Background: Health literacy was identified as a main determinant in self-care of chronic diseases. This results in responsibilities for health professionals for daily practice. For primary care setting, special requirements arise due to the heterogeneity of communities. The objective of this scoping review was to explore and map the scope of the research material on strategies led by community health nurses to improve health literacy in (patients with) chronic diseases. This review aimed to identify gaps in the literature and existing approaches on promoting health literacy by community nurse practitioners. Methods: The following criteria were included for the research: Adults with chronic diseases, health literacy, community health nursing and primary healthcare. All types of searches for studies from 1970 to present were carried out in electronic databases and in a Google and a Google Scholar search. The search procedure is presented in a flow chart. Results: From all reviewed studies, nine records were included in the review. Findings with regard to the increase in health literacy in self-management of chronically ill patients were identified. Conclusion: Studies focusing on specific demands with regard to the role of community health nurses need to be carried out in depth.

The importance of health promotion for health professional students is increasingly crucial, as the rising requirements for those students can have a negative impact on their health. Despite this awareness, there is still limited knowledge in Germany about the specific health needs of this group of students. This study’s aim was, therefore, to assess the subjective health of first-year students and to identify health needs. Thus, this study is based on an online survey using standardized measurement instruments. First-year students from three degree programs were included. The data were analyzed descriptively. A total of n = 98 (72.6%) participated in the survey. The results showed that a major proportion of participants (80.3%) rated their health positively, but a significant proportion reported weight disorders (24%) and pre-existing health conditions (62.1%) at baseline. Interestingly, a high proportion (59%) reported a high level of mental well-being at the time of the survey. However, worrying findings regarding lifestyle behaviors, including physical inactivity (40.6%), smoking (20%), risky alcohol use (24%), and unhealthy eating habits (37%) were determined. In terms of health literacy, around 45% of students rated their health competencies as problematic. Furthermore, it was found that students with low health literacy had a significantly higher prevalence of low mental well-being (53.3% vs. 30.8%, p = 0.036) and unhealthy eating habits (48.8% vs. 26.5%, p = 0.027) compared to students with sufficient health literacy. Health professional students should be considered a relevant target group for health and health competence promotion from the beginning of their studies. The identified fields of action should be addressed in the context of health promotion. This is of particular importance as they are not only aimed at improving the students’ well-being but also will later work directly with patients and, therefore, have a direct influence on the health of others.

Zusammenfassung. Hintergrund: Die Erweiterung um die Pflegeprofession in der Primärversorgung wird im deutschsprachigen Raum gegenwärtig in Bezug auf Community Health Nursing (CHN) diskutiert. Dabei handelt es sich um einen bedarfsorientierten, evidenzbasierten und lebensweltbezogenen Ansatz. Akademisch qualifizierte Pflegefachpersonen versorgen eigenverantwortlich. In anderen Ländern ist CHN langjährig verankert. In Deutschland fehlt es an Modellversuchen und Belegen, um die spezifische Wirkweise in der Anwendung zu bewerten und Vergütungsoptionen durch potentielle Kostenträger abzubilden. Fragestellung/Ziel: Das CoSta-Projekt entwickelt modellhaft ein professionelles CHN-Konzept für chronisch kranke Menschen in einem marginalisierten Stadtquartier. Methode: Die Praxisentwicklung des CHN-Konzeptes erfolgt auf Grundlage einer Literaturübersicht, einer Bedarfserhebung im Quartier und eines theoretischen Rahmens unter Beteiligung des multiprofessionellen Teams in einem Stadtteil-Gesundheitszentrum. Ergebnisse: Die Konzeptentwicklung ist abgeschlossen. Das Modellkonzept basiert auf den Komponenten Public Health, Pflegetheorie, Leitbild, rechtlicher Rahmen und Evidenzbasierung. Als Interventionen sind pflegegeleitete Hausbesuche, Sprechstunden und Schulungen vorgesehen. Ihre Wirksamkeit wird derzeit in einer laufenden Interventionsstudie überprüft. Die Ergebnisse zur Machbarkeit stehen aus. Schlussfolgerungen: Das entwickelte Konzept wird als bedarfsorientiertes Angebot eingeschätzt. Für die Intervention erscheinen kultur- und peersensible Aspekte noch bedeutsamer als erwartet.

Background: Implementing community health nursing programs is a new field of application in the primary health sector of Germany. Hence, there is limited evidence of effective community-based and nurse-led interventions with regard to the German health care system. International research findings are mostly not transferable. The Community Health Nursing in der Stadt (CoSta; ie, “Community Health Nursing in the City”) project is the first study that examines a community health nurse–led intervention for adults with chronic health conditions. Objective: This study protocol describes the design and methods of a randomized controlled field trial that will investigate if a community health nurse–based intervention has an impact on health-related quality of life in adults with chronic conditions. Methods: The study was designed as a randomized controlled trial that will be conducted under real-life conditions in the field. In a 4-month period, patients with at least 1 chronic International Classification of Diseases, Tenth Revision, diagnosis will be enrolled. Participants will be randomly allocated to an intervention group or a control group. The sample size was assumed based on an effect size of 0.50 with a significance level of .05, using a 2-sided (2-tailed), 2-sample unequal variance t test. The control group will be treated as usual. The intervention group will receive—in addition to the usual treatment—preventive home visits; consultations; and educative training, which will be offered by 2 community health nurses for up to 12 months. Both groups will be followed up at baseline, after 6 months, and after 12 months. The primary outcome measure is the mental component summary score from the 36-Item Short Form Health Survey after 12-months. Secondary patient outcomes will be included. The study received ethics approval from the Competence Health Center’s institutional review board at the University of Applied Sciences Hamburg (procedure number: 2020-14). Results: The CoSta project was funded by the Federal Ministry of Education and Research Germany (contract number: 13FH019SX8). In total, 187 participants were recruited at the beginning of August 2021. Further, 92 were excluded and 94 were randomized. Data collection will be conducted until the end of 2022. Conclusions: Our study will provide data with regard to the effectiveness of community nurse–led interventions that focus on the treatment of vulnerable adults with chronic health conditions in a community health center. In secondary analyses, the associations among influencing social factors (education, income, and employment) will be examined. We expect results that will help reduce the research-to-practice gap. Trial Registration: German Clinical Trials Register DRKS00026164; https://tinyurl.com/yckxc5ut International Registered Report Identifier (IRRID): DERR1-10.2196/37965

Background: In research and practice to promote health literacy, people with chronic illnesses represent an important target group. They are confronted with complex demands during the course of their illness. And, they utilize healthcare services more frequently. Patients are often dependent on the support of healthcare professionals. Population-based studies in Germany conducted that the majority of people find it most difficult to assess health information. The studies emphasize the enhancement of professional‘s health literacy, e. g. in nursing profession, as a prerequisite for improving capabilities in the population. In order to achieve better access and a needs-based care for people with chronic illnesses, a project in northern Germany has developed and offered a care-led concept. Methods: As part of this project, data on self-assessed health literacy of chronically ill patients from a community health center was collected and analyzed using a quantitative survey in a mixed-methods study. Results: The data analysis shows that more than half of the participants, regardless of gender and age, rate their health literacy as inadequate. On every level of information requirements and areas difficulties were reported. Conclusion: The involvement of patients is needed in order to establish suitable strategies to empower health literacy for people with chronic illnesses. Particularly, the promotion of professional and organizational health literacy is essential for this.

Zusammenfassung: Einleitung: Das Konzept der Sorgenden Gemeinschaft beschreibt einen Ansatz, bei dem nicht nur professionelle Pflegekräfte, sondern Familien, Nachbar:innen, Ehrenamtliche, lokale Organisationen und Kommunen gemeinsam Verantwortung für ältere oder unterstützungsbedürftige Menschen übernehmen. Digitale Technologien können dabei die Vernetzung und Kommunikation erleichtern sowie Zusammenarbeit über Quartiersgrenzen hinweg ermöglichen. Methode: Zur Auswertung der Forschungsliteratur wurde ein Scoping Review nach dem Joanna Briggs Institute durchgeführt. Die systematische Suche erfolgte in vier wissenschaftlichen Datenbanken sowie Google Scholar und Semantic Scholar. Eingeschlossen wurden Publikationen ab 2017 in deutscher oder englischer Sprache, die pflege- oder unterstützungsbedürftige Menschen und digitale Technologien zur Vernetzung innerhalb Sorgender Gemeinschaften thematisierten. Artikel, von denen nur Abstracts vorlagen, wurden ausgeschlossen. Die Recherche erfolgte anhand der PCC-Elemente: (1) Pflegepersonen, (2) Pflege- oder unterstützungsbedürftige Menschen, (3) Sorgende Gemeinschaften, (4) Digitale Technologien. Ergebnisse: Insgesamt wurden n = 105 Publikationen geprüft. Davon konnten n = 20 Publikationen in die Scoping-Überprüfung einbezogen werden. 15 Publikationen behandelten Modelle und Rahmenbedingungen von Sorgenden Gemeinschaften. 5 Artikel thematisierten digitale Technologien und Anwendungen für die Kommunikation und Vernetzung. Keine der Publikationen liefert Informationen über die Besonderheiten von Menschen mit Behinderungen. Schlussfolgerung: Es bestehen vielfältige Modelle und Rahmenbedingungen Sorgender Gemeinschaften. Die konzeptionelle Vielfalt und heterogenen Strukturen erschweren einen Vergleich der Modelle und ihrer Voraussetzungen. Partizipation, Governance und gemeinsame Verantwortung werden als zentrale Erfolgsfaktoren für die Implementierung beschrieben. Insgesamt lässt sich im deutschsprachigen Raum ein Trend hin zu partizipativen und gemeinwesenorientierten Versorgungsansätzen für unterstützungsbedürftige Menschen feststellen, die formelle und informelle Sorgeakteure miteinander vernetzen, wobei digitale Technologien die Kommunikation und Zusammenarbeit wesentlich unterstützen können.