporated beforehand in a self-management support model. Subsequently, literature analysis, empirical research and expertise from the research group guided stages 2 and 3. Results: We found that changes in “psychological capability”, “physical opportunity”, “reflective motivation” and “automatic motivation” are required to optimize professionals’ behaviour towards self-management support. The two key intervention functions identified were “enablement” and “education”. Therefore, a blended learning trajectory that incorporated these interventional building blocks was developed, integrating specific behaviour change techniques (BCTs) including: (1) Information about social and environmental consequences, (2) Information about health consequences, and (3) Social support (practical). The learning design was finalized by applying the Absorb-Do-Connect learning framework developed by Horton. Conclusions: Application of the BCW framework shaped a self-management support intervention to educate and enable healthcare professionals. Future research will pilot and refine the intervention.

Background General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand.Methods Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index.Results Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated.Conclusions In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population.

BACKGROUND:Self-management of a chronic condition is a complex but increasingly important issue. However, a supportive attitude and behaviour among healthcare professionals is hampered by a lack of awareness, knowledge and motivation. In addition, the role of professionals in supporting self-management seems unclear. METHODS:A blended learning program for primary healthcare professionals was developed to strengthen self-management support in primary care. The program was piloted in community health centres and multidisciplinary medical practices in Flanders. Using the Kirkpatrick model, the impact on healthcare professionals' reaction, learning and behaviour regarding self-management support was evaluated. RESULTS:A total of 60 healthcare professionals registered for the educational program. Post-learning questionnaires and verbal feedback showed a positive response, with professionals highly appreciating the innovative blended learning approach. In terms of learning, participants showed a good understanding of self-management support, although nuances were observed in the application of acquired knowledge to practice scenarios. Finally, preliminary insights into behavioural change were explored, revealing a positive impact of the intervention on participants' supportive self-management behaviours in healthcare practice. CONCLUSIONS:Our study provides preliminary insights into the outcomes of a blended learning program designed to increase awareness and knowledge of self-management support among professionals. The program needs to be refined for general implementation in primary care.

Background Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities. Methods A cross-sectional household survey among women aged 15–49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied. Results A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women’s health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law. Conclusion Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women’s health. There is a need for widespread sensitization about the new law and its benefits.

BACKGROUND:Chronic Fatigue Syndrome patients suffer from symptoms that cannot be explained by a single underlying biological cause. It is sometimes claimed that these symptoms are a manifestation of a disrupted autonomic nervous system. Prior works studying this claim from the complex adaptive systems perspective, have observed a lower average complexity of physical activity patterns in chronic fatigue syndrome patients compared to healthy controls. To further study the robustness of such methods, we investigate the within-patient changes in complexity of activity over time. Furthermore, we explore how these changes might be related to changes in patient functioning.METHODS:We propose an extension of the allometric aggregation method, which characterises the complexity of a physiological signal by quantifying the evolution of its fractal dimension. We use it to investigate the temporal variations in within-patient complexity. To this end, physical activity patterns of 7 patients diagnosed with chronic fatigue syndrome were recorded over a period of 3 weeks. These recordings are accompanied by physicians' judgements in terms of the patients' weekly functioning.RESULTS:We report significant within-patient variations in complexity over time. The obtained metrics are shown to depend on the range of timescales for which these are evaluated. We were unable to establish a consistent link between complexity and functioning on a week-by-week basis for the majority of the patients.CONCLUSIONS:The considerable within-patient variations of the fractal dimension across scales and time force us to question the utility of previous studies that characterise long-term activity signals using a single static complexity metric. The complexity of a Chronic Fatigue Syndrome patient's physical activity signal does not suffice to characterise their high-level functioning over time and has limited potential as an objective monitoring metric by itself.

Background : To support self-management of chronically ill persons, innovative approaches of care practice are being developed. Unfortunately, many self-management supporting interventions struggle to achieve reliable and consistent improvements at various levels (patient, provider and healthcare system level). One possible strategy to facilitate translating theory into practice, is to consider the healthcare professionals’ perspective prior to the development of new interventions. An exploration of their knowledge and opinion about barriers and facilitators is necessary before employing any self-management support (SMS) intervention. Therefore, our study aims to explore care professionals’ perspectives about SMS within the Flemish primary care setting. Methods : This study used a qualitative study design to examine SMS in primary care setting. Five focus groups were conducted, grouped into three waves. Participants were healthcare professionals in Flanders representing different disciplines and settings. A maximum variation purposive sampling was used to recruit participants. For the data analysis, the framework of thematic networks by Attride-Stirling was applied. Results : A total of 34 healthcare professionals participated. Three global themes related to SMS were derived from the thematic analysis: (1) Characteristics, (2) Support strategies, (3) Barriers and facilitators. SMS was characterised as a collaboration-based and person-centred approach. A variety of supporting strategies were mentioned by the focus group participants. Most strategies consisted of informing and educating patients. Complementary to individual strategies, collaborative strategies were deemed necessary to support self-management. Regarding barriers and facilitators, different patient-related factors were identified. Additionally, competencies of healthcare providers and external factors seem to hinder the implementation of SMS in practice. Conclusions : This focus group study highlights the importance of a collaborative, person-centred approach to SMS in the context of chronic diseases. Our findings point to the need for interventions that raise awareness and address barriers associated with SMS. Since generic SMS does not exist, the road to success is a growth process in which support must be adapted to the individual patient.

CONTEXT: The COVID-19 pandemic highlights the importance of strong public health (PH) and primary health care (PHC) systems to respond nimbly and effectively during times of crisis. Both play a crucial role in triage and prevention, management, vaccination, and communication. PH and PHC systems, however, often act in parallel streams, but rarely together. OBJECTIVE: This study aims to describe PH and PHC collaboration during the COVID-19 pandemic in eight high-income countries. METHODS: In-depth case study reports were generated for each country or jurisdiction. Reports searched both peer-review publications and grey literature on five dimensions identified by the World Health Organization regarding COVID-19 management. Reports included country-specific health system descriptions, PH and PHC actions during the pandemic, and an evaluation of strengths and weaknesses. Expert validation was conducted by internal country stakeholders prior to cross-jurisdiction analyses. ANALYSIS: Thematic content analysis was conducted on all reports to develop a coding framework. Codes were identified that were relevant to the research questions. The study team discussed and reconciled discrepancies in themes until consensus was reached. RESULTS: Data was collected from eight high-income countries (Belgium, Canada, Germany, Italy, Japan, the Netherlands, Norway, and Spain) from March 2020 to July 2021. Four key themes were identified along with respective strengths/weaknesses. 1) Health information systems: this played a critical role for disease containment and management when designed for efficient data management and cross-sectoral data-sharing. 2) Communication: In countries where PHC was engaged early on, PH messages were amplified; in other countries, a lack of cohesion in communication resulted in poor or delayed community-level responses. 3) Human resource capacity: Health human resources were overwhelmed, with many staff redeployed and undertrained. 4) Professional training: Health professionals who received dual training in PH and PHC acted as strong community champions and may be a bridge for future pandemics. CONCLUSION: Health system needs shifted dramatically throughout the COVID-19 pandemic. Our findings highlight four key lessons regarding PH and PHC collaboration from eight high-income countries. Future pandemic preparedness should focus on health information systems and data management, PH communication, health human resources, and education and training.

Objective: To provide an overview of types and characteristics of self-management support (SMS) interventions in adults with chronic disease and to assess the impact on the patient reported outcome Quality of Life (QoL).Methods: An umbrella review of systematic reviews was conducted. We searched PubMed, Embase, Web of Science, CINAHL and the Cochrane Library from January 2016 to November 2020 for reviews on SMS interventions for chronic diseases, assessing the impact on the patient reported outcome QoL. Quality assessment was based on the JBI Critical Appraisal Checklist for Systematic reviews and Research Syntheses tool.Results: 28 reviews were included. The extensive literature review revealed a variety of SMS interventions. The most frequently cited target group for the interventions were individuals with diabetes. Interventions primarily took place in the home setting. Interventional components that were often incorporated were education, eHealth and mHealth technologies, and coaching techniques. Telephone communication was regularly reported as a type of intervention follow-up. The impact on QoL was mixed and no firm conclusions can be drawn. However, our review revealed a beneficial effect of education.Conclusions and practical implications: Interventions including educational components seem promising for supporting self-management and showed a beneficial effect on QoL. More research is needed to explore where, by whom and how interventions are ideally delivered.

BACKGROUND:Existing evidence on the role of community health workers (CHWs) in primary healthcare originates primarily from the United States, Canada and Australia, and from low- and middle-income countries. Little is known about the role of CHWs in primary healthcare in European countries. This scoping review aimed to contribute to filling this gap by providing an overview of literature reporting on the involvement of CHWs in primary healthcare in WHO-EU countries since 2001 with a focus on the role, training, recruitment and remuneration. METHODS:This systematic scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses, extension for Scoping Reviews. All published peer-reviewed literature indexed in PubMed, Web of Science, and Embase databases from Jan 2001 to Feb 2023 were reviewed for inclusion. Included studies were screened on title, abstract and full text according to predetermined eligibility criteria. Studies were included if they were conducted in the WHO-EU region and provided information regarding the role, training, recruitment or remuneration of CHWs. RESULTS:Forty studies were included in this review, originating from eight countries. The involvement of CHWs in the WHO-EU regions was usually project-based, except in the United Kingdom. A substantial amount of literature with variability in the terminology used to describe CHWs, the areas of involvement, recruitment, training, and remuneration strategies was found. The included studies reported a trend towards recruitment from within the communities with some form of training and payment of CHWs. A salient finding was the social embeddedness of CHWs in the communities they served. Their roles can be classified into one or a combination of the following: educational; navigational and supportive. CONCLUSION:Future research projects involving CHWs should detail their involvement and elaborate on CHWs' role, training and recruitment procedures. In addition, further research on CHW programmes in the WHO-EU region is necessary to prepare for their integration into the broader national health systems.

BACKGROUND:The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions.METHODS:We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021.RESULTS:Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries.CONCLUSIONS:This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.

Background: In Mozambique, 76% of adolescents have been pregnant before the age of 20 years. Thus, this study explores adults’ perceptions on adolescent attitudes towards pregnancy and abortion in Maputo and Quelimane cities. Methods: A qualitative study was conducted in Maputo and Quelimane, with four focus group discussions. A cross-sectional household survey was used to select adult women participants. Data were analysed applying a thematic analysis approach. Results: Intrapersonal, interpersonal, cultural, and environmental factors influence pregnancy and abortion decision making among adolescents. Generational conflicts reduce the importance paid to traditional knowledge transfer, contraceptive beliefs, denial of paternity, lack of parental support, and procreation value were found to influence abortion decision making and early pregnancy among adolescents. Conclusions: There is a need to improve relationships between adults and adolescents to reduce girls’ vulnerability to early pregnancy, as well as empowering adolescents in order to negotiate safe sex, reducing unwanted pregnancy and induced abortion.

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.

(1) Background: Community health workers (CHWs) are an essential public health workforce defined by their trustful relationships with vulnerable citizens. However, how trustful relationships are built remains unclear. This study aimed to understand how and under which circumstances CHWs are likely to build trust with their vulnerable clients during the COVID-19 pandemic. (2) Methods: We developed a program theory using a realist research design. Data were collected through focus groups and in-depth interviews with CHWs and their clients. Using a grounded theory approach, we aimed to unravel mechanisms and contextual factors that determine the trust in a CHW program offering psychosocial support to vulnerable citizens during the COVID-19 pandemic. (3) Results: The trustful relationship between CHWs and their clients is rooted in three mental models: recognition, equality, and reciprocity. Five contextual factors (adopting a client-centered attitude, coordination, temporariness, and link with primary care practice (PCP)) enable the program mechanisms to work. (4) Conclusions: CHWs are a crucial public health outreach strategy for PCP and complement and enhance trust-building by primary care professionals. In the process of building trustful relationships between CHWs and clients, different mechanisms and contextual factors play a role in the trustful relationship between primary care professionals and patients. Future research should assess whether these findings also apply to a non-covid context, to the involvement of CHWs in other facets of primary healthcare (e.g., prevention campaigns, etc.), and to a low- and middle-income country (LMIC) setting. Furthermore, implementation research should elaborate on the integration of CHWs in PCP to support CHWs in developing the mental models leading to build trust with vulnerable citizens and to establish the required conditions.

Background Coping with a chronic disease can be really challenging. Self-management represents a promising strategy to improve daily life experiences. The role of primary healthcare professionals cannot be underestimated in supporting self-management. Due to a shortage of theory, implementation of self-management support is hindered in primary care practice. The aim of this study is to create a conceptual model for self-management support by analysing patients’ care experiences towards self-management support. Methods An explorative-descriptive qualitative study was conducted in Flanders, Belgium. Semi-structured interviews were performed with 16 patients and their informal caregiver (dyads) using a purposive sampling strategy and processed by an inductive content analysis. Results Interviews revealed in-depth insights into patients’ care experiences. A conceptual model was developed for primary care practice, including five fundamental tasks for healthcare professionals - Supporting, Involving, Listening, Coordinating and Questioning (SILCQ) – contributing to the support of self-management of chronic patients. Conclusion This qualitative paper emphasises the use of the SILCQ-model to develop optimal roadmaps and hands-on toolkits for healthcare professionals to support self-management. The model needs to be further explored by all stakeholders to support the development of self-management interventions in primary care practice.

Background In times of COVID-19, we are challenged to experiment with alternative platforms or software to connect people. In particular, the struggle that arose in health research was how to interact with patients and care professionals. The latter is additionally faced with an extreme workload to fight the pandemic crisis. Creative strategies have been developed to continue research among patients and care professionals to improve quality of care. This paper addresses the issue of synchronous, online, nominal group sessions, a common consensus method used for group brainstorming. Objective The purpose of this study was to share our experiences with performing online, nominal group sessions using the video conference software Microsoft Teams. In addition, we aimed to create a practical guide with recommendations for researchers. Methods We critically analyzed the procedures for the online nominal group technique, according to the Fishbone methodology. Results Performing synchronous, online, nominal group sessions is challenging but offers opportunities. Although interaction with and among the attendees complicates the process, the major advantage of online sessions is their accessibility and comfort because of reduced barriers to participation (eg, lower time investment). The role of the moderators is of major importance, and good preparation beforehand is required. Recommendations for future online, nominal research were formulated. Conclusions Online, nominal group sessions seem to be a promising alternative for the real-life commonly used technique. Especially during the COVID-19 pandemic, the benefits must be highlighted. More expertise is needed to further refine the practical guide for using digital software in research and to achieve optimal performance.