The research focus of the DHPRM corresponds to long-lasting tradition of multidisciplinary socio-epidemiological research of social determinants of health, especially among vulnerable populations such as children and adolescents, and health or socially disadvantaged groups of population. While in children and adolescents we focus mainly on their healthy development, in adults it is especially health/disease progression and quality of life, as well as patients’ disease management (compliance, health literacy).
HEALTH AND HEALTH-RELATED BEHAVIOURS IN SCHOOL-AGED CHILDREN IN THEIR SOCIAL CONTEXT
The Health Behaviour in School-aged Children (HBSC) study monitors health and health-related behaviours in school-aged children aged 11-15 years. The data is country-representative and comparable with other 50 countries of the Northern Hemisphere and enables also time-series analysis since data collection takes place in 4-year intervals. The study allows us not only to monitor the healthy development of school-aged children, but also to perform analyses and come up with new findings on risk and protective factors for their healthy development.
HEALTHY DEVELOPMENT OF HEALTH IMPAIRED SCHOOL-AGED CHILDREN
In order to involve the largest possible portion of school-aged children into the HBSC study and not to exclude either children from national or ethnic minorities or children with health impairment, an international working group has been established. In collaboration with the WHO Office in Bratislava and the HBSC research network, this group developed the methodology that would facilitate participation of these population groups in the study and also its implementation into the national protocols. In connection with these efforts, we develop our cooperation with clinical departments and satellite studies concentrating on selected clinical groups, such as overweight or obese adolescents (Department of Paediatrics and Adolescent Medicine UPJŠ and Children University Hospital), adolescents suffering from diabetes mellitus (Departments of Endocrinology), etc. Besides, we are involved in the working group within the HBSC network, which aims to create a suitable tool for mapping the health literacy in school-aged children.
MAPPING THE SYSTEM OF CARE FOR ADOLESCENTS WITH EMOTIONAL AND BEHAVIOURAL PROBLEMS
Children and adolescents with emotional and behavioural disorders represent a research challenge not only from the perspective of diagnostics and care, but especially from the perspective of their development and social consequences. For this reason, in collaboration with international institutions (University of Groningen, Masaryk university in Brno) and experts from various fields we prepared a quantitative and qualitative project Care4Youth aimed to map the system of care for adolescents with emotional and behavioral problems as well as to monitor risk and protective developmental factors in context of trajectory of clients from this group in the system of care.
SOCIAL DETERMINANTS OF HEALTH IN MARGINALIZED ROMA COMMUNITIES
Social and health disadvantaged populations are the second important target group. Attention was paid to the issues of migration, migrants, ethnic minorities and their health needs, and also to the groups at risk of poverty or school-aged children with special health needs.
Inhabitants of Roma communities are one of the most frequent target populations. Their health and its social determinants are analysed using ecological (K. Rosičová) and population studies (P. Kolarčik, D. Bobáková), including biochemical health indicators (e.g. HepaMeta). We continue in this work and extended it by ethnographic approach (A. Belák). Apart from this, we take part in preparation of the comprehensive system of health monitoring in marginalized Roma communities and also methodology for evaluation of the national project entitled Healthy Communities, which represents the largest and most developed program of health mediation for Roma communities. We are currently focusing on the research on early childhood development in the marginalized Roma communities and factors threatening health and healthy development, as well as on identifying and removing health system barriers regarding access of people from marginalized communities to vaccination against HPV viruses.
Health literacy, as a capability to profit from the services provided, is an important construct. Therefore, we try to develop a valid measurement tool, which would allow us to monitor profiles of individual dimensions of health literacy in groups of patients/clients in the context of the health care/services provided. Moreover, each healthcare system and type of the healthcare has different demands on health literacy of the given group of clients. This will be reflected in quality of cooperation between the health care/service provider and patient/client and, in turn, also in health and quality of life. The cultural competence of care providers might significantly influence the harmony between demands and actual possibilities and subsequently also efficiency of the services provided.
In its research work, the Care4health research group (www.care4health.sk) continues its cooperation, which has been carried out in recent years with clinics and institutes of UPJS and UNLP, especially with the Department of Neurology of UPJŠ and UNLP, II. Department of Internal Medicine, Department of Dentistry, Department of Vascular Surgery, Department of Children and Adolescents, UPJŠ and DFN, Logman a.s. and Fresenius – dialysis services s.r.o. and the Institute of Medical and Clinical Biochemistry. We are also developing cooperation with the Department of Dental Hygiene PU FZO. In collaboration with dialysis networks we continue monitoring activities of 2- and 5- years mortality rates in patients involved in previous research activities and data collection. Furthermore, based on our research experience, we are preparing recommendations and video instructions for effective interventions in dialysed patients.
INDIVIDUAL PATIENTS’ EXPERIENCES – HEALTH TALKS (DIPEx)
We are currently working on involving our department in the international research network DIPEx International. It is an international network of researchers engaged in qualitative research on people’s experiences of health and disease, with the aim of deepening the understanding of individual health experiences for the benefit of patients and their families, as well as healthcare providers, researchers and policy makers. The network currently covers 14 countries and almost 200 health conditions and reaches millions of people every year. We consider the DIPEx study to be a key part of educating future doctors and healthcare professionals, as well as improving the healthcare system and patients’ quality of life. More information can be found at https://dipexinternational.org/. From the point of view of our department, this is a project that will gradually cover each of its research domains. Our long-term goal is thus to create modules of individual patient experiences in connection with the research domains of our department.
INNOVATIVE METHODS PROMOTING STAKEHOLDERS’ ENGAGEMENT
Especially, cooperation with the WHO Office in Bratislava and also WHO Offices in Venice, Copenhagen, Ljubljana, Vilnius and Prague stimulated interest in development of innovative methods promoting involvement of stakeholders (policymakers, expert practitioners, academics, but also representatives of target groups, i.e. vulnerable populations), stakeholders’ capacity building, transfer of knowledge and prioritizing the agenda with focus on promotion of target group involvement in research. The aim is not only to stimulate “evidence based policy”, but also “policy based research” in the closest cooperation possible with the relevant target groups.
The Deakin University in Melbourne, Australia, is one of the leading Australian universities. We cooperate with them in the field of research on health literacy. Our collaboration is related to translation and validation of the Health Literacy Questionnaire that was developed by the team of Prof. Richard Osborne at the School of Health and Social Development. We plan to deepen the cooperation during further applications of health literacy, especially in disadvantaged communities.
Within the research cooperation with the University of Groningen (Netherlands) which carried out the C4Youth Take Care study focusing on children and youth with emotional and behavioural problems in the Netherlands (http://www.c4youth.nl/), we prepared the project Care4Youth ((https://care4youth.com/) aiming to map the system of care for adolescents with emotional and behavioral problems and to monitor trajectories of children and adolescent with emotional and behavioural disorders in the system of social and health care in close collaboration with experts from the fields of psychiatry, psychology, and social work. Opportunity to compare Slovak and Dutch findings based on both realized longitudinal studies on adolescents suffering from emotional and behavioural problems in their social context and also in the context of system of care strives for bringing the missing knowledge, deepening the understanding of the issue and, in turn, promotion of development of the integrated system of social and health care for children and adolescents with emotional and behavioural disorders. Collaboration on this project was realized also with help from Institute of Research on Children, Youth, and Family at the Masaryk University.
As part of the DIPEx project, we work closely with the University of Oxford in the UK and Olomouc University Social Health Institute (OUSHI).
Within the HBSC international network we intensively collaborate, for instance, with colleagues from the University of St. Andrews and University of Copenhagen on development of measures of socioeconomic characteristics of family, with the National University of Ireland in Galway in the field of violent behaviours, or with the Center of Kinanthropology Research at the Palacky University in the research of active lifestyle.
In the areas of new communication technologies and screen-based behaviour, and also in the area of children’s trajectories in the educational system we cooperate with the IVDMR at the Faculty of Social Studies, Masaryk University in Brno.
Within the framework of international cooperation on the COST platform (European Cooperation in Science and Technology), we cooperate with academics, researchers and other stakeholders in 25 countries of the world in the project The European researchers’ network working on second victims (ERNST – Cost Action CA19113). We are developing close cooperation especially with FISABIO in Spain.
The research collaboration with several external researchers and institutions resulted in establishment of the research hub entitled Community Health Research Network (CoHeRenT), www.coherent.sk