Cocreating Action to Improve Rationality in the Health System
NCT ID: NCT07237971
Last Updated: 2025-12-02
Study Results
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Basic Information
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RECRUITING
NA
4000 participants
INTERVENTIONAL
2025-10-21
2029-04-01
Brief Summary
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The scientific approach uses mixed methods and incorporates theory from multiple disciplines. This study will appraise how the current system addresses psychological well-being, cardiovascular (CV) health, and rational use of antibiotics using a population survey, a survey of patients collecting their medication at community pharmacies, aggregate health service indicators on medication consumption and primary care consultations, and qualitative methods exploring stakeholders' perceptions.The investigators will undertake community-based participatory research to engage citizen scientists in the cocreation of community-led actions to promote psychological well-being, CV health, and prevent antimicrobial resistance. The design, implementation, and evaluation of the actions will apply an assets-based approach and apply theories and frameworks from implementation science in an iterative manner over 3 years. Finally, the impact of the cocreated actions will be analysed, considering effectiveness and broader contextual issues such as initiative adoption, implementation, and maintenance. The investigators will use a before-after comparison of survey indicators, an interrupted time-series analysis of health service data and qualitative analysis.
The goal is to demonstrate how the integration of community action with attention to the social determinants of health, can lead to a more rational approach to health care and ultimately improve health and health equity.
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Detailed Description
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As the title of this study suggests, the investigators question whether the current approach to these important public health issues is truly rational. Health action remains heavily dominated by individual-level solutions (e.g., medication, patient counselling, vaccination) despite widespread recognition of the social, economic, or environmental factors that determine health. Health professionals frequently acknowledge the importance and potential of non-pharmacological community-based interventions, yet barriers exist to put them into practice. Even the way that the public health system is conceptualised leads to overemphasize the importance of the health services as the accountable component for providing health and well-being. In fact, there are numerous organizations and individuals who develop actions in areas that are not directly recognizable as part of the health system (e.g., senior citizens clubs, urban planners, cultural centres), but which greatly facilitate the effectiveness of the system and have the potential to produce significant health and wellbeing benefits. The project will apply a "systems thinking" approach and consider that any organization, person, or action that influences the physical or social environment has the potential to influence health and wellbeing, and thus could be considered part of the public health system if they are incorporated into the decision-making domains that have a primary desire or interest in maximizing health. Important, yet frequently underestimated, health systems components are found in the community.
Identifying and activating health promoting resources in the community is a legitimate and effective way to improve health and health equity. It forms the basis of a substantial body of research and practice on health promotion with community assets. A community can also be characterised and described by its level of social capital, which in itself is a key component of community resources, as well as a determinant of physical and mental health. It includes the perceptions that people have about the level of interpersonal trust, exchange and reciprocity in their community, as well as the density of their social networks and patterns of civic engagement. This study put forward an ambitious plan to show how the power of the community and its members can be harnessed to cocreate actions that move them from a predominant biomedical vision to a truly rational health system.
Engaging the community in research or practice is acknowledged as a powerful tool to elicit meaningful and sustainable change. Furthermore, it is an effective way to reduce inequity. In this line, increasing attention is centred on developing citizen science initiatives that move beyond engaging citizens in data collection, and towards citizens having a meaningful input in all phases of the research, including design and translation of the findings into practice. The community-based participatory research model has proven useful in this endeavour. This study considers here that deep community engagement in research can improve critical health literacy (CHL), not just among the citizen scientists but among the community as a whole. CHL refers to individuals or communities that are able to critically appraise information, understand the social determinants of health and have skills oriented towards collective social and political action. The issue is paramount to the problem addressed here as CHL is widely assumed to lead to a more effective and efficient use of health services. In light of these considerations, the research proposed seeks to foster the complexity and dynamism of the health system by integrating community action and attention to the social determinants of health. This will refocus how psychological wellbeing, CV health, and antimicrobial resistance are approached. Together with citizen scientists the investigators will cocreate community actions in each of these 3 areas and will show how they can ultimately impact health and health equity. The objectives are:
Overall objective: To determine the impact on health and health equity of a series of cocreated actions to improve rationality in the health system.
Specific objectives:
1. To generate rigorous quantitative and qualitative epidemiological data on the current health systems approach to address psychological wellbeing, CV health, and antimicrobial resistance.
2. To cocreate actions to promote psychological wellbeing, CV health, and rational use of antibiotics with a community approach.
3. To assess the impact of the cocreated actions on health and health equity at local population level.
Conditions
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Study Design
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NA
SINGLE_GROUP
OTHER
NONE
Study Groups
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Cocreating process to improve rationality in the health system in a deprived neighborhood
Cocreation process
The cocreation process will involve various advisory and participatory bodies to ensure the active involvement of the community and local institutions, also with the research team, ensuring that actions respond to collective needs of the community. Recruitment of these advisory and participatory bodies will be carried out through a participatory strategy involving the Basic Health Councils of the healthcare centers in the area, as well as other associations, religious institutions, and local leaders. Based on previous sociograms, strategic locations will be identified for organizing informational meetings in accessible places in the area, such as community centers. Dissemination will be carried out through social media, posters, and other inclusive means to ensure the participation of vulnerable groups. Participation in the cocreation process will be open, voluntary, and will depend on the interest of individuals and entities in the area.
Interventions
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Cocreation process
The cocreation process will involve various advisory and participatory bodies to ensure the active involvement of the community and local institutions, also with the research team, ensuring that actions respond to collective needs of the community. Recruitment of these advisory and participatory bodies will be carried out through a participatory strategy involving the Basic Health Councils of the healthcare centers in the area, as well as other associations, religious institutions, and local leaders. Based on previous sociograms, strategic locations will be identified for organizing informational meetings in accessible places in the area, such as community centers. Dissemination will be carried out through social media, posters, and other inclusive means to ensure the participation of vulnerable groups. Participation in the cocreation process will be open, voluntary, and will depend on the interest of individuals and entities in the area.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
Focus groups, sociograms and in-depth interviews will include 6-8 participants and last approximately 90 minutes. Participation in the co-creation process will be open, voluntary, and will depend on the interest of individuals and entities in the area. Eligibility criteria:
* People aged 18 and over who are residents or have a job or family connection in the Municipal District 2 of Elche (Spain) who are interested in participating, wish to be actively involved in the co-creation, planning, and implementation of community initiatives, and are available to attend the conferences, meetings, and workshops.
* Representatives from community institutions and associations, including professionals from the Elche Public Health Center, primary care teams in the area, Elche Council staff, as well as professionals and volunteers from NGOs and other local organizations with experience in community work in the district.
18 Years
ALL
Yes
Sponsors
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Universidad Miguel Hernandez de Elche
OTHER
Responsible Party
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Lucy Anne Parker
Associate professor
Locations
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Community
Elche, Alicante, Spain
Community based. Municipal District 2 of Elche
Elche, Alicante, Spain
Countries
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Central Contacts
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Facility Contacts
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References
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Campos L, Dias P, Costa M, Rabin L, Miles R, Lestari S, Feraihan R, Pant N, Sriwichai N, Boonchieng W, Yu L. Mental health literacy questionnaire-short version for adults (MHLq-SVa): validation study in China, India, Indonesia, Portugal, Thailand, and the United States. BMC Psychiatry. 2022 Nov 16;22(1):713. doi: 10.1186/s12888-022-04308-0.
INCB. (n.d.). Report of the International Narcotics Control Board for 2021.
World Health Organization - Regional Office for Europe. (2015). The European Mental Health Action Plan 2013-2020. World Health Organization, 19.
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernandez-Sola J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundstrom J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020 Dec 22;76(25):2982-3021. doi: 10.1016/j.jacc.2020.11.010.
Selim AJ, Rothendler JA, Qian SX, Bailey HM, Kazis LE. The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12). J Ambul Care Manage. 2022 Jul-Sep 01;45(3):161-170. doi: 10.1097/JAC.0000000000000420.
Rosas LG, Rodriguez Espinosa P, Montes Jimenez F, King AC. The Role of Citizen Science in Promoting Health Equity. Annu Rev Public Health. 2022 Apr 5;43:215-234. doi: 10.1146/annurev-publhealth-090419-102856. Epub 2021 Nov 1.
Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R, Reyes AG, Clement J, Burris A. Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health. 2010 Nov;100(11):2094-102. doi: 10.2105/AJPH.2009.170506. Epub 2010 Sep 23.
Chinn D. Critical health literacy: a review and critical analysis. Soc Sci Med. 2011 Jul;73(1):60-7. doi: 10.1016/j.socscimed.2011.04.004. Epub 2011 May 12.
Villalonga-Olives E, Adams I, Kawachi I. The development of a bridging social capital questionnaire for use in population health research. SSM Popul Health. 2016 Aug 31;2:613-622. doi: 10.1016/j.ssmph.2016.08.008. eCollection 2016 Dec.
Nutbeam, D. (2020). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259-267.
Related Links
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Website of the project
Other Identifiers
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Grant No. 101125843
Identifier Type: -
Identifier Source: org_study_id
ERC-2023-COG 101125843
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
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