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This paper aims to explore smokefree prison policy, from the perspective of people in custody in Scotland.

In total, 77 people in custody in Scotland were interviewed in the period leading up to implementation of a nationwide prison smokefree policy. Data were thematically analysed to identify the diversity of views and experiences.

Participants described a widespread awareness in prisons of plans to implement a smokefree policy from 30 November 2018. Opinions about smokefree prisons varied among participants based on perceptions of the fairness, and anticipated positive and negative consequences of removing tobacco from prisons. At the time of the interviews, people in custody were responding to the impending smokefree policy, either by proactively preparing for the smokefree rule change or by deploying avoidance strategies. Participants described opportunities and challenges for implementing smokefree policy in prisons across three main themes: the role of smoking in prison, prison smoking cessation services and motivations for quitting smoking among people in custody.

This study exploring smokefree prisons from the perspectives of people in custody has several novel features which extend the evidence base. The findings highlight measures for jurisdictions to consider when planning to prohibit smoking in their prisons in the future. These include the need for evidence-based smoking cessation support in advance of smokefree policy, effective communication campaigns, consideration of broader structural determinants of health in prison and ongoing measures to reduce rates of return to smoking post release.

This study aims to co-develop a Frailty, Health and Care Needs Assessment (FHCNA) questionnaire for people experiencing homelessness and explore the feasibility of its use by non-clinical staff in homeless hostels.

The FHCNA, aimed at identifying frailty and other health and care priorities for people experiencing homelessness, was co-designed in workshops (online and in person) with homelessness and inclusion health staff. Its feasibility was tested by staff and their clients in two hostels, with pre- and post-study focus groups held with hostel staff to gain input and feedback.

The FHCNA was co-developed and then used to collect 74 pairs of resident and key worker inputted data (62% of eligible hostel residents). The mean age of clients was 48 years (range 22–82 years). High levels of unmet need were identified. Over half (53%) were identified as frail. Common concerns included difficulty walking (46%), frequent falls (43%), chronic pain (36%), mental health issues (57%) and dental concerns (50%). In total, 59% of clients reported difficulty in performing at least one basic activity of daily living, while only 14% had undergone a Care Act Assessment. Hostel staff found using the FHCNA to be feasible, acceptable and potentially useful in facilitating explorations of met and unmet health and social care needs of hostel clients. By identifying unmet needs, the FHCNA has the potential to support staff to advocate for access to health and social care support.

To the best of the authors’ knowledge, this is the first study to co-develop and feasibility test a questionnaire for use by non-clinically trained staff to identify frailty and other health and care needs of people experiencing homelessness in a hostel setting.

The Models of Child Health Appraised (MOCHA) project recognises that child health policy is determined to a great extent by national culture; thus, exploring and understanding the cultural influences on national policies are essential to fully appraise the models of primary care. Cultures are created by the population who adopt national rituals, beliefs and code systems and are unique to each country. To understand the effects of culture on public policy, and the resulting primary care services, we explored the socio-cultural background of four components of policy-making: content, actors, contexts and processes. Responses from the MOCHA Country Agents about recent key national concerns and debates about child health and policy were analysed to identify the key factors as determinants of policy. These included awareness, contextual change, freedom, history, lifestyle, religion, societal activation and tolerance. To understand the influence of these factors on policy, we identified important internal and external structural determinants, which we grouped into those identified within the structure of health care policy (internal), and those which are only indirectly correlated with the policy environment (external). An important child-focused cultural determinant of policy is the national attitude to child abuse. We focused on the role of primary care in preventing and identifying abuse of children and young people, and treating its consequences, which can last a lifetime.

Africa has been identified as an area where higher mortality happens due to un-accessibility to health care, drugs and other health facilities. Nigeria, as one of the African countries, is not excluded from such difficulties. This study aims to examine the determinants of efficient last-mile delivery at selected health facilities and the Kaduna State Health Supplies Management Agency (KADSHMA).

The study sourced data from KADSHMA and the health facilities’ staff, with a total of 261 observations used. Likewise, the respondents were picked from warehouses of each health facility and KADSHMA. The data was analysed using the partial least square structural equation modelling analysis to estimate the relationship among the variables of the study.

The study’s findings revealed that all five variables of the study (i.e. determinants) were significantly affecting the efficient last-mile delivery. Four constructs (delivery cost [DC], delivery time [DT], mode of delivery [MD] and facilities technology [FT]) have shown a positive and significant association with efficient last-mile delivery, whereas one variable (product mix [PM]) indicated a negative and significant association with efficient last-mile delivery. The study concludes that DC, DT, MD, FT and PM played significant roles in efficient last-mile delivery.

The study provides that specific means of transportation should always be on standby to transport health supplies. Time schedules should always be prepared and adhered to when transporting health supplies to the facilities, and each facility should network with robust technology to ease communication in terms of order and order planning. Additionally, facilities should try as much as possible to reduce the varieties of products when ordering health supplies, as it will increase the efficiency of the delivery.

To the best of the authors’ knowledge, this study is the first of its kind that considered these five variables (DC, DT, MD, FT and PM) with impact on the last-mile delivery in one model, especially in the Nigerian case. This is a great contribution to knowledge, more importantly, to the last-mile delivery of the health sector. The result confirmed the importance of these determinants (DC, DT, FT and PM) of last-mile delivery efficiency in saving lives.

The purpose of this paper is to describe Karen refugee women’s experience of resettlement and the factors which structured community capacity to support their mental health and well-being.

A postcolonial and feminist standpoint was used to bring Karen women’s voice to the knowledge production process. Data were collected through ethnographic field observation, in-depth semi-structured individual and focus group interviews with Karen women as well as healthcare and social service providers.

Three interrelated themes emerged from the data: Karen women’s construction of mental health as “stress and worry”; gender, language and health literacy intersected, shaping Karen women’s access to health care and social resources; flexible partnerships between settlement agencies, primary care and public health promoted community capacity but were challenged by neoliberalism.

Karen women and families are a diverse group with a unique historical context. Not all the findings are applicable across refugee women.

This paper highlights the social determinants of mental health for Karen women and community responses for mitigating psychological distress during resettlement.

Public health policy requires a contextualized understanding of refugee women’s mental health. Health promotion in resettlement must include culturally safe provision of health care to mitigate sources of psychological distress during resettlement.

This research brings a postcolonial and feminist analysis to community capacity as a public health strategy.

Evaluating primary care for children has not before been undertaken on a national level, and only infrequently on an international level, an adult-focused perspective is the norm. The Models of Child Health Appraised (MOCHA) project explored the evaluation of quality of primary care for children in a nationally comparable way, which recognises the influence of all components of child well-being and well-becoming. Using adult-focused metrics fails to account for children’s physical and psycho-social development at different ages, differences in health and non-health determinants, patterns of disease and risk factors and the stages of the life course. To do this, we attempted to identify comparable measures of child health in the European Union and European Economic Area countries, we aimed to perform a structural equation modelling technique to identify causal effects of certain policies or procedures in children’s primary care and we aimed to identify and interrogate large datasets for key tracer conditions. We found that the creation of comparative data for children and child health services remains a low priority in Europe, and the largely unmet need for indicators covering all the healthcare dimensions hampers development of evidence-based policy. In terms of the MOCHA project objective of appraising models of child primary health care, the results of this specific work show that the means of appraisal of system and service quality are not yet agreed or mature, as well as having inadequate data to fuel them.

Health is at the center of society concerns, being characterized by the dilemma of contributing to the population well-being, while demanding high financial investments at the same time. In this sense, information technology (IT) becomes essential for the progress of the sector, directly impacting on how care practices are performed. This study aims to analyze the adoption of mobile devices in the mobile emergency care service (MECS) of the state of Rio Grande do Sul, Brazil.

The authors carried out a multi-method study with an initial qualitative exploration through a focal group, followed by a survey. Potential determinants and impacts of mobile device use on the work context of the MECS teams were identified. Following, we tested the proposed conceptual model applying a questionnaire to 350 professionals from a total of 160 bases throughout the State. Partial least squares structural equation modeling was used to test the hypotheses herein.

The authors found that Satisfaction with the Use of Mobile PHC (PHC – Primary Health Care) is determined by the application compatibility with MECS work, followed by the performance expectancy with the use of the technology and the technical support provided to the users – acting as important facilitators of this process; while the technological complexity inherent in the use of the technology appears as the main barrier to the success of this technology. Besides, the authors found that both intensity of Use and Satisfaction with the Use of the technology provide different benefits to those involved (teams, patients and the organization).

As limitations of the study, the authors point out to the fact that the data are from a single Brazilian State, and therefore, its results cannot be generalized. Another limitation is that the study considered only the use of a specific mobile technology, which requires caution when using this information in contexts where the health information technology is different, besides the fact that the findings may not be compatible in environments where IT adoption is voluntary.

The study can help managers of public and private organizations in the planning and implementation of different technologies, whether mobile or applied to the health context, as well as in the expansion of their use in their respective institutions.

The research contributes to other studies that realize that the adoption of IT can cause relevant changes to health being associated to productivity gains and improvement of the quality of service provided to society through different forms and solutions.

The adoption and use of IT – such as mobile devices – impacts on how care practices are performed in the MECS, providing different benefits to those involved (teams, patients and the organization).

Policies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity.

The analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities.

The place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities.

This study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society.

Sex and gender are regarded as critical structural determinants of mental health and mental illness. Mental illness is a complex phenomenon, and risky behaviour and substance use commonly occur simultaneously or subsequent to one another. A gendered vulnerability in biological, environmental, and behavioural risk factors has been registered in the development and escalation of mental illness. Studies have found that women who use drugs experience greater physical and mental health repercussions than men. Women who use drugs present higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress. This chapter addresses the most common mental illnesses associated with women who use drugs: depression, anxiety, trauma-related disorders, and eating disorders.