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Cancer survival has doubled and is likely to continue increasing in the near future. Cancer survivors experience long-term adverse effects, with associated psychological changes, and often they have needs that are yet to be met. Recognizing the lack of continuity-of-care initiatives for cancer survivors and caregivers, Osakidetza Basque Health Service has started to implement through primary care a peer-led active patient education program called \"Looking after my health after cancer\". This study explores how cancer survivors and their caregivers rate the experience of participating in the program, to what extent the program helps them understand and address their unmet felt needs, and helps them improve their activation for self-care and self-management. A qualitative exploratory phenomenological study was conducted using five focus groups: four with cancer survivors (n = 29) and caregivers (n = 2), and one with peer leaders (n = 7). Narrative content analysis was performed using the constant comparison method, facilitated by Atlas-ti software. Descriptive analysis of sociodemographic and clinical data was performed. The study was developed according to the Consolidated criteria for reporting qualitative research (COREQ) checklist. Five main themes emerged from the content analysis: 1) satisfaction with the program as a positive learning experience; 2) peer sharing and learning (\"if they can, so can I\"); 3) fears prior to attending the program; 4) becoming more aware of unmet felt needs and feeling understood in the \"new normal\"; and 5) a more positive view of their experience, helping them become active in self-care and empowered in the self-management of their condition. The peer education program has shown to have a positive impact on cancer survivors and caregivers. It is necessary to design, implement and evaluate interventions of this type to address unmet felt needs during cancer survivorship and improve their quality of life.

Purpose. The purpose of this study was to assess the feasibility of the Spanish Diabetes Self-Management Program (SDSMP) in the primary care setting of the Basque Health Service and offer initial estimations of the randomized controlled trial (RCT) effects. Methods. Ten health centers (HCs) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012. Recruitment was performed via invitation letters, health professionals, and the local media. Each intervention group consisted of 8–15 people. The ability of each HC in forming up to 2 groups, participants’ compliance with the course, and coordination and data collection issues were evaluated. Glycated haemoglobin (HbA1c) was the main outcome variable. Secondary outcomes were cardiovascular risk factors, drugs consumption, medical visits, quality of life, self-efficacy, physical exercise, and diet. Results. Two HCs did not organize a course. A total of 173 patients initiated the program, 2 dropped out without baseline data, and 90% completed it. No pre-post HbA1c differences existed. Certain improvements were observed in blood pressure control, self-efficacy, physical activity, and some dietary habits. Conclusion. The SDSMP is feasible in our setting. Our experience can be of interest when planning and conducting this program in similar health settings. The trial is registered with ClinicalTrials.gov identifier NCT01642394.

An introduction: The life expectancy of the general population in the Basque Country is around 80 years, while in the case of gypsy people it is below 60 years. A number of unhealthy eating habits and hygiene habits very common in the gypsy community are among the reasons for these marked differences. These have been some of the triggers for the Basque Government's Department of Health, Osakidetza and the Basque Gypsy community to work together in the development of an initiative that improves health education and contributes to the empowerment of the Gypsy community.Short description of practice change implemented: The Active Patient Program (APP) is a self-care education program that contributes to raising the health status of chronic patients. During 2016, a working group with representatives of the APP and the gypsy associations has worked on adapting the course \"Caring for my health\" to the socio-cultural context of the Gypsy people, emerging in the \"Caring for the health of the Gypsy people\" new course.One of the key points is that the workshops are facilitated by two trained leaders, both of whom are non-health professionals belonging to the gypsy community, so it is easier for the message to reach its objectives and increase attendees’ motivation to improve their living habits.Aim and theory of change: Health education and specifically the empowerment of patients and citizens through structured educational interventions have proven to be a very effective action in engaging people in the self-management of their own health conditions.Targeted population, stakeholders and timeline: All the Gypsy associations of the Basque Country were invited to participate in the initiative. During November and December 2016, 24 gypsies, all of them very active members of Gypsy associations in the Basque Country, have been accredited as facilitators of the workshop \"Caring for the health of the Gypsy people\". There are 12 workshops scheduled for the first quarter of 2017, expected to be attended by around 150 gypsies.Highlights: The training experience has been very positive for both the workshop trainers and the future facilitators.Lessons learned: This new program is aimed at people of gypsy ethnicity who want to improve their general health status.Discussions: Once the results have been evaluated in terms of acquired knowledge, perceived utility and overall satisfaction with the workshop, it will be assessed whether it is worthwhile to extend the program to other groups of gypsies and with what characteristics it should be done.Comments on sustainability and transferability: In a first phase we plan to implement the program in the Basque Country and, if the experience is positive, it could be transferred to other Autonomous Communities of Spain.Conclusions: They consider this methodology very useful for working with any kind of community, althouh some adaptations appeared as necessary for any particular cultural group. We show you a video made to show the program between them https://youtu.be/H4ulZUXI_ZA

Introduction: Type 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) proved to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Health Service – Osakidetza (Spain).Methods: This is a randomized clinical trial in which patients diagnosed with DM2, 18-79 years of age, from four health regions within the Basque Health Service have been randomized into two groups: an intervention group, who has followed the SDSMP, and a control group, who has received usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region. The intervention has consisted of 2.5-hour group sessions once a week for six weeks. The sessions cover target setting and problem solving techniques, promotion of physical exercise, basic knowledge of nutrition, proper use of medication, effective communication with relatives and health professionals, and basic knowledge about DM2 and its complications. This content is complemented by educational material: books, leaflets and CDs.The primary outcome measure has been the change in glycated hemoglobin (HbA1c), and secondary outcome measures have included changes in levels of physical activity and intake of fruit and vegetables, cardiovascular risk, quality of life, self-efficacy, number of consultations and drug prescriptions.The results have been analyzed 6, 12 and 24 months after the intervention by a repeated measures approach .Results: 594 patients have been included in the longitudinal analysis, 297 in each group (Control Group and Intervention Group). They have been monitored for two years. 532 patients have completed the whole monitoring.Overall, 59.75 % of the sample were male, with mean (SD) age 63.9(8.5) years old. The majority of participants (93.25%) were recruited by healthcare staff. The HbA1c basal average was 7.1 (1.66), the average blood pressure was 136.64/79.13 (19.2/11.3) and the BMI was 30.26 (4.92).Self-efficacy significantly improved both overall and in the different areas, namely, diet, physical activity and control of the disease. Significant differences in fruit consumption have been discovered as well. Satisfaction rate is very high.No statistically significant differences between the control and the intervention groups have been found in the HbA1c, cardiovascular variables, nor in the frequency of visits at primary care, ED and hospital admissions. Neither in the quality of life and the physical exercise. Anyway, we could affirm that there are significant differences in basal data and the following in many of the variables, but this difference happens in both groups.Discussion: Many initiatives aiming at an improvement in diabetes control have been implemented over the clinical trial period of time, within the “Strategy to tackle the challenge of chronicity in the Basque Country” frame, as the improved of diabetes clinical indicators through the clinical management \"Contract Program\" or D-Plan project. These initiatives have obtained positive outcomes and they have proved that diabetes control has improved in all its variables along this period of time. This situation has had direct effect on the research outcomes.Self-efficacy increase, considered as the first step to reach a successful change of behavior, gets reinforced with a qualitative analysis that addresses the following: patients are more conscious, more able to manage diabetes properly, not just from a physical point of view, but from an emotional and social dimension, too.Conclusion: Diabetes care in the Basque Country is good. Both standard care and the SDSMP can be considered suitable tools to improve diabetes control.At the same time, an evolution towards a more collaborative professional-patient relationship model can be seen in the care provided to patients. It is not just about empowering patients; there is work to be done with health professionals so they accept this change in the role of patients.A further research should be done to assess if this kind of interventions would obtain better outcomes in other pathologies less popular in the Health System.

Introduction: The management of chronic diseases represents a challenge for healthcare services. It is necessary to provide more efficient and coordinated care to patients with chronic conditions. As in other developed countries, the Spanish Health System is outdated, and a new organisational model is needed to provide a better care to chronic patients. A key role is given to self-management and educational programmes, implying a more active role of the patientIn 2010 the Health Department of the Basque Country Government promoted a new strategy for chronic patient care based on the Chronic Care Model. Two of the cornerstones of this model are self-care promotion and community education. In this context, the “Active Patient” programme, based on the Chronic Disease Self-Management Program, has been proposed as a useful instrument.Description: The Active Patient programme is aimed at patients with a chronic condition or/and at their caregivers. It consists of 2.5 hours group sessions (8 to 15 people) once a week for 7 or 8 weeks. These sessions enable participants to acquire knowledge and skills related to the disease and its management, placing a strong emphasis on proactive tools (how to set realistic achievable targets, cope with problems related to their disease, effectively communication, share decision making…) to achieve healthier lifestyles (in terms of diet, physical exercise, management of emotions, and correct use of medication, among others).Each session is conducted by two leaders. At least one of them should be a chronic patient him/herself or caregiver. Lay leaders who are themselves chronic patients, or have close personal experience of a chronic condition, show greater empathy and tend to suggest more appropriate and realistic options than health professionals. They are volunteers.In this programme there are involved a lot of different stakeholders, among others, the public health system, citizens, patient associations, city halls, culture houses…Key findings: This programme was implanted in 2010 in 4 Osakidetza health care organisations. From 2012 has been expanded to all of them.Since November 2010 we have trained 3030 patients in two different courses.The effectiveness of the programme was evaluated by a randomized controlled clinical trial and a cualitative research.Participants satisfaction is very high 4.5/5. Nowadays we have 219 leaders, 80 are lay leaders and 139 professional leaders.During the past years the programme has been spread inside as well as outside the organisation. Focusing on the responsibility of the citizens towards their own health.Highlights: This innovative approach implies care from a holistic perspective and empowers patients through :- A better relationship between clinicians and patients- And extended knowledge of the illness and the habits recommended- Taking the drama out of the illness- Facilitating strategies to face the chronic condition and to strengthen self-esteem- Achieving a better quality of live and family relationships.- Supporting them to self-care, self-manage, engage in share decision making and co-develop and implement personalised care plansSelf-efficacy significantly improved in diet, physical activity and control of the disease but no statistically significant differencies have been found in cardiovascular variables. .On the other side bringing this new approach has also found resistances among many clinicians, some agents and even some patients. We come from a traditional paternalist model and we are trying to change to a more cooperative model and so this needs some measures in order to readjustThe main resistance we want to focus on is the fear and insecurity that comes up in some clinicians regarding their ability to work with and empowered patients. We must support clinicians to better support the health needs and goals of peopleThis kind of change is progressive and need timeConclusion: It´s necessary to empower, activate and engage citizens, patients, families, carers and communities to coproduce health care service.At the same time we put in action a programme like this, we must train clinicians to encourage patients to be proactive.We must also help communication between patients and clinicians in order to make this change of philosophy possible. To involve clinicians is crucial to succeed.Even senior managers of healthcare organisations should have no doubts about the benefits of this new paradigm and should be aligned with it.The success of this innovative program will be possible when all the implicated parts are able to see the advantages that empowerment brings to all of them.

Background Type 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) has proven to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Health Service – Osakidetza (Spain). Method/Design This is a randomised clinical trial in which patients diagnosed with DM2, 18–79 years of age, from four health regions within the Basque Health Service will be randomised into two groups: an intervention group, who will follow the SDSMP, and a control group, who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region. The intervention consists of 2,5 hour-group sessions once a week for six weeks. The sessions cover target setting and problem solving techniques, promotion of physical exercise, basic knowledge of nutrition, proper use of medication, effective communication with relatives and health professionals, and basic knowledge about DM2 and its complications. This content is complemented by educational material: books, leaflets and CDs. The primary outcome measure will be the change in glycated haemoglobin (HbA1c), and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables, cardiovascular risk, quality of life, self-efficacy, number of consultations and drug prescriptions. The results will be analysed 6, 12 and 24 months after the intervention. Discussion If the intervention were to be effective, the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases. Trial registration ClinicalTrials.gov identifier NCT01642394

Menstrual health plays a crucial role in health-related quality of life (HRQoL). However, there is a gap addressing HRQoL in relation to broader aspects of menstrual health definition. This study aims to analyse the relationship between menstrual health and self-reported health-related quality of life in women and people who menstruate (PWM) ≥ 18 years in five regions of Spain (Andalusia, Basque Country, Canary Islands, Catalonia, and Galicia). A cross-sectional survey-based study with gender perspective was conducted. Thirty-two healthcare centres took part in the study across five regions of Spain between May and September 2023. Participants were women and PWM aged 18 or over with at least one menstruation in the last 6 months. Self-reported sociodemographic, menstrual health and HRQoL variables (using EQ-5D-5 L scale) were collected. Descriptive statistics and linear regression models were performed. EQ-VAS scale was employed to perform sensitivity analyses. A total of 1,381 women and PWM were included (Mean age = 34.63, SD = 10.06). The mean of EQ-5D-5 L index was 0.88 (SD = 0.13) and EQ-VAS was 73.63 (SD = 22.60). Several menstrual health variables were significantly associated with lower HRQoL. The strongest associations were observed for high frequency of premenstrual symptoms (β= -0.144; 95%CI= -0.139 to -0.090), high impact of premenstrual symptoms (β= -0.071; 95%CI= -0.102 to -0.040), high impact on social participation during menstruation (β= -0.104; 95%CI= -0.128 to -0.080), moderate frequency of menstrual poverty (β= -0.054; 95%CI= -0.078 to -0.029) and menstrual pain intensity (β= -0.047; 95%CI= -0.068 to -0.025). These findings highlight the substantial impact of menstrual health on HRQoL, particularly in some EQ-5D-5 L domains (usual activities, anxiety/depression, and pain/discomfort). From a public health perspective, it is important to recognise menstrual health as a relevant component of overall well-being of women and PWM. Specifically paying greater attention to menstrual health relation to general pain, emotional health and participation in daily activities when designing health promotion and primary healthcare interventions.

En España se estima que hay alrededor de 1.500.00 de supervivientes de cáncer. En Euskadi la supervivencia relativa a los 5 años, entre 2000 y 2012, fue del 52,2% en hombres y 59,9% en mujeres. En numerosos estudios realizados con supervivientes de cáncer, se constata la necesidad de implementar programas de formación en promoción de hábitos saludables, además de establecer un plan de seguimiento que promueva una rehabilitación completa abordando el aspecto físico, psicológico y social. El empoderamiento unido a conceptos como la activación, el autocuidado, la autogestión, y la atención centrada en la persona, son elementos claves para mejorar resultados en salud, así como obtener mayor adherencia al plan de cuidados y optimizar recursos y costes de la atención en salud. En 2010 nace en Euskadi el programa Paziente Bizia-Paciente Activo,  programa de educación en autocuidados y autogestión impartido por iguales.  En 2016, un grupo multidisciplinar trabajaron en el desarrollo de un taller específico para supervivientes de cáncer. En 2018 el  programa se incluye como línea de actuación dentro del Plan Oncológico de Euskadi 2018-2023.  El taller “Cuidando mi salud después del cáncer” está dirigido a pacientes y/o cuidadores, que han pasado por un proceso oncológico como mínimo un año antes del inicio del taller e impartido por 2 monitores previamente formados (supervivientes de cáncer y/o cuidadores). Consta de 1 sesión semanal de 2,5h, durante 7 semanas. Se acompaña de material educativo, CD con ejercicios de relajación y DVD con tablas de ejercicio físico. Los contenidos del taller  trabajan el impacto que supone holísticamente el diagnóstico y el tratamiento del cáncer, así como herramientas para  el establecimiento de objetivos, la resolución de problemas, técnicas de comunicación, control del estrés y la toma de decisiones. Entre Diciembre de 2017 y Junio de 2018, se formaron 42 monitores (90,47% mujeres). En los primeros talleres ofertados se formaron 115 participantes  (15 hombres, 100 mujeres) con edad media de 60 años siendo la tasa de finalización de un 72,17%. Actualmente, nos encontramos en proceso de medición del impacto del programa a varios niveles: abordaje de las necesidades sentidas y no cubiertas; la satisfacción con el programa, la mejora en la percepción de habilidades de afrontamiento y autoeficacia; la mejora en la calidad de vida y el bienestar emocional. Testimonios de los participantes: “Sin quererlo  comenzamos a dar voz a todos esos miedos que arrastramos, a todo eso que sin querer se volvió mochila a nuestras espaldas y no nos deja avanzar como quisiéramos, y como por arte de magia te das cuenta que no estás solo, que llorar no es malo, que enriquece, que el camino no es fácil, pero es compartido”. “Siento que puedo tomar decisiones para cuidar mi cuerpo y mente, ahora me reconozco en mi momento, ahora estoy de nuevo en la puerta de salida, donde la realidad se hace visible, y ya no hay miedo en lo desconocido, porque me han enseñado a continuar hacia adelante”.