WELCOME to the 4th CHRODIS PLUS Newsletter

Dear Reader,

In this newsletter we will present responses to the Budapest Conference and a summary of some of the round-table discussions that took place in Budapest on the second day of event. We interviewed Dr. Jelka Zaletel /our Work Package 7 co-leader/ to highlight a CHRODIS PLUS success story: the roll-out of CHRODIS models across Slovenia. Since the topic of mental and physical strength was very well received by the audience at the Budapest Conference, we interviewed its presenter, Eeva Rantala, who explained how we can become a master of our own lives through better choices in regards to healthier lifestyles. Finally, we will provide a brief introduction to our new collaboration with the OECD, which will provide support to CHRODIS PLUS in assessing the cost effectiveness of policies and by assisting with the transfer of best practices.

On behalf of the CHRODIS PLUS Joint Action, we wish you an enjoyable read of this Newsletter and a happy summer break.

Looking back at the Budapest Conference

On behalf of the organisational team and our work package leaders, we would like to thank you once more for your active and lively participation. The Budapest Conference received very positive reviews and attendees appreciated the topics presented during the conference, which was noted in the conference satisfaction survey. We also received suggestions for the topics attendees would like to see in the programme of the Joint Action’s Final Conference next year, in 2020.

For those of you who could not be present at the Conference and are interested in the overall flow, programme and picture gallery, do not hesitate to view all of these on the conference website here. If you are curious and would like to know more about the background of our speakers, leaf through our pre-conference newsletter to find more information.

We look forward to seeing you all at the Joint Action closing conference next year!

Greetings from your CHRODIS PLUS Communications Team Leaders:


Zuzana Matlonova  

Zoltan Albert Aszalos

Welcome message by Wojciech Kalamarz, Head of Unit for Health Determinants and International Relations, DG SANTE, European Commission

CHRODIS PLUS is approaching the last year of its operation. Its future life, its continuation depends partly on the usefulness of the project results, and also on priorities that will be set by the new EU presidencies. Currently the trends show that the new focus will be on healthy ageing and healthy lifestyles. Here, the results of CHRODIS PLUS will certainly prove to be useful, considering that healthy ageing is not starting at the age of 65 but needs to be prepared during the entire life span. Such a health-conscious life should rely on health promotion and disease prevention measures as well as on healthy workplaces- topics included in CHRODIS PLUS. I wish a continued deepening teamwork of the partner organisations in your excellent project!

Round-table discussions during the Budapest Conference

During the second day of the Budapest Conference, round-table discussions were organised around selected key topics from the joint action. (The full list of round-table topics as well as the institutional affiliation of the chairs is available on the conference website.)

We asked the chairs of the various round tables to share just one idea from the many discussions and debates held during these discussions.


Chair: Valentina Strammiello

To achieve meaningful patient involvement, our health systems need to undertake a cultural shift. First of all the interaction between the healthcare professional and patient needs to evolve into a partnership between equals, with shared decision-making. Patients need to be empowered so that when practices are introduced or evaluated, the patient perspective should be included from the design phase until the follow-up feedback.


Chair:  Paolo Michelutti,  Andrew Barnfield; Giovanni Nicoletti, Ana Carriazo, Rafael Rodriguez Acuna.

During the discussion we agreed that we all need to work on the conditions that will guarantee the integration of the good practices into national policies in the future as well their sustainability in the long term, including innovative solutions to finance them. Participants are also aware that EU collaboration is a keystone of this complex process. We are looking forward to work with you! Thanks a lot!


CHAIR: Lara Janusdottir

Recruitment and involvement of participants in a health promotion programme could be a challenge. In order to tackle this challenge, you need the help of people of the same age, gender, and/or culture as the target group of participants. Tailored advertisements and public relations to reach the specific target group and informational meetings with health and training professionals are crucial elements for recruitment. Another important aspect of success is ongoing motivation, trust building and the involvement of supporting people from the community of the target group of the health promotion programme. Providing personal follow-up to participants, through social media or phone, with friendly mental and motivational support by the team will make participants feel important and instil in them that we care about each individual with the aim that they continue the health promotion programme.


Chairs: Laimis Dambrauskas and Ida Liseckiene

We agreed during the discussion that while applying the Integrated Multimorbidity Care Model, it is vital to include the key stakeholders. The model needs to be adapted to local needs, ensuring integrated care and its benefits. All 16 components are applicable and could be implemented step by step at different levels across different countries, regions, and even care providers. 


Chair: Antonio Sarría Santamera

Research is necessary on non-communicable diseases to overcome the gap between available knowledge on the efficacy of interventions and on how to make sure they are applied in real-life situations and adapted to local contexts. We need to co-create “usable” knowledge between scientists and decision-makers at the political level through collaborative methodologies. 


CHAIRS: Jaana Lindström and Eeva Rantala

Coordinating the future dissemination and implementation of CHRODIS PLUS WP8 products, the Training tool and the Toolkit for the management of workplaces, could be facilitated by both top-down and bottom-up approaches. The products could be presented to the ministry of health and municipal public health bureaus responsible for the implementation of public health services, and by creating a network of stakeholders in the “health at work” area (or relying on an existing one). A prerequisite for the uptake of the two products is to provide employers/managers information on the benefits of using the products, and training on how to use them. One example of how employers could be motivated to adopt the tools would be arranging “the Healthiest Workplace” competitions.

Note: The CHRODIS PLUS Toolkit for the Adaptation of the Workplace will be an evidence-based, practice-oriented guide for employers to adapt to their work environments to support healthy lifestyles and prevent and manage chronic diseases in work settings.


Chair: Rokas Navickas, Scientific Coordinator of the Joint Action:

Measuring relevant outcomes will ensure a better short and long term result. The indicators should include patients, health professionals and policy makers. The most important indicators should be agreed upon between the policy makers and the actual beneficiaries in advance.  


Chairs: Ingibjorg Gudmundsdottir and Gigja Gunnasdottir

During the discussion we all agreed that in order to promote the health and well-being of children a comprehensive, systematic public health work is required across sectors and levels, based on best available evidence and experiences, promoting healthy lifestyles, health and well-being throughout life. 

Conference presentations on the CHRODIS PLUS YouTube channel

The Conference’s plenary session was recorded on video. Altogether, we had 11 presentations, which are now available on the Conference’s website as well as on our YouTube channel.

Please click on this link to watch the videos.

The roll-out of a CHRODIS PLUS good practice in the Slovenian healthcare system

Interview with Jelka Zaletel of the National Institute of Public Health in Slovenia and co-leader of WP7

Jelka, can you tell us about the Chrodis Plus good practice that has been implemented in Slovenia and the story about coming up with this idea?

“Integration across the levels of care was found to be insufficient.”

Jelka: The Slovenian Ministry of Health, which closely followed the work of the previous CHRODIS Joint Action (JA), decided to join the CHRODIS PLUS JA with an aim to develop a new model within WP7 for the care of patients with chronic wounds. In Slovenia, we already have a process in place to develop the competencies of primary care, however, integration across the levels of care was found to be insufficient. Our model for the care of patients with chronic wounds aims to link these two and care for the complex needs of these patients.

How far along are you with your project and who are the patients involved in it?

“A pilot action with 12 patients in two institutions.”

Jelka: We are currently running a pilot action with 12 patients in two institutions: in the Primary Care Center Novo Mesto and General Hospital Novo Mesto in Slovenia. The patients come from different age and gender groups with various socio-economic backgrounds, which allows us to accurately represent Slovenian society in our research. We conduct individual, in-depth interviews with these patients where we aim to gather feedback on how their disease could be best treated and also to gain a holistic view on the patient’s life in general. We are of course also mapping the clinical pathways, but at the same time we also focus on the psychological effects, family background, and other impacts their disease has on their life. Further interviews were also conducted with the representatives of different healthcare professions, who are members of the local implementation working group.

And just here, let me share a short story with you about a patient who is involved in our project: At each of our meetings the last word goes to the patient. At one occasion a patient – Dusan Jukic – said: ‘I’m very grateful to you, because you are discussing about my disease’ – and simultaneously, he drew a dot and a big circle around it on a piece of paper. ‘However, what you are discussing here today about me only equals to the small dot on this paper, compared to the huge circle representing the impact this disease has on my life’. I think Dusan’s statement explains very well what the scope of our project in Slovenia is. We aim to not only cover that small dot, but to get a wider view on how our patients’ life is affected by their disease.

Who is involved locally from the CHRODIS PLUS community and what are the next steps in the project?

“There’s a high probability that Slovenia will carry on with the project on a national level.”

Jelka: Locally we have Denis Opresnik, Mila Mrsic and Milivoj Piletic as the leaders of the local implementation working group. The next step is to define the characteristics of the model, and to submit the pilot action report by the end of 2019. After this, there’s a high probability that Slovenia will carry on with the project on a national level.

Changing personal behaviour to follow a healthier lifestyle

Eeva Rantala from the National Institute of Public Health delivered two presentations during our Plenary Assembly and Conference in Budapest that captured our hearts and also our attention. We were excited when she agreed to an interview with us in order to provide a little more insight about pursuing healthy lifestyles and translating our good intentions into actions.

Eeva, can you tell us about your background and how you arrived at the topic of healthy eating?

“A dancing dietitian intrigued by the psychology of eating”

Eeva: I’ve been fascinated with nutrition and health since high school. I made a little detour though before actually ending up in the field, as I got my first academic degree from the Theatre  Academy Helsinki, where I studied contemporary dance. After five years of professional training and a Master’s degree in my pocket, I started working as a freelance dancer. Nutrition, however, did not leave me be, and after only two years in the field of performing arts I backtracked and applied to the University of Eastern Finland to study clinical nutrition. This spring, nearly six years after the career switch, my second round of studies has come to an end as I qualified as an authorised nutritionist with a Master’s of Health Sciences. Currently I’m starting my PhD and work as a researcher at the National Institute for Health and Welfare and at the VTT Technical Research Institute of Finland. Within the science of nutrition, I’m particularly interested in dietary behaviour.

During the conference in Budapest you presented on psychological patterns related to healthier choices. Can you tell us a little bit more how this mind mechanism works?

“Hunger, rush, and fatigue make the autopilot take the lead”

Eeva: Decision-making and behaviour are regulated by two types of cognitive processes: automatic and reflective. Both of these processes are worthwhile and have their strengths. They operate in parallel and interact with each other in processing information and drawing behavioural decisions. Automatic processes operate fast and intuitively, and require little or no cognitive effort. Hence, they excel in routine situations, such as brushing teeth, and function well even when we are cognitively not at our sharpest. Reflective processes, in turn, steer behaviour through careful consideration, honouring personal values, beliefs, and conscious desires, and rely on the evaluation of the probability and worth of potential consequences of various actions. The weak spot of the reflective system is that it is slow, consumes a lot of cognitive resources, and becomes easily distracted. Fatigue, hunger, and strong emotions, for instance, impair the functioning of the reflective system, and shift behaviour-regulation more onto the automatic system.

What are usually the decisive factors when it comes to healthy eating choices and what are the major barriers that people encounter? 

“Designed to detect food”

Eeva: Decisions related to food and eating are typically directed through automatic cognitive processes. We humans are sensitive to food-related cues, and recognise them easily in the surrounding environment. The evolution of this feature has been crucial for survival in the early phases of the human race. In the modern world, however, where a vast variety of mouthwatering foods is constantly available, this trait can easily lead us in trouble. Particularly, since food choices made via automatic cognitive pathways tend to be inclined towards highly rewarding and less healthy alternatives – meaning foods and beverages high in fat, sugar and salt.

The automatic and the reflective processes do not operate in a vacuum, but are affected by a complex network of interacting contextual, individual, and environmental influences. Our emotional and physiological state, individual characteristics and habits, as well as the surrounding physical, socio-cultural, economic, and political environment all affect our choices. Hence, providing factual information and advice on healthy diets is often not enough to make people change their dietary patterns. We also need an environment in which healthy alternatives are available, effortlessly accessible, and attractive for all.

Do you have some specific examples from everyday life that you could share with us?

 “Healthy eating habits evolve through repetition”

Eeva: The abundance of external influences guiding choices related to food and eating, and the tendency to rely on automatic thought processes when making food-related decisions do not mean we are not able to affect our dietary patterns. Quite the contrary. Learning new, lifelong habits is possible for all of us. It just requires a little concentration and practice. Like learning to ride a bike. Repeating a given behaviour (e.g., filling half of the plate with vegetables) in a certain context (e.g., at lunch) gradually forms this action into a habit that occurs automatically without requiring efforts of cognitive processing.

Can you share with us on how our daily dietary choices can affect the overall natural environment?

“Healthy is also sustainable”

Eeva: For those of us worried about the future of our planet, adopting a healthier diet can also alleviate environmental anxiety. Adding more plant-based foods on our plates not only reduces the risk of non-communicable diseases, but also aids in the fight against climate change. In practice this means favouring fruit and vegetables, pulses, whole grain cereal products, nuts and seeds, and vegetable oils rich in unsaturated fats (e.g., canola [rapeseed] and olive oil).

OECD action to assess the cost-effectiveness of CHRODIS PLUS activities”

On 4-5 May, the Governing Board together with the Executive  Board of the CHRODIS PLUS Joint Action met to debate and reflect on the strategic issues concerning CHRODIS PLUS. Click here to see more details of this meeting.

Michele Cecchini, representing the Health Division of the OECD, delivered a presentation on how the effectiveness of the projects we implement can be measured on a policy scale. The title of this presentation was: OECD action to support CHRODIS PLUS in assessing the cost-effectiveness of policies and assisting the transfer of best practices.

Click here to read this OECD presentation.


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