BACKGROUND. Socio-economic status (SES) is a key health determinant affecting life expectancy, healthcare access, and chronic disease prevalence, yet the health values and needs of people living in socio-economic vulnerable circumstances are often overlooked in traditional health assessments—enforcing health inequities.
APPROACH. This study aims to identify and understand the health perspectives, values, priorities and needs of people living in socio-economic vulnerable circumstances in Flanders, Belgium. Using a qualitative study design, we will engage directly with individuals living in socio-economic vulnerable circumstances through in-depth, semi-structured interviews. A sample of 10–15 participants will be recruited through community partners, including Zorgzaam Leuven, Pioen Vorselaar, and LiCalab, ensuring trusted community workers enhance participant engagement and trust. Semi-structured interviews will explore individual definitions of health, perceived good and bad health factors, and well-being priorities and needs of our study population. An inductive thematic analysis of anonymized transcripts will identify recurring themes, allowing insights into health determinants specific to this underserved population. Data collection and analysis will occur simultaneously, allowing initial findings to refine ongoing data gathering.
RESULTS. The findings, to be presented at the conference, will highlight key health values, themes, and indicators that people living in socio-economic vulnerable circumstances in Flanders consider essential for their health and well-being. These results will provide insights into relevant health determinants, priorities, and unmet needs within this demographic, helping to guide more targeted and effective health interventions.
IMPLICATIONS. By revealing the health perspectives and values of people living in socio-economic vulnerable circumstances, this research provides critical insights that challenge traditional general health assessments. The next steps involve co-creation workshops aimed at adapting current general health measures to reflect the social, economic, and environmental realities of these disadvantaged groups. This study underscores the importance of community partnership and participatory methods to inform a more inclusive and equitable health system responsive to the local context and the lived experiences of its most underserved citizens.

Background: Medications are one of the most common health-related interventions, with certain populations, such as individuals with spinal cord injury/dysfunction (SCI/D), commonly prescribed multiple medications. Consequently, adults with SCI/D often interact with multiple healthcare providers and engage in activities related to medication self-management. There are limited resources for this population that comprehensively address medication self-management. Therefore, the objective of this study was to co-design a toolkit to support medication self-management among adults with SCI/D.

Approach: We conducted a participatory mixed methods study. Using the Good Things Foundation Pathfinder Model as a guide for the co-design process, we engaged with adults with SCI/D, caregivers, and healthcare providers from across Canada. In Stage 1, we conducted a scoping review, concept mapping study, and working group sessions to understand and define the problem. In Stage 2, we conducted working group sessions and website development meetings to create a prototype of the toolkit. In Stage 3, we conducted a working group session to test the toolkit.

Results: MedManageSCI is available at www.medmanagesci.ca. We engaged with 44 participants in the concept mapping study, which included 21 adults with SCI/D, 11 caregivers, and 12 healthcare providers. The working group consisted of 19 individuals, including 9 adults with SCI/D, 1 caregiver, and 9 healthcare providers. In Stage 1, we identified the need for a comprehensive medication self-management resource, brainstormed content to include in the toolkit, and identified methods to deliver it. We also thematized and prioritized the content into eight categories (in order of importance): safety and lifestyle considerations, supports and services for accessing prescription medications and medication information, information-sharing and communication, general medication information, practical information and strategies related to medication-taking, healthcare provider interactions and involvement, information on non-prescription medication and medication supplies, and peer and community connections. Written and visual content were created by the research team and reviewed by experts. In Stage 2, feedback on the content mapped onto five categories: first impressions, message and purpose, visual elements, layout and flow, and graphics. MedManageSCI was selected as the name and an online version of the toolkit was created through an iterative process with the website development company. In Stage 3, participants provided recommendations to improve the functionality and navigation of the website.

Implications: MedManageSCI is a comprehensive medication self-management toolkit designed to empower adults with SCI/D to take an active role in their health management and promote overall health and well-being. Future work is needed to refine the content, assess the feasibility, acceptability, and appropriateness of the toolkit, and examine outcomes related to medication self-management. Through this co-design project, we have developed meaningful partnerships with adults with SCI/D, caregivers, and healthcare providers, which will support implementation and sustainability. MedManageSCI has the potential to further support integrated care by empowering individuals with SCI/D to be actively involved in their healthcare, facilitating communication amongst individuals with SCI/D and their care team, and providing resources to support self-management.

Background: Planning of healthcare systems has traditionally been top-down, focused more on illness care rather than health and wellbeing, and retentive of control. Locally, nationally and globally this approach no longer meets the needs of individuals and populations. Comments of healthcare systems being in crisis or no longer sustainable are ubiquitous. Rather than perpetuate “doing more of the same, and hoping for different results”, at the broadest system level, we sought to radically change our approach to healthcare using integrated care principles.
Approach: Using many of the pillars of integrated care, as well as an assed-based community development approach, we sought to identify what was of importance to achieve health and wellbeing for individuals, groups and communities. We also were cognizant of the need to understand how services should be organised and who should be the organizer. Finally, as we started the work, we realized that individuals and groups whom we considered as “recipients” of care, particularly in terms of achieving equity, also had a role as community assets. This work was carried out through interviews with over 200 groups and communities, with themes and roles being identified and grouped.
Results: Interviews spanned the entities which we considered as being involved in integrated care: the volunteer sector (both service providing and peer/condition specific), municipalities, portfolios within our health system, caregivers, individuals with medical conditions or subject to inequities, government departments, primary care, and others. In these interviews there was strong support for the component pillars of integrated care. Many entities (caregivers, municipalities) were shocked to realize the importance of their efforts in promoting health and wellbeing. Without exception, all groups indicated strong willingness to work collaboratively. From the health system perspective, we developed an awareness of the capacity of many groups to support integrated care and we translated this into ongoing relationships. At an individual level, people developed an understanding of the importance of social factors and community in health. They also shared what was important to them to have health and wellness, and commonly this was different from what the historical health system saw as being important. Moreover, we humbly learned that all individuals and groups had talents and could be considered a resource. For example, individuals experiencing homelessness were often the best source of support and resource for others in the same condition. From a service-based approach, we carried out a monetization exercise using published data and found that resources external to the health system, calculated at $26 billion, equated to the total health system budget of $26 billion.
Implication: Pillar 1 of Integrated Care – common vision – seems to be the key factor in facilitating care. With this common vision, all the other pillars of integrated care seem to fall into place. Understanding is needed from all regarding the roles and abilities of the various sectors and individuals. Importantly, the historical health system has to be comfortable in ceding control and working as an equal partner, or even having citizens lead priority-setting and ways of doing.

Background:
Short-term residential care (STRC) is an intermediate care model in the Netherlands that provides temporary inpatient care for community-dwelling older adults who experience a sudden health or functionality decline. Variations in admission criteria, treatment in STRC and admission capacity across regions leads to lack of insights into population characteristics but also in standardization of treatment.

Approach:
Together with professionals of nine STRC departments in the Netherlands, a patient-centered integrated care pathway for STRC was developed. To provide insight into patient characteristics within STRC and to examine the effect of implementing the new care pathway, a process and effect evaluation is performed. To assess the effects, a prospective cohort study will be performed. Across nine STRC departments in the Netherlands data is collected on age, gender, informal care, functional status (measured with Barthel Index), quality of life (measured with EQ-5D), quantity of received care and treatment, set and achieved recovery goals and discharge location. To assess whether or not STRC departments implemented the patient-centered care pathway, data was collected on adherence to planned implementation, perceived feasibility, factors that either facilitate or hinder the care pathway and the experiences of both clients and healthcare providers regarding the care provided.

Results:
Currently (October 2024) the baseline measurement is ongoing. Results of patient characteristics on the baseline measurement will be presented during the conference, as well as differences between organizations and regions. Next to this, results of the process evaluation will be presented which will be performed between January – July 2025. These results will provide insight into the feasibility of the new STRC care pathway, identifying the facilitating and hindering factors as well as experiences of clients and healthcare providers with the care provided using the new STRC care pathway.

Implications:
This study sheds light on the expected variation of patients admitted to STRC facilities, both between regions and organizations, as well as recommendations on the feasibility and experiences of clients and healthcare providers with the new STRC care pathway. It is expected that implementation of the pathway will lead to a decrease in variations in admission criteria and treatment provided in STRC and will better suit the needs of the patients admitted.

Abstract
Background: Extreme Weather Events (EWE’) in KwaZulu-Natal (KZN) province, South Africa are increasingly common causing disease outbreaks, loss of homes, property and life with pressure on the health system. An Early Warning System (EWS) intervention is needed to alert communities and government, to increase preparedness for floods, improving resilience of health services to predict, detect and respond to emergencies and potential disease outbreaks.

Objectives: To improve the preparedness/response of the healthcare systems/disaster management organisations and reduce healthcare burden. The EWS based on Artificial Intelligence (AI) and sensor technology for four vulnerable communities will be developed for implementation in two districts: eThekwini and Ugu districts of KZN province. An AI-based solution will give vulnerable communities, health officials and policy makers early warning/alerts that they can use to make informed decisions, thereby limiting the impact of EWE’s.

Approach: The study sites are eThekwini and Ugu Health Districts. The study population comprises the community and health facilities in selected sites in the two health districts one urban and one rural. This transdisciplinary project will build on prior engagement with communities/health providers (e.g., communities, professionals, policy makers) integrating a participatory, co-creation approach. An over-arching intervention development framework will guide this project with evaluation conducted via a longitudinal, mixed methods approach in four work packages (WP’s). These consist of a systematic review on the impact of climate change on disease outbreaks (WP 1), an assessment of the disease burden at primary care clinics in Ugu and eThekwini (WP 2), health needs and community experiences at the time of an extreme weather event (WP 3), an assessment of the health systems resilience in responding to an extreme weather event. WP 4 will apply an overarching Realist Evaluation and SROI approach (focus groups, interviews and questionnaires) to evaluate the efficiency, acceptability and cost effectiveness of EWS impact on health outcomes during flooding in KZN province. EWS will be conducted in (WP 4). Ethics for the project has been sought from the relevant ethical committees.

Results: The data analysis will be informed by the data collected. Descriptive and inferential statistical analysis will be conducted on questionnaire data to understand pathogen leading to disease outbreaks and risk management strategies for health systems during flooding. The project will design, development and launch a dashboard for a command-and-control centre to enable EWE and disease outbreak alert/warning for selected vulnerable communities and establish communication with healthcare organisations (input to WP3 for resource management), vulnerable communities, community leaders and disaster management organisations based on a cascaded structure model. WP3 will develop training and mentor healthcare workers on how to ensure a resilient health system and respond in EWE’s. Finally, WP4 will capture the social cost benefit analysis of the EWS intervention to take account of the economic, environmental and social value of the EWS for communities and disaster risk reduction and the associated value.
Implications: Based on the study findings, recommendations will be made to the Department of Health with respect to an early warning system and health systems resilience.

Background: Population screening for health conditions is common in many health systems for people of all ages. Such screening programmes often target specific diseases, such as cancer or diabetes to identify early signs of the disease and improve treatment outcomes. For older people, increased risk of falls as well as age-related conditions such as sarcopenia and frailty, have all been recommended for screening to facilitate early interventions, such as physical activity. A comprehensive frailty screening approach has been implemented in the UK based on the accumulation of deficits approach. The electronic Frailty Index (eFI) uses electronic health records data to identify older people who might be moderately or severely frail, with diagnosis confirmed using a tool such as the Clinical Frailty Scale. Although this approach is successful, data in electronic health records can be incomplete, particularly among ethnic minority groups who are less likely to visit their GP. This could mean that many frail older people are undetected. In terms of physical frailty and sarcopenia, the UK does not have a screening programme in place, although tools such as the SARC-F, FRAIL, or gait speed tests are recommended. The main issues with a proactive approach to screening for frailty and sarcopenia, as recommended by international guidelines, is that there is a lack of public awareness of both conditions, while for many older people it is difficult to access primary care. Other issues include whether older adults accept screening for these conditions, while healthcare professionals in primary care have limited time to perform opportunistic screening. The aim of this study is to develop a screening programme for physical frailty and sarcopenia in community dwelling older people from a culturally diverse population.

Approach: This study uses a co-production approach that involves a wide range of stakeholders in the area covered by the Bedford, Luton, and Milton Keynes Integrated Care Service (BLMK ICS), which has one of the most culturally diverse populations in the UK. These stakeholders include older people from a range of different cultural backgrounds, community leaders, members of local authorities, as well as a wide range of healthcare professionals. Initial focus groups will be held within each group to identify barriers and facilitators to physical frailty and sarcopenia screening, as well as the components required in the screening programme. The screening programme that will be developed will use the Behaviour Change Wheel as an organisational tool to ensure that behaviour change is a core component of the programme. Following on from the initial focus groups, the screening programme will be co-produced by a group of stakeholders from the initial groups.

Implications: This will be the first example of a co-produced screening programme for physical frailty and sarcopenia. The programme will then be evaluated in a culturally diverse population of older people. This will directly impact both policy and practice and will proactively identify older people at risk of physical frailty and sarcopenia.

Background:
The understanding of service integration for improved health, attempts at achieving health equity for marginalized groups, and the collaboration with marginalized groups in the organization of their health services are usually treated as discrete topics. The aim of this study was to identify the relationship between the marginalized status of the Orthodox Jewish Community, an historically stigmatized community, and clinician and community-led efforts to improve health service integration for their community.

Approach:
An interdisciplinary, mixed-methods, participatory research study was co-designed to understand infectious disease response during the COVID-19 pandemic in a large urban Orthodox Jewish Community in Canada. With substantial engagement with community leaders and representatives, we undertook blood sampling, researcher-led surveys, key informant and community member interviews, and extensive participant-observation. A sensitivity-specificity analysis was conducted of dried blood samples. Hypothesized survey responses were analyzed in GraphPad Prism version 8.4.0 and R version 4.2.1. Semi-structured interview transcripts, and ethnographic fieldnotes, were analyzed thematically.

Results:
During the COVID-19 pandemic, community leadership of the community’s central clinic, and healthcare professionals, took greater responsibility for community members’ welfare and increased engagement with larger health services and a hospital to optimize universal coverage and streamline communication and referrals. Early in the COVID-19 pandemic, the Orthodox Jewish Community yielded an antibody rate more than five times higher than the general population (59% versus 10%). Assumptions were made in the media which reflected historic stigmatization of the Orthodox Jewish Community. Trust in government policy responses to the pandemic declined, especially among men. Bearing witness to the negotiation efforts of community leaders to the challenges and opportunities of enhancing care integration showed stigmatized responses to the community’s efforts to straddle unique cultural with broad societal needs and priorities.

Implications:
This project shows: 1). the importance of integrating community perspectives in practice improvement initiatives, given that citizens can have realistic and sustainable solutions to integrated care across services; 2). the dangers for health equity of a “one-size-fits-all” approach to health policy without ways to integrate the needs of particular groups; and 3). the importance of understanding gendered differences in meanings and responses associated with catastrophic health events. Lessons have been shared with community leaders and policy-makers. Follow up research will involve key informant interviews, focus groups, surveys and record review to assess the effectiveness of clinic integration with other health services.