007. Факультет охорони здоров`я, соціальної роботи і психології

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Факультет створений у 2023 році.

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Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population
(2024) Mazhnaya, Alyona; Geurts, Brogan; Brigida, Krestina; Bakieva, Shokhista; Sadirova, Shakhlo; Witzigmann, Annika; Musabaev, Erkin; Brandl, Michael; Weishaar, Heide; Dudareva, Sandra; El Bcheraoui, Charbel
Introduction In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022–2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions. Methods This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan. Results Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator. Conclusions A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.
Bridging gaps: improving the access of primary health care in rural Ukraine through mobile health units
(2024) Suzyma, Valentyna; Yurochko, Tetiana
Rural healthcare is an integral part of the Ukrainian healthcare system. However, access to healthcare for the rural population is uneven due to poor development of medical infrastructure and staffing. The problem of access to medical care in rural areas has been exacerbated by the full-scale war. The objective: to study and analyze the current state of accessibility of primary health care in rural areas in Ukraine, followed by a discussion of promising areas for the introduction of mobile health units as a tool for implementing the "Medical Guarantees" program in hard-to-reach regions of Ukraine. Materials and methods. The study included data from official statistical reports, regulatory documents and scientific sources. The methodology includes bibliosemantic, medical and statistical methods and the method of structural logical analysis. Results. It has been established that the low level of access to primary health care for the rural population of Ukraine has been significantly exacerbated by the devastating impact of the war on medical and transport infrastructure, especially in the frontline and recently de-occupied rural areas, and by migration processes. The situation is complicated by the fact that most patients in rural areas are elderly people who are physically unable to use public transportation, even if it is available. The analysis of international practice has shown that mobile health units can be introduced into the public healthcare system as a temporary measure to meet the urgent needs of the Ukrainian population, especially in rural areas. Integration of mobile health units into the state program "Medical Guarantees" can effectively address the urgent health care needs to increase access to health care for the rural population of Ukraine. State regulation of the division of these units will eliminate problems such as duplication and uneven service delivery and will create a transparent system of remuneration for the staff included in these units. Conclusions. The results of the study suggest that the practice of mobile medical units should be introduced as a tool for implementing the "Medical Guarantees" program for regions/locations of Ukraine with low access to medical infrastructure, namely remote rural areas and areas that have been devastated by the war. Mobile medical units will ensure the stability of access to primary health care services and contribute to improving the health of the population.
Common strategies in empirically supported psychological interventions for alcohol use disorders: A meta-review
(2023) Nadkarni, Abhijit; Massazza, Alessandro; Guda, Rahul; Fernandes, Luanna; Garg, Ankur; Jolly, Mehak; Skovgaard Andersen, Lena; Bhatia, Urvita; Bogdanov, Sergiy; Roberts, Bayard; Tol, Wietse; Velleman, Richard; Moore, Quincy; Fuhr, Daniela
Issues: Despite the large number of effective psychological interventions for alcohol use disorders (AUD), there is still a lack of clarity concerning the strategies that make these interventions effective. Approach: The overall goal of this review was to identify, examine and synthesise the information about common strategies from evidence-based psychological interventions for AUDs by conducting a review of systematic reviews, that is, a meta-review. We isolated the relevant primary studies from eligible systematic reviews and extracted information about the interventions from these studies to understand the strategies used. Analysis was restricted to narrative summaries. Key Findings: Thirteen reviews were eligible for inclusion in our meta-review. Of these, eight demonstrated the effectiveness of a range of psychological interventions—behavioural couples therapy, cognitive behaviour therapy combined with motivational interviewing, brief interventions, contingency management, psychotherapy plus brief interventions, Alcoholics Anonymous and 12-step treatment programs, family-therapy or family-involved treatment, and community reinforcement approach. The most commonly used component strategies in effective interventions for AUDs included assessment, personalised feedback, motivational interviewing, goal setting, setting and review of homework, problem solving skills and relapse prevention/management. Implications: Evidence about commonly used strategies in evidence-based psychological interventions for AUDs offer the possibility of creating menu-driven interventions that can be tailored to respond to individual client needs and preferences in different contexts.
Countermeasure policy for chronic noncommunicable diseases in Ukraine
(2023) Yurochko, Tetiana; Kondratiuk, Viktoriia
Background: Noncommunicable diseases (ncd) are main reason for disability and precocious mortality rate in ukraine. they are determining main socio-economic consequences for countrys development and need urgent intervention in political decisions and coordinated actions on all levels. Objective: Comprehensively assess situation of countermeasures, consolidate data from pre-war period about ncd preventive conditions in strategy development of post-war health care system restoration in Ukraine. Methods: The assessment was done accordingly to who methodology "effective treatment of non-communicable diseases: challenges and solutions for the healthcare systems" within the Ukrainian-switzerland project " act for health " Results: The major NCDS are not only part of irreversible losses because of mortality but factors in reducing life expectancy. contribution of ncds is significant, mainly cardiovascular disease, as Ukraines overall disease burden (dalys) which were 8/9 of total years of life lost for women and - for men. There are gaps in primary care in prevention and control of ncds, despite its importance and work done by the system to overcome the epidemy of cardiovascular disease (CVD), diabetes, and oncology diseases in Ukraine. nevertheless, mortality rate from these pathologies remains high, showing a systemic fracture in patient group management system and lack of attention to prevention and financial support. As a result, unhealthy lifestyle practices lead to a high level of CVD spread. the number of neglected cases of diabetes and their complications caused by uncontrolled disease courses remains high. Oncology treatment spending from the government and patient budget remains an acute problem. Conclusions: Results of research show gaps in the pre-war periods activities, which significantly increased due to the destructive impact of war that system passes. Health care system post-war restoration plan development should be based on challenges and barriers depending on populations health condition analysis and pre-war system work.
Current challenges in accessibility to ophthalmological care in Ukraine
(2024) Skrypnikova, Olena; Yurochko, Tetiana
Aim: The purpose of the study is to identify challenges in the organization and access to ophthalmic services through the analysis of expert opinion of practitioners and government officials. Materials and Methods: Materials developed during expert interviews with practitioners and government officials were used in the study. We also used materials worked out within the project ID 22120107 supported by Visegrád Fund. Conclusions: Despite all the challenges in access to high-quality ophthalmology services, practitioners and government officials have common opinions on how to improve the organization of eye services, how to make care more inclusive and effective, so that the development of blindness and visual impairment does not cause a burden on the state and society.
Development and Piloting of a Mental Health Prevention and Referral Program for Veterans and Their Families in Ukraine
(2023) Nguyen, Amanda J.; Russell, Tara; Skavenski, Stephanie; Bogdanov, Sergiy; Lomakina, Kira; Ivaniuk, Iryna; Aldridge, Luke R.; Bolton, Paul; Murray, Laura; Bass, Judy
Background: While growing evidence exists for the effectiveness of mental health interventions in global mental health, the evidence base for psychosocial supports is lacking despite the need for a broader range of supports that span the prevention–treatment continuum and can be integrated into other service systems. Following rigorous evaluation of the Common Elements Treatment Approach (CETA) in Ukraine, this article describes the development and feasibility testing of CETA Psychosocial Support (CPSS), a brief psychosocial prevention and referral program for Ukrainian veterans and their families. CPSS Development: CPSS development used evidence-based CETA intervention components and was informed by a stakeholder needs analysis incorporating feedback from veterans and their families, literature review, and expert consultations. The program includes psychoeducation, cognitive coping skill development, and a self-assessment tool that identifies participants for potential referral. After initial development of the program, the intervention underwent: (1) initial implementation by skilled providers focused on iterative refinement; (2) additional field-testing of the refined intervention by newly trained providers in real-world conditions; and (3) a formal pilot evaluation with collection of pre-post mental health assessments and implementation ratings using locally validated instruments. Results: Fifteen CPSS providers delivered 14 group sessions to 109 participants (55 veterans, 39 family members, and 15 providers from veterans’ service organizations). After incorporating changes related to content, process, and group dynamics, data from the pilot evaluation suggest the refined CPSS program is an acceptable and potentially effective brief psychosocial prevention and promotion program that can be implemented by trained veteran providers. Forty percent of participants required safety or referral follow-ups. Conclusion: The iterative, inclusive development process resulted in an appropriate program with content and implementation strategies tailored to Ukrainian veterans and their families. Brief psychosocial programs can fit within a larger multitiered mental health and psychosocial continuum of care that supports further referral.
Digital solutions for the development of corporate health programs
(2023) Aleksandrenko, Hlib; Shevchenko, Maryna
Introduction. The article examines the relevance and importance of the health status of employees in modern society. Considering the rapid development of digital technologies, the expediency of their use to improve health and well-being at workplaces is being investigated. Purpose. The purpose of the article is to analyze the current state of development of digital technologies for corporate health programs, as well as to present the results of the developed and implemented digital tool for the implementation of the corporate health program. Materials and methods. The research materials are: 1) regulatory and legal support for the regulation of corporate health of employees of enterprises; 2) information resources of foreign companies that use scientific and practical achievements in the field of digital technology development to preserve and strengthen the corporate health of enterprise employees. In the process of carrying out the research, the following scientific methods were used: theoretical generalization (to characterize corporate health programs and digital applications for tracking the individual corporate health of employees); formalization, analysis and synthesis (to build a model of strengthening corporate health); logical generalization of results (formulation of conclusions). Results. One of the modern trends in the field of personnel management (or, as we call it now, human resources or HR) is the implementation of a holistic approach to the well-being of employees. Companies offer innovative programs to ensure financial well-being, mental health, a healthy lifestyle (in particular, nutrition, physical activity), stress management, etc. It has been becoming a part of both the employer's corporate social responsibility and a strategy crafted to ensure the maintenance of a positive HR brand, attract and retain talents, and increase the level of employee engagement as well as efficiency. It has been confirmed by the results of the Deloitte study. The developed and implemented model of the corporate health program, one of the components of which is the use of digital tools in the form of an automated system of interaction, ensured effective communication and feedback with program participants and prompt response to their needs. Automated distribution of information, support, and personalization were carried out thanks to the proposed algorithm and the possibility of customization through the personal account of each program participant. Thus, we were able to provide a personalized approach to each of them. Discussion. The predicted economic efficiency of this program is estimated for the company's management at approximately $51,000 per year. It has been established that strategies, conditions, or activities carried out in the work environment can motivate employees to make changes that will not only have a positive effect on their health and well-being but also allow for increased productivity at the workplace.
Diverse social identities and their importance for public health : a syllabi collection with hands-on material for teaching
(ASPHER, 2023) Wandschneider, Lisa; Wetzel, Lorena; Skrypnikova, Olena; Podar, Monica Diana; Lütke Lanfer, Hanna; Selig, Suzanne; Namer, Yudit
Members of minoritised population groups are exposed to higher burdens of morbidity and mortality and face barriers to accessing health care systems and other critical resources to achieve optimal health. Intersectional perspectives that emphasise the dimensions of social power and discrimination are just beginning to emerge in public health research. These perspectives contextualise longstanding patterns of health inequalities but are rarely translated into public health curricula. Concepts like "cultural competence" or "diversity, equity and inclusion" do address the importance of awareness and respect for (cultural) diversity in (patient/client) populations. The research and teaching examples available are largely limited to a USA context, tend to consider specific identities, rather than intersectional characteristics, are not systematically integrated in public health curricula and are usually not rooted in a theoretical approach of teaching. It is imperative that Europe bridges the knowledge-to-teaching gap and begins introducing similar programs, while learning from the limitations of USA efforts. Two steps are needed to strengthen public health educational institutions and improve population health: first, to systematically incorporate an intersectional paradigm into public health curricula; and second, to provide faculty members in public health programs with transformative teaching skills (Namer & Wandschneider, 2021). In advocating for the improvement of public health education in Europe, ASPHER fully endorses the need to bring diversity more into the focus of teaching. ASPHER therefore developed a policy on diversity competence to be an element of the ASPHER 2025 strategy. This approach goes beyond the notion of cultural diversity as ASPHER envisages an intersectional, holistic notion to reflect on multiple dimensions of diversity that affect the health of populations (Wandschneider et al., 2020).
Environmental competencies for healthcare management at a 2nd education level as a component of strategic management
(2024) Turianytsia, Solomiia; Yurochko, Tetiana; Balashov, Kostyantyn; Hulchiy, Olesya
Aim: To present the results of the analysis of educational standards and curricula of the second educational level of training of specialists, who may be managers of healthcare, on the content of the environmental component as an element of strategic management. Materials and Methods: Content analysis 24 educational standards of the Ministry of Education and Science of Ukraine for 6 fields of knowledge and 200 master’s curricula from 87 institutions of higher education of Ukraine. Conclusions: There is a distribution of basic leadership and management competencies both by types of these competencies and between specialties. The requirements for the inclusion of the environmental component in the framework documents are poorly expressed. The content of environmental issues in the curricula is insufficient.
Exploring prevalence and factors associated with postpartum depression among Ukrainian wome
(2024) Gusak, Nataliia; Kendall, Sally; Nizalova, Olena
Introduction: Postpartum depression negatively impacts maternal mental health and child development. The high prevalence of postpartum depression (PPD) in low and lower middle-income countries raises questions about its predictors. This study examines the association between PPD and breastfeeding experience, child death, unresolved pregnancy, forced displacement, COVID-19 pandemic lockdown, marital, and financial status among Ukrainian women. Methods: This online study recruited 1634 Ukrainian mothers of children aged 0–5 years through non-governmental organizations providing services to them. The Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥13, was used to assess depressive symptoms in the postpartum period. Independent t-tests, chi-squared tests, one-way ANOVA, non-parametric correlations, and logistic regression tests were used to analyze the data. Results: The prevalence of depressive symptoms was 39.0% (n=1631). There was a positive association between EPDS scores and breastfeeding difficulties, pandemic lockdown, and financial difficulties. We did not find an association between PPD symptoms and unresolved pregnancy, death of a child, being affected by COVID-19, and forced displacement. We found that EPDS scores for women who did not experience forced displacement (n=1528) were significantly higher compared to displaced mothers (n=74). Conclusions: The present study of Ukrainian women shows that women experienced depressive symptoms influenced by various factors including breastfeeding difficulties, pandemic lockdown, and financial difficulties. There is a need for additional research into such factors as unresolved pregnancy, the death of a child, being affected by COVID-19, and forced displacement.
Facilitators and barriers for implementation of community-based mental health interventions in Western and Eastern Europe - a systematic literature review
(2023) Remy, Maurice Luca; Blijleven, Putu Stephanie; Coetzer, Jessica Amy; Bondarenko, Nataliia
With a high prevalence of mental health disorders in Europe and the increasing call for human-rights approaches in their treatment, the number of community-based mental health (CBMH) interventions is growing within the region. However, the implementation of these CMBH interventions differs between countries and regions, especially between Western and Eastern European countries. The reasons for these differences are based on societal and health systems, but also the design and implementation of the intervention. This systematic literature review examined the existing literature on CMBH interventions in Europe, to identify facilitators and barriers in the implementation process. Emerging themes that were found are the importance of collaboration, the availability of adequate resources, and the consideration of the community perspective in the process. The differences between Western and Eastern Europe which were discovered were mostly caused by a lack of financial and human resources and a higher existing stigma around mental health disorders in communities.
Higher education at wartime: research trends, gaps and perspectives
(2023) Vereshchahina, Tetiana; Bodnar, Alla; Lyashchenko, O.
Матеріали доповіді учасників ХХ Міжнародної науково-практичної конференції "Конфліктологічна експертиза: теорія та методика" від 16 листопада 2023 р., Київ, Україна.
How language affects access to services and information
(2023) Fricke, Christine; Gusak, Nataliia; Kryshtal, Andrii
Effective support for people fleeing the war in Ukraine requires an understanding of their language and communication needs and preferences. Ukraine is multilingual. Ukrainian, the official language, is spoken alongside Russian and minority languages like Romani, Crimean Tatar, Hungarian and Gagauz. Ukrainians affected by the war face multiple language challenges, and barriers to communicating their needs and accessing information and services. The cooperation and involvement of Governments, NGOs and language service providers can all play a vital role in helping Ukrainian refugees to overcome language and communication obstacles, access the information and services they need, and start building their lives in new countries.
How much can we learn from each other? Polish and Hungarian good practices in financing ophthalmology care as a proposal for implementation in Ukraine
(2024) Więckowska, Barbara; Byszek, Katarzyna; Rękas, Marek; Yurochko, Tetiana; Shevchenko, Maryna; Skrypnikova, Olena; Dozsa, Csaba; Toth, Melanie
The article aims to compare payment schemes for cataract, glaucoma, vitrectomy, cornea transplantations, DME, and AMD across Hungary, Poland, and Ukraine, and to identify implementable practices in Ukraine within the context of ongoing healthcare reforms.
Meeting the long-term health needs of Ukrainian refugees
(2023) Murphy, Adrianna; Bartovic, Jozef; Bogdanov, Sergiy; Bozorgmehr, Kayvan; Gheorgita, Stela; Habicht, Triin; Richardson, Erica; Azzopardi-Muscat, Natasha; McKee, Martin
Objectives: Since Russia's full-scale invasion of Ukraine on 24 February 2022, millions of people have fled the country. Most people have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. Our objectives were to review host country health system experiences and identify priorities for research to inform sustainable health system responses to the health care needs of refugees from Ukraine. Study Design: In-person conference workshop. Methods: A workshop on this subject was held in November 2022 at the European Public Health Conference in Berlin. Results: The workshop included participants from academia and non-governmental organisations, health practitioners, and World Health Organisation regional and country offices. This short communication reports the main conclusions from the workshop. Conclusion: Addressing the challenges and research priorities identified will require international solidarity and co-operation.
Narrative in Social Work Education
(2023) Kabachenko, Nadiya; Boyko, Oksana
The lecture is aimed at analysis of existing understanding of narrative method of teaching by modern scholars, as well as the specific ways and goals of its application in everyday practice. Specific consideration is given to exploration of narratives in social work education in higher education settings. Detailed description and in-depth analysis is provided on the use of narratives in teaching social work courses at the Bachelor program at the School of Social Work of the National University of Kyiv-Mohyla Academy. An analysis is provided for the content of topics of studies where such narratives are used, like life history, oral narratives etc. Specific cases of narrative use presented in the lecture include: students’ creating and telling the narrative on behalf of the imagined character with the relevant characteristics; using visualization (photos), based on which the narrative is created; creating and delivering the future narrative by participation of the other character; understanding the history narrative; analysis and interpretation of narratives collected by the use of oral narrative or life story. It is claimed that using the narrative promotes students' activization, empowers them for the project work, enables their gaining new experience and experiential learning. Moreover, developing and telling the narratives enhances students’ intense communication and creativity as well as their engagement into the education process which is of high importance within the distance learning framework. The narrative is of high value for the social work education and training as this approach ensures developing capacity to listen to the clients’ stories, to analyze and to understand their life stories, to assist in changing clients’ lives by using success stories. Since the full scale war in Ukraine in 2022, people's war narratives bring a wide range of personal and professional insights for social work students.
Organization of ophthalmological care in Ukraine
(2023) Skrypnikova, Olena; Yurochko, Tetiana
The aim: To consider the organization of ophthalmological care in Ukraine for cataract and glaucoma and +nd out whether it is appropriate to implement advanced good practices of reference countries for Ukraine. Materials and methods: The method of desk review was used, supported by secondary analysis of data, in particular legislative acts. The research included conducting expert interviews with ophthalmologist of the public and private sectors, heads of public healthcare institutions, and management of the National Health Service of Ukraine. We also used materials on good practices from partners within the project ID 22120107 supported by Visegrád Fund. Results: Since the burden of ophthalmological pathologies is increasing and processes of reforming the health care system are taking place, changes in the organization and +nancing of ophthalmological services are taking place. Within the framework of the partner project, "Access to healthcare services in the context of +nancing mechanisms. The case of ophthalmology" identi+ed good practices in the organization of ophthalmological care in the context of improving access to services and improving quality. The results of interviews with key stakeholders led to the fact that the respondents generally support all the good practices proposed by the partner countries and indicate their arguments why the proposed practices are (not)appropriate to implement in Ukraine. Conclusions: The organization and +nancing of healthcare in Ukraine still require the study and implementation of good practices so that patients can have access to quality services and treatment.
The perception of outpatient care quality by healthcare users in Ukraine
(2024) Anufriyeva, Valentyna ; Pavlova, Milena ; Stepurko, Tetiana; Groot, Wim
Background: Ukraine has been improving the quality of health care by reforming the health care system. Evidence on healthcare users’ perceptions of quality is important for future system changes. This paper aims to analyze the aspects of quality that outpatient care users find most important. Methods: Data from a longitudinal household survey ‘Health Index. Ukraine’ in 2016–2019 were used. The survey had a sample size of over 10,000 participants per wave. Data were analyzed using descriptive statistics as well as binary regression analysis. Results: Our results showed the importance of quality attributes as ‘effectiveness of treatment’ and ‘qualification of medical personnel’ as well as changes in the perception of quality attributes connected with payment policies and general management of the facility (like working hours, setting and hygiene ensuring by medical personnel). Conclusions: Our study provides new insights into the importance of healthcare quality attributes for outpatient healthcare users in Ukraine, showing the need to develop in future a national policy on quality and a national quality strategy for health care that incorporates quality aspects important to patients to make the healthcare system more responsive to the needs and expectations of healthcare users.
Perceptions of quality and satisfaction with primary healthcare in Ukraine : dissertation to obtain the degree Doctor at Maastricht University
(2024) Anufriyeva, Valentyna
This dissertation focuses on the perceptions of healthcare quality in primary care in Ukraine. Healthcare services in Ukraine, as in other countries, aim to ensure accessible and affordable healthcare of the highest possible quality. This makes quality of healthcare one of the most essential values of the health system. Good quality of healthcare services in terms of healthcare that is effective, safe and patient-centered, and that is accessible and affordable for all, is a known predictor of population health. Quality is a major component of health system performance and quality improvement is an important aim of health policy. To ensure this, health policies at all levels (national, regional, and facility) need adequate instruments to measure, maintain and improve healthcare quality. Chapter 1 of this dissertation describes the concepts of healthcare quality and satisfaction as well as gives the aim and objectives of the studies included in the dissertation. As explained in the chapter, healthcare quality determines satisfaction with healthcare services, the latter being the driving force of decisions and behaviors as well as a known predictor of healthcare utilization and an influencing factor of health outcomes. Apart from being an element of quality, patient-satisfaction measures are an important tool to gain insight into the aspects of healthcare that patients truly value. There is little evidence on the perception of healthcare quality in Ukraine. Quality assurance procedures, though legally well-developed, are somewhat chaotic and formal. At the same time, Ukraine is experiencing a transition from central budgeting to capitation financing, from the Semashko model of healthcare organization to more managerial autonomy and free choice of healthcare provider. Therefore, the central aim of this dissertation is to obtain new knowledge on the perception of healthcare quality by different stakeholders as well as insights on self-reported satisfaction with primary healthcare, specifically, on general satisfaction with primary healthcare in Ukraine. In Chapter 2, the method of systematic literature review is used to study the psychometric properties of self-reported satisfaction with healthcare as a measure of quality. The aim of this chapter is to systematize the evidence on the validity and reliability of subjective measurements of satisfaction with healthcare. In this systematic literature review, we searched for relevant publications in PubMed and JSTOR databases. The key inclusion criteria were: (a) original research articles in peer-reviewed journals; (b) year of publication from 2008 onward; (c) English language publications. We applied directed qualitative content analysis to the publications included in the review. Overall, 1167 publications are found and screened. Of these, 39 publications that focus on the psychometric properties of the measurement of patient satisfaction, are included. The majority of the studies validate already existing instruments adapted to different contexts; the rest describe psychometric properties of self-developed tools. Psychometric properties are assessed by means of reliability and validity assessment. Reliability assessment is performed via Cronbach alpha and test-retest reliability. In total, 94.9% of studies find that the satisfaction measures are reliable. Validation is performed by a variety of different methods, among which the most applicable are face validity and factor analysis. Overall, 71.8% of studies find that the satisfaction measures are valid. Thus, we identified tools to measure quality, which were adapted to different contexts and self-developed, and we systematized evidence on their psychometric properties, specifically, on their validity and reliability. We find that quality measurement tools exist in a great variety depending on their purpose, context, resources, and others. Adaptive subjective measures prevail, which might be explained by their long-term usage, effectiveness as shown by the number of studies, as well as positive experience of usage of the measurements' results on micro- (organizational) and macro- (national) levels. At the same time, the growing number of studies measuring psychometric properties of self-developed patient satisfaction assessment tools shows the desire to have as exact an instrument as possible for the specific domains and specific healthcare facilities. Because of the complexity of the studies, we could not make strong recommendations on the application of self-reported satisfaction measures. We recommended the following key strategies: (1) developing a unified standard for satisfaction measurement; and (2) identifying a combination of tools to routinely measure satisfaction. We also suggested further research on the issue of subjectivity reduction. In Chapter 3, a combination of qualitative and quantitative data analysis is presented. This chapter provides new insights into primary care managers' perceptions of healthcare quality in Ukraine. Ukraine is reforming its health system to improve healthcare quality. Insight into how primary healthcare managers perceive quality is important for the ongoing reform as well as for the improvement of medical services. Data were gathered in an online survey, which was conducted as part of the UkrainianSwiss project "Medical Educational Development" in April-May 2019. A mixture of sampling methods was used: a total population sampling method and a convenience sampling method. The sampling was based on the contact list of USAID project "Health Reform Support", and additionally on the database of the National Health Service of Ukraine and other channels. Data were analyzed using descriptive statistics and qualitative data analysis. In total, 302 healthcare managers took part in the study. We identified fifteen groups of quality attributes important to primary healthcare managers. We also investigated quality assessment practices used by primary healthcare managers. The majority of primary healthcare managers perceive quality in healthcare as process quality. The frequency of mentioning the "compliance to standards" and "indicators" attributes confirms the traditional focus of the Ukrainian approach to quality and shows the lack of association of quality with integrated care. Primary healthcare managers prefer to assess outcome quality via a system of indicators and feedback. We find a high number of unclear descriptions of measurement tools given by the participants of our survey. This may have two major explanations. Primary healthcare managers do not distinguish between quality assessment (as a process) and the quality level in their facilities. Or the formulation of the question was unclear for the participants. There appears to be a lack of consensus about healthcare quality. Furthermore, most Ukrainian primary healthcare managers who took part in our survey do not recognize the multidimensionality of quality. This may be due to a lack of awareness of the national strategy for better quality of healthcare service. The absence of a clear consensus about quality complicates the discussion about quality and how to measure quality in healthcare. This appears to be one of the obstacles to systemwide quality improvement. The data used in the studies described in Chapter 4 and Chapter 5 were collected by means of repeated cross-section household surveys via face-to-face interviews by trained interviewers. The survey had a sample size of over 10,000 participants per wave. Based on these data in Chapter 4, we explored perceptions of outpatient care quality among healthcare users in Ukraine by identifying and comparing attributes important to outpatient healthcare users as well as by comparing any changes in their importance over a four-year period (2016 - 2019). We also explored changes in the importance of quality attributes that might have been provoked by the reform, which started in 2017. Evidence on healthcare users' perceptions of quality is important for future system changes. Data were analyzed using descriptive statistics as well as binary regression analysis. Healthcare quality in Ukraine is mostly associated by users with "effectiveness of treatment (the correct diagnosis, adequate treatment)" and "qualified medical personnel using modern and safe treatment methods". Both aspects are predisposed by socio-demographic characteristics. The "effectiveness of treatment (the correct diagnosis, adequate treatment)" aspect is predisposed by gender (more important for female respondents), low income and good self-reported health status. And "qualified medical personnel using modern and safe treatment methods" is predisposed by specialized education and low income. The perceptions of outpatient care users about attributes connected with payment policies and general management of the facility have changed over time. At the same time, quality is least associated with such aspects of quality as "the possibility to stay close to family members of patients" and "respect, trust and empathy to the patient". Whereas the "the possibility to stay close to family members of patients" aspect is not predisposed by socio-demographic characteristics included in the analysis and "respect, trust and empathy to the patient" is predisposed by gender, health status, occupation and type of settlement (less important to female respondents and respondents with average self-reported health status but more important for employed and urban inhabitants). Our analysis showed an increase in the importance (it more than doubled) of all the quality attributes in 2019 in comparison with other years. The reason behind this increase require further investigation. This chapter provides new insights into the importance of healthcare quality attributes for outpatient healthcare users in Ukraine, showing the need to develop a national policy on quality and a national quality strategy for healthcare that incorporates quality aspects important to patients. This will help to make the health system more responsive to the needs and expectations of healthcare users. Based on the same data in Chapter 5, we examined the general satisfaction with primary healthcare services in Ukraine among service users and nonusers before and after the implementation of the capitation reform in 2017-2020. We compared primary care users and non-users over a five-year period before and after the reform. Effects were estimated using difference-in-differences methods based on matched samples. Our findings show that in general, respondents are "rather satisfied" with the services of district/family doctors and pediatricians. Users of primary healthcare in our study rated their satisfaction with the family doctor and satisfaction with pediatrician higher than nonusers. In total, 72.1 % (users) and 69.2% (nonusers) were satisfied with their family doctor in 2016. This was 75.3% and 71.9% in 2020. For pediatrician services, these shares were 73.6% (users) and 71.1% (nonusers) in 2016; and 74.7% and 70.2% in 2020, respectively. The study in this chapter also revealed an increase in satisfaction with the district/family doctor over time. However, this does not seem to be due to the reform. The results for pediatrician services were mixed. Why satisfaction with primary care is fairly high and slightly increasing over time is unclear. However, we offer several possible explanations, such as low expectations of primary healthcare, subjective perception of healthcare quality, improved access and affordability, and general improvements in primary healthcare settings not directly linked to the reform. Other confounding variables included in our analysis, such as age, gender, education, type of settlement, self-reported health status, and the number of persons in the household, also showed an influence on satisfaction among users. However, only gender and selfreported health status had statistical significance over the years (2016-2020). Whereas age showed no statistical significance, and other variables were statistically significant three years out of five included in the analysis. Thus, the results of our analysis confirm the results of previous analyses described in the literature. At the same time, the reason why some of the variables had an effect in certain years could not be identified in the study. The final Chapter 6 outlines and discusses the main findings presented in the dissertation. The main findings of the studies included in this dissertation are presented in the form of five statements. Statement 1: Satisfaction with healthcare measures aspects of quality that are not measured by clinical quality measurement tools. This dissertation supports the importance of valid and reliable self-reported satisfaction with healthcare as a measure of quality. Including satisfaction in quality measures helps to measure the aspects of healthcare that healthcare users truly value. The discussion of this statement reveals a vague understanding of quality assessment tools and practices among healthcare managers in Ukraine. Thus, at the research level, there is a need to further study the routine application of measurement tools in healthcare management practice in Ukraine. At the policy level, there is a need to revise quality assessment practices on the levels of the system and facility. Statement 2: The healthcare financing reform of 2017-2020 has changed the discussion on the quality and satisfaction with healthcare in Ukraine. With the healthcare financing reform 2017-2020, Ukraine experienced dramatic change not only in financing principle and managerial freedom but more importantly in views and perceptions of healthcare professionals and users on the health system in general and on quality in particular. The discussion of this statement revealed a long history of top-down practices as well as paternalistic views on healthcare, leaving no place for providers' and patients' views on quality. Rapid health system changes and lack of data on quality perceptions lead to the recommendation that at the research level, it is important to collect and analyze repeated cross-sectional data on views and satisfaction of healthcare stakeholders (policy makers, healthcare providers and healthcare users) on quality. At the policy level, it is important to maintain the dialogue between the stakeholders, take into consideration their views and expectations, and to develop a working quality strategy. Statement 3: Primary healthcare managers and patients in Ukraine perceive quality mostly as process quality. The attention to outcome quality is limited. The discussion of this statement shows that both healthcare professionals (managers, medical doctors and nurses) and healthcare users in Ukraine perceive quality mostly as process quality. At the same time, attention to outcome is limited. This also explains the lack of attention to patient satisfaction. This means that at the policy level, health system responsiveness should be improved by raising awareness of important attributes of structure (like tangibles) or outcome (patient satisfaction) among healthcare professionals and users. At the research level, we did not find other studies of healthcare managers' perceptions of quality in Ukraine. We perceive the findings of Chapter 3 to be the baseline of such kind. Thus, healthcare managers' perceptions of quality in Ukraine require further study. Also, system responsiveness studies are rare in Ukraine and require further elaboration. Statement 4: A clear consensus about quality assessment and how to measure it is needed in Ukraine. The discussion of this statement shows little consensus about quality among Ukrainian healthcare managers as well as an unclear understanding of quality assessment. Education and clear messages on quality in healthcare from the Ministry of Health of Ukraine are important in developing a clear consensus about quality assessment and how to measure it. To achieve this at the policy level, the development and promotion of a national policy on quality and a national quality strategy for healthcare should become one of the priorities of the healthcare sector. Up-to-date quality education should be a part of clinical training as well as continuous professional development programs for medical doctors and nurses. At the research level, the perception of healthcare quality among healthcare managers, medical doctors, and nurses, as well as the routine application of measurement tools in healthcare management practice, require further study. Statement S: Paradoxically in Ukraine, satisfaction with primary care is high, although the health system does not perform well. The discussion of this statement reveals that the reasons behind high and increasing over time satisfaction are unclear and seem not to be directly linked to the reform. Healthcare users in Ukraine tend to express satisfaction with the services received on a facility level and relocate their satisfaction with primary healthcare services onto the health system in general. This implies that at the policy level, healthcare reforms should be strengthened by quality improvements in healthcare settings. At the same time, the principles of health system functioning should be well communicated to healthcare users. At the research level, further research is needed to fully understand the drivers of satisfaction, the extent to which responses are affected by adaptation bias and scale of reference bias, and to assess the impact of healthcare financing reforms on the quality and accessibility of primary care. During the work on this dissertation, the Ukrainian health system was rapidly changing. Healthcare financing reforms launched changes in managerial and educational practices, triggering different healthcare discussions. In general, healthcare stakeholders became more open and willing to be a part of discussions that had the ability to reshape the health system. Thus, quality perceptions and satisfaction with healthcare services gained more importance. The findings of the studies included in this dissertation will be relevant to policy makers, who could use our analysis to improve health system performance. Our analysis will also be beneficial for healthcare providers, who can use it to improve their quality assessment practices and strengthen the loyalty of their patients. Our findings will also be interesting to the countries with similar health system, experiencing similar transition.
Project: Safe Space: comprehensive psychosocial support to war-affected Ukrainian schools : research report
(2023) Bogdanov, Sergiy; Harbar, Kateryna; Bychko, Hanna
The "Safe Space" is a comprehensive psychosocial program, specifically aimed at enhancing the resilience of schoolchildren in the aftermath of traumatic events. Its multifaceted approach includes components directed at both children and their immediate social environment, involving parents and teachers. The Safe Space programme has a multi-level structure. This ensures that support is provided to everyone involved at different stages of implementation. Recognizing the dynamic nature of trauma response, the program allows for the integration of new research and methodologies, continuously evolving to meet the ever-changing needs of the community it serves. The model includes training teachers on resilience strengthening at the first level and training school psychologists in the 7-session group intervention with students at second level. Within educational institutions, the program is executed by school psychologists and teachers, who undergo specialized training in Safe Space methodology. Training for psychologists includes 3 days of didactics followed by weekly supervisions. Certification can succeed after conducting at list 2 children’s groups under supervision. Teacher’s training includes 1 day of didactic in the class room followed by 2 monthly online supervisions. Due to the security reasons caused by war all didactically trainings for teachers and school psychologists have happened in online format only.

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