Culture-based prescribing to improve mental health: a scoping review protocol.

OBJECTIVE: The objective of this review is to investigate what is known about culture-based prescribing to improve mental health and well-being. INTRODUCTION: Culture-based prescribing, where a person is referred by a clinical professional to an arts or cultural activity aimed at improving mental health and well-being, is increasingly used as a community-based source of support. Although culture-based prescribing seems promising, the field is heterogeneous with respect to definition, underlying hypotheses, and cultural activity. This hampers its further development and implementation. INCLUSION CRITERIA: We will consider publications that report on or explore culture-based prescribing to improve mental health and well-being for adults with symptoms related to mental health conditions who are seeking care from any clinical professional. METHODS: We will search 8 electronic literature databases for published or unpublished reports on culture-based prescribing, without date limits. We will also search for gray literature and screen reference lists of relevant reviews. No language restrictions will be applied during the screening process, but for data extraction, we will only extract studies in languages our team has proficiency in. The screening and data extraction will be performed by 2 reviewers, independently. Data analysis will be descriptive, with results tabulated separately for each subquestion. The results will be complemented with a narrative summary. REVIEW REGISTRATION: Open Science Framework https://osf.io/ndbqj.

Short-term effectiveness of face-to-face periodic occupational health screening versus electronic screening with targeted follow-up: results from a quasi-randomized controlled trial in four Belgian hospitals.

OBJECTIVES: In many countries, organisations are legally obliged to have occupational physicians screen employees regularly. However, this system is time-intensive, and there may be more cost-effective alternatives. Our objective is to compare the short-term effectiveness of periodic occupational health screening of hospital employees by an occupational physician with a system of electronic screening with targeted follow-up. METHODS: A randomized controlled trial was set up among personnel of four Belgian hospitals, with three measurement moments between June 2019 and December 2020, to compare differences in self-assessed health, healthcare use, productivity and intermediate outcomes over 19 months. Mixed effects models were used to assess differences in effectiveness. Superiority and non-inferiority post-hoc tests were used as a robustness check. The experiment coincided with the first two COVID-19 waves during which hospital employees were exposed to an exceptional period of occupational stress. RESULTS: In total, 1077 employees (34% of the target population) participated. Although we observed some immediate effects of the intervention (less trust in the physician, absenteeism, and healthcare use), all these effects disappeared over time. After 19 months, including two waves of COVID-19 hospitalizations, no significant differences were observed between employees screened through face-to-face contact and those screened electronically. CONCLUSIONS: Our study finds no indication that, in the short-term, substituting physician screening of the workforce with a quicker survey-based screening with targeted follow-up has different effects on the studied endpoints. However, as health and disease are often the result of a long-term process, more evidence is needed to determine long-term effects.

Disclosure in Online vs. Face-to-Face Occupational Health Screenings: A Cross-Sectional Study in Belgian Hospital Employees.

Replacing or supplementing face-to-face health screening by occupational physicians with online surveys can be attractive for various reasons. However, the (cost-)effectiveness of both depends on employees' willingness to disclose occupational health problems. This article investigates whether employees show a different willingness to disclose information in online surveys compared to face-to-face consultations with an occupational physician. Employees from four Flemish hospitals were asked whether they would disclose a range of typical occupational health problems to either surveys or physicians. The results were analyzed through chi-square tests and multilevel ordinary least squares regression. Of the 776 respondents, 26% indicated that they did not always disclose health problems. Respondents were more inclined to disclose mental health problems to a survey than face-to-face to a physician, whereas the opposite was true for medication misuse. Being male, younger, with lower educational attainment or lower trust in physicians, taking medication, or having a lower risk on alcohol abuse increased the likelihood of a person withholding information. We conclude that this study provides indications that online vs. face-to-face health check-ups have different strengths and weaknesses in this respect. These must be considered when evaluating the need to use online surveys (instead of, or together with, face-to-face contacts) for health screening.

Methodological Challenges in the Economic Evaluation of Occupational Health and Safety Programmes.

An emerging issue in occupational health and safety (OHS) is that interventions increasingly have to demonstrate that they offer sufficient value for money. To this end, the last decennia have seen more and more economic evaluation methods being employed in this field. However, several recent publications have indicated that many of the published studies suffer from important shortcomings. This paper aims to highlight difficulties in assessing the value of OHS by use of current economic evaluation methods. First, a summary framework presents an overview of the costs and benefits relevant for OHS interventions. Next, three elements from this framework are selected that are at the same time crucial to OHS value, but also challenging to measure and monetise: Effects on worker productivity, 'intangible' benefits, such as reputation effects, and the influence of the broader legal⁻fiscal context in which an intervention takes place. The following sections then discuss the following research questions for each of these elements: Why is it difficult to exclude these factors from OHS economic evaluations? Why do they pose a challenge to the quality of economic evaluations in OHS? How can they be included, and what are the known advantages and disadvantages of the methods to measure these factors? Future work should investigate (and standardise) better methods to include these elements.

Productivity estimation in economic evaluations of occupational health and safety interventions: a systematic review.

Objectives Occupational health and safety (OHS) interventions` effect on worker productivity is an essential, but complex element of the value of these programs. The trustworthiness of economic evaluation studies, aiming to provide guidance to decision-makers in the field of OHS, depends at least partly on how accurately productivity changes are measured. We aim to review the methods used to estimate productivity changes in recently published economic evaluations of OHS interventions. Methods We performed systematic searches of economic evaluations of OHS programs published between 2007 and 2017 and reviewed these studies` methods to quantify the programs` impact on worker productivity Results Of the 90 identified studies, 44 used a human capital approach, 17 a friction cost approach, 13 stated productivity in natural units (eg, a cost-per-absence-day-avoided), 7 made use of compensation expenses, 4 used output-based methods, 4 an "ad hoc" approach, and 1 study did not state its method. Different approaches were combined in 19 studies. Within these methods, we observed a wide diversity in their precise implementation, especially regarding the measurement and valuation of absenteeism and presenteeism. Conclusions Productivity is a key element of the economic attractiveness of investing in OHS. Economic evaluation studies of OHS would benefit from more methodological standardization in their approach to quantifying productivity change. Future research should better account for the methodological uncertainty that occurs in estimating it in order to demonstrate the impact that particular choices and approaches to productivity estimation can have on cost-effectiveness results.

Out-of-Pocket Payments and Subjective Unmet Need of Healthcare.

We present a critical review of the literature that discusses the link between the level of out-of-pocket payments in developed countries and the share of people in these countries reporting that they postpone or forgo healthcare for financial reasons. We discuss the pros and cons of measuring access problems with this subjective variable. Whereas the quantitative findings in terms of numbers of people postponing care must be interpreted with utmost caution, the picture for the vulnerable groups in society is reasonably robust and unsurprising: people with low incomes and high morbidity and incomplete (or non-existent) insurance coverage are most likely to postpone or forgo healthcare for financial reasons. It is more surprising that people with high incomes and generous insurance coverage also report that they postpone care. We focus on some policy-relevant issues that call for further research: the subtle interactions between financial and non-financial factors, the possibility of differentiation of out-of-pocket payments between patients and between healthcare services, and the normative debate around accessibility and affordability.