Socioeconomic inequalities in the incidence of COVID-19 in Barcelona students.

Objective: This study aimed to assess socioeconomic inequalities in schools regarding the COVID-19 incidence during different epidemic waves among Barcelona students, differentiating by sex and educational stage. Study design: Cross-sectional ecological study. Methods: We included in the study all students from childhood to secondary education in Barcelona city. The unit of analysis was the schools. The study covered the epidemic waves coinciding with the 2020-21 and 2021-22 school courses. The cumulative incidence (CI) per school and wave was calculated. Bivariate and multivariate analyses using Poisson regression were conducted to estimate relative risks. The population attributable risk, by sex and educational stage, was calculated as a measure of impact. Results: In the second wave, higher CI in students was associated with greater school socioeconomic deprivation in all groups. In the younger girls, 24.5 % (5.2-41.4) of the CI was attributed to school socioeconomic vulnerability, increasing to 33.1 % (15.1-47.2) in older girls. During the sixth wave, the impact was lower in the most vulnerable schools in all strata. Conclusions: Socioeconomic factors significantly impacted the incidence of COVID-19 in schools, reflecting social inequalities in Barcelona. There was an inversion of the pattern of inequalities in the sixth wave compared to the previous ones. The results emphasize the need for urgent action and targeted resources to address health inequalities in education and understand the impact of epidemic dynamics on socioeconomic context.

Community health action and COVID-19 in Barcelona neighbourhoods: responses and challenges.

The COVID-19 pandemic exacerbated pre-existing social, economic and political inequalities. The evidence describes the use of community engagement approaches to support appropriate COVID-19 prevention and control measures. We aimed to delve deeper into the community response to COVID-19 in Barcelona neighbourhoods with different pre-existing levels of development of community health action (CHA). A qualitative phenomenological study was conducted in six Barcelona neighbourhoods with different types of CHAs. The sample included 37 in-depth interviews with community agents with good knowledge of the territory. The content analysis focused on three dimensions: symbolic (conceptions motivating action), substantive (the content and resources of the action) and operational (interactions between agents). Regardless of their CHA typology, all neighbourhoods responded to the needs generated by the pandemic. Symbolic: strong-CHA development, characterized by well-established participatory structures, facilitated responses to the crisis. In medium-CHA neighbourhoods, the emergency exacerbated previous tensions. In emerging-CHA neighbourhoods, previous participatory structures, although not health-specific, favoured the coordination of responses. Substantive: technology influenced the way CHA activities were conducted. Operative: in the strong-CHA neighbourhood, new participants were able to join previous participatory structures. In medium-CHA neighbourhoods, power dynamics hindered coordination. In conclusion, strong CHA can play a key role in addressing the adverse consequences of social and health crisis. Empowering citizens and communities should be a primary objective of public policy that integrates the 'health-in-all-policies' approach. This approach entails allocating public resources to strengthen the role of community action and power.

A City Surveillance System for Social Health Inequalities: The Case of Barcelona.

INTRODUCTION: In the past, health inequalities were not prioritised in the political agenda of Barcelona. The change of city government (2015) was an opportunity to develop a Surveillance System for Social Health Inequalities in the city, which is described in this article. METHODS: The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), funded by the European Union. Various steps were considered by the experts to set up the System: define its objectives, target population, domains and indicators, and sources of information; perform data analysis; implement and disseminate the system; define the evaluation; and perform regular data updates. RESULTS: The System considers the following domains: social determinants of health, health-related with behaviours, use of healthcare, and health outcomes, and includes eight indicators. As axes of inequality, the experts chose sex, age, social class, country of origin, and geographical area. The Surveillance System for Social Health Inequalities is presented on a website including different types of figures. CONCLUSION: The methodology used to implement the Surveillance System can be used to implement similar systems in other urban areas around the world.

Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency.

BACKGROUND: Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. METHODS: The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). RESULTS: Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. CONCLUSIONS: The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.

Multi-level policy responses to tackle socioeconomic inequalities in the incidence of COVID-19 in a European urban area.

BACKGROUND: Spain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas. We share experiences from Barcelona in measuring socioeconomic inequalities in the incidence of COVID-19 in the different waves, and in implementing coordinated and equity-oriented public health policy responses. METHODS: We collected daily data on confirmed COVID-19 cases, geocoded the address of residence to assign each case to one of the 73 neighborhoods and 1068 census tracts, and calculated the cumulative incidence of COVID-19 by neighborhood and five income groups (quintiles of census tracts) by sex across four waves of the pandemic. We adjusted hierarchical Bayesian spatial models to obtain the relative risk (RR) of cumulative incidences in each quintile compared with the richest areas. A variety of public health policies implemented to tackle the pandemic and especially these inequalities in COVID-19 incidence and vaccination are selected and described. RESULTS: Area-level income inequalities in the incidence of COVID-19 were present at different degree in all four waves. In the second wave (10/1/2020 to 12/6/2020), RR for the poorest income quintile census tracts compared with the richest was 1.43 (95% credible interval-CI-: 1.22-1.67) for men and 1.58 (95% CI: 1.35-1.83) for women. Later, inequalities in vaccination coverage also arose. Equity-oriented policy responses included: "health hotels" or home delivery of basic products for individuals with COVID-19 and without adequate conditions for isolation; new emergency facilities for homeless people, including those with active drug use; mass screening in high incidence areas; contingency plans for nursing homes and schools; adapting community health programs for their early reactivation; digital self-appointment support points and community vaccination days. CONCLUSION: COVID-19 hit Barcelona neighborhoods unequally, with variations between waves. The rapid availability of geolocalized data and by socioeconomic level helped public authorities to implement targeted policies and collaborative interventions for the most vulnerable populations. Further studies would be needed to evaluate their impact.

Barcelona Salut als Barris: twelve years' experience of tackling social health inequalities through community-based interventions / Barcelona Salut als Barris: la experiencia de doce años abordando las desigualdades sociales en salud a través de intervenciones comunitarias

Community health can reduce inequalities in health and improve the health of the most disadvantaged populations. In 2007, Barcelona Salut als Barris (Barcelona Health in the Neighbourhoods) was launched, a community health programme to reduce social inequalities in health. In 2018, this programme reached the 25 most disadvantaged neighbourhoods of the city. This article shares the lessons learned after 12 years of work. The programme was initially funded by a research grant and the funds were maintained during the economic crisis and were tripled when the programme became a political priority in the last municipal government. During the 12-year period, partnerships with stakeholders were generally stable and productive. Maximum community participation was obtained in the detection of health assets and needs and in action plans. During 2018, Barcelona Salut als Barris worked with more than 460 agents that co-produced 183 interventions involving more than 13,600 people. Most of the interventions assessed showed improvements in the health of participants, which could help to reduce health inequalities. The greatest difficulties were: a) citizen participation, b) the sustainability of working groups over the years, c) conflicts of interest, d) the sustainability of interventions, e) reaching certain minority groups and f) evaluation. The increase in resources in the last period contributed to the maturity and expansion of the programme. Key factors in its scope and results were political will, strong technical capacity and methodology, strong intersectoral partnerships and continued community work. (AU)

La salud comunitaria puede reducir las inequidades en salud y mejorar la salud de las poblaciones más desfavorecidas. En 2007 se inició Barcelona Salut als Barris (Barcelona Salud en los Barrios), un programa de salud comunitaria para reducir las desigualdades sociales en salud. En 2018, el programa alcanzó los 25 barrios más desfavorecidos de la ciudad. Este artículo comparte las lecciones aprendidas tras 12 años de trabajo. Los primeros fondos del programa procedieron de una beca de investigación, se mantuvieron durante la crisis económica y se triplicaron cuando pasó a ser una prioridad política en el último gobierno municipal. Durante estos 12 años, las alianzas con las partes interesadas se mantuvieron, en general, estables y productivas. La máxima participación comunitaria se obtuvo en la detección de activos y necesidades en salud y en los planes de acción. Durante 2018, Barcelona Salut als Barris trabajó con más de 460 agentes que coprodujeron 183 intervenciones en las que participaron más de 13.600 personas. Gran parte de las intervenciones evaluadas mostraron mejoras en la salud de las personas participantes, pudiendo contribuir a la reducción de desigualdades. Las mayores dificultades fueron: a) la participación ciudadana, b) la sostenibilidad de los grupos de trabajo a lo largo de los años, c) los conflictos de intereses, d) la sostenibilidad de las intervenciones, e) acceder a algunos grupos minoritarios y e) la evaluación. El aumento de los recursos del último periodo contribuyó a la madurez y la extensión del programa. La voluntad política, una sólida capacidad técnica y metodológica, consolidadas alianzas intersectoriales y el trabajo comunitario continuado han sido factores clave de su alcance y resultados. (AU)

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention / Mejorando la salud mental y el bienestar de las personas mayores aisladas en casa debido a las barreras arquitectónicas: una intervención de salud comunitaria

Objetivos: Explorar los efectos sobre la salud de una intervención de salud comunitaria en personas mayores aisladas en casa debido a problemas de movilidad o a barreras arquitectónicas, identificar las características asociadas y evaluar la satisfacción de las personas participantes. Diseño: Estudio cuasi-experimental antes-después. Emplazamiento: Cinco barrios de baja renta de Barcelona durante 2010-15. Participantes: Se entrevistó a 147 participantes, ≥59 años, antes y 6 meses después de la intervención. Intervención: Equipos de atención primaria, trabajadores sociales, de salud pública y otros agentes comunitarios desarrollaron una intervención que consistía en salidas semanales, facilitadas por voluntarios. Mediciones: Se evalúo la salud autopercibida, la salud mental utilizando la escala GHQ-12 y la calidad de vida mediante la escala EuroQol. La satisfacción se evaluó mediante un conjunto de preguntas. Analizamos los datos previos y posteriores con pruebas de McNemar y modelos de regresión lineal y de Poisson ajustados. Resultados: A los 6 meses, los participantes mostraron mejoras en la salud percibida, en la salud mental y en la reducción de la ansiedad. Las mejoras fueron mayores entre las mujeres, las personas que no habían salido de casa durante ≥4 meses, las de bajo nivel educativo y las que habían realizado ≥9 salidas. La salud percibida (aRR: 1,29 [1,04-1,62]) y las mejoras en salud mental [(β: 2,92 [1,64-4,2]) permanecieron significativas en los modelos multivariados. La satisfacción media fue de 9,3 sobre 10. Conclusión: Esta intervención de salud comunitaria parece mejorar varios resultados de salud en las personas mayores aisladas, especialmente en los grupos más vulnerables. Replicar este tipo de intervención podría funcionar en contextos similares.(AU)

Objectives: To explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants’ satisfaction.Design: Quasi-experimental before–after study. Setting: Five low-income neighbourhoods of Barcelona during 2010–15. Participants: 147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months. Intervention: Primary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers. Measurements: We assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models. Results: At 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04–1.62)] and mental health improvements [β: 2.92(1.64–4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10. Conclusion: This community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.(AU)

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention.

OBJECTIVES: To explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants' satisfaction. DESIGN: Quasi-experimental before-after study. SETTING: Five low-income neighbourhoods of Barcelona during 2010-15. PARTICIPANTS: 147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months. INTERVENTION: Primary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers. MEASUREMENTS: We assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models. RESULTS: At 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04-1.62)] and mental health improvements [ß: 2.92(1.64-4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10. CONCLUSION: This community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.

Socioeconomic Inequalities in COVID-19 in a European Urban Area: Two Waves, Two Patterns.

Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41-1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44-1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe.

Evaluación de la atención primaria, versión modificada del instrumento PCAT-A10 / Modified version of the PCAT-A10 tool for the evaluation of primary care

OBJETIVO: Evaluar las características métricas del índice Primary Care Assessment Tool de 10 ítems, para adultos (PCAT-A10), versión en castellano y catalán, reducida del original Primary Care Assessment Tool-Adult Edition (PCAT-AE), habiendo modificado el ítem de salud mental. DISEÑO: Estudio observacional transversal. Emplazamiento: Población residente en la ciudad de Barcelona. PARTICIPANTES: De los 3.496 participantes mayores de 14 años de la muestra aleatoria representativa de la población de Barcelona, de la Encuesta de Salud de Barcelona 2016-17, se seleccionaron los que declararon tener un médico/a de cabecera, que alguna vez en la vida habían realizado una visita a algún especialista y que habían contestado más del 50% de ítems del PCAT-A10 (n = 3.107). Mediciones principales: Descriptiva de los ítems, análisis de consistencia interna y de correlación ítem-total corregida del índice PCAT-A10 modificado y los 10 ítems que lo conforman. Se analizan tres escenarios de tratamiento de las no respuestas: sustitución por 0, por el valor intermedio (2,5) y excluyendo las personas que no contestaron algún ítem. RESULTADOS: El índice PCAT-A10 obtuvo alfa de Cronbach de 0,73, 0,79 y 0,85 en los tres escenarios nombrados, correlaciones ítem-total corregida entre 0,41 y 0,66, y 20,8% de no respuesta al ítem de salud mental. CONCLUSIONES: La nueva versión del PCAT-A10 presenta una alta fiabilidad con una mayor respuesta en el ítem de salud mental respecto a la versión anterior

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n = 3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version

Barcelona Salut als Barris: Twelve years' experience of tackling social health inequalities through community-based interventions.

Community health can reduce inequalities in health and improve the health of the most disadvantaged populations. In 2007, Barcelona Salut als Barris (Barcelona Health in the Neighbourhoods) was launched, a community health programme to reduce social inequalities in health. In 2018, this programme reached the 25 most disadvantaged neighbourhoods of the city. This article shares the lessons learned after 12 years of work. The programme was initially funded by a research grant and the funds were maintained during the economic crisis and were tripled when the programme became a political priority in the last municipal government. During the 12-year period, partnerships with stakeholders were generally stable and productive. Maximum community participation was obtained in the detection of health assets and needs and in action plans. During 2018, Barcelona Salut als Barris worked with more than 460 agents that co-produced 183 interventions involving more than 13,600 people. Most of the interventions assessed showed improvements in the health of participants, which could help to reduce health inequalities. The greatest difficulties were: a) citizen participation, b) the sustainability of working groups over the years, c) conflicts of interest, d) the sustainability of interventions, e) reaching certain minority groups and f) evaluation. The increase in resources in the last period contributed to the maturity and expansion of the programme. Key factors in its scope and results were political will, strong technical capacity and methodology, strong intersectoral partnerships and continued community work.

[Modified version of the PCAT-A10 tool for the evaluation of primary care]. / Evaluación de la atención primaria, versión modificada del instrumento PCAT-A10.

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n=3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version.

Las desigualdades en salud como prioridad política en Barcelona / Health inequalities as a political priority in Barcelona

Existe abundante información e investigaciones sobre las desigualdades en salud en Barcelona, pero este tema no estuvo claramente priorizado en la agenda política. Con la llegada al gobierno de un partido de la nueva izquierda (Barcelona en Comú) en 2015 hubo un impulso importante de la agenda política para reducir las desigualdades, también las de salud. El objetivo de esta revisión es describir el avance realizado respecto a las desigualdades en salud en estos 4 años, sobre todo en los ámbitos donde ha participado la salud pública. Respecto a la evidencia y la comunicación sobre las desigualdades en salud, se presentan los avances en el Informe Anual de Salud de Barcelona y la creación del Observatorio de Salud, Desigualdades e Impactos de las Políticas Municipales. Las políticas que se presentan se refieren a diferentes estrategias municipales, el Plan de Salud, el impulso del programa Barcelona Salud en los Barrios y el Plan para el Abordaje de las Desigualdades en la Agència de Salut Pública de Barcelona. La conjunción de la voluntad política, la capacidad técnica y el impulso de la ciudadanía han facilitado un avance en la ciudad de Barcelona en las políticas para reducir las desigualdades sociales en salud

There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health

[Health inequalities as a political priority in Barcelona]. / Las desigualdades en salud como prioridad política en Barcelona.

There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities.

BACKGROUND: The aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood. METHODS: We performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI). RESULTS: The percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25-0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74-1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA. CONCLUSIONS: Our study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.

Armonización iberoamericana de los instrumentos PCAT para la evaluación del primer nivel de atención

Cuarenta años después de Alma Ata, el mundo está reforzando la consciencia sobre la importancia de los atributos y funciones del primer nivel de atención, pero aún queda mucho por hacer para implementarlos, medirlos y aprender de las experiencias exitosas de algunos países. El conjunto de instrumentos Primary Care Assessment Tools (PCAT), desarrollados en los años 90 en Estados Unidos de América por Starfield y Shi (1), se ha mostrado como la herramienta más completa para el análisis de la atención primaria de la salud (APS) y su utilidad fue reconocida en numerosos países y regiones del mundo. El objetivo de esta carta es comunicar preliminarmente el proceso de armonización de las versiones PCAT ya adaptadas en diversos países de Iberoamérica y subrayar la importancia de estas herramientas para evaluar y comparar el primer nivel de atención, particularmente en sistemas de salud fundados en la estrategia de APS.

Adaptación transcultural colaborativa de cuestionarios PCAT para Colombia / Collaborative transcultural adaptation of the PCAT questionnaires for Colombia / Adaptação transcultural colaborativa de questionários PCAT para Colômbia

Objetivo: obtener versiones de los cuestionarios Primary Care Assessment Tool (PCAT) para Colombia (CO-PCAT), dirigidos a profesionales (PCAT-PE), gestores y directivos de atención primaria (PCAT-FE) a través de un proceso colaborativo internacional. Metodos: proceso de adaptación transcultural modificado a partir de las versiones adaptadas y validadas en español, en consenso con la Colaboración Iberoamericana IA-PCAT. El método busca conseguir la equivalencia de la versión CO-PCAT de los cuestionarios con la versión original de Estados Unidos de América. Se desarrollaron tres fases de trabajo: I) valoración de la adecuación de versiones iberoamericanas en lengua española y adaptación al contexto colombiano, II) revisión internacional realizada por investigadores de la Colaboración Iberoamericana PCAT y III) pruebas preliminares de los cuestionarios. Consideraciones éticas: es una investigación sin riesgos para los seres humanos conforme a la Resolución 08430 de 1993 de Colombia y la Declaración de Helsinki. Resultados: del PCAT-PE se incluyeron en la versión colombiana 182 ítems. En cuanto al PCAT-FE se trabajó con 197 ítems en total. Conclusión: se obtuvieron versiones adaptadas al sistema de salud colombiano. La metodología empleada puede contribuir al logro de mayor equivalencia entre instrumentos de diferentes países.

Objective: Obtain versions of the Primary Care Assessment Tool (PCAT) questionnaires for Colombia (CO-PCAT), directed to professionals (PCAT-PE), managers and directives of primary care (PCAT-FE) through an international, collaborative process. Methods: a transcultural adaptation process modified from the adapted and validated Spanish versions, in consensus with the Ibero-American Collaboration IA-PCAT. The method intends to get an equivalence of the CO-PCAT questionnaires version with the original version of the United States. Three phases of the work were developed: I) assessment of the adaptation of ibero-american versions in Spanish and adaptation to the Colombian context. II) international review performed by researchers of the Ibero-American Collaboration PCAT, and III) preliminary trials of the questionnaires. Ethical considerations: it is a non-risk research for human beings according to the Resolution 08430 of 1993 of Colombia and the Declaration of Helsinki. Results: From the PCAT-PE, 182 items were included in the Colombian version. Regarding PCAT-PE, the research worked with a total of 197 items. Conclusion: Adapted versions to the Colombian health system were obtained. The methodology used can contribute to the accomplishment of a greater equivalence between instruments of different countries.

Objetivo: obter versões dos questionários Primary Care Assessment Tool (PCAT) para Colômbia (CO-PCAT), dirigidos a professionais (PCAT-PE), encargados e diretivos de atenção primária (PCAT-FE) através de um processo colaborativo internacional. Métodos: processo de adaptação transcultural modificado a partir das versões adaptadas e validadas em espanhol, em consenso com a Colaboração Ibero-americana IA-PCAT. O método procura alcançar a equivalência da versão CO-PCAT dos questionários com a versão original de Estados Unidos da América. Desenvolveram-se três fases de trabalho: I) valoração da adequação de versões Ibero-americanas em língua espanhola e adaptação ao contexto colombiano, II) revisão internacional realizada por pesquisadores da Colaboração Ibero-americana PCAT e III) testes preliminares dos questionários. Considerações éticas: é uma pesquisa sem riscos para os seres humanos conforme à Resolução 08430 de 1993 da Colômbia e a Declaração de Helsinki. Resultados: do PCAT-PE se incluíram na versão colombiana 182 itens. Em quanto ao PCAT-FE se trabalho com 197 itens em total. Conclusão: obtiveram-se versões adaptadas ao sistema de saúde colombiano. A metodologia utilizada pode contribuir para a obtenção de maior equivalência entre instrumentos de diferentes países.

Evaluación de un programa piloto promotor de habilidades parentales desde una perspectiva de salud pública / Evaluation a parenting skills pilot programme from a public health perspective

Objetivo: Evaluar el proceso y los resultados de la fase piloto del Programa de desarrollo de habilidades parentales para familias (PHP), una estrategia de promoción de la parentalidad positiva basada en la evidencia y aplicable en contextos comunitarios y socioeducativos. Métodos: Diseño cuasiexperimental antes-después sin grupo control para la evaluación de la fase piloto del PHP implementada entre octubre de 2011 y junio de 2013 en Barcelona. Se condujeron 11 grupos en los que participaron 128 padres y madres y 28 profesionales. La intervención consistió en 10 u 11 sesiones. La información se recogió con cuestionarios a padres y madres y entrevistas en profundidad, individuales o grupales, a los/las profesionales. Las habilidades parentales se recogieron mediante un cuestionario con seis dimensiones. Se comparó la situación inmediatamente antes (T0) e inmediatamente después (T1) de la intervención. Resultados: El número de participantes en T1 se redujo a 83 (retención del 64,8%). El grado de satisfacción de los participantes con diversos aspectos del programa fue muy alto. Sobre una puntuación máxima de 10, la satisfacción de las personas moderadoras fue de 8,7. Se identificaron aspectos clave y áreas de mejora para el futuro de la intervención. En el análisis cuantitativo se observaron mejoras en todas las dimensiones de habilidades parentales que fueron consistentes con los resultados del análisis cualitativo. Conclusiones: Los resultados de la fase piloto de este programa apuntan a que una intervención universal de educación parental puede mejorar el bienestar de padres y madres (AU)

Objective: To evaluate the process and the results of the pilot phase of the Parenting skills development programme for families (PSP), an evidence-based strategy to promote positive parenting skills in socio-educational and community settings. Methods: Before-after quasi-experimental design without a control group for the evaluation of the pilot phase of the PSD carried out in Barcelona (Spain) between October 2011 and June 2013. Eleven groups were established with the participation of 128 parents and 28 professionals. The intervention consisted of 10 or 11 sessions. Information was collected through questionnaires for parents and in-depth individual or group interviews for professionals. Parenting skills were identified through a questionnaire with six dimensions. The situation before the intervention (T0) and immediately after (T1) was compared. Results: In T1 the number of participants decreased to 83 (retention=64.8%). Participants showed a high level of satisfaction with different dimensions of the program. On a maximum score of 10, the satisfaction of professionals was 8.7. Several key aspects and areas for improvement were identified for the future of the intervention. The quantitative analysis revealed improvements in all parenting skills dimensions and these improvements were consistent with the results of the qualitative analysis. Conclusions: The results of the pilot phase of this program suggest that a universal intervention on parenting skills can improve wellbeing among parents (AU)