Suchergebnisse

In 2003, the Swedish Parliament adopted a national public health policy that included the domain - "A more health-promoting health service". Strategies and tools are needed in the work to reorient health services. Personal health documents are documents concerning a person's health, and are owned by the individual. Several studies that have evaluated such documents indicate that they could be of interest in health-promotion work. However, there is insufficient knowledge concerning personal health documents that target adolescents, and little is known about the feasibility of such documents in a Swedish cultural context. The concept of empowerment is gaining increased interest for health services, but the associations between empowerment, self-rated health and health behaviour are sparsely studied. The overall aim of the thesis is to explore a strategy - empowerment - and a tool - personal health documents - that might facilitate the work of the public health goal of a health-promoting health service. Specific aims are to examine the feasibility of using personal health documents in health promotion; to examine professionals' experiences of working with health promotion and personal health documents; to examine the association between personal health documents and self-reported health behaviour change; and to examine the perception of empowerment in relation to self-rated health and health behaviour among adolescents. Two personal health documents that targeted adults and adolescents were developed and evaluated. Distribution to adults in different settings was compared in a cross-sectional study (n = 1 306). Adolescents received the document in school, and surveys were performed at baseline and after one year (n = 339). Practical use and attitudes by document owners were studied by questionnaires. Teachers (n = 69) answered a questionnaire, and community health nurses were interviewed (n = 12). The interviews also explored nurses' experiences of working with health promotion in general, and were analysed by qualitative methodology. Adolescents' empowerment was examined by a questionnaire (n = 1 046). Most participants reported reading in the documents; writing in the documents varied between 16% (distribution in occupational health) and 87% (adolescents). The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker and having a positive school experience. Community health nurses were striving for a balance of being a doer of practical, disease-oriented tasks and a health-promotion communicator. The structural organisation in health care centres was important for their work with health promotion and the health document. Teachers were generally in favour of continued work with the document. In different settings, between 10% and 26% of adults reported changes in their health situations as a result of reading the booklet. Self-reported changes in health situations were less likely using postal distribution, and there were no significant differences between the other types of distribution. Adolescents with low empowerment scores reported poorer self-rated health and more risk-taking behaviours such as smoking and binge drinking. To conclude, personal health documents are feasible to use in different settings. Health promotion in health services needs active support from leaders as well as adequate support systems. Findings suggest that personal health documents can be tools for promoting self-reported lifestyle changes among adults in different settings. There is a close relation among adolescents between low empowerment in the domain of health, low self-rated health and health behaviours such as binge drinking and smoking.

Adolescent girls' subjective health, or well-being, is of international concern as the frequency of psychological and psychosomatic complaints is continuously increasing in several countries world-wide. The causes of this development are still obscure. The aim of this study was to explore well-being and strategies for increased well-being among adolescent girls. Grounded Theory method was used, in which in-depth interviews were held with 18 adolescent girls, 17–18 years of age. Results showed that striving for acceptance and avoiding rejection were central for their well-being. When rejection was experienced, emotions of stress–shame were recognized, a phenomena we call the stress–shame cycle. In the struggle to prevent rejection and to become accepted, the girls strived to boost their social attractiveness by impression management.

Background: Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients' unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods: Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results: Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients' tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions: Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients' lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses' attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians' uptake and use of the CPGs. ; Originally included in thesis in manuscript form with title: "Implementation of clinical guidelines on lifestyle in primary health care - a two-year follow up".

Abstract Background Smoking most often starts in adolescence, implying that understanding of predicting factors for smoking initiation during this time period is essential for successful smoking prevention. The aim of this study was to examine predicting factors in early adolescence for smoking in late adolescence. Methods Longitudinal cohort study, involving 649 Swedish adolescents from lower secondary school (12–13 years old) to upper secondary school (17–18 years old). Tobacco habits, behavioural, intra- and interpersonal factors and socio-demographic variables were assessed through questionnaires. Descriptive statistics, univariable and multivariable logistic regression were used to identify predicting factors. Results Smoking prevalence increased from 3.3% among 12–13 year olds to 25.1% among 17–18 year olds. Possible predictors of smoking were: female sex, lower parental education, poorer family mood, poorer self-rated health, poorer self-esteem, less negative attitude towards smoking, binge drinking, snus use and smoking. In a multivariable logistic regression analysis, female sex (OR 1.64, CI 1.08-2.49), medium and low self-esteem (medium: OR 1.57, CI 1.03-2.38, low: 2.79, CI 1.46-5.33), less negative attitude towards smoking (OR 2.81, CI 1.70-4.66) and ever using snus (OR 3.43, CI 1.78-6.62) remained significant independent predicting factors. Conclusions The study stresses the importance of strengthening adolescents' self-esteem, promoting anti-smoking attitudes in early adolescence, as well as avoidance of early initiation of snus. Such measures should be joint efforts involving parents, schools, youth associations, and legislating authorities.

BACKGROUND: Smoking most often starts in adolescence, implying that understanding of predicting factors for smoking initiation during this time period is essential for successful smoking prevention. The aim of this study was to examine predicting factors in early adolescence for smoking in late adolescence. METHODS: Longitudinal cohort study, involving 649 Swedish adolescents from lower secondary school (12-13 years old) to upper secondary school (17-18 years old). Tobacco habits, behavioural, intra- and interpersonal factors and socio-demographic variables were assessed through questionnaires. Descriptive statistics, univariable and multivariable logistic regression were used to identify predicting factors. RESULTS: Smoking prevalence increased from 3.3% among 12-13 year olds to 25.1% among 17-18 year olds. Possible predictors of smoking were: female sex, lower parental education, poorer family mood, poorer self-rated health, poorer self-esteem, less negative attitude towards smoking, binge drinking, snus use and smoking. In a multivariable logistic regression analysis, female sex (OR 1.64, CI 1.08-2.49), medium and low self-esteem (medium: OR 1.57, CI 1.03-2.38, low: 2.79, CI 1.46-5.33), less negative attitude towards smoking (OR 2.81, CI 1.70-4.66) and ever using snus (OR 3.43, CI 1.78-6.62) remained significant independent predicting factors. CONCLUSIONS: The study stresses the importance of strengthening adolescents' self-esteem, promoting anti-smoking attitudes in early adolescence, as well as avoidance of early initiation of snus. Such measures should be joint efforts involving parents, schools, youth associations, and legislating authorities.

Background: The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Methods: Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. Results: We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. Conclusion: The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation.

INTRODUCTION: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. METHODS: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. RESULTS: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. CONCLUSIONS: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.

Introduction: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. Methods: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. Results: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. Conclusions: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.