Twitter Irene Torres @lairene1 Acknowledgements The authors are grateful to all people that provided information in our crowdsourcing effort and the Gender and COVID-19 working group for their input and thoughts. Contributors All authors contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

BackgroundPhysical inactivity presents a major public health challenge and is estimated to cause six to ten percent of the major non-communicable diseases. Studies show that immigrants, especially women, have an increased risk of non-communicable diseases compared to ethnic Swedes. Somali immigrant women have increased rates of overweight and obesity, low fitness levels and low levels of cardiorespiratory fitness compared to non-immigrant women. These findings suggest that Somali women are at increased risk of developing lifestyle-related diseases. Few studies explore determinants of physical activity among Somali women. The aim of this study was to explore Somali women’s views and experiences of physical activity after migration to Sweden.MethodsA qualitative focused ethnographic approach was used in this study. Four focus groups were conducted with twenty-six Somali women ranging from 17 to 67 years of age. Focus group discussions were recorded, transcribed verbatim and analysed using qualitative content analysis.ResultsThe analysis resulted in four main themes and ten categories: Life in Somalia and Life in Sweden, Understanding and enhancing health and Facilitators and barriers to physical activity. Great differences were seen between living in Somalia and in Sweden but also similarities such as finding time to manage housework, the family and the health of the woman. The extended family is non-existent in Sweden, making life more difficult. Health was considered a gift from God but living a healthy life was perceived as the responsibility of the individual. Misconceptions about enhancing health occurred depending on the woman’s previous life experience and traditions. There was an awareness of the importance of physical activity among the participants but lack of knowledge of how to enhance activity on an individual basis. Enhancing factors to an active lifestyle were identified as being a safe and comfortable environment.ConclusionsSome barriers, such as climate, lack of motivation and time are universal barriers to an active lifestyle, but some factors, such as tradition and religion, are distinctive for Somali women. Since traditional Somali life never involves leisure-time physical activity, one cannot expect to compensate for the low daily activity level with leisure-time activity the Swedish way. Immigrant Somali women are a heterogeneous group with individual needs depending on age, education and background. Tailored interventions with respect to Somali traditions are necessary to achieve an actual increase in physical activity among migrant women of Somalian origin.

BackgroundDeveloping Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel.MethodsA qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis.ResultsHealth communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel.ConclusionsHealth communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate health communication for promoting health, i.e. ‘health promoting communication’.

Background: Health literacy as a concept is gaining importance in European countries, although it is still not adequately addressed among health personnel. Health literacy supports the self-management of patients in maintaining and improving health, which could decrease the burden on health systems in Europe. However, health professionals lack adequate knowledge about health literacy and the skills to promote health literacy among their patients. Objective: The Health Literacy Practices and Educational Competencies for Health Professionals (a health literacy training curriculum for health professionals) was recently developed in the United States, and the study presented here aimed to refine that assessment for health personnel in European settings. Methods: The modified Delphi method was used and data collected online via electronic communication to achieve consensus among an expert panel. The participants were a group of 20 health literacy and health care experts from 10 professional fields representing 13 European countries. The participants rated health literacy competencies on a four-point Likert scale and provided written feedback and recommendations. If a predetermined threshold of 70% or more of the participants agreed on the competency, the consensus was defined (similar to the criteria in the Health Literacy Practices and Educational Competencies for Health Professionals intervention). Key Results: After three rounds of ratings and modifications, consensus agreement was reached on 56 health literacy competencies (20 knowledge items, 25 skills items, 11 attitude items) and 38 practices. Eight items were removed from the original list and eight new items were added to the final list. Conclusions: This study is the first known attempt to develop a measurable list of health literacy competencies for health personnel in Europe. Further work is needed to develop educational curricula, standard national and regional guidelines, and questionnaires for the process of implementation to maximize health literacy responsiveness in health care organizations. [ Health Literacy Research and Practice . 2017;1(4):e247–e256.] Plain Language Summary: The Health Literacy Practices and Educational Competencies for Health Professionals was recently developed in the United States. This study aimed to refine that assessment for health care professionals in Europe. The modified Delphi method was used and data collected online via electronic communication, and in the end, 56 health literacy competencies were included.