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Aasan BEV, Lillefjell M, Krokstad S, Sund ER. Trends in social inequality and how mental wellbeing vary and covary among Norwegian adolescents and their families: the Young-HUNT Study. Scand J Public Health 2023:14034948231172634. [PMID: 37776173 DOI: 10.1177/14034948231172634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND The study had two aims: first, to investigate trends in socioeconomic inequalities in psychological distress and loneliness among Norwegian adolescents, and second, to study variation and covariation of psychological distress and loneliness within adolescents and between siblings within families. METHODS Multivariate mixed models were used to investigate trends in socioeconomic inequality in psychological distress and loneliness using three separate cohorts of Norwegian adolescents from the Young-HUNT study conducted in 1995-1997 (Young-HUNT1, n = 8980), 2006-2008 (Young-HUNT3, n = 8199) and 2017-2019 (Young-HUNT4, n = 8066). Register data on parental education level was used as a marker of socioeconomic position (SEP), and a unique family number was used to identify adolescents belonging to the same family. A three-level multivariate mixed model was created, consisting of the outcomes at level 1, adolescents at level 2 and families at level 3. RESULTS No statistically significant difference in scores on loneliness and psychological distress was observed between low and high parental education level in Young-HUNT1, whereas in Young-HUNT4, low parental education level was associated with a higher score on both psychological distress (β = 0.09; 95% confidence interval (CI), 0.03-0.14) and loneliness (β = 0.12; 95% CI 0.07-0.17). Analyses of covariation between psychological distress and loneliness showed that they were correlated within adolescents and strongly correlated within families across all timepoints. CONCLUSIONS Increasing socioeconomic inequalities in psychological distress and loneliness among Norwegian adolescents is worrisome. Further, the family seems to be an important arena for potential prevention of psychological distress and loneliness among adolescents, regardless of parental education level.
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Affiliation(s)
- Bodil Elisabeth Valstad Aasan
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Erik R Sund
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Sylte M, Lillefjell M, Anthun KS. Co-creating public health measures with adolescents in municipalities: municipal actors' views on inhibitors and promoters for adolescent involvement. Scand J Public Health 2023:14034948231170430. [PMID: 37139945 DOI: 10.1177/14034948231170430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
AIM To explore what municipal actors consider as inhibiting and promoting adolescents' involvement in public health measures in municipalities. METHODS A qualitative study with individual and group interviews was conducted among 15 municipal actors who were central in involving adolescents from five Norwegian municipalities participating in the National Programme for Public Health Work in Municipalities (2017-2027). In addition, participatory observation of project activities was done in two municipalities. A data-driven thematic analysis was applied to analyse data. RESULTS In the analysis, we developed four themes, including both inhibitors and promoters for adolescent involvement: (a) Timeframe challenges in adolescent involvement; (b) Lack of necessary knowledge and awareness among adolescents; (c) Limited competencies and resources in the project groups; and (d) Facilitators' attitudes on and perceptions of adolescent involvement. CONCLUSIONS
This study reports factors that are important to consider when facilitating involvement processes with young people. Findings suggest that further work should be done to ensure involvement of adolescents in public health measures in municipalities, and actors involving adolescents must be provided with competence and resources to ensure such participation.
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Affiliation(s)
- Mari Sylte
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway
- Department of Public Health, University of Stavanger, Norway
| | - Kirsti S Anthun
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway
- Department of Health Research, SINTEF Digital, Norway
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Aasan BEV, Lillefjell M, Kvaløy K, Krokstad S, Sund ER. Social inequality and change in psychological distress during the Covid-19 pandemic in Norway. Eur J Public Health 2022. [PMCID: PMC9594399 DOI: 10.1093/eurpub/ckac131.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Emerging research findings suggest that the Covid-19 pandemic may have affected various social groups differently. Using follow-up health data from Norway, the aim of this study was to investigate whether change in psychological distress in adolescents during the Covid-19 pandemic differed across socioeconomic position (SEP). Methods Data consisted of 1254 Norwegian adolescents who participated in Young-HUNT4 (2017-19) and Young-HUNT COVID (spring 2021). Psychological distress (PD) was assessed by the Symptom Checklist-10, using a cut-off point of ≥ 1.85 to identify adolescents with high PD. Based on the adolescents PD score prior to and during the Covid-19 pandemic, four groups were identified: persistent low PD, improved PD, worsened PD, and persistent high PD. Adolescents reported their parents’ education level which was used as an indicator for SEP. SEP was dichotomized separating low and high SEP, where having at least one parent with a higher education was defined as high SEP. Multinomial logistic regression models were used to investigate if the likelihood of the outcome groups varied across SEP, adjusted for age and sex. Results Compared to the persistent low PD group, no statistically significant difference was found between low and high SEP in the improved PD and worsened PD group (RR 1.33 95% CI 0.77 - 2.31, RR 1.22 95% CI 0.82 - 1.81, respectively). However, adolescents of low SEP had a higher likelihood to be in the persistent high PD group compared with the high SEP group (RR 1.93 95% CI 1.30 - 2.87). Conclusions These preliminary findings suggest that the pandemic may not have led to greater social inequality in mental health among Norwegian adolescents. However, the results showed that social inequality that existed prior to the pandemic has persisted, as adolescents of lower SEP had a higher likelihood of reporting high PD that persisted from prior to and throughout the Covid-19 pandemic. Key messages • Social inequality in psychological distress among Norwegian adolescents has persisted prior to and during the Covid-19 pandemic. • The Covid-19 pandemic does not seem to have increased existing social inequalities in psychological distress among Norwegian adolescents.
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Affiliation(s)
- BEV Aasan
- Department of Public Health and Nursing, Norwegian University of Science and Technology , Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust , Levanger, Norway
| | - M Lillefjell
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology , Trondheim, Norway
- Department of Public Health, University of Stavanger , Stavanger, Norway
| | - K Kvaløy
- Department of Public Health and Nursing, Norwegian University of Science and Technology , Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust , Levanger, Norway
| | - S Krokstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology , Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust , Levanger, Norway
| | - ER Sund
- Department of Public Health and Nursing, Norwegian University of Science and Technology , Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust , Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University , Levanger, Norway
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Anthun KS, Lillefjell M, Anthun KS. Reablement in a small municipality, a survival analysis. BMC Health Serv Res 2021; 21:877. [PMID: 34445993 PMCID: PMC8390107 DOI: 10.1186/s12913-021-06910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reablement is a municipal service given to patients at home. The purpose of the service is to assist recovery after hospital discharges or other sudden changes in a patient's functional level. The service is often provided by a team of nurses, physiotherapists, and occupational therapists. The purpose of this paper is to compare users of this service to users who receive traditional home care services. Outcomes to be measured are risk of long-term care and mortality. METHODS All users of health and care services in a Norwegian municipality were eligible for inclusion. Data was extracted from the local user administrative database. Users were divided in two groups: those who received reablement and those home care users who did not receive reablement service. Propensity score matching was used to match users based on age, sex, and level of functioning in activities of daily living (ADL). Survival analysis was deployed to test if the reablement users had different risk of becoming long-term care users, and whether the mortality rate differed for this group. RESULTS 153 reablement users were included in the study. These were matched to 153 non-reablement home care users. The groups had similar distributions of age, sex, and level of functioning when starting their service trajectories. Regressions showed that reablement users had lower risk of using long-term care services in the study period (time at risk up to 4 years), and lower mortality. However, none of these estimates were statistically significant. CONCLUSIONS The study indicates that the reablement users in one municipality had lower use of long -term care and lower mortality when properly estimated, but numbers were too small for statistical significance to be found.
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Affiliation(s)
- Kjartan Sarheim Anthun
- Department of Health Research, SINTEF Digital, Trondheim, Norway. .,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsti Sarheim Anthun
- Department of Health Research, SINTEF Digital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Stegeman I, Godfrey A, Romeo-Velilla M, Bell R, Staatsen B, van der Vliet N, Kruize H, Morris G, Taylor T, Strube R, Anthun K, Lillefjell M, Zvěřinová I, Ščasný M, Máca V, Costongs C. Encouraging and Enabling Lifestyles and Behaviours to Simultaneously Promote Environmental Sustainability, Health and Equity: Key Policy Messages from INHERIT. Int J Environ Res Public Health 2020; 17:E7166. [PMID: 33007942 PMCID: PMC7579413 DOI: 10.3390/ijerph17197166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 01/12/2023]
Abstract
Human consumption and activity are damaging the global ecosystem and the resources on which we rely for health, well-being and survival. The COVID-19 crisis is yet another manifestation of the urgent need to transition to more sustainable societies, further exposing the weaknesses in health systems and the injustice in our societies. It also underlines that many of the factors leading to environmental degradation, ill health and social and health inequities are interlinked. The current situation provides an unprecedented opportunity to invest in initiatives that address these common factors and encourage people to live more healthily and sustainably. Such initiatives can generate the positive feedback loops needed to change the systems and structures that shape our lives. INHERIT (January 2016-December 2019), an ambitious, multisectoral and transnational research project that involved 18 organisations across Europe, funded by the European Commission, explored such solutions. It identified, defined and analysed promising inter-sectoral policies, practices and approaches to simultaneously promote environmental sustainability, protect and promote health and contribute to health equity (the INHERIT "triple-win") and that can encourage and enable people to live, move and consume more healthfully and sustainably. It also explored the facilitators and barriers to working across sectors and in public private cooperation. The insights were brought together in guidelines setting out how policy makers can help instigate and support local "triple-win" initiatives that influence behaviours as an approach to contributing to the change that is so urgently needed to stem environmental degradation and the interlinked threats to health and wellbeing. This article sets out this guidance, providing timely insights on how to "build back better" in the post pandemic era.
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Affiliation(s)
- Ingrid Stegeman
- EuroHealthNet, Royale Rue 146, 1000 Brussels, Belgium; (A.G.); (M.R.-V.); (C.C.)
| | - Alba Godfrey
- EuroHealthNet, Royale Rue 146, 1000 Brussels, Belgium; (A.G.); (M.R.-V.); (C.C.)
| | - Maria Romeo-Velilla
- EuroHealthNet, Royale Rue 146, 1000 Brussels, Belgium; (A.G.); (M.R.-V.); (C.C.)
| | - Ruth Bell
- Institute of Health Equity, UCL, London WC1E 7HB, UK;
| | - Brigit Staatsen
- Centre for Environmental Health Research, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands; (B.S.); (H.K.)
| | - Nina van der Vliet
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands;
| | - Hanneke Kruize
- Centre for Environmental Health Research, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands; (B.S.); (H.K.)
| | - George Morris
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK; (G.M.); (T.T.)
| | - Timothy Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK; (G.M.); (T.T.)
| | - Rosa Strube
- Collaborating Centre on Sustainable Consumption and Production (CSCP) gGmbH, Hagenauer Strasse 30, 42107 Wuppertal, Germany;
| | - Kirsti Anthun
- Norwegian University of Science and Technology, Tungasletta 2, NO-7491 Trondheim, Norway; (K.A.); (M.L.)
| | - Monica Lillefjell
- Norwegian University of Science and Technology, Tungasletta 2, NO-7491 Trondheim, Norway; (K.A.); (M.L.)
| | - Iva Zvěřinová
- Environment Centre, Charles University, 16200 Praha, Czech Republic; (I.Z.); (M.Š.); (V.M.)
| | - Milan Ščasný
- Environment Centre, Charles University, 16200 Praha, Czech Republic; (I.Z.); (M.Š.); (V.M.)
| | - Vojtěch Máca
- Environment Centre, Charles University, 16200 Praha, Czech Republic; (I.Z.); (M.Š.); (V.M.)
| | - Caroline Costongs
- EuroHealthNet, Royale Rue 146, 1000 Brussels, Belgium; (A.G.); (M.R.-V.); (C.C.)
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Myhr A, Anthun KS, Lillefjell M, Sund ER. Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health From 2014 to 2018: A Repeated Cross-Sectional Study. Front Psychol 2020; 11:1472. [PMID: 32733331 PMCID: PMC7358281 DOI: 10.3389/fpsyg.2020.01472] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/02/2020] [Indexed: 01/20/2023] Open
Abstract
Background Adolescents’ mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents’ mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014–2018. Methods The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014–2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014–2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period. Conclusion Rising rates of adolescents’ psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents’ mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts.
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Affiliation(s)
- Arnhild Myhr
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Trøndelag R&D Institute, Steinkjer, Norway
| | - Kirsti S Anthun
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Bjerre N, Lillefjell M, Magnus E, Anthun KS. Effective interventions targeting the mental health of children and young adults: A scoping review. Scand J Public Health 2020; 49:333-345. [PMID: 32009546 DOI: 10.1177/1403494820901406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Children and young adults are in general characterised by good health, but evidence shows increasing mental-health problems. Numerous interventions have been developed to target their mental health, but the effectiveness of these interventions remains varied. In this scoping review, we investigated factors associated with the effectiveness of interventions. Methods: A scoping review based on a three-block search strategy was performed to review the current literature of effective interventions. Each block (interventions, mental health and children and young adults) were operationalised to search terms. Systematic searches were conducted in three electronic databases and supplemented with citation searches, resulting in 51 studies in total. All studies were critically analysed, and a standardised extraction chart was used to systemise the data. Results: Our scoping review revealed a range of factors influencing the effectiveness of interventions. These factors were (a) characteristics of the target group (age, sex and level of baseline symptoms), (b) factors linked to implementation (use of manuals, training of implementers and context) and (c) characteristics of the interventions (universal versus indicated delivery, multiple-domain approaches, level of theory and adjustment to age and socio-economic status). Elements are discussed for each factor. Conclusions: Based on this review, it can be concluded that the use of stepwise, multi-domain approaches incorporating the social networks of the target group, adjusting activities to specific age groups and the social context, training implementers well and using stringent implementation manuals will improve the effectiveness of interventions targeting the mental health of children and young adults.
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Affiliation(s)
- Natasja Bjerre
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway.,Health Promotion, Steno Diabetes Center, Copenhagen, Denmark
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway
| | - Eva Magnus
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway
| | - Kirsti S Anthun
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway
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Anthun KS, Maass REK, Hope S, Espnes GA, Bell R, Khan M, Lillefjell M. Addressing Inequity: Evaluation of an Intervention to Improve Accessibility and Quality of a Green Space. Int J Environ Res Public Health 2019; 16:E5015. [PMID: 31835473 PMCID: PMC6950353 DOI: 10.3390/ijerph16245015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022]
Abstract
Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015-2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.
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Affiliation(s)
- Kirsti S. Anthun
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (R.E.K.M.); (S.H.); (M.L.)
| | - Ruca Elisa Katrin Maass
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (R.E.K.M.); (S.H.); (M.L.)
| | - Siren Hope
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (R.E.K.M.); (S.H.); (M.L.)
- Department of Public Health and Nursing, Center for Health Promotion Research, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Geir Arild Espnes
- Department of Public Health and Nursing, Center for Health Promotion Research, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Ruth Bell
- Institute of Health Equity, Department for Epidemiology & Public Health, University College London, London WC1E 7HB, UK; (R.B.); (M.K.)
| | - Matluba Khan
- Institute of Health Equity, Department for Epidemiology & Public Health, University College London, London WC1E 7HB, UK; (R.B.); (M.K.)
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (R.E.K.M.); (S.H.); (M.L.)
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Wlodarczyk D, Lazarewicz M, Rzadkiewicz M, Chylinska J, Adamus M, Jaworski M, Lillefjell M, Haugan G, Espnes GA. Teaching general practitioners to activate older patients: The intervening role of changes in perceived communication skills. Patient Educ Couns 2019; 102:1687-1694. [PMID: 31036331 DOI: 10.1016/j.pec.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/08/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This report examined whether a change in the perceived communication behaviour (PeCoBe) of general practitioners (GPs) influenced the effect of the Promoting Active Aging (PRACTA) intervention on activation of older patients as perceived by GPs. METHODS Pre- and post-intervention questionnaires were filled out by 225 GPs, who were assigned to three groups, e-learning, pdf-article, and control. GPs self-reported their communication behaviour and their perceptions of the attitudes of older patients toward treatment and health. RESULTS Participation in the e-learning intervention showed an increase in the PeCoBe of GPs, while reading the pdf-article resulted in a decrease of such behaviours. An increase in the PeCoBe of GPs was positively related to an increase in their perception of an active attitude among older patients. The indirect effects observed for e-learning and pdf-article interventions had opposite directions. CONCLUSION Both types of PRACTA intervention exerted an impact on GPs' perception of the attitudes of older patients, and change in PeCoBe of GPs could be considered as a mechanism driving this effect. PRACTICAL IMPLICATIONS The methods based on a combination of knowledge delivery and modelling of communication skills are strongly recommended forms of teaching for GPs on how to communicate with and activate seniors.
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Affiliation(s)
- Dorota Wlodarczyk
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, ul. Litewska 14-16, 00-575 Warszawa, Poland.
| | - Magdalena Lazarewicz
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, ul. Litewska 14-16, 00-575 Warszawa, Poland
| | - Marta Rzadkiewicz
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, ul. Litewska 14-16, 00-575 Warszawa, Poland
| | - Joanna Chylinska
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, ul. Litewska 14-16, 00-575 Warszawa, Poland
| | - Miroslawa Adamus
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, ul. Litewska 14-16, 00-575 Warszawa, Poland
| | - Mariusz Jaworski
- Department of Medical Psychology and Medical Communication, Medical University of Warsaw, ul. Litewska 14-16, 00-575 Warszawa, Poland
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Tungasletta 2, 7491 Trondheim, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Center for Health Promotion Research, Norwegian University of Science and Technology, Tungasletta 2, 7491 Trondheim, Norway
| | - Geir A Espnes
- Department of Public Health and Nursing, Center for Health Promotion Research, Norwegian University of Science and Technology, Tungasletta 2, 7491 Trondheim, Norway
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10
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Lazarewicz MA, Wlodarczyk D, Chylinska J, Jaworski M, Rzadkiewicz M, Adamus M, Haugan GØ, Lillefjell M, Espnes GA. Testing a New Tool Assessing Attitude Towards Treatment and Health in Primary Health Care Setting: Senior Patients and Doctors Perspectives. Scand J Public Health 2018; 47:61-69. [DOI: 10.1177/1403494818780855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Patients’ attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care. Methods: The data were collected in two waves of the Polish–Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients ( n = 3392) and their general practitioners ( n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients ( n = 2765) and a follow-up sample of doctors ( n = 393). Results: The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors’ ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution. Conclusions: The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients’ ATH and concordance between doctors and patients’ perspectives.
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Affiliation(s)
- Magdalena A. Lazarewicz
- Second Faculty of Medicine, Department of Medical Psychology & Medical Communication, Medical University of Warsaw, Poland
| | - Dorota Wlodarczyk
- Second Faculty of Medicine, Department of Medical Psychology & Medical Communication, Medical University of Warsaw, Poland
| | - Joanna Chylinska
- Second Faculty of Medicine, Department of Medical Psychology & Medical Communication, Medical University of Warsaw, Poland
| | - Mariusz Jaworski
- Faculty of Health Sciences, The Division of Teaching and Outcomes of Education, Medical University of Warsaw, Poland
| | - Marta Rzadkiewicz
- Second Faculty of Medicine, Department of Medical Psychology & Medical Communication, Medical University of Warsaw, Poland
| | - Miroslawa Adamus
- Second Faculty of Medicine, Department of Medical Psychology & Medical Communication, Medical University of Warsaw, Poland
| | - GØrill Haugan
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
| | - Monica Lillefjell
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway
| | - Geir A. Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
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Lillefjell M, Magnus E, Knudtsen MS, Wist G, Horghagen S, Espnes GA, Maass R, Anthun KS. Governance for public health and health equity: The Tröndelag model for public health work. Scand J Public Health 2018; 46:37-47. [DOI: 10.1177/1403494818765704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Multi-sectoral governance of population health is linked to the realization that health is the property of many societal systems. This study aims to contribute knowledge and methods that can strengthen the capacities of municipalities regarding how to work more systematically, knowledge-based and multi-sectoral in promoting health and health equity in the population. Methods: Process evaluation was conducted, applying a mixed-methods research design, combining qualitative and quantitative data collection methods. Results: Processes strengthening systematic and multi-sectoral development, implementation and evaluation of research-based measures to promote health, quality of life, and health equity in, for and with municipalities were revealed. A step-by-step model, that emphasizes the promotion of knowledge-based, systematic, multi-sectoral public health work, as well as joint ownership of local resources, initiatives and policies has been developed. Conclusions: Implementation of systematic, knowledge-based and multi-sectoral governance of public health measures in municipalities demand shared understanding of the challenges, updated overview of the population health and impact factors, anchoring in plans, new skills and methods for selection and implementation of measures, as well as development of trust, ownership, shared ethics and goals among those involved.
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Affiliation(s)
- Monica Lillefjell
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Program of Occupational Therapy, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eva Magnus
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Program of Occupational Therapy, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Guri Wist
- Nord-Trøndelag County Counsil, Steinkjer, Norway
| | - Sissel Horghagen
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Program of Occupational Therapy, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Social Medicine and Nursing. Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Ruca Maass
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Program of Occupational Therapy, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsti Sarheim Anthun
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Program of Occupational Therapy, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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Myhr A, Haugan T, Lillefjell M, Halvorsen T. Non-completion of secondary education and early disability in Norway: geographic patterns, individual and community risks. BMC Public Health 2018; 18:682. [PMID: 29855297 PMCID: PMC5984305 DOI: 10.1186/s12889-018-5551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 05/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background School non-completion and early work disability is a great public health challenge in Norway, as in most western countries. This study aims to investigate how medically based disability pension (DP) among young adults varies geographically and how municipal socioeconomic conditions interact with non-completion of secondary education in determining DP risk. Methods The study includes a nationally representative sample of 30% of all Norwegians (N = 350,699) aged 21–40 in 2010 from Statistic Norway’s population registries. Multilevel models incorporating factors at the individual, neighbourhood and municipal levels were applied to estimate the neighbourhood and municipality general contextual effects in DP receipt, and detect possible differences in the impact of municipal socioeconomic conditions on DP risk between completers and non-completers of secondary education. Results A pattern of spatial clustering at the neighbourhood (ICC = 0.124) and municipality (ICC = 0.021) levels are clearly evident, indicating that the underlying causes of DP receipt have a systematic neighbourhood and municipality variation in Norway. Non-completion of secondary education is strongly correlated with DP receipt among those younger than 40. Socioeconomic characteristics of the municipality are also significantly correlated with DP risk, but these associations are conditioned by the completion of secondary education. Living in a socioeconomically advantageous municipality (i.e. high income, high education levels and low unemployment and social security payment rates) is associated with a higher risk of DP, but only among those who do not complete their secondary education. Although the proportion of DPs was equal in rural and urban areas, it is evident that young people living in urban settings are more at risk of early DP than their counterparts living in rural parts of the country when controlling for other risk factors. Conclusion The association between school non-completion and DP risk varies between municipalities and local socioeconomic environments. The interplay between personal characteristics and the local community is important in DP risk among young adults, implying that preventive measures should be directed not only at the individual level, but also include the educational system and the local community.
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Affiliation(s)
- Arnhild Myhr
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tommy Haugan
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Technology and Society, Trondheim, Norway
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Rzadkiewicz M, Chylinska J, Jaworski M, Lazarewicz M, Adamus M, Haugan G, Lillefjell M, Espnes GA, Wlodarczyk D. Activation of older patients through PRACTA intervention for primary healthcare doctors: does the method matter? Eur J Public Health 2017; 27:998-1003. [DOI: 10.1093/eurpub/ckx129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maass R, Lindström B, Lillefjell M. Neighborhood-resources for the development of a strong SOC and the importance of understanding why and how resources work: a grounded theory approach. BMC Public Health 2017; 17:704. [PMID: 28899368 PMCID: PMC5596861 DOI: 10.1186/s12889-017-4705-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/04/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Providing individuals with psychosocial resources such as sense of coherence (SOC) seems a beneficial strategy for health promotion in the neighborhood. In order to become a supporting theory for health promotion, Salutogenesis should renew its focus on resources for health, and explore how the development of a strong SOC can be facilitated. METHODS Relevant issues were explored using a Grounded Theory- approach. Three focus-group-sessions and three in-depth interviews were conducted with strategically sampled participants. The transcripts of the focus groups were initially analyzed line-by-line to ensure that insights emerged from the data. We then applied focused and systemic analyses to achieve axial coding, and to include insights into how social interactions during focus groups may reveal social processes in real-life-neighborhoods. The data from the in-depth interviews were used to validate and fill emerging categories, as well as to ensure data-saturation. RESULTS Findings indicate the importance of repeated experiences with resources and every-day-challenges to develop a strong SOC. Active engagement with resources is a favorable condition for significant experiences, which enhance the internalization of resources. Core experiences are characterized by a re-organization of resources. Participation in intellectual meaning-making through equal power dialogue seems to broaden perspectives and promote the strengthening of SOC. A strong SOC can also be described as a deeper understanding of how and why resources work, which allows for a more flexible use of resources, including replacing missing resources. CONCLUSION A new understanding of SOC as an intuitive understanding of how, why and under which circumstances resources work, as well as a new focus on everyday life and repeated experiences might facilitate new approaches to a purposeful strengthening of SOC through the planning and implementation of public measures.
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Affiliation(s)
- Ruca Maass
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bengt Lindström
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
- Departement of Public health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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Myhr A, Lillefjell M, Espnes GA, Halvorsen T. Correction: Do family and neighbourhood matter in secondary school completion? A multilevel study of determinants and their interactions in a life-course perspective. PLoS One 2017; 12:e0184231. [PMID: 28850592 PMCID: PMC5574580 DOI: 10.1371/journal.pone.0184231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0172281.].
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Myhr A, Lillefjell M, Espnes GA, Halvorsen T. Do family and neighbourhood matter in secondary school completion? A multilevel study of determinants and their interactions in a life-course perspective. PLoS One 2017; 12:e0172281. [PMID: 28222115 PMCID: PMC5319759 DOI: 10.1371/journal.pone.0172281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 02/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Completion of secondary education is important for individuals' future health and health behaviour. The fundamental purpose of this study is to investigate the variation and clustering of school completion in families and neighbourhoods. Secondly, we aim to examine the impact of individuals' family structure and neighbourhood of residence and examine to what extent parental education level moderates these associations. METHODS Longitudinal register data for 30% of the entire Norwegian population aged 21-27 years in 2010 (N = 107,003) was extracted from Statistic Norway´s event database. Three-level logistic regression models, which incorporated individual, family, and neighbourhood contextual factors, were applied to estimate the family and neighbourhood general contextual effects and detect possible educational differences in the impact of family structure and urban place of residence in school completion. RESULTS Completion rates were significantly higher within families with higher education level (79% in tertiary educated families vs. 61% and 48% in secondary and primary educated families respectively) and were strongly correlated within families (ICC = 39.6) and neighbourhoods (ICC = 5.7). Several structural factors at the family level negatively associated with school completion (e.g., family disruption, large family size, and young maternal age) were more prevalent and displayed more negative impact among primary educated individuals. Urban residence was associated with school completion, but only among the tertiary educated. CONCLUSIONS Investment in the resources in the individuals' immediate surroundings, including family and neighbourhood, may address a substantial portion of the social inequalities in the completion of upper secondary education. The high intra-familial correlation in school completion suggests that public health policies and future research should acknowledge family environments in order to improve secondary education completion rates among young people within lower educated families.
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Affiliation(s)
- Arnhild Myhr
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Monica Lillefjell
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Halvorsen
- SINTEF Technology and Society, Department of Health Research, Trondheim, Norway
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Wlodarczyk D, Chylińska J, Lazarewicz M, Rzadkiewicz M, Jaworski M, Adamus M, Haugan G, Lillefjell M, Espnes GA. Enhancing Doctors' Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study. J Med Internet Res 2017; 19:e45. [PMID: 28228370 PMCID: PMC5343213 DOI: 10.2196/jmir.6948] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/07/2017] [Accepted: 01/29/2017] [Indexed: 01/27/2023] Open
Abstract
Background Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. Objective Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. Methods The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. Results GPs participating in e-learning demonstrated a significant rise in their perception of older patients’ expectations for disease explanation (Wald χ2=19.7, P<.001) and in perception of motivational aspect of older patients’ attitude toward treatment and health (Wald χ2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald χ2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility’s organizational structure. Conclusions Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors’ reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients’ proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients.
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Affiliation(s)
- Dorota Wlodarczyk
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Chylińska
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Lazarewicz
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Rzadkiewicz
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Jaworski
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Miroslawa Adamus
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Gørill Haugan
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjell
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Jaworski M, Rzadkiewicz M, Adamus M, Chylinska J, Lazarewicz M, Haugan G, Lillefjell M, Espnes GA, Wlodarczyk D. Primary care patients' expectations regarding medical appointments and their experiences during a visit: does age matter? Patient Prefer Adherence 2017; 11:1221-1233. [PMID: 28761335 PMCID: PMC5522818 DOI: 10.2147/ppa.s133390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION There is evidence that meeting patients' expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. PATIENTS AND METHODS The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. RESULTS We observed differences related to age in patients' expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients' appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. CONCLUSION Patients' expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit.
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Affiliation(s)
- Mariusz Jaworski
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Mariusz Jaworski, Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, ZJAM Building–First Floor, 81 Zwirki i Wigury Street, Warsaw 02-091, Poland, Tel +48 22 572 0533, Fax +48 22 572 0542, Email
| | - Marta Rzadkiewicz
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Miroslawa Adamus
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Chylinska
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Lazarewicz
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Dorota Wlodarczyk
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Maass R, Kloeckner CA, Lindstrøm B, Lillefjell M. The impact of neighborhood social capital on life satisfaction and self-rated health: A possible pathway for health promotion? Health Place 2016; 42:120-128. [PMID: 27770668 DOI: 10.1016/j.healthplace.2016.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/19/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022]
Abstract
Neighborhood social capital has repeatedly been linked to favorable health-outcomes and life satisfaction. However, it has been questioned whether it's impact on health has been over-rated. We aim to investigate relationships between neighborhood social capital and self-rated health (SRH) and life satisfaction (LS) respectively, both directly and indirectly mediated via Sense of Coherence and self-esteem. Based on a cross-sectional population-survey (N=865) in a medium size Norwegian municipality, we specified a structural equation model (SEM) including the above-listed variables, while controlling for gender, age, education, income, and employment status. The applied model explains more variance in LS (46%) than in SRH (23%). Social capital has a stronger impact on life satisfaction than on health. The indirect pathway via SOC had the highest impact on life satisfaction, but no significant relationship to SRH. Self-rated health was more tightly linked to personal background variables. Enhancing social capital in the neighborhood might be a beneficial strategy to promote life satisfaction, as well as strengthening sense of coherence even in healthy communities.
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Affiliation(s)
- Ruca Maass
- Department of Health Science, Faculty of Health and Social Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway; Center for Health Promotion Research, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway.
| | - Christian A Kloeckner
- Department of Psychology, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway.
| | - Bengt Lindstrøm
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway.
| | - Monica Lillefjell
- Department of Health Science, Faculty of Health and Social Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway; Center for Health Promotion Research, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway.
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Magnus E, Knudtsen MS, Wist G, Weiss D, Lillefjell M. The Search Conference as a Method in Planning Community Health Promotion Actions. J Public Health Res 2016; 5:621. [PMID: 27747199 PMCID: PMC5062752 DOI: 10.4081/jphr.2016.621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/02/2016] [Indexed: 12/05/2022] Open
Abstract
Aims: The aim of this article is to describe and discuss how the search conference can be used as a method for planning health promotion actions in local communities. Design and methods: The article draws on experiences with using the method for an innovative project in health promotion in three Norwegian municipalities. The method is described both in general and how it was specifically adopted for the project. Results and conclusions: The search conference as a method was used to develop evidence-based health promotion action plans. With its use of both bottom-up and top-down approaches, this method is a relevant strategy for involving a community in the planning stages of health promotion actions in line with political expectations of participation, ownership, and evidence-based initiatives. Significance for public health This article describe and discuss how the Search conference can be used as a method when working with knowledge based health promotion actions in local communities. The article describe the sequences of the conference and shows how this have been adapted when planning and prioritizing health promotion actions in three Norwegian municipalities. The significance of the article is that it shows how central elements in the planning of health promotion actions, as participation and involvements as well as evidence was a fundamental thinking in how the conference were accomplished. The article continue discussing how the method function as both a top-down and a bottom-up strategy, and in what way working evidence based can be in conflict with a bottom-up strategy. The experiences described can be used as guidance planning knowledge based health promotion actions in communities.
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Affiliation(s)
- Eva Magnus
- Faculty of Halt and Social Science, Department of Health Science, Norwegian University of Science and Technology , Trondheim
| | | | - Guri Wist
- Nord-Trondelag County Council , Nord-Trondelag, Norway
| | - Daniel Weiss
- Faculty of Halt and Social Science, Department of Health Science, Norwegian University of Science and Technology , Trondheim
| | - Monica Lillefjell
- Faculty of Halt and Social Science, Department of Health Science, Norwegian University of Science and Technology , Trondheim
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Abstract
OBJECTIVES Lack of work-participation and early disability pensions (DP's) among young adults are increasing public health problems in most western European countries. The present study investigated determinants of early DP in young adults in vocational rehabilitation. METHODS Data from 928 young adults (aged 18-40 years) attending a vocational rehabilitation program was linked to DP's recorded in the Norwegian Labor and Welfare Organization registries (1992-2010) and later compared to a group of 65 employees (workers). We used logistic regression to estimate the odds ratio for entitlement to DP following rehabilitation, adjusting for socio-demographical, psychosocial and health-behavior factors. RESULTS Significant differences in socio-demographical, psychosocial and health-behavior factors were found between the rehabilitation group and workers. A total of 60 individuals (6.5%) were granted a DP during follow-up. Increase in age, teenage parenthood, single status, as well as low education level and not being employed were found to be the strongest independent determinants of DP. CONCLUSION Poor social relations (being lone), early childbearing and weak connection to working life contributed to increase in risk of DP's among young adults in vocational rehabilitation, also after adjusting for education level. These findings are important in the prevention of early disability retirements among young adults and should be considered in the development of targeted interventions aimed at individuals particularly at risk of not being integrated into future work lives.
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Affiliation(s)
- Arnhild Myhr
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tommy Haugan
- Nord-Trøndelag University College, Steinkjer, Norway
| | - Geir A Espnes
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Health Promotion Research, Trondheim, Norway
| | - Monica Lillefjell
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Health Promotion Research, Trondheim, Norway
- Department of Occupational Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway
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Weiss D, Lillefjell M, Magnus E. Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level. BMC Public Health 2016; 16:140. [PMID: 26869177 PMCID: PMC4751684 DOI: 10.1186/s12889-016-2811-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/02/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels - due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement. METHODS We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions. RESULTS The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within each of these important facilitating factors, various elements supporting implementation were discussed and highlighted in this study. CONCLUSION Our results indicate that clear and consistent facilitators exist for supporting health promoting policy development and program implementation at the local level. These results offer a starting point for local action on the Social Determinants of Health and have the potential to contribute to the development of a framework for improving action at the local level.
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Affiliation(s)
- Daniel Weiss
- Department of Occupational Therapy, Norwegian University of Science and Technology, Faculty of Health and Social Science, NO-7491, Trondheim, Norway.
| | - Monica Lillefjell
- Department of Occupational Therapy, Norwegian University of Science and Technology, Faculty of Health and Social Science, NO-7491, Trondheim, Norway.
| | - Eva Magnus
- Department of Occupational Therapy, Norwegian University of Science and Technology, Faculty of Health and Social Science, NO-7491, Trondheim, Norway.
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Abstract
PURPOSE The purpose of this paper is to examine the contribution of modern correctional service in health promotion exemplified by the case study of Norwegian health promotion policies in prison settings. DESIGN/METHODOLOGY/APPROACH This paper applies a two-fold methodology. First a narrative systematic literature review based on the Norwegian policy documents relevant for correctional settings is conducted. This is followed by a general review of the literature on the principles of humane service delivery in offender rehabilitation. FINDINGS Alongside the contribution of the Risk-Need-Responsivity Model in corrections and prevention of reoffending, the findings demonstrate an evident involvement of Norway in health promotion through authentic health promoting actions applied in prison settings. The actions are anchored in health policy's overarching goals of equity and "health in all public policy" aiming to reduce social inequalities in population health. ORIGINALITY/VALUE In order to achieve a potential success of promoting health in correctional settings, policy makers have much to gain from endorsing a dialogue that respects the unique contributions of correctional research and health promotion. Focussing on inter-agency partnership and interdisciplinary collaboration between humane services may result in promising outcomes for individual, community and public health gain. The organizational factors and community involvement may be a significant aspect in prisoner rehabilitation, reentry and reintegration.
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Affiliation(s)
- Lidia Santora
- Researcher, based at Department of Social Work and Health Science, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Myhr A, Halvorsen T, Lillefjell M. Secondary school completion: Gender differences and the role of childhood family structure. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Monica Lillefjell
- Research Centre for Health Promotion and Resources HiST/NTNU, Department of Occupational Therapy, Faculty of Health Education and Social Work , Sør-Trøndelag University College, Trondheim, Norway
- Norwegian University of Science and Technology, NTNU, Department of Social Work and Health Science, Trondheim, Norway
| | - Klara Jakobsen
- Research Centre for Health Promotion and Resources HiST/NTNU, Department of Occupational Therapy, Faculty of Health Education and Social Work , Sør-Trøndelag University College, Trondheim, Norway
| | - Linda Ernstsen
- Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway
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Espnes GA, Lillefjell M. How to use new scientific data to influence central and local politics - the case of Norway. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lillefjell M, Knudtsen MS, Wist G, Magnus E. How to come from research to policy documents and how to come from policy documents to research in counties and local communities - the case of Trøndelag. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Løhre A, Kvande MN, Hjemdal O, Lillefjell M. A two-year perspective: who may ease the burden of girls' loneliness in school? Child Adolesc Psychiatry Ment Health 2014; 8:10. [PMID: 24712912 PMCID: PMC4234933 DOI: 10.1186/1753-2000-8-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/02/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Loneliness is negatively related to good health and wellbeing, especially among girls. There is little research, however, on factors that may ease the burdens of loneliness in the school setting. Thus, we explored the relationship between girls' loneliness and later school wellbeing adjusted for other adversities. Furthermore, we assessed the significance of having someone whom the girl trusted by investigating possible modifying influences on the addressed association. METHODS Altogether, 119 girls in grades 1-8 provided baseline data and answered the same set of questions two years later. Logistic regression models including perceived academic problems, victimisation by bullying, loneliness and trusted others were tested with bad versus good school wellbeing two years later as outcome using SPSS. RESULTS In the multivariable analysis of loneliness, academic problems, and victimisation, loneliness was the only variable showing a strong and negative contribution to later school wellbeing. Next, demonstrated in separate models; the inclusion of having a trusted class advisor fully attenuated the association of loneliness with later school wellbeing. In contrast, other trusted teachers, trusted parents, or trusted students did not affect the association. CONCLUSIONS Loneliness in girls strongly predicted school wellbeing two years later. However, having a class advisor whom the girl trusted to contact in hurtful situations clearly reduced the burden of loneliness. This finding highlights the clinical importance of stability, long-lasting relations, and trust that main teachers may represent for lonely girls.
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Affiliation(s)
- Audhild Løhre
- Research Centre for Health Promotion and Resources, Trondheim, Norway
- Department of Social Work and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne N Kvande
- Research Centre for Health Promotion and Resources, Trondheim, Norway
- Department of Social Work and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjell
- Research Centre for Health Promotion and Resources, Trondheim, Norway
- Department of Social Work and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Occupational Therapy, Sør-Trøndelag University College, Trondheim, Norway
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Maass R, Lindstrøm B, Lillefjell M. Exploring the relationship between perceptions of neighbourhoodresources, sense of coherence and health for different groups in a norwegian neighbourhood. J Public Health Res 2014; 3:208. [PMID: 25170510 PMCID: PMC4140378 DOI: 10.4081/jphr.2014.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 12/05/2022] Open
Abstract
Background Health and conditions for health are unevenly distributed across neighbourhoods. Within a salutogenic perspective, neighbourhood-resources can be internalised, and become generalised resistance resources. This paper aims to examine whether the neighbourhood could be a supportive arena for health-promotion, and for whom. Design and Methods A cross-sectional study, based on register data from the population-survey in Malvik, Norway, (N=865) was conducted. Using multiple regression analysis, total sample and sub-group analyses (men/women, low/high earners, employed/unemployed) of 5 independent neighbourhood-measures (overall satisfaction, neighbourhood Social Capital, satisfaction with availability and quality of neighbourhood-resources, and neighbourhood participation) on Sense of Coherence (SOC) and health respectively were obtained. Results Overall satisfaction (β=0.153) and neighbourhood social capital (β=0.134) emerged as the most consistent partial correlates of SOC across groups. In turn, SOC was the strongest coefficient for health-outcomes (β=0.238). Neighbourhood participation had more consistent correlations with health than SOC across groups. Group-differences became visible in proportions of explained variance in SOC (varying from 7 to 23.7%) and health (varying from 6.7 to 20.6%), and in the relative importance of neighbourhood-variables. Satisfaction with quality of neighbourhood-resources was significantly related to SOC in non-workers (β=0.451) and low-earners (β=0.261), and health-outcomes in women (β=0.143). Conclusions Health might be promoted in the neighbourhood mainly through strengthening SOC, and deprived groups, especially non-workers, may benefit most from health-promotion in the neighbourhood. Findings suggest that high satisfaction with quality can contribute to better health-outcomes for groups with weaker average SOC. The proposed theoretical framework is only partly supported. Significance for public health The creation of health-promoting settings has been outlined as one of the main strategies ahead by the Ottawa-charter. Findings from this study suggest that health can be promoted through the neighbourhood, both through strengthening Sense of coherence (SOC), and providing resources for health-promotion. It is suggested that the neighbourhood might be of benefit for promoting health in groups which might be otherwise hard to reach, such as people outside the work-force. Moreover, investigating the relationships between various perceptions of neighbourhood-resources and SOC/health across groups allows for developing strategies for positive change, including improving quality of neighbourhood-resources, and facilitating neighbourhood participation.
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Affiliation(s)
| | - Bengt Lindstrøm
- Research Centre for Health Promotion and Resources and Department of Social Work and Health Sciences, Norwegian University of Science and Technology , Trondheim Norway ; Department of Social Work and Health Sciences, Norwegian University of Science and Technology , Trondheim Norway
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Ernstsen L, Lillefjell M. Physical functioning after occupational rehabilitation and returning to work among employees with chronic musculoskeletal pain and comorbid depressive symptoms. J Multidiscip Healthc 2014; 7:55-63. [PMID: 24489473 PMCID: PMC3904812 DOI: 10.2147/jmdh.s55828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms. Methods Included were 92 employees with chronic musculoskeletal disorders who had participated in a 57- week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on “active work strategies,” such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as “on their way into/in work”. Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals. Results There were no differences between the “on their way into/in work” group (n=70) and the “on their way out/out of work” group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work. Conclusion The findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program.
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Affiliation(s)
- Linda Ernstsen
- Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway
| | - Monica Lillefjell
- Department of Occupational Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway
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Abstract
OBJECTIVE Efforts have been made to explain the inability to return to work (RTW) due to employees' chronic musculoskeletal pain. Knowledge of factors facilitating the RTW process is however still limited. Based on the experiences of employees and employers, this study aims to identify factors promoting a successful return process for persons with chronic musculoskeletal pain. METHODS The findings from interviews, involving six employees with musculoskeletal pain, and five employers with various work experience, were analysed by Giorgi's phenomenological analysis through four stages. RESULTS The major themes underlying the employees' comments for a successful RTW were identifying and mobilizing their personal resources, adapting a balanced daily life, and requiring a positive dialogue with family and their employer, while the employers underlined the need for a helpful adjustment at work and how they wanted to become more involved in the rehabilitation process. CONCLUSIONS In conclusion our findings underline the need for extended collaboration between the employees, employer, and rehabilitation staff, and should encourage occupational therapists to direct even more of their expertise towards the situation at the workplace.
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Affiliation(s)
- Klara Jakobsen
- Faculty of Health Education and Social Work, Sør-Trøndelag University College , Trondheim , Norway
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Lillefjell M, Knudtsen MS, Wist G, Ihlebæk C. From knowledge to action in public health management: Experiences from a Norwegian context. Scand J Public Health 2013; 41:771-7. [DOI: 10.1177/1403494813496600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: A pro-active approach that incorporates the effective use of scientific evidence and data is a major goal in public health work. This study aimed to identify local and regional strengths and barriers to identify, translate, and use relevant evidence of “what works” in public health management. Methods: Focus group discussions were performed among 22 researchers, public health leaders and/or leaders with organisational and policy responsibilities in two municipalities, one county, and a university research centre. Results: Access to the population’s health data is insufficient for taking action. The focus group discussions clarified a need for a skills programme that specifically focuses on analysis and process expertise. Moreover, communication and collaboration among key stakeholders involved in evidence-based practices like research, policy, and practice should be enhanced in order to facilitate evidence-based policy making. Conclusions: The complex relationship between context and behaviour and the necessity of influencing systems and structures as well as individuals to promote change underlines the need for a clear national initiative to facilitate knowledge exchanges among practitioners, policy makers, and researchers.
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Affiliation(s)
- M. Lillefjell
- Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway
- Research Centre for Health Promotion and Resources HiST/NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - G. Wist
- Nord-Trøndelag County Council, Steinkjer, Norway
| | - C. Ihlebæk
- Section of Public Health, ILP, Norwegian University of Life Sciences, Ås, Norway
- Østfold University College, Moss, Norway
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Sivertsen H, Lillefjell M, Espnes GA. The relationship between health promoting resources and work participation in a sample reporting musculoskeletal pain from the Nord-Trøndelag Health Study, HUNT 3, Norway. BMC Musculoskelet Disord 2013; 14:100. [PMID: 23509959 PMCID: PMC3606465 DOI: 10.1186/1471-2474-14-100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background Musculoskeletal pain (MSP) is one of the most frequent causes of sick leave from work, and is a common and potentially disabling condition. This study is based on the salutogenic perspective and investigates the relationship between personal, social, and functional health resources and work participation in a population reporting MSP. Method Analysis was performed on cross sectional data from the Nord-Trøndelag Health Study, HUNT 3, in Norway. The sample of n= 6702 was extracted from HUNT 3, including a total of N= 50807 participants. Self-reported health (SRH) and, personal, social, and functional resources were assessed by a questionnaire. Reported sick leave was collected by interview at the point of time when the data were collected, from October 2006 until June 2008. Results Logistic regression analysis demonstrated statistically significant differences between the work group and sick leave group in self-rated health, work support, work control, work load, and feeling strong, and the model predicted 68% of the cases correctly. Females had a lower statistically significant probability (B= −.53) to be in the work group then men when suffering from MSP, with odds of 41%. Conclusion There was a statistically significant relationship between health promoting resources such as SRH, feeling strong, absence of neuroticism, work load, work control, and work participation in MSP population.
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Affiliation(s)
- Heidi Sivertsen
- Department of Social Work and Health Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
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Moksnes UK, Espnes GA, Lillefjell M. Sense of coherence and emotional health in adolescents. J Adolesc 2012; 35:433-41. [PMID: 21831417 DOI: 10.1016/j.adolescence.2011.07.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/30/2011] [Accepted: 07/10/2011] [Indexed: 11/25/2022]
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Lillefjell M, Krokstad S, Espnes GA. Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study. BMC Musculoskelet Disord 2007; 8:65. [PMID: 17623074 PMCID: PMC1933535 DOI: 10.1186/1471-2474-8-65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 07/10/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of chronic musculoskeletal pain is high, with widespread negative economic, psychological, and social consequences for the individual. It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life. The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function, and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain. METHODS A prospective study was conducted among one hundred and forty three (N = 143) musculoskeletal pain patients. Measures of pain, function, and functional health status were obtained at baseline, after 5 weeks of intensive training, at the end of the 57-week rehabilitation programme, and at a 1 year follow-up, using validated self-administrated measures. Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain, individual-, and psychosocial factors in function. RESULTS The participants studied showed a significant increase in function during the 57 weeks rehabilitation period. There was also a significant increase in function from the end of the rehabilitation period (57th week) to the one year follow-up measures. Pain intensity associated significantly with pain experience over all measurement periods. High levels of pain intensity (beta = .42**) and pain experience (beta = .37*), and poor psychological capacity (beta = -.68*) at baseline, as well as poor physiological capacity (beta = -.44**) and high levels of anxiety (beta = .48**) and depression (beta = .58***) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods. CONCLUSION The data suggest that physical capacity, emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life.
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Affiliation(s)
- Monica Lillefjell
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Occupational Therapy, Sør-Trøndelag University College, Trondheim, Norway
| | - Steinar Krokstad
- The Nord-Trøndelag Health Study Research centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Arild Espnes
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Nursing, Sør-Trøndelag University College, Trondheim, Norway
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Lillefjell M, Jakobsen K. Sense of coherence as a predictor of work reentry following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain. J Occup Health Psychol 2007; 12:222-31. [PMID: 17638489 DOI: 10.1037/1076-8998.12.3.222] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the association between sense of coherence (SOC) and work reentry. One hundred and fifty-three patients with musculoskeletal pain (mean age=45.6 years, SD=9.1) were included. SOC, demographics, personal characteristics, work status, pain intensity, pain experience, anxiety, and depression were collected during a 57-week rehabilitation period. SOC significantly improved, and pain experience, anxiety, and depression significantly decreased during the rehabilitation period. SOC was found to significantly predict anxiety and depression in the nonwork reentry subsample (n=44). No significant association was found between SOC and work reentry. These data clarify the role of SOC in chronic pain and emotional distress and question the role of SOC in predicting work reentry in long-term chronic musculoskeletal pain conditions.
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Affiliation(s)
- Monica Lillefjell
- Department of Occupational Therapy, University College of Sør-Trøndelag, Trondheim, Norway.
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Lillefjell M, Krokstad S, Espnes GA. Factors predicting work ability following multidisciplinary rehabilitation for chronic musculoskeletal pain. J Occup Rehabil 2006; 16:543-55. [PMID: 16708277 DOI: 10.1007/s10926-005-9011-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION This study aimed to investigate the outcome and outcome predictors of multidisciplinary rehabilitation in terms of working ability. METHODS One hundred and forty three (n=143) patients with musculoskeletal pain (mean age=45.7, SD=8.9) were included. Work status, pain, functional health status and psychosocial factors were collected previous to treatment, after a 5 week intensive training and a 52 week follow-up period. Demographics and data on personal characteristics were also collected. RESULTS Workability increased from 57.4 to 80% during treatment period. Stepwise multivariate logistic regression indicated that age, sleeplessness, cognitive function, overall health, pain experience, and anxiety were the strongest predictors of work ability. Pain severity and depression were not found to be significant predictors of work ability. CONCLUSIONS These data suggest that emotional distress, cognitive function and overall health are important priority areas in rehabilitation programmes to improve work ability.
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Affiliation(s)
- Monica Lillefjell
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
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Lillefjell M. Gender differences in psychosocial influence and rehabilitation outcomes for work-disabled individuals with chronic musculoskeletal pain. J Occup Rehabil 2006; 16:659-74. [PMID: 17089197 DOI: 10.1007/s10926-006-9056-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION This study aimed to investigate gender differences in rehabilitation outcomes and how psychosocial factors may interact to influence rehabilitation outcome in work-disabled with chronic musculoskeletal pain. METHODS One hundred and sixty eight (n=168) persons (mean age = 45.5/SD=9.0) participating in a multidisciplinary rehabilitation program, were included. Data on pain, functional health and psychosocial factors were collected previous to treatment, after 5 week intensive training and after 52 week follow-up period. Demographics, socio-economics and data on personal characteristics were also collected. RESULTS Significant (p<.05) gender differences were found on sleeplessness, meaningfulness and manageability. No significant gender differences were found on pain or functional health status variables. Gender differences (p<.001) were found in how socio-demographic and psychosocial factors influence rehabilitation outcomes in terms of functional health status. CONCLUSIONS These data suggests that knowledge of gender differences and the way psychosocial factors influence rehabilitation outcomes must be taken into account in designing rehabilitation intervention.
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Affiliation(s)
- Monica Lillefjell
- Department of Social Work and Health Science, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
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