Leena Eklund Karlsson

The Nexus Between Health Literacy and Empowerment

The aim of this article was to explore what is known about the assumed connection between health literacy and empowerment and how this connection is portrayed in the scientific literature. If empowerment is an outcome of health literacy, what are the mechanisms behind this process? A literature search conducted in 2013 yielded 216 hits, of which five met the inclusion criteria, and thus were read in depth and analyzed through a narrative-review approach. The findings indicate that health literacy might be regarded as a tool for empowerment but does not automatically lead to empowerment. Health literacy might be increased by health education. Crucial for empowerment is to achieve the critical level of health literacy including an ability to question and reflect on the prevailing power relations and societal conditions; increased senses of power, self-esteem, and self-efficacy; and an ability to utilize these resources to engage in social and political action for change. This article suggests that for health literacy to be critical to empowerment, there must be a focus on social health determinants and individuals’ subjective perceptions of health and health needs. The article proposes functional and interactive health literacy as a form of capacity building for health and empowerment and critical health literacy as a way to describe empowerment. This scoping review indicates a research gap and a need for future research examining the relationship between health literacy and empowerment.

Are equity aspects communicated in Nordic public health documents

Aims: To explore if the term equity was applied and how measures for addressing social inequalities in health and reducing inequity were communicated in selected Nordic documents concerning public health. Methods: Documents from Denmark, Finland, Norway, and Sweden were collected and analysed by Nordic authors. Data included material from websites of ministries and authorities responsible for public health issues, with primary focus on steering documents, action programmes, and reports from 2001 until spring 2013. Results: Most strategies applied in Danish, Finnish, and Swedish documents focused on the population in general but paid special attention to vulnerable groups. The latest Danish and Finnish documents communicate a clearer commitment to address social inequalities in health. They emphasise the social gradient and the need to address the social determinants in order to improve the position of disadvantaged groups. Norwegian authorities have paid increasing attention to inequity/social inequalities in health and initiated a new law in 2012 which aims to address the social gradient in a more clear way than seen elsewhere in the Nordic countries. Conclusions: In the Nordic countries, redistribution by means of universal welfare policies is historically viewed as a vital mechanism to improve the situation of vulnerable groups and level the social gradient. To establish the concept of equity as a strong concern and a core value within health promotion, it is important to be aware how policies can contribute to enable reduction of social health differences.

Determinants of evidence use in public health policy making: Results from a study across six EU countries

Highlights • Media attitude towards underpinning policy with evidence influences policy decision makers.• Individual skills, attitudes, values of policy makers impact the extent evidence use.• A solid research infrastructure is facilitating but not sufficient for evidence use.• Factors that impact evidence use in policy making differ by country and policy context.• Interventions connecting policy makers and researchers in the policy context seem most promising.

Roma Empowerment and Social Inclusion Through Work-Integrated Learning

The basis for this article was a health promotion program based on participatory action research and work-integrated learning (WIL). Seven Roma people were employed and trained to work as local coordinators to empower the local Roma community by strengthening their participation in society and their sense of community, as well as to promote self-led integration. The study aimed to analyze the program from the Roma coordinators’ perspectives, focusing on perceived individual empowerment and perceptions of contribution to the common good and to community empowerment. The findings, based on qualitative data, primarily interviews with the Roma coordinators, indicated that the WIL approach, the participatory nature of the program, and the trust and support from the Roma colleagues and non-Roma facilitators were essential for the development of empowerment. Three main themes emerged that portrayed the participants’ psychological empowerment: strengthened Roma identity, a sense of power, and a sense of enculturated social inclusion.

Work-integrated learning and health literacy as catalysts for Roma empowerment and social inclusion - A participatory action research

Roma people all over the world have often been subject to prejudice, stigma, discrimination and oppression. Many Roma have little or no education, which in combination with other factors often leads to unemployment and marginalization. Based on a case study in Sweden, this paper proposes an approach that can be used in participatory projects aiming at improving the living situation of marginalized people. In such an approach, the Roma themselves would be the leaders in all activities concerning the group. The first aim of this paper is to describe how health literacy and work-integrated learning functioned as empowering tools for a Roma-led inclusion process within a participatory action research framework. The second aim is to discuss and reflect on the use of participatory action research in community work with Roma based on the experiences of the participatory action research participants. The findings indicate that work-integrated learning may be a worthwhile approach for increasing the individual empowerment and self-led social inclusion of vulnerable people. However, the obstacles of structural discriminatory nature hindered the project to reach its full potential in its intended emancipatory goals.

Nordic School of Public Health NHV and its legacy in global health

This article describes the legacy of the Nordic School of Public Health NHV (NHV) in global health. We delineate how this field developed at NHV and describe selected research and research training endeavours with examples from Vietnam and Nepal as well as long-term teaching collaborations such as BRIMHEALTH (Baltic RIM Partnership for Public HEALTH) in the Baltic countries and Arkhangelsk International School of Public Health in Russia.

The Physician-Patient Relationship and Its Association with Self-Efficacy in Female Patients Managing Chronic Diseases in Riyadh, Saudi Arabia

Evidence has shown that the physician-patient relationship may affect patients in several dimensions, particularly in patients’ self-efficacy in managing chronic disease. This cross-sectional study assessed the association of the perceived physicianpatient relationship on perceived self-efficacy in self-managing chronic disease in 253 female patients aged 18-55 years from six primary care clinics in Riyadh, Saudi Arabia. The data were collected using two standard questionnaires (PDRQ-9 and SEMCD) and analysis was performed using the Kruskal-Wallis test (SPSS Software). Our findings showed that overall the patients perceived the physician-patient relationship as somewhat satisfactory. Participants’ self-efficacy in managing their chronic diseases was also shown to be moderate. The association between the physician-patient relationship and patient self-efficacy in self-managing chronic diseases was found to be statistically significant (p=0.047). The group of patients with high satisfaction with the physician-patient relationship (HSG) was found to have statistically significant higher self-efficacy compared to the group with low satisfaction (LSG) (p=0.014). These findings suggest that strengthening the physician-patient relationship can be an important element towards enhancing patients’ self-efficacy in order to further improve the self-management and health of patients with chronic diseases in Saudi Arabia.

Informal Payments and Health System Governance in Serbia: A Pilot Study

Few studies address Serbian providers’ perceptions of informal payments and the association between these perceptions and health system governance. The aim was to investigate civil servants’ perceptions on informal payments of the health care system in Serbia and to link these results with available evidence on informal payments in other Western Balkan countries. A literature review on informal payments in Western Balkan and in-depth interviews of civil servants working with Serbian health care were conducted. Informal payments were mostly taking place in inpatient care and were based on low salaries of doctors, poor resources, a desire to receive better or faster service, fear of being denied treatment, and an expression of gratitude through gifts. Policy measures had limited effect and vulnerable groups were more likely to pay informally. There is a need for further research to highlight how health system governance and prevailing policies affect informal payments in Western Balkan.Few studies address Serbian providers’ perceptions of informal payments and the association between these perceptions and health system governance. The aim was to investigate civil servants’ perceptions on informal payments of the health care system in Serbia and to link these results with available evidence on informal payments in other Western Balkan countries. A literature review on informal payments in Western Balkan and in-depth interviews of civil servants working with Serbian health care were conducted. Informal payments were mostly taking place in inpatient care and were based on low salaries of doctors, poor resources, a desire to receive better or faster service, fear of being denied treatment, and an expression of gratitude through gifts. Policy measures had limited effect and vulnerable groups were more likely to pay informally. There is a need for further research to highlight how health system governance and prevailing policies affect informal payments in Western Balkan.

Informal Patient Payments and Bought and Brought Goods in the Western Balkans – A Scoping Review

Introduction: Informal patient payments for healthcare are common in the Western Balkans, negatively affecting public health and healthcare. Aim: To identify literature from the Western Balkans on what is known about informal patient payments and bought and brought goods, to examine their effects on healthcare and to determine what actions can be taken to tackle these payments. Methods: After conducting a scoping review that involved searching websites and databases and filtering with eligibility criteria and quality assessment tools, 24 relevant studies were revealed. The data were synthesized using a narrative approach that identified key concepts, types of evidence, and research gaps. Results: The number of studies of informal patient payments increased between 2002 and 2015, but evidence regarding the issues of concern is scattered across various countries. Research has reported incidents of informal patient payments on a wide scale and has described various patterns and characteristics of these payments. Although these payments have typically been small – particularly to providers in common areas of specialized medicine – evidence regarding bought and brought goods remains limited, indicating that such practices are likely even more common, of greater magnitude and perhaps more problematic than informal patient payments. Only scant research has examined the measures that are used to tackle informal patient payments. The evidence indicates that legalizing informal patient payments, introducing performance-based payment systems, strengthening reporting, changing mentalities and involving the media and the European Union (EU) or religious organizations in anti-corruption campaigns are understood as some of the possible remedies that might help reduce informal patient payments. Conclusion: Despite comprehensive evidence regarding informal patient payments, data remain scattered and contradictory, implying that informal patient payments are a complex phenomenon. Additionally, the data on bought and brought goods illustrate that not much is known about this matter. Although informal patient payments have been studied and described in several settings, there is still little research on the effectiveness of such strategies in the Western Balkans context.