Vesna Bjegovic-Mikanovic

Functional health literacy among primary health-care patients: data from the Belgrade pilot study

BACKGROUND Over the last decade, health literacy has become a vibrant area of research. Our objective was to evaluate health literacy and its association with socio-demographic variables, self-perception of health and the presence of chronic conditions in primary health-care patients. METHODS A cross-sectional study among 120 patients was conducted in two primary health-care centers. The test of functional health literacy in adults, a 50-item reading comprehension and 17-item numerical ability test (score, 0-100) were administered. Chi-square test and logistic regression analyses were applied. RESULTS Inadequate and marginal health literacy existed in 43 participants (41.0%), and adequate health literacy was present in 62 participants (59.0%). Functional health literacy was significantly different by location, gender, age, marital status, employment, education, material status, self-perception of health and presence of chronic conditions. Based on the multivariate analysis, health literacy was significantly associated with the participants age (odds ratio [OR], 4.86; 95% confidence interval [CI], 2.41-9.80; P = 0.000), level of education (OR, 4.48; 95% CI, 1.73-11.57; P = 0.002) and chronic conditions (OR, 1.90; 95% CI, 1.16-3.11; P = 0.010). CONCLUSION These results provide evidence that limitations in functional health literacy are widespread among primary health-care patients and encourage efforts for further monitoring. Low health literacy may impair a patients understanding of health messages and limit their ability to attend to their medical problems.

Ebola: an open letter to European governments

After months of inaction and neglect from the international community, the Ebola epidemic in west Africa has now spiralled utterly out of control. Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world. We urge our governments to mobilise all possible resources to assist west Africa in controlling this horrific epidemic. Based on our expertise in public health and emergency response, we believe the following measures would be particularly eff ective. First, with regards to human resources, given the huge need for trained health-care professionals in west Africa, we urge European governments to create mechanisms that allow professionals working in public health-care systems to volunteer for temporary leave (with hazard pay) to contribute to the epidemic control eff orts in the region. European countries can and should step up to contribute in line with their capacity and potential.

In search for a public health leadership competency framework to support leadership curriculum-a consensus study.

BACKGROUND Competency-based education is increasingly popular, especially in the area of continuing professional development. Many competency frameworks have been developed; however, few address leadership competencies for European public health professionals. The aim of this study was to develop a public health leadership competency framework to inform a leadership curriculum for public health professionals. The framework was developed as part of the Leaders for European Public Health project-supported by the EU Lifelong Learning Programme. METHODS The study was carried out in three phases: a literature review, consensus development panel and Delphi survey. The public health leadership competency framework was initially developed from a literature review. A preliminary list of competencies was submitted to a panel of experts. Two consensus development panels were held to evaluate and make changes to the initial draft competency framework. Then two rounds of a Delphi survey were carried out in an effort to reach consensus. Both surveys were presented through Survey Monkey to members of the Association of the Schools of Public Health in the European Region Working Group on Innovation in Public Health Teaching and Education. RESULTS The framework was developed consisting of 52 competencies organized into eight domains: Systems Thinking; Political Leadership; Collaborative Leadership: Building and Leading Interdisciplinary Teams; Leadership and Communication; Leading Change; Emotional Intelligence and Leadership in Team-based Organizations; Leadership, Organizational Learning and Development and Ethics and Professionalism. CONCLUSION The framework can serve as a useful tool in identifying gaps in knowledge and skills, and shaping competency-based continuing professional development leadership curricula for public health professionals in Europe.

Health literacy in a population of primary health-care patients in Belgrade, Serbia

ObjectiveOur objective was to evaluate the health literacy and its association with sociodemographic variables, the self-perception of health and the presence of chronic conditions in primary health-care patients.MethodsA cluster survey was conducted. A total of 1,500 patients were enrolled. Functional health literacy was measured by the Serbian version of the Short Test of Functional Health Literacy in Adults. Chi-square testing and multilevel logistic regression analyses were applied.ResultsWe found that health literacy was inadequate and marginal in 436 (32%) and 195 participants (14.4%), respectively, and adequate in 730 participants (53.6%). A better health literacy score was present among the following participants: younger, employed, and those with a high level of education, a good self-perception of health, a good socioeconomic status and no chronic conditions. If, on multilevel analysis, the primary health center and individual variables were included, the probability for adequate health literacy was higher among younger, employed, higher educated and those with no chronic conditions.ConclusionsPrimary health-care patients do not have the literacy skills necessary to function adequately in the health-care environment.

Evaluation of a health literacy screening tool in primary care patients: evidence from Serbia

Improving health literacy skills is important for patient comprehension of health-related topics and their ability to attend to their medical problems. Promoting health literacy is a pivotal policy for maintaining and promoting health. The objective of the present study was to translate the Test of Functional Health Literacy in Adults (TOFHLA; long and short versions) into Serbian and evaluate the translated and cross-culturally adapted questionnaires in Serbian primary care patients. The translated TOFHLA questionnaires were administered to 120 patients. Additionally, a self-completed questionnaire was used. Both descriptive and inferential statistics were measured. The mean score for the TOFHLA was 73.49 (median, 78; SD = 17.94; range, 0-100) and the mean score for the Short Test of Functional Health Literacy in Adults (STOFHLA) was 29.28 (median, 32; SD = 6.16; range, 0-36). Sex, age, education, self-perceived health and presence of any chronic disease were associated with health literacy scores. The internal consistency (Cronbachs alpha) was 0.73 for the TOFHLA numeracy subset, 0.95 for reading comprehension, 0.94 for the TOFHLA and 0.90 for the STOFHLA. The Pearson correlation between the TOFHLA and STOFHLA was 0.89. The area under the curve of these two tests was 0.79 (95% CI, 0.602-0.817). The Serbian translated versions of the TOHFLA questionnaires offer valid measures of functional health literacy. There were no differences between the reliability and validity of the short and long TOFHLA forms.

Education for public health in Europe and its global outreach

Introduction At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges. Review Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance. Conclusions As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice.Introduction At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges. Review Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance. Conclusions As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice.

Which women patients have better health literacy in Serbia

OBJECTIVE To evaluate health literacy among female primary care patients and the possible factors which contribute to better health literacy. METHODS A cross-sectional study was conducted among 824 female primary health care patients. Functional health literacy was measured by the Serbian version of the Short Test of Functional Health Literacy in Adults (STOFHLA). Chi-square testing and logistic regression analyses were applied. RESULTS We found that inadequate or marginal health literacy was present in 363 participants (44.1%) and adequate health literacy was present in 461 participants (55.9%). Functional health literacy was significantly different by age, marital status, employment, education, material status, self-perception of health, and health status. Based on multivariate analysis, health literacy was significantly associated with participant age, employment status, level of education, and perception of health. CONCLUSION Better health literacy existed among younger, employed participants with a higher education and better self-perception of health. PRACTICE IMPLICATIONS Strengthening the knowledge and evidence base for measuring and assessing health literacy are action points for health strategies to decrease the ill effects of low health literacy.

Training hospital managers for strategic planning and management: a prospective study

BackgroundTraining is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization’s strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams.MethodsThe study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes.ResultsThe quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p < 0.001). Principal component analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan.ConclusionThis study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of state general hospitals involved in team training have formulated the development of an official strategic plan. The positive effects of the formal training program justify additional investment in future education and training.

Does workplace violence exist in primary health care? Evidence from Serbia

BACKGROUND Violence in the workplace is a serious social and public health problem. The objective of this study was to estimate the prevalence of workplace violence and to identify potential predictors of workplace violence at Serbian Primary Health Care (PHC) centres. METHODS A cross-sectional study was conducted between October 2012 and July 2013. The sample consisted of medical and non-medical staff employed at PHC centres in Belgrade, Serbia. Among 1757 currently presented at work, 1526 returned the questionnaires. The data were collected by questionnaire Workplace Violence in the Health Sector-Country Case Studies, developed by the ILO/ICN/WHO/PSI. Binary logistic regression was conducted to assess the association between exposure to workplace violence and sociodemographic and work-related characteristics. RESULTS The prevalence of workplace violence, was 803 (52.6%), with 147 (18.3%), exposed to physical violence. Multiple logistic regression models indicated that the following work-related characteristics were positive associated of workplace violence with working between 18:00 and 07:00 h [odds ratio (OR): 1.37, 95% confidence interval (CI): 1.08-1.73], nurses as a professional group (OR: 1.91, 95% CI: 1.16-3.17), working with preschool children (OR: 0.56, 95% CI: 0.34-0.91). There was negative association of workplace violence with encouragement to report violence (OR: 0.61, 95% CI: 0.49-0.76) and the number of staff in the same work setting (OR: 0.73, 95% CI: 0.56-0.96). CONCLUSIONS More than half of employees in Belgrade PHC centres were exposed to different types of workplace violence. There is a need for interventions to protect health workers and provide safer workplace environments.

Strategic challenges in upgrading the population’s health in the transition countries of South Eastern Europe

Since the devastating nineties of the last century a slow but steady improvement of the living conditions in the region of South Eastern Europe (SEE) has be observed. However, so far only three countries, i.e. Bulgaria, Romania and Slovenia, have managed to ascent to the European Union and only Slovenia has joined the European currency. All others are still struggling with a difficult heritage of inappropriate vertical management structures, overstaffing and outmigration of the well educated young. This resume applies also to the field of public health where, for example, the old hygienic tradition remained dominant, often maintaining huge laboratory facilities in the institutes of public health and very small numbers of staff being allocated to health promotion and modern participative management. This situation cannot be overcome easily nor in short term. Supported by funds from the German contribution to the European Stability Pact, the Forum for Public Health in South Eastern Europe (FPH-SEE: www.snz.hr/fphsee) has established a permanent collaboration between the public health institutions in the region, including foremost the Schools of Public Health (SPH), the National Public Health Associations (PHA) and some national Institutes of Public Health (IPH).