Health Access, Health Promotion, and Health Self-Management: Barriers When Building Comprehensive Ageing Communities.

A new intervention model for promoting healthy ageing grounded on integrated value-based care was developed and tested in the city of Valencia (Spain). Its implementation raised relevant barriers for older adults in their access to health, health promotion, and health self-management linked with their health and digital literacy. This new intervention model included several aspects. On the one hand, researchers together with older adults and their informal caregivers participating in the study, designed personalized care plans, based on older adults' specific needs, to be implemented with the support of a digital solution. On the other hand, researchers and health and social professionals implemented a series of workshops in different locations of the city to encourage a sense of community among participants, reinforcing their trust in the new care model and increasing their adherence. Social activities were at the core of the workshops to understand older people's interaction with the health and social services provided in the neighborhood. Qualitative and quantitative methods were combined to extract information from older participants on how to engage them as active actors of their health and understand their values and preferences. In the present manuscript, we focus on the qualitative results, which show that after a post-pandemic situation, they were more concerned about social isolation and desired face-to-face contact with their professional care team; however, feelings of loneliness and/or sadness were not considered among the reasons to visit health professionals. Some of the conclusions revealed that the use of technology as a supportive tool is well received but with a stress on its role as "supportive", and not replacing the close contact with healthcare professionals. Professionals recognized the benefits of this new approach but required more time and incentives to dedicate the effort needed. The main aim of this study was to present these barriers related to health access, health promotion, and health self-management, as well as the actions developed to face them.

A Qualitative Study of the Values, Needs, and Preferences of Patients Regarding Stroke Care: The ValueCare Study.

Introduction: An in-depth understanding of patient perspectives contributes to high-quality, value-based health care. The aim of this study was to explore the values, needs, and preferences of stroke patients across the continuum of care. Methods: We performed a qualitative study, as part of the larger ValueCare study, involving 36 patients who have had ischemic stroke within the past 18 months at the time of recruitment. Data were collected between December 2020 and April 2021 via one-to-one telephone interviews. All interviews were audio-taped and transcribed verbatim. The interview data were analysed using a thematic approach. Results: The analysis resulted in five themes: (1) patients' values about health care, (2) information and education, (3) psychological support, (4) follow-up care, and (5) continuity and coordination of care. Patients valued a compassionate professional who is responsive to their needs. Furthermore, patients indicated a need for tailored health information, psychosocial services, pro-active follow-up care and improved coordination of care. Discussion and conclusion: Stroke patients emphasised the need for tailored information, psychological support, pro-active follow-up, and improved coordination of care. It is advocated for professionals to use a value-based care approach in order to satisfy the individual needs of patients with regard to information, communication, and follow-up care.

Patients' Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study.

BACKGROUND: Digital technologies such as mobile apps and robotics have the potential to involve stroke patients better in the care process and to promote self-management. However, barriers exist that constrain the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for health-related technology. To address these barriers, co-design can be used to enable patients to reflect on their experiences of a service and to tailor digital technologies to the needs and preferences of end users regarding content and usability. OBJECTIVE: This study aims to explore the perspectives of stroke patients toward how digital health technology could support self-management regarding health and well-being, as well as integrated stroke care. METHODS: A qualitative study was conducted to understand patient perspectives. Data were collected in co-design sessions during the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on sociodemographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach. RESULTS: Patients held mixed attitudes toward digital health technologies. Some patients viewed digital technology as a convenient product or service, while others expressed no desire or need to use technology for self-management or care. Digital features suggested by stroke patients included (1) information about the causes of stroke, medication, prognosis, and follow-up care; (2) an online library with information regarding stroke-related health and care issues; (3) a personal health record by which patients can retrieve and manage their own health information; and (4) online rehabilitation support to empower patients to exercise at home. Regarding the user interface of future digital health technology, patients emphasized the need for easy-to-use and simple designs. CONCLUSIONS: Stroke patients mentioned credible health information, an online library with stroke-related health and care information, a personal health record, and online rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the "voice of the stroke patients" regarding both functionality and the characteristics of the interface. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12877-022-03333-8.

Engaging People and Co-Producing Research with Persons and Communities to Foster Person-Centred Care: A Meta-Synthesis.

INTRODUCTION: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential knowledge to foster engagement and co-production. MATERIALS AND METHODS: A meta-synthesis research design was used to compile existing qualitative research papers on health communication, engagement, and empowerment in vulnerable groups in high-income countries (HICs) from 2008 to 2018. A total of 23 papers were selected and analysed. RESULTS: 'Design and recruitment' and 'engagement and co-production' thematic areas are presented considering the factors related to researcher-communities attunement and the strategical plans for conducting research. The insights are discussed in light of the literature. Long-term alliances, sustainable structures, and strengthened bonds are critical factors for producing real long-term change, empowering persons and communities, and paving the way to person-centred care. CONCLUSIONS: The enhancement of the recruitment, involvement, and empowerment of traditionally disengaged communities and individuals depends on the awareness and analysis of social determinants, power differentials and specific tactics, and the capacity of researchers and individuals to apply all these principles in real-world practice.

Custody and child symptomatology in high conflict divorce: an analysis of latent profiles / Custodia y Sintomatología de los Hijos en Divorcios Altamente Conflictivos: Análisis de Perfiles Latentes

BACKGROUND: There is much controversy about the impact of joint physical custody on child symptomatology in the context of high interparental conflict. In this study we analyzed child symptomatology with person-centered methodology, identifying differential profiles, considering post-divorce custody, parental symptomatology, and coparenting variables. We examined the association between these profiles and child symptomatology, as well as the mediating role of parenting in that association. METHOD: The participants were 303 divorced or separated Spanish parents with high interparental conflict. We used the study of latent profiles and the INDIRECT procedure in Mplus. We also controlled for the variables age and number of children, new partners, frequency of the relationship with the ex-partner, time elapsed since the divorce, and gender of the parent. RESULTS: From the parents' perspective, the profile characterized by low parental symptomatology and high coparenting, regardless of the type of custody, was related to children exhibiting less somatic, anxious, and depressive symptomatology, and aggressive behavior. The mediating role of parenting was also identified. CONCLUSIONS: Parental symptomatology, coparenting, and parenting are essential for understanding post-divorce child symptomatology and the study highlights importance of person-centered multidimensional models

ANTECEDENTES: existe una gran controversia acerca del impacto de la custodia física compartida en la sintomatología infantil en contexto de alto conflicto interparental. El presente estudio analizó la sintomatología infantil a través de una metodología centrada en la persona, identificando perfiles diferenciales al considerar las variables custodia postdivorcio, sintomatología parental y coparentalidad. Se analizó la asociación entre estos perfiles y la sintomatología infantil, así como el papel mediador de la parentalidad. MÉTODO: participaron 303 progenitores españoles divorciados o separados con alto conflicto interparental. Se empleó el estudio de perfiles latentes y el procedimiento INDIRECT Mplus, controlando las variables edad, número de hijos/as, nuevas parejas estables, frecuencia de relación entre progenitores, tiempo transcurrido desde el divorcio y género del/a progenitor/a. RESULTADOS: desde la perspectiva de los progenitores, el perfil caracterizado por baja sintomatología parental y alta coparentalidad, independientemente del tipo de custodia, se relacionó con menor sintomatología somática y ansioso-depresiva de hijos/as, y con menor comportamiento agresivo. Se confirmó el papel mediador de la parentalidad. CONCLUSIONES: se identifica la sintomatología parental, la coparentalidad y la parentalidad como variables fundamentales para comprender la sintomatología infantil postdivorcio, así como la relevancia de emplear modelos multidimensionales centrados en la persona

Custody and Child Symptomatology in High Conflict Divorce: An Analysis of Latent Profiles.

BACKGROUND: There is much controversy about the impact of joint physical custody on child symptomatology in the context of high interparental conflict. In this study we analyzed child symptomatology with person-centered methodology, identifying differential profiles, considering post-divorce custody, parental symptomatology, and coparenting variables. We examined the association between these profiles and child symptomatology, as well as the mediating role of parenting in that association. METHOD: The participants were 303 divorced or separated Spanish parents with high interparental conflict. We used the study of latent profiles and the INDIRECT procedure in Mplus. We also controlled for the variables age and number of children, new partners, frequency of the relationship with the ex-partner, time elapsed since the divorce, and gender of the parent. RESULTS: From the parents' perspective, the profile characterized by low parental symptomatology and high coparenting, regardless of the type of custody, was related to children exhibiting less somatic, anxious, and depressive symptomatology, and aggressive behavior. The mediating role of parenting was also identified. CONCLUSIONS: Parental symptomatology, coparenting, and parenting are essential for understanding post-divorce child symptomatology and the study highlights importance of person-centered multidimensional models.

Metric Goodness of the Adult Prosocialness Scale. Comparative Study of Italy and Spain.

The main goal of the study is to analyze the metric goodness of the Spanish version of the Adult Prosocialness Scale (Caprara, Steca, Zelli, & Capanna, 2005). Analysis of construct and concurrent validity in two similar samples of young adults, a Spanish sample (target of the adaptation) and an Italian sample (source language), revealed the adequacy of the Spanish version of instrument, with adequate fit of the model in the Spanish group, χ2(96) = 405.28, p = .001, RMSEA = .071, CFI = .94, GFI = .93, and the Italian group χ2(97) = 224.5, p = .001, RMSEA = .075, CFI = .91, GFI = .90. The results also replicated the adequacy of the instrument found in the Italian sample, as the configural and metric invariance was verified in both groups. Analyses of benevolent and power values related to prosociality and differences between genders supported the validity of the scale. In short, the present study confirms the adequacy and sensitivity of the instrument to study prosociality in young adults in a Spanish sample.

Metric goodness of the adult prosocialness scale. Comparative study of Italy and Spain

The main goal of the study is to analyze the metric goodness of the Spanish version of the Adult Prosocialness Scale (Caprara, Steca, Zelli, & Capanna, 2005). Analysis of construct and concurrent validity in two similar samples of young adults, a Spanish sample (target of the adaptation) and an Italian sample (source language), revealed the adequacy of the Spanish version of instrument, with adequate fit of the model in the Spanish group, χ2(96) = 405.28, p = .001, RMSEA = .071, CFI = .94, GFI = .93, and the Italian group χ2(97) = 224.5, p = .001, RMSEA = .075, CFI = .91, GFI = .90. The results also replicated the adequacy of the instrument found in the Italian sample, as the configural and metric invariance was verified in both groups. Analyses of benevolent and power values related to prosociality and differences between genders supported the validity of the scale. In short, the present study confirms the adequacy and sensitivity of the instrument to study prosociality in young adults in a Spanish sample

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El turismo como estrategia de envejecimiento activo y saludable: efectos del turismo en la salud de las personas mayores / Tourism as a healthy and active ageing strategy: The effects of tourism on the health of the elederly

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Modelo cognitivo-contextual del conflicto interparental y la adaptación de los hijos / A cognitive-contextual framework of the marital conflict and child-ren’s adjustment

El objetivo de este estudio ha sido comprobar en población española la validez del modelo cognitivo-contextual como modelo teórico explicativo de la relación existente entre el conflicto interparental y la adaptación de los hijos. Para ello se contó con la participación de 3957 estudiantes (50.2% mujeres, 49.8% hombres; edad media= 15.68 años). Se valoraron a través de cuestionario las siguientes variables: el conflicto inteparental percibido por parte de los hijos (CPIC), el bienestar-malestar psicológico de los hijos (YSR), el rendimiento académico (CDE) y la satis-facción familiar (FS). Sendos modelos de regresión jerárquica consiguen explicar un 22.6% de la varianza del malestar emocional de los hijos y un 26% de las rendimiento académico. Un modelo de estructura de covarianza (CFI, GFI y AGFI >.95) permite constatar un efecto claro y directo del conflicto interparental sobre la afectividad de los hijos pero no sobre el rendimiento académico el cual es repercutido más directamente por el grado de malestar emocional presente en los hijos; es decir, la relación del conflicto parental con el rendimiento académico no es directa, sino que viene mediada por el grado de afectividad (AU)

The aim of these research is to check cognitive-contextual model’s validity in Spanish population as a theoretical framework which can explain the connection between marital conflict and childrens’ adjustment. 3957 students were included in the sample (50.2% female, 49.8% male; Average age= 15.68 years old). The following variables were assessed through questionnaires: children perception of interparental conflict (CPIC), children’s psychological wellbeing (YSR), academic performance (CDE) and family satisfaction (FS). Hierarchical regression models are able to explain the 22.6% of the variance on children’s emotional unrest, and the 26% on academic performance. A covariance structure model (CFI, GFI y AGFI >0.95) has confirmed a clear and direct effect of interparental conflict on children’s affectivity, but no on academic performance, which is more directly affected by children’s emotional unrest. In other words, the relation between interparental conflict and academic performance is not direct, it is mediated by the level of affectivity (AU)

Conflicto marital y consumo de drogas en los hijos / Marital conflict and children´s drug use

Objetivo.- Se analiza la relación entre el funcionamiento familiar, los conflictos de la pareja y el consumo de drogas por parte de los hijos. Método.- A través de un diseño transversal se ha encuestado a una muestra de 130 jóvenes (72 chicas y 57 chicos; con edades comprendidas entre los 13 y 17 años) y sus respectivas madres. Para la valoración de las variables de interés se ha utilizado una batería de cuestionarios que comprende los siguientes: Consumo de Sustancias (CS), la Escala de Percepción de los Hijos del Conflicto Interparental (CPIC), el Inventario para Hijos del Comportamiento Parental (CRPBI), la Escala de Evaluación de Adaptabilidad y Cohesión Familiar (FACES), el Índice de Satisfacción Matrimonial (ISM) y la Escala de Estabilidad Matrimonial (EEM). Los hijos respondían a los cuatro primeros (CS, CPIC, CRPBI y FACES), mientras sus familiares lo hacían a los tres últimos (FACES, ISM, EEM). Para el análisis de las relaciones entre variables se utilizaron modelos de regresión logística tomando como variable dependiente ser o no ser el hijo consumidor de sustancias. Resultados.- Cuatro dimensiones de conflicto marital (frecuencia: OR=1,30; intensidad: OR=1,56; inestabilidad: OR=1,32; y contenido: OR=1,33), siete de las ocho dimensiones del CRPBI y la percepción de cohesión familiar por parte de los hijos (OR=0,51) resultaron estadísticamente significativos (p<0,05). No obstante, el control del conjunto de variables mediante un modelo de regresión múltiple ofreció significación estadística para sólo dos de ellas: la percepción de cohesión familiar por parte del hijo/a (OR=0,59; p=0,03) y la percepción de control por parte de la madre (OR=0,69; p=0,04). Conclusiones.- Los resultados muestran que la presencia de conflicto entre los padres se asocia a una mayor presencia de consumo de sustancias entre los hijos, si bien son necesarias más investigaciones para confirmar estos hallazgos. El estudio sí permite constatar el efecto protector de la cohesión familiar y el control materno percibido por los hijos sobre la probabilidad de consumir drogas por éstos

Objective.-We examined the relationship between family functioning, marital conflict and drug use by children. Method.- A cross-over design was used in interviewing a sample of 130 young people (72 girls and 57 boys, ranging from 13 to 17 years of age) and their respective mothers. The battery of questionnaires, used to evaluate the variables of interest, comprised: Substance Use (SU), the Children’s Perception of Interparental Conflict Scale (CPIC), the Children’s Report on Parent Behaviour Inventory (CRPBI), the Family Adaptability and Cohesion Evaluation Scale (FACES), Marital Satisfaction Index (MSI), and the Marital Stability Scale (MSS). The children answered the first four (SU, CPIC, CRPBI and FACES), and their mothers the last three (FACES, MSI and MSS). Logistic regression models were used to analyse the relationship between different variables, taking the child being a substance user or non-user as the dependent variable. Results.- Four dimensions of marital conflict (frequency: OR=1.30; intensity: OR=1.56; uncertainty: OR=1.32; and content: OR=1.33), seven of the eight CRPBI dimensions and the family cohesion perceived by children (OR=0,51) were statistically significant (p <0,05). Nevertheless, multiple regression on the group of variables showed statistical significance for only two of them, the children’s perception of family cohesion (OR=0.59; p=0.03) and the mothers’ perception of control (OR=0.69; p=004). Conclusions.- The results show that the presence of conflict between parents is associated with a greater presence of drug use in children; although further research is necessary to confirm these relationships. However, the study does point to family cohesion, and children’s perception of control by the mother as having a protective effect on the probability of drug use by the former