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      „… oder doch lieber daheimbleiben?“ – Unterstützung bei der Entscheidung zur Inanspruchnahme der Regelversorgung während der COVID-19-Pandemie durch Akteure des Gesundheitssystems Translated title: “I better stay at home…”—health system decisions to support the use of routine healthcare during the COVID-19 pandemic

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          Abstract

          Hintergrund

          In der COVID-19-Pandemie ging die Versorgung nichtübertragbarer Erkrankungen zeitweise deutlich zurück, auch weil Menschen Angst vor einer Ansteckung hatten. Wir führen eine Bestandsaufnahme zur organisationalen Gesundheitskompetenz in der Regelversorgung nichtübertragbarer Erkrankungen in der ersten Welle der COVID-19-Pandemie durch und fragen: Inwiefern wurden Menschen mit gesundheitlichen Beschwerden dabei unterstützt, gesundheitskompetente Entscheidungen für oder gegen die Inanspruchnahme von Versorgungsleistungen zu treffen?

          Methodik

          Strukturierende Inhaltsanalyse der Internetpräsenzen der Mitglieder der Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften (AWMF; n = 179), der kassen(zahn)ärztlichen Vereinigungen (K(Z)Ven; n = 38), ausgewählter Krankenkassen ( n = 21), ausgewählter Behandlungseinrichtungen ( n = 25) und überregionaler Anbieter von Gesundheitsinformationen ( n = 5) zu Informationen und Angeboten zum Thema.

          Ergebnisse

          Die geprüften Internetpräsenzen informieren weitgehend rund um COVID-19, aber nur selten darüber, wie man sich bei einer (vermuteten) anderen Erkrankung in Bezug auf die Inanspruchnahme von Versorgungsleistungen verhält. 2 Portale von Anbietern von Gesundheitsinformationen, eine Krankenkasse, aber keine der KVen bieten explizite Entscheidungshilfen an. KVen weisen öfter, aber nicht durchgängig auf die generelle Möglichkeit von Videosprechstunden hin.

          Diskussion

          Für die meisten Patient*innen gab es damit keine gezielten Informationen zu dem Thema. Angesichts der Fortdauer der COVID-19-Pandemie gilt es, vorhandene vertrauenswürdige, qualitativ hochwertige Informations- und Beratungskapazitäten auszubauen und ihre Bekanntheit zu erhöhen, um gesundheitskompetente Entscheidungen auch in der Pandemie zu ermöglichen.

          Translated abstract

          Background

          During the COVID-19 pandemic, sharp disruptions of healthcare utilization for noncommunicable diseases were observed to some extent because of people’s fear of infection. We undertook a review of German healthcare institutions asking: To what extent were people supported in their decisions (not) to seek medical care for health problems other than COVID-19?

          Methods

          Content analysis of the websites of the members of the Association of Scientific Medical Societies (AWMF; n = 179), the association of statutory (dental) health insurance physicians (K(Z)Vs; n = 38), selected health insurances ( n = 21), selected healthcare institutions ( n = 25), and supraregional health information providers ( n = 5) for information and offers that address people with noncommunicable diseases.

          Results

          The examined websites provide information about COVID-19, but only rarely about how to behave in the case of another (suspected) disease regarding healthcare utilization. Two health information provider portals, one health insurance company, but none of the KVs offer explicit decision support. KVs refer more often, but not consistently, to the general possibility of video consulting.

          Discussion

          Information concerning the topic is scarce for most of the patients. In the face of the ongoing pandemic, it is important to expand existing, trustworthy, high-quality information and advisory capacities to increase their profile in order to enable health-literate decisions even during a pandemic.

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          Most cited references37

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          Health literacy and public health: A systematic review and integration of definitions and models

          Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
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            Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

            Background The COVID‐19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID‐19. Methods A global expert‐response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian beta‐regression model was used to estimate 12‐week cancellation rates for 190 countries. Elective surgical case‐mix data, stratified by specialty and indication (cancer versus benign surgery), was determined. This case‐mix was applied to country‐level surgical volumes. The 12‐week cancellation rates were then applied to these figures to calculate total cancelled operations. Results The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID‐19 (2,367,050 operations per week). Most would be operations for benign disease (90.2%, 25,638,922/28,404,603). The overall 12‐week cancellation rate would be 72.3%. Globally, 81.7% (25,638,921/31,378,062) of benign surgery, 37.7% (2,324,069/6,162,311) of cancer surgery, and 25.4% (441,611/1,735,483) of elective Caesarean sections would be cancelled or postponed. If countries increase their normal surgical volume by 20% post‐pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID‐19 disruption. Conclusions A very large number of operations will be cancelled or postponed due to disruption caused by COVID‐19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. This article is protected by copyright. All rights reserved.
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              COVID-19: health literacy is an underestimated problem

              Rapid development of coronavirus disease 2019 (COVID-19) into a pandemic has called for people to acquire and apply health information, and adapt their behaviour at a fast pace. 1 Health communication intended to educate people about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and how to avoid getting or spreading the infection has become widely available. Most valuable information is created in an easy-to-understand manner that offers simple and practical solutions, such as washing hands, maintaining physical distance 2 , and where to find information about the latest recommendations, and advice. Unfortunately, there is also complex, contradictory, and false information. 1 Similarly, individuals are considered able to acquire, understand, and use this information in a sound and ethical manner—ie, to be health literate. However, the COVID-19 infodemic 1 has highlighted that poor health literacy among a population is an underestimated public health problem globally. For instance, in Europe, nearly half of adults reported having problems with health literacy and not having relevant competencies to take care of their health and that of others. 3 Health literacy is already seen as a crucial tool for the prevention of non-communicable diseases with investments in education and communication sought to be sustainable, long-term measures starting early in the life course. 4 However, when COVID-19 emerged rapidly, two aspects became striking. First, globally, health literacy is as important for the prevention of communicable diseases as it is for non-communicable diseases. Second, along with system preparedness, individual preparedness is key for solving complex real-life problems. In this pandemic, it is difficult, yet possible, to take the time to enhance health literacy because immediate action is required by governments and citizens. For countries to secure health-care services for the most susceptible individuals, many people have adopted policies that restrict physical contact by banning events, sizing limits for group gatherings, and even issuing stay-at-home orders. Governments and health authorities are pleading for individual responsibility in avoiding all unnecessary risks for infection with or spread of SARS-CoV-2. During these times, the discussion around human rights and personal freedom, democracy, social responsibility, and public health action are put to the test. Amid the pandemic, it is difficult to agree with the argument made by Wikler 5 that “if people know they are taking risks but accept them as the price of pursuing goals to which they assign higher priority, then it is not the business of public health to insist that health be valued above all”. 5 This argument might be true under different circumstances, but now, irrational behaviour in non-compliance with COVID-19 policies, which might be motivated by misperception of risks 6 or other personal priorities, allows a so-called free rider problem. 7 This issue has been widely discussed in the context of vaccination, 8 but it can also occur during the COVID-19 outbreak by deliberately neglecting precautions and protective behaviour. Most people act in a socially responsible way and with solidarity, thus creating a collective good of infection-free space and decreased infection risk. The so-called free riders enjoy the benefits themselves of others complying with the given policies (ie, decreasing risks) 7 ; however, they travel, hang around in groups, and ignore pleas for protective and preventive behaviour, feeling a false sense of invulnerability. 9 Nonetheless, as the risk of becoming infected is dependent on other people's compliance with the guidelines and the risk of others is dependent on commitment to joint efforts, unwillingness to contribute to collective good is unfair on other members of society.8, 10 In the COVID-19 pandemic, this behaviour does injustice, especially to high-risk groups, people with diseases, and the health workforce trying to treat these patient groups and save their lives. Health literacy might help people to grasp the reasons behind the recommendations and reflect on outcomes of their various possible actions. However, taking social responsibility, thinking beyond personal interests, and understanding how people make choices—aspects such as ethical viewpoints and behavioural insights—should also be considered within the toolbox of health literacy. Solidarity and social responsibility should not only be accounted for by the general population and decision makers, but also by those individuals who produce and share misleading and false information about SARS-CoV-2. The development of health literacy is even more topical than ever to prepare individuals for situations that require rapid reaction. Above all, health literacy should be seen in relation to social responsibility and solidarity, and is needed from both people in need of information and services and the individuals who provide them and assure their accessibility for the general population.
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                Author and article information

                Contributors
                evamaria.bitzer@ph-freiburg.de
                Journal
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-9990
                1437-1588
                12 February 2021
                12 February 2021
                : 1-8
                Affiliations
                [1 ]GRID grid.461778.b, ISNI 0000 0000 9752 9146, Institut für Alltagskultur und Bewegung und Gesundheit, Fachrichtung: Public Health & Health Education, , Pädagogische Hochschule Freiburg, ; Kunzenweg 21, 79117 Freiburg, Deutschland
                [2 ]GRID grid.5560.6, ISNI 0000 0001 1009 3608, Fakultät VI Medizin und Gesundheitswissenschaften, Organisationsbezogene Versorgungsforschung, , Carl von Ossietzky Universität Oldenburg, ; Oldenburg, Deutschland
                [3 ]GRID grid.5807.a, ISNI 0000 0001 1018 4307, Medizinische Fakultät, Institut für Sozialmedizin und Gesundheitssystemforschung, , Otto-von-Guericke-Universität Magdeburg, ; Magdeburg, Deutschland
                Article
                3282
                10.1007/s00103-021-03282-4
                7880208
                33580268
                5ea2f46b-aacb-40b0-a45c-5c7eed5ebb3f
                © The Author(s) 2021

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 10 September 2020
                : 14 January 2021
                Funding
                Funded by: Pädagogische Hochschule Freiburg (3122)
                Categories
                Leitthema

                individuelle gesundheitskompetenz,organisationale gesundheitskompetenz,gesundheitsinformation,entscheidungsunterstützung,gesundheitssystem,health literacy,health-literate healthcare,health information,decision support,healthcare system

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