Five-hub General Conceptual Framework to improve the vaccination coverage for newly arrived migrants

Abstract Background Within the Project “Increased Access for Newly Arrived Migrants-AcToVax4NAM” (Grant n 101018349, 3rd EU Health Programme), a General Conceptual Framework (GCF) was developed for understanding how to improve vaccination coverage for Newly Arrived Migrants (NAM), by characterizing and critically analysing system barriers and possible solutions to increase vaccination Methods A logical pathway was hypothesized based on conceptual hubs in the immunization process. The identification of barriers and solutions was carried on by: a) non-systematic revision of scientific and grey literature, institutions and relevant websites, and documents suggested by Consortium Partners; b) qualitative research conducted in each Consortium Country. The GCF was used as a guide for the above mentioned activities and organize results into the GCF itself to enrich it with content Results 5 conceptual hubs were identified: ENTITLEMENT to vaccination, REACHABILITY of people to be vaccinated, ADHERENCE to vaccination, ACHIEVEMENT of vaccination, EVALUATION of the intervention. All hubs are linked sequentially, starting with Entitlement without which the process cannot take place. Hubs are connected: if vaccination does not take place, it’s important to go back to the previous hubs to understand the barriers. Reachability-Adherence-Achievement are closely related because some approaches are cross-cutting, such as proximity interventions which, in addition to allowing the system to approach NAM, promote adherence and thus possibility of completing the process. Other strategies may be implemented with different purposes: training aims to foster a culturally competent approach to facilitate adherence and avoid vaccination hesitancy, but also to improve competence in the entire process and lead to vaccination completion Conclusions The proposed GCF facilitates identification of barriers and possible solutions to the effective achievement of immunization, at all stages of the process Key messages • The GCF can be the basis for the creation of country-specific flow-charts through which to test strategies aimed at increasing immunization coverage in NAM. • The GCF will be useful at EU level, to facilitate both the harmonisation of approaches and interventions and the evaluation of comparable approaches.


Background:
Colorectal cancer (CRC) is among the most common cancers and cancer causes of death worldwide. CRC screening and early detection is essential to reduce CRC incidence and mortality. CRC screening has been initiated in the Czech Republic in 2000 for persons over 50 and currently offers a faecal occult blood test (FOBT) or screening colonoscopy (CS). The aim of our study was to present complete coverage by examinations in relation to the trends in CRC burden and impact of COVID-19.

Methods:
We defined the complete coverage by examinations as the proportion of persons aged over 50 undergoing examination with CRC early detection potential (FOBT or CS for any indication) during past 3 years. Standardized incidence and mortality rates were used to assess epidemiological trends. The impact of COVID-19 was assessed for 2020 and 2021 by comparing the volume of examinations with 2019. We used national health registries (National Registry of Reimbursed Health Services, Czech National Cancer Registry) as the source of data. Results: Complete coverage was increasing over time and reached around 50% in recent years (target population is more than 4 million persons, most of the performed examinations were screening FOBT). However, coverage has decreased to 47.9% in 2020. In 2020 and 2021, the number of tests performed decreased by 16.9% and 5.5%, respectively, compared to 2019. CRC incidence and mortality rates have decreased by more than 20% and almost 30%, respectively, in the last decade.

Conclusions:
Complete coverage has reached a satisfactory level and has likely a positive impact on the epidemiological trends. However, further action is needed to increase coverage, recently affected by COVID-19 pandemic, when non-acute health care may have been neglected. Key messages: The long-term high level of coverage by examinations likely has a positive impact on CRC burden. The observed decrease in coverage caused by COVID-19 needs to be appropriately compensated.  iii425 qualitative research conducted in each Consortium Country. The GCF was used as a guide for the above mentioned activities and organize results into the GCF itself to enrich it with content Results: 5 conceptual hubs were identified: ENTITLEMENT to vaccination, REACHABILITY of people to be vaccinated, ADHERENCE to vaccination, ACHIEVEMENT of vaccination, EVALUATION of the intervention. All hubs are linked sequentially, starting with Entitlement without which the process cannot take place. Hubs are connected: if vaccination does not take place, it's important to go back to the previous hubs to understand the barriers. Reachability-Adherence-Achievement are closely related because some approaches are cross-cutting, such as proximity interventions which, in addition to allowing the system to approach NAM, promote adherence and thus possibility of completing the process. Other strategies may be implemented with different purposes: training aims to foster a culturally competent approach to facilitate adherence and avoid vaccination hesitancy, but also to improve competence in the entire process and lead to vaccination completion Conclusions: The proposed GCF facilitates identification of barriers and possible solutions to the effective achievement of immunization, at all stages of the process Key messages: The GCF can be the basis for the creation of country-specific flow-charts through which to test strategies aimed at increasing immunization coverage in NAM. The GCF will be useful at EU level, to facilitate both the harmonisation of approaches and interventions and the evaluation of comparable approaches. In 2020, the Namibian Ministry of Health and Social Services (MoHSS) and the Robert Koch Institute (RKI) started a twinning project with the long-term goal of establishing a Namibia Institute of Public Health (NIPH). A fundamental pillar of an NIPH is a fully operational Public Health laboratory system. Due to the COVID-19 pandemic, the need for strengthening the existing Namibian Laboratory system became eminent. Following the Intra-Action Review (IAR) of the COVID-19 response in Namibia in 2020, three regional diagnostic laboratories, at points of entry, were assessed. The major issues identified were long delays between sampling of both suspected cases and COVID-19 patients and receiving test results due to extended sample transport times to the central laboratory in Windhoek and the overload of the central capacities due to overwhelming numbers of samples during peak times. This led to the establishment of three SARS-CoV-2 PCR diagnostic laboratories through procurement and installation of equipment, provision of consumables/ reagents, and on-site training of laboratory technicians with continued virtual technical support. Consequently, an important reduction of the diagnosis turnaround time was achieved. Of great value was the technical support given by the staff at the central laboratory during the trainings allowing for immediate validation of the newly established laboratories and to strengthen the communication between regional laboratories and the central laboratory. The Namibian molecular diagnostic capacities have increased in important regions in Namibia and will provide data to support the health policies of the future NIPH. New diagnostic protocols will be developed to foster the sustainability of the established laboratories and could support the implementation of genomic surveillance capacities. Finally, stronger relationships were built through these joint activities, which will support and the next steps of the establishment of the NIPH.  (1), where informal caregivers are key actors (2). Optimization in policies designed to support their caregiving role is needed. Portugal is an aged country with high prevalence of family that take care of dependent relatives. 'Informal caregivers' profile in Lisbon County: a health community approach' is a nurse-led research project designed to meet these challenges with the main aim: to develop a profile on informal caregivers in Lisbon county.

Methods:
Reporting the descriptive phase, a survey containing health/ social questions was submitted to a non-probabilistic representative sample of careers, aged 18 years old or above in about 300 caregiver's caring dependent persons resident in Lisbon, in 2021. Univariate descriptive analysis was performed.

Results:
Married and retired women' caring for a parent were the most typical informal caregiver profile (n = 13, 4%). The majority do not have support from social services (n = 209, 61%). Two thirds live with the cared-for person (n = 219, 64%). Almost half (n = 150, 44%) have a university degree and only few planned the transition to a caregiver role (n = 13, 4%). No more than 10% had access to support programs (n = 71, 20%).

Conclusions:
Caregivers' unmet needs can complexify societal mechanisms relying on their work. Addressing these needs will be key to develop a strategy focused on supporting informal caregivers' priorities.