Intervention and evaluation studies
MAMAACT is a complex intervention study for increased ethnic equality in maternal and child health. The study is a cluster randomised trial with 19 Danish maternity wards participating and aims to create change in the clinical setting by improving the communication between pregnant women and midwives regarding signs of complications in pregnancy. Optimal and timely response to warning signs in pregnancy from both the women and the health system are expected to lead to improved health literacy of the women and reduced infant morbidity and survival. For more information: https://sulim.ku.dk/dansk/mamaact/
Contact person: Sarah Fredsted Villadsen
The International Diabetes Federation estimates that 382 million people live with diabetes worldwide and this number is expected to rise to over half a billion by 2035. Urban life is one of the key drivers behind the global diabetes challenge. By 2050, nearly 70% of the world’s population will live in urban areas, and already today, nearly two thirds of all people with diabetes live in cities. As a response, Novo Nordisk has initiated Cities Changing Diabetes (CCD) – a global partnership programme to address the urban diabetes challenge. In Europe, Copenhagen has been appointed as CCD city, and in August 2014 collaboration between Novo Nordisk, the municipality of Copenhagen, Danish Diabetes Association and Steno Diabetes Center Copenhagen - and Department of Public Health, University of Copenhagen was established, focusing on social inequality and vulnerability within the subareas in Copenhagen.
Section of Social Medicine has contributed to an initial mapping phase, conducting a quantitative analysis of the diabetes problem in Copenhagen(1) and a qualitative vulnerability assessment analysis based on the results from the quantitative analysis(2). The overall objective in the qualitative analysis was to gain in-depth information on what attributes the most to vulnerability seen from the perspectives of vulnerable diabetes patients and citizens at risk. The analyzes concluded a need for a comprehensive and coordinated effort that could form a bridge between health care and the individual's everyday life, and the recommendations were adopted in a city action plan for type 2 diabetes.
Based on the analyzes and the city action plan, the Copenhagen partnership is currently developing three diabetes interventions targeted vulnerable persons living with type 2 diabetes in vulnerable areas in Copenhagen. The three initiatives consist of a peer-support program, an outgoing rehabilitation function and a new GP practice in the social vulnerable area Tingbjerg In Copenhagen. The overall purpose is to reduce inequalities in health by strengthen the vulnerable groups access to healthcare.
An industrial PhD study has been established in the CCD partnership together with the Center for Diabetes at the Municipality of Copenhagen. The purpose of the PhD study is to follow the implementation of the initiatives and conduct an evaluation in the period from 2018 to 2021. The Realistic Evaluation framework, which is a theory-driven evaluation will be used to investigate in both the implementation and the effect of the initiatives. Further, the contextual factors that influence the implementation will be addressed. Methodically, a mixed-method design will be used.
Contact persons: Ulla Christensen, Stine Øien Dandanell
A recent Rule of Halves analysis indicated that Copenhagen is doing better than the Rule of Halves. However, when it comes to diabetes treatment, there is still room for improvement. The proportions achieving treatment goals are only around 40-60%. Further, one out of four of those with diabetes have not been diagnosed, and approx. 50% of the diabetes population is achieving the desired outcomes in terms of no prevalent experienced cardiovascular complications. Although 98% receive some form of care, that does not necessarily reflect appropriate and timely care. The proportion of patients receiving screening for complications and clinical assessment according to national guidelines is markedly lower and ranging between 80% and 90%.
Further, the results show that there are major socioeconomic differences in the prevalence of risk factors and occurrence of diabetes. Low educated have twice the prevalence of high risk score and diabetes compared to high educated. Not employed have 40 to 80% higher rates than employed in the same age. Populations with non-western background also have twice the risk compared to others. The aim of this project is to identify the risk factors that would contribute to the development of health care services targeted towards socially vulnerable diabetes 2 patients.
The project is based on an extensive ethnographic study, conducted in a hospital ward and in 10 different general practices in the capital region of Denmark. 16 patients in the hospital ward and 16 patients in general practice are followed during two consultations with diabetes nurses and medical doctors, 64 consultations in total. After each of these consultations semi-structured research interviews are conducted with both the patient and the health care professional. Based on the results a feasibility study will be developed in collaboration with the health care professionals in order to qualify the cross sectional health services offered the socially vulnerable patients.
Contact person: Ulla Christensen