Promoting Health Behavior Change in Canada: A Quality Improvement Project Integrating Prevention and Wellness in Frontline Care

Background: The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effectiveness and acceptability of Fountain of Health HBC tools as a minimal intervention for primary and secondary prevention among Canadian clinicians and their patients. Methods: Clinicians received HBC education and tools (paper tools and app-based) to assist their patients in setting a S.M.A.R.T (Specific, Measurable, Action-oriented, Realistic, Time-limited) goal at baseline and assessed four weeks later. Primary outcome measures were: 1) patient self-report of success at goal attainment;2) patient self-reported evaluation of change in well-being and health attitudes;and 3) clinician experience and engagement. Results: A total of 2184 clinicians received HBC education. Of these, 759 clinicians registered to participate in the project. 961 patients set S.M.A.R.T. HBC goals using either the paper tools (PT) or the app format. Patient data revealed nearly all patients (89% of PT users and 90% of app users) at least partially succeeded in attaining their goal at a four-week follow-up. Most patients (85% of PT and 80% of app users) also reported improvement in their well-being. A significant difference in health beliefs and attitudes was found in both PT (p < 0.001) and app users (p = 0.003). Conclusions: HBC is challenging. Educating and providing clinicians with HBC tools as a minimal intervention was found to be a successful health prevention strategy to improve patient well-being and health attitudes, and achieve S.M.A.R.T. goals. Results show HBC tools, education, and support for clinicians are both acceptable and effective for HBC in frontline care. These findings are relevant and timely given greater reliance on virtual care in the wake of the COVID-19 pandemic. Further research with rigorous methodology is needed to implement programs to achieve sustainable HBC to promote health on a large scale.

Association between change of health care providers and pregnancy exposure to FDA category C, D and X drugs

Background Changing health care providers frequently breaks the continuity of care,which is associated with many health care problems.The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C,D and X drugs.Methods A 50% random sample of women who gave a birth in Saskatchewan between January 1,1997 and December 31,2000 were chosen for this study.The association between the number of changes in health care providers and with pregnancy exposure to category C,D,and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression,with adjusted odds ratios （ORs） and its 95% confidence intervals （C/s） as the association measures.Results A total of 18 568 women were included in this study.Rates of FDA C,D,and X drug uses were 14.35%,17.07%,21.72%,and 31.14%,in women with no change of provider,1-2 changes,3-5 changes,and more than 5 changes of health care providers.An association between the number of changes of health care providers and pregnancy exposure to FDA C,D,and X drugs existed in women without chronic diseases but not in women with chronic disease.Conclusion Change of health care providers is associated with pregnancy exposure to FDA category C,D and X drugs in women without chronic diseases.

Feasibility of a Fully Automated Multiple Session Alcohol Intervention to University Students,Using Different Modes of Electronic Delivery—The TOPHAT 1 Study

Background: In recent years more and more electronic health behaviour interventions have been developed in order to reach individuals with an unhealthy behaviour such as risky drinking. This is especially relevant in university students who are among those who most frequently are risky drinkers. This study explored the acceptability and feasibility, in an unselected group of university students, of a fully automated multiple session alcohol intervention offering different modes of delivery such as email, SMS and Android. Material and Methods: A total of 11,283 students at Link?ping University in Sweden were invited to perform a single session alcohol intervention and among those accepting this (4916 students) a total of 24.7% accepted to further participate in the extended multiple intervention lasting 3 - 6 weeks. The students could choose mode of delivery, total length of the intervention (between 3 - 6 weeks) and number of messages per week (3, 5, or 7 per week). A follow-up questionnaire was applied after the intervention to which 82.7% responded. Results: most students wanted to receive the messages by email with the shortest intervention length (3 weeks) and as few messages as possible per week (3 messages). However, no major difference was seen regarding satisfaction with the length and frequency of the intervention despite chosen length and frequency. Most students also expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. Discussion and Conclusion: Based upon feedback from the students, a multiple push-based intervention appears to be feasible to offer students interested in additional support after a single session alcohol intervention. In a forthcoming study we will further explore the optimal mode of delivery and length of intervention and number of messages per week.

The Fall and Rise of Tuberculosis： How Institutional Change Affected Health Outcomes in Shanghai, 1927--2013

This paper examines the decline of tuberculosis and the faltering of TB in China. Specifically, I examine how institutional change--the construction and dismantling of the work-unit system--has affected TB control. The work-unit system was an employment system under which the vast majority of the population, in both urban and rural areas, had guaranteed employment and a host of benefits, including health insurance and access to the public health and health care systems. This system was created in the 1950s, which coincided with the decline of TB mortality and morbidity. The 1990s dismantling of the work-unit system has coincided with resurgent TB. This comparative historical sociological work examines TB control in Shanghai at three critical junctures： before the work-unit system was constructed, while it was in place, and since it has been dismantled. I examine both Shanghai＇s urban districts and rural counties, based on data gathered from archival sources and in-depth interviews during 17 months of field research. I argue that the work-unit system provided an effective basic-level infrastructure for the provision of public health and health care services that reached the entire population. This infrastructure was critical to the success of TB control efforts during the work-unit era, and its dismantling has been a key cause of the faltering of TB control in recent years.

China’s migrant population and health

Population flow brings vitality to China’s economy and society,while at the same time it also impacts traditional social structures and culture.In recent years,with the gradual disappearance of the“demographic dividend”and the advancement of economic structural transformation and upgrading,there have been changes to China’s population flow that are worth of noting.In particular,the changing health status of China’s migrant population has attracted the attention of scholars.Because non-migrant and migrant populations have significant behavioral and lifestyle differences,and because living environments and the provision and utilization of medical and health care services differ,the health status of the two populations are different.Young migrants are more prone to mental health problems than young non-migrants,while migrant women of childbearing age are likely have reproductive health problems than local women.The health status of young and middle-aged migrants will deteriorate with the extension of their flowing time.For elderly migrants,social support has a positive effect on health status.At present,China’s migrant population is threatened by infectious diseases,chronic non-infectious diseases and mental illnesses,while the supply of basic public health services is insufficient.Therefore,health work for migrant populations should occur against the backdrop of the“Comprehensive Health”,with this being used as a guideline.At the same time,health planning should make use of social integration and health promotion,equalization of basic public health care services,“Internet+”,and other schemes to improve the health status of the migrant population.