Joris Michielsen

Bio: Joris Michielsen is an academic researcher from University of Antwerp. The author has contributed to research in topics: Medicine & Mental health. The author has an hindex of 5, co-authored 9 publications receiving 128 citations.

Can health insurance improve access to quality care for the Indian poor

Abstract: Purpose. Recently, the Indian government launched health insurance schemes for the poor both to protect them from high health spending and to improve access to high-quality health services. This article aims to review the potentials of health insurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes.

Social protection in health: the need for a transformative dimension.

Abstract: 1 Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium2 Unit of Health Policy and Financing, Institute of Tropical Medicine, Antwerp, Belgium3 Institute of Public Health, Bangaluru, India4 Institute of Development Policy and Management, University of Antwerp, Belgium5 Herman Deleeck Centre for Social Policy, University of Antwerp, Belgium

The long road to universal antiretroviral treatment coverage in South Africa

Abstract: In order to sustainably scale-up antiretroviral treatment (ART), South Africa needs to develop an efficient and effective implementation strategy, based on the best available scientific evidence. This article aims to bridge this knowledge gap first by describing the progress South Africa has made in the fight against HIV/AIDS in terms of virological efficacy, survival rates and retention in care, and second by identifying the potential remaining impediments to a durable and sustainable policy response to the epidemic. The study findings demonstrate that, despite favorable results in terms of virologic suppression, survival/mortality and retention in care, four challenges to a sustainable ART scale-up remain: first, the lack of integration of ART services into the general health system; second, the growing need for comprehensive HIV/AIDS care; third, the rising costs associated with the growing case load of people; and fourth, the crippling shortage in human resources for healthcare.

Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals

Abstract: An unmet mental health need exists when someone has a mental health problem but doesn’t receive formal care, or when the care received is insufficient or inadequate. Epidemiological research has identified both structural and attitudinal barriers to care which lead to unmet mental health needs, but reviewed literature has shown gaps in qualitative research on unmet mental health needs. This study aimed to explore unmet mental health needs in the general population from the perspective of professionals working with vulnerable groups. Four focus group discussions and two interviews with 34 participants were conducted from October 2019 to January 2020. Participants’ professional backgrounds encompassed social work, mental health care and primary care in one rural and one urban primary care zone in Antwerp, Belgium. A topic guide was used to prompt discussions about which groups have high unmet mental health needs and why. Transcripts were coded using thematic analysis. Five themes emerged, which are subdivided in several subthemes: (1) socio-demographic determinants and disorder characteristics associated with unmet mental health needs; (2) demand-side barriers; (3) supply-side barriers; (4) consequences of unmet mental health needs; and (5) suggested improvements for meeting unmet mental health needs. Findings of epidemiological research were largely corroborated. Some additional groups with high unmet needs were identified. Professionals argued that they are often confronted with cases which are too complex for regular psychiatric care and highlighted the problem of care avoidance. Important system-level factors include waiting times of subsidized services and cost of non-subsidized services. Feelings of burden and powerlessness are common among professionals who are often confronted with unmet needs. Professionals discussed future directions for an equitable mental health care provision, which should be accessible and targeted at those in the greatest need. Further research is needed to include the patients’ perspective of unmet mental health needs.

A review of the acculturation experiences of international students

Abstract: Universities in Western countries host a substantial number of international students. These students bring a range of benefits to the host country and in return the students gain higher education. However, the choice to study overseas in Western countries may present many challenges for the international student including the experience of acculturative stress and difficulties with adjustment to the environment of the host country. The present paper provides a review of current acculturation models as applied to international students. Given that these models have typically been empirically tested on migrant and refugee populations only, the review aims to determine the extent to which these models characterise the acculturation experience of international students. Literature pertaining to salient variables from acculturation models was explored including acculturative stressors encountered frequently by international students (e.g., language barriers, educational difficulties, loneliness, discrimination, and practical problems associated with changing environments). Further discussed was the subsequent impact of social support and coping strategies on acculturative stress experienced by international students, and the psychological and sociocultural adaptation of this student group. This review found that the international student literature provides support for some aspects of the acculturation models discussed, however, further investigation of these models is needed to determine their accuracy in describing the acculturation of international students. Additionally, prominent acculturation models portray the host society as an important factor influencing international students’ acculturation, which suggests the need for future intervention.

The concept of mechanism from a realist approach: a scoping review to facilitate its operationalization in public health program evaluation

Abstract: Background: Public health interventions are complex by nature, and their evaluation requires unpacking their intervention logic and their interactions with open social systems. By focusing on the interrelationships between context, mechanism, and outcome, Pawson and Tilley's realist approach appears a promising innovation for public health-related evaluation works. However, and as expected of any methodological innovation, this approach is being constructed gradually by answering the multiple challenges to its operationalization that fall in its path. One of these challenges, users of this approach agree on, is the necessity of clarifying its key concept of mechanism. Method: We first collected the definitions of mechanism from published works of Pawson and colleagues. Secondly, a scoping review was conducted to identify the ones quoted by users of the realist approach for evaluating public health interventions (1997–2012). We then appraised the clarity and precision of this concept against the three dimensions defined by Daigneault and Jacobs " term, sense and referent. " Results: Of the 2344 documents identified in the scoping review, 49 documents were included. Term: Users of the realist approach use adjectives qualifying the term mechanism that were not specifically endorsed by Pawson and colleagues. Sense: None of the attributes stated by Pawson and colleagues has been listed in all of the documents analyzed, and some contributions clarified its attributes. Referent: The concept of mechanism within a realist approach can be ascribed to theory-based evaluation, complex social interventions, and critical realism. Conclusion: This review led us to reconsider the concept of mechanism within the realist approach by confronting the theoretical stance of its proponents to the practical one of its users. This resulted in a clearer, more precise definition of the concept of mechanism which may in turn trigger further improvements in the way the realist approach is applied in evaluative practice in public health and potentially beyond. A mechanism is hidden but real, is an element of reasoning and reactions of agents in regard to the resources available in a given context to bring about changes through the implementation of an intervention, and evolves within an open space-time and social system of relationships.

The Health System Dynamics Framework: The introduction of an analytical model for health system analysis and its application to two case-studies

Abstract: Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The added value of this framework is: 1) consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2) emphasizes the importance of values; 3) a central axis linking governance, human resources, service delivery and population, and 4) taking into account the key elements of complexity in analysis and strategy development. We urge the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening.