Anbefalinger til anvendelse af organisatorisk sundhedskompetence til forandring af etniske minoriteters deltagelse i forebyggende sundhedsindsatser

Abstract

Titel: Anbefalinger til anvendelse af organisatorisk sundhedskompetence til forandring af etniske minoriteters deltagelse i forebyggende sundhedsindsatser Baggrund: Der ses en højere forekomst af forebyggelige kroniske sygdomme blandt etniske minoriteter end blandt etniske danskere. Samtidig ses det, at etniske minoriteter i lavere grad end etniske danskere benytter sig af forebyggende sundhedsindsatser, trods et større forbrug af øvrige sundhedsydelser. Sundhedskompetence fremhæves som determinant for etniske minoriteters sundhed og sygdom. Et nyere fokus inden for forskning i sundhedskompetence gør det klart, at sundhedskompetence skabes i et samspil mellem individuel og organisatorisk sundhedskompetence. Imidlertid har der i mange år været et stort fokus på individuel sundhedskompetence, mens organisatorisk sundhedskompetence er relativt overset. Dertil mangler der yderligere viden om organisatorisk sundhedskompetence i relation til forebyggelse. Formål: Formålet er, med et kritisk realistisk perspektiv, at undersøge mekanismer, der indvirker på etniske minoriteters deltagelse i forebyggende sundhedsindsatser, og hvordan organisationer, der udbyder forebyggelse kan anvende organisatorisk sundhedskompetence mhp. at forbedre etniske minoriteters adgang til forebyggende sundhedsindsatser. Metode: Der er udført et kvalitativt litteraturreview. Søgningen er foretaget i PubMed, Embase, Cinahl, ProQuest, PsykNet og Scopus efter studier, der bidrager med kvalitativ viden om etniske minoriteters deltagelse i forebyggende sundhedsindsatser. Dataekstraktion er foretaget i Nvivo 12, hvorefter data er syntetiseret i temaer, og de enkelte temaer er efterfølgende analyseret med udgangspunkt i Org-HLR frameworket af Trezona et al. (2017), som danner rammen for organisatorisk sundhedskompetence i specialet. Resultater: 19 artikler blev inkluderet, som bidrog med barrierer og facilitatorer for etniske minoriteters deltagelse i forebyggende sundhedsindsatser ud fra forskellige perspektiver. De identificerede barrierer og facilitatorer for etniske minoriteters deltagelse i forebyggende sundhedsindsatser relaterer sig til otte temaer; navigering i sundhedsvæsenet, socialt netværk, arbejdsgange, forståelser af sygdom, interventionens rammer, kommunikation, organisationens ressourcer og tilgængelighed. Alle syv domæner i Org-HLR frameworket bidrager med strategier, som kan imødekomme de identificerede barrierer og facilitatorer, i særdeleshed involvering af og samarbejde med lokalsamfundet. Der ses imidlertid også begrænsninger ved brugen af frameworket. Konklusion: Barrierer og facilitatorer for etniske minoriteters deltagelse i forebyggende sundhedsindsatser er afhængige af den tid og kontekst, de udspiller sig i. En systematisk tilgang til at blive en sundhedskompetent organisation kan bidrage positivt til forandring af etniske minoriteters deltagelse i forebyggende sundhedsindsatser. Det kræver imidlertid et aktivt valg og at der tildeles ressourcer til det. Politisk prioritering kan understøtte forandringen. Fremtidig forskning bør se på etniske minoriteters brug af forebyggende sundhedsindsatser. Der bør desuden være fokus på utilsigtede konsekvenser ved brug af Org-HLR frameworket.

Titel: Recommendations for the use of organizational health literacy for changing the participation of ethnic minorities in preventive health interventions. Background: There is a higher occurrence of preventable chronic diseases amongst ethnic minorities than ethnic Danes. At the same time ethnic minorities use preventive health interventions less, despite a higher use of other medical services. Health literacy is emphasized as a determinant for the health and disease of ethnic minorities. A more recent focus within health literacy research shows that, health literacy is created in an interaction between individual and organizational health literacy. However, for many years there has been great focus put on individual health literacy, while organizational health literacy has been relatively overlooked. To that there is a lack of knowledge of organizational health literacy in relation to prevention. Aim: The aim is, from a critical realistic perspective, to examine mechanisms that influence the participation of ethnic minorities in preventive health interventions, and how organizations that provide preventive health interventions can use organizational health literacy in order to improve the access to these interventions for ethnic minorities. Methods: A qualitative literature review was carried out. A search for studies that contribute qualitative knowledge on the participation of ethnic minorities in preventive health interventions was conducted in PubMed, Embase, Cinahl, ProQuest, PsykNet and Scopus. Extraction of data was carried out in Nvivo 12, after which data was synthesized into themes, and each theme was analyzed based on the Org-HLR framework by Trezona et al. (2017), which frames organizational health literacy in this thesis. Results: 19 articles were included, which contributed to barriers and facilitators for the participation of ethnic minorities in preventive health interventions. The identified barriers and facilitators for the participation of ethnic minorities in preventive health interventions relate to eight themes; navigation in the healthcare system, social network, work processes, understandings of disease, the intervention form, communication, the organizational resources and accessibility. All seven domains in the Org-HLR framework contribute with strategies that can meet the identified barriers and facilitators, in particular, community engagement and partnerships. However, there are also limitations when using the framework. Conclusion: Barriers and facilitators for ethnic minorities' participation in preventive health interventions are dependent on the time and context in which they take place. A systematic approach to becoming a health literate responsive organization can contribute positively to a change in participation of ethnic minorities in preventive healthcare. However, it requires an active choice and an allocation of resources towards it. Political prioritization can support the change. Future research should investigate ethnic minorities' use of preventive health interventions. Moreover there should be a focus on unintended consequences when using the Org-HLR framework.

A master thesis from Aalborg University

Anbefalinger til anvendelse af organisatorisk sundhedskompetence til forandring af etniske minoriteters deltagelse i forebyggende sundhedsindsatser

[Recommendations for the use of organizational health literacy for changing the participation of ethnic minorities in preventive health interventions.]