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This study is oriented towards getting insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.

A thematic qualitative study was carried out using semi-structured interviews with 12 Syrian refugees living in the Netherlands. Data analysis consisted of three steps and was oriented towards the development of themes.

Participants were confronted with restricted access to antibiotics in the Netherlands which was contrary to their experiences in Syria. Some of them continued to self-prescribe antibiotics, while others adhered to the Dutch General Practitioner (GP)’s advice. Especially mothers with young children took up the Dutch GP’s advice. Syrian refugees expressed health beliefs about the healing effects of antibiotics which are related to their past experiences of use and which influenced their current use. Respondents complained about the Dutch health-care system and expressed a preference for the one in Syria.

Syrian refugees vary in their way of dealing with restricted access to antibiotics in Dutch primary care. More in-depth knowledge is required to improve refugee patient–doctor communication about antibiotic use.

The message that antibiotics are not needed may be challenging. Additional communication seems to be necessary to persuade Syrian refugees from self-prescribing antibiotics. Therefore, identifying refugee patient concerns and carefully counseling and communicating it with them is substantial. Developing educational toolkits consisting of various experiences of antibiotic use and ways of dealing with it can equip doctors to more adequately react to migrants’ needs for care.

Primary care professionals seem insufficiently equipped to tackle issues related to antibiotic use amongst newly arrived migrants. Therefore, it is important to support professionals in their communication with this patient group about the proper use of antibiotics.

This study shows that more in-depth knowledge is needed about the strategies of newly arrived migrants and their complex reactions to treatment prescriptions with which they are not familiar.

The purpose of this paper is to measure reliability, validity and accuracy of the 12-item General Health Questionnaire (GHQ-12) as a measure of emotional wellbeing in pregnant women; utility and threshold in particular.

The authors measured self-reported emotional wellbeing responses of 164 low-risk pregnant Dutch women with the GHQ-12 and a dichotomous case-finding item (Gold standard). The authors established internal consistency of the 12 GHQ-items (Cronbach’s coefficient α); construct validity: factor analysis using Oblimin rotation; convergent validity (Pearson’s correlation) and discriminatory ability (area under the receiver operating characteristics curve and index of union); and external validity of the dichotomous criterion standard against the GHQ-12 responses (sensitivity, specificity, likelihood ratios and predictive values), applying a cut-off value of ⩾ 12 and ⩾ 17, respectively.

A coefficient of 0.85 showed construct reliability. The GHQ-12 items in the pattern matrix showed a three-dimensional factorial model: factor 1, anxiety and depression; factor 2, coping; and factor 3, significance/effect on life, with a total variance of 59 per cent. The GHQ-12 showed good accuracy (0.84; p=<0.001) and external validity (r=0.57; p=<0.001) when the cut-off value was set at the ⩾ 17 value. Using a cut-off value of ⩾ 17 demonstrated higher sensitivity (72.32 vs 41.07 per cent) but lower specificity (32.69 vs 55.77 per cent) compared to the commonly used cut-off value of ⩾ 12.

Findings generally support the reliability, validity and accuracy of the Dutch version of the GHQ-12. Further evaluation of the measure, at more than one timepoint during pregnancy, is recommended.

The GHQ-12 holds the potential to measure antenatal emotional wellbeing and women’s emotional responses and coping mechanisms with reduced antenatal emotional wellbeing.

Adapting the GHQ-12 cut-off value enables effective identification of reduced emotional wellbeing to provide adequate care and allows potential reduction of anxiety among healthy pregnant women who are incorrectly screened as positive.

A novel aspect is adapting the threshold of the GHQ-12 to ⩾ 17 in antenatal care.

Health care integration is crucial in improving service equality and patient outcomes. However, measuring integration between the health and social care sectors remains challenging. This article aims to review existing systematic models to identify alternative health and social care integration measurement tools. The review focuses on models that involve systematic planning and long-term cooperation across different organizational sectors.

The study examines various dimensions and elements of integration, including process, outcome and structural measures. It compares different tools used to measure social and health care integration, such as the Rainbow model, Balanced Scorecard (BSC) Scorecard, PRISMA, SCIROCCO, integRATE, health-data simulation (HSIM) and the model developed by Åhgren and Axelsson. The analysis includes both empirical studies and theoretical frameworks.

The findings highlight the importance of standardized measurement methods to assess the impact of integration initiatives on patient outcomes, healthcare costs and the quality of care.

The review contributes to the ongoing discourse on social and health care integration, particularly in the Nordic context. The results can inform social and healthcare providers, policymakers and researchers in evaluating and improving integration initiatives.

A global trend of type 2 diabetes prevalence is rising. Preventing and managing of systemic and dental complications is crucial to decrease negative effects on glycemic control. The purpose of this paper is to estimate the efficacy of Brief Lifestyle Change in conjunction with Dental Care (Brief-LCDC) Programs to decrease glycemic level and improve periodontal status in patients with type 2 diabetes.

Health Center 54 conducted randomized controlled trial among 192 patients (96 intervention and 96 control) from February to August 2018. Group education for lifestyle modification, individual oral hygiene instruction and lifestyle counseling by motivational interviewing was provided to the intervention group at baseline. Motivation of lifestyle modification every month by multimedia was also provided to the intervention group. The usual program was provided to the control group. At baseline and a six-month follow-up, glycemic level and periodontal status were assessed from participants. Data were analyzed by descriptive statistic, t-test, χ² test, Fisher’s exact test, Repeated measure ANOVA and multiple linear regression.

Glycemic level and periodontal status were lower in the intervention group than the control group at the sixth-month followed up with statistical significances. Glycemic level and periodontal status had negatively correlated to intervention group with statistically significant.

Brief-LCDC Program which incorporated lifestyle modification and oral health care had efficacious to decrease glycemic level and improve periodontal status in patients with type 2 diabetes. Early prevention program by Brief-LCDC Program is crucial to prevent dental complications.

This article aims to provide a literature review on the use of quality function deployment (QFD) in healthcare and a case study in order to provide contextual knowledge as a means of improving applications of QFD in healthcare.

The literature search was done via Google Scholar, PubMed/MEDLINE, and Web of Science using the keywords “quality function deployment” and “healthcare”; focusing on journal publications and their related citations. The case study was done within a design for Six Sigma project (DFSS) in a Swedish hospital. Empirical data were collected through face‐to‐face interviews and project documentation.

Four potentials (better understanding of customers' needs and wants, identification of opportunities for process improvement, effective system thinking approach, and better communication and more transparent process) and three antecedents (understanding the customer, understanding the customer's needs, and finding ways to prioritize and translate those needs) of QFD application in healthcare were identified from the literature review. From the case study, the application of QFD leads to an increased awareness of a complex multiple‐customer concept, traceability of the improvement strategies in a more structured way, and the formation of a new process organization. A time study at one clinic (cardiology) before and after the project within which the QFD was used showed that the time spent on prescription of medication has decreased by more than 20 percent. This has increased the time that doctors can spend with their patients.

This paper highlights the potentials and antecedents of applying QFD in healthcare from previous research. Furthermore, the practical findings obtained from applying QFD in the project can also provide some useful insights for practitioners.

The novel contribution is two‐fold. First, it is the identification of the potentials and antecedents of using QFD in healthcare context. Second, it is the findings and learning from a practical application of QFD for improving a medication process in the hospital.

The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools reported in these studies while highlighting gaps in the literature.

Peer-reviewed studies, published in English during 1961–2016 across eight electronic databases, were subjected to a narrative literature review.

Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: assessing intervention effects on PSC (n=17), and assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Interventions varied from a single action lasting five weeks to a more comprehensive four year package. The time between baseline and follow-up assessment varied from 6 to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC.

Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs and find ways to incorporate the patient’s voice.

This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

In the Netherlands, childcare and primary schools are governed by two different systems of two ministries, and although these institutes are usually located nearby, there always have been low levels of cohesion with respect to institute-to-institute collaboration. However currently, there is a national trend in enhancing interprofessional collaboration (IPC) with the aim of inclusion and equity. This study focuses on getting insight into the differences in intensity of collaboration and how IPC is organized. A two-dimensional Child Centre Integration Model which accounts for the variations in the degree of IPC in child centres and gives insight into IPC at different levels and into conditions for intensifying IPC is presented. That Dutch education and childcare systems do not connect with each other is seen to be an important cause of the failure or complication of IPC. Because the systems do not connect at the macro level, we see struggles in the necessary normative dimension due to status differences (i.e., inequality between employees) and differences in funding and autonomy. Differences between public (education) and private (childcare) institutions also lead to difficulties when it comes to fostering closer collaboration. This chapter ends with key lessons for practice and policy, including the suggestion that one strong ministry for child affairs, including education and childcare, which stimulates an unambitious course at national level, is required. This course can then be translated at regional and local levels.