| 1. |
- Aweko, Juliet, et al.
(författare)
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Patient and Provider Dilemmas of Type 2 Diabetes Self-Management : A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm
- 2018
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 15:9
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Tidskriftsartikel (refereegranskat)abstract
- Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.
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| 2. |
- Berggreen-Clausen, Aravinda, 1980-, et al.
(författare)
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Food environment characteristics and neighborhood socioeconomic status in Stockholm, Sweden
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To determine how food environment characteristics are related to neighborhood socioeconomic status (SES) in the city of Stockholm, Sweden. Design: We carried out a cross-sectional mapping of the food environment in the years 2017-2019. This combined a focused community observation and an in-depth food retail outlet assessment. We analyzed how neighborhood SES was associated with types of food outlets, price and food item availability, with a focus on unhealthy and healthy food items.Setting: In this study, 10 low and 12 middle SES neighborhoods were included; within these, in-depth assessments of 92 stores were carried out.Participants: There were no human subjects included in this study.Results: In this sample, SES was highly negatively correlated with percentage of foreign-born residents in neighborhoods. We found that availability of food items and access to food outlets was similar across SES, though middle SES neighborhoods had more food service outlets like restaurants and cafés and lower SES had more independent grocers, primarily ethnic stores, most of which sold fruit and vegetables. Fruits and vegetables were priced lower in neighborhoods of lower SES. Unhealthy food availability and prices were comparable across neighborhoods of different SES.Conclusions: Ethnic food outlets may play a role in making fruits and vegetables available at lower prices in lower SES neighborhoods. Policies nudging consumers towards healthier items in supermarkets and urban planning to encourage or limit specific food outlet types are potential implications.
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| 3. |
- Berggreen-Clausen, Aravinda, et al.
(författare)
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Food environment interactions after migration : a scoping review on low- and middle-income country immigrants in high-income countries
- 2022
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 25:1, s. 136-158
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries.Design: A scoping review was carried out following the framework outlined by Arksey and O'Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A 'Best fit' framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.Setting: High-income countries.Participants: Immigrants from low- and middle-income countries.Results: A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children's demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired.Conclusion: This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.
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| 4. |
- Berggreen-Clausen, Aravinda, 1980-
(författare)
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Food environments in socioeconomically disadvantaged and immigrant populations through a non-communicable disease lens
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Globally, non-communicable diseases are increasing. With an evidenced link to the social determinants of health, this highlights a social gradient, whereby socioeconomic status, ethnicity and other factors influence poorer health outcomes. They are also linked to food environments, the interface of interaction between the food system and consumers.Aim: The aim of this thesis is to improve understanding of the food environment and its interactions with a focus on socioeconomic disadvantage and immigrant populations through a non-communicable disease lens.Methods: In Study I-III, the external food environment was mapped using a modified version of the Environmental Profile of a Community’s Health observation tool. Study I included under-resourced and socioeconomically disadvantaged sites, one urban and one rural, in a low- (Uganda), middle- (South Africa) and high-income (Sweden) country. Further, twenty-two lower and middle socioeconomic status neighborhoods of Stockholm were mapped in Study II and III. Descriptive and inferential statistical analyses were carried out. Study IV, a scoping review, used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to analyze and interpret the data on the interaction between personal and external food environments. Results: Across countries, food environments differed in the number of informal outlets present, the most found in Uganda and the least in Sweden. Primarily supermarkets, as well as other stores, were a source of both unhealthy and healthy food items, while advertising unhealthy items in store. Overall, outdoor advertisements of unhealthy foods were the most common and more prevalent in areas of higher socioeconomic disadvantage. Fruits and vegetables had similar prices across countries, though in the Swedish context, these cost less with lower neighborhood socioeconomic status. Structural and social factors like income, time, mobility and children’s preferences influenced the healthiness of foods acquired by immigrants from low-and middle-income countries living in high-income countries.Conclusion: Unhealthy items were both widely prevalent, as well as advertised across settings, at a higher rate in areas of higher disadvantage. Combined with structural and social factors that push consumers towards unhealthy practices, this could exacerbate existing health and nutrition inequities. Further research to better understand the food environment and its interactions with consumers are needed to facilitate healthier choices and improve health.
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| 5. |
- Berggreen-Clausen, Aravinda, 1980-, et al.
(författare)
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Outdoor and in-store food advertising : Unhealthy and health promoting advertisements in neighborhoods of low and middle socioeconomic status in Stockholm, Sweden
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Globally, obesity and other diet-related non-communicable diseases continue to rise. Moreover, those living in lower socioeconomic status (SES) neighborhoods in high-income countries, particularly immigrants, are more likely to suffer from negative health outcomes compared to those in more affluent neighborhoods. The high availability and marketing of unhealthy foods as well as tobacco and alcohol has been linked to unhealthy practices contributing towards negative health outcomes. Advertising has the aim of influencing practices and many studies have found that a large portion of advertisements promote unhealthy foods as well as tobacco and alcohol. We carried out a cross-sectional observational study mapping health-related food advertising in 10 low and 12 middle-income neighborhoods in Stockholm, Sweden. By using a checklist with pre-determined categories, we found that almost 60% of the noted outdoor advertisements promoted the sale of energy-dense, nutrient-poor foods and sugar sweetened beverages (i.e., “unhealthy”), compared to 20% of advertisements being food-related health promoting (i.e., “healthy”). On average, lower SES neighborhoods observed in the study had more advertising present (both unhealthy and health promoting) when compared to observed middle SES neighborhoods. In-store advertisements followed the same trend, where the majority in both neighborhoods were “unhealthy”. Furthermore, when considering store type, supermarkets had the most advertisements for both categories, compared to convenience stores and independent grocers; informal vendors had no observed advertisements at all. Exposing those living in lower SES neighborhoods to more unhealthy product advertising may play a role in furthering health and nutrition inequities which are already starkly present in the socioeconomically and ethnically segregated Swedish capital. Further research is needed to understand this nature of advertising in these neighborhoods, including outdoor and in-store, and its impact on health behaviors and related outcomes. Regulating advertising could play a part in protecting the health of the population over time, particularly in vulnerable groups.
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| 6. |
- Cedstrand, Emma, et al.
(författare)
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Co-Creating an Occupational Health Intervention within the Construction Industry in Sweden : Stakeholder Perceptions of the Process and Output
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:24
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Tidskriftsartikel (refereegranskat)abstract
- One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants' experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.
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| 7. |
- Dennermalm, Nicklas, et al.
(författare)
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Growing up in the shadow of HIV : post-AIDS generation of HIV-negative men who have sex with men in Sweden and their perceptions of HIV and stigma.
- 2024
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Ingår i: Culture, Health and Sexuality. - 1369-1058 .- 1464-5351. ; , s. 1-15
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Tidskriftsartikel (refereegranskat)abstract
- Despite growing understanding and acceptance of the concept of Undetectable = Untransmittable (U = U) among gay men, HIV stigma remains a burden for people living with HIV. This study explored perceptions of HIV among HIV seronegative gay men in Sweden in this new context. Using snowball sampling, 15 gay men born between 1980 and 2000 were recruited to the study. Semi-structured interviews were conducted and data were subjected to reflexive thematic analysis. Men grew up experiencing gay stigma and were repeatedly informed by parents, schools, communities, peers, and popular culture about the dangers of HIV, and that gay men were a high-risk group. As men grew older, and the premise of HIV shifted dramatically due to U = U, some remained emotionally anchored to the pre-U = U era, while others realigned their perceptions, often after a process of reconciling emotional responses (e.g. HIV = death) with the logical-rational claims made about U = U. The study highlights key areas for future efforts, namely establishing a balance between HIV education strategies and stigma reduction initiatives. Study findings underscore the need to care for the memory of those lost during the crisis years, while also addressing the stigma faced by those currently living with HIV.
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| 8. |
- Dennermalm, Nicklas, et al.
(författare)
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Sex, drugs and techno - a qualitative study on finding the balance between risk, safety and pleasure among men who have sex with men engaging in recreational and sexualised drug use
- 2021
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recreational and sexual drug use among men who have sex with men may result in increased risk of poor health. The aim of this study was to better understand drug use and harm reduction techniques among Swedish men who have sex with men traveling to Berlin in order to improve the health of this population and inform public health strategies.Methods: A qualitative study based on semi-structured interviews with 15 Swedish men aged 23-44 with experience of drug use were recruited through network sampling. Interviews were conducted in Stockholm and Berlin and analysed using content analysis. The interview guide included questions on drug use, context, health and safety.Results: The participants engaged in drug use in both settings and in various contexts. Participants saw themselves as capable of finding a balance between pleasure, safety and risk with the aim to maximize positive effects while minimizing negative ones. The different risks of drug use were known, and participants relied on knowledge, harm reduction strategies and self-defined rules of intake to stay safe and healthy in a broad sense, both short term (i.e. during each session) and long term. Choice of drug and, frequency of intake, multi-use, risk of overdose, risk of HIV, purpose and context of use, how often, etc. were all part of the overall strategy. Knowledge of these methods was spread within the community and on-line rather than from counsellors or other health care providers. However, it did not always translate perfectly into practice and some had experienced overdoses and problematic use.Conclusions: The findings of this study point to the need for increased adoption of harm reduction techniques in this population focusing on mitigating harm and prevention of risk of problematic use or starting injection drugs. Existing traditional services require adaptations to become more accessible and acceptable to sub-groups of drug users, including low-threshold services providing non-judgemental, evidence-based information. This will require funding of alternative providers such as STI/HIV clinics, among others, and health care providers to increase adoption of prevention strategies, specifically pre-exposure prophylaxis for HIV.
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| 9. |
- Kiguli, Juliet, et al.
(författare)
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Dietary patterns and practices in rural eastern Uganda : Implications for prevention and management of type 2 diabetes
- 2019
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Ingår i: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 143
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The burden of type 2 diabetes in Sub-Saharan Africa is projected to double by 2040, partly attributable to rapidly changing diets. In this paper, we analysed how community members in rural Uganda understood the concept of a healthy or unhealthy diet, food preparation and serving practices to inform the process of facilitating knowledge and skill necessary for self-management and care for type 2 diabetes. This was a qualitative study involving 20 focus group discussions and eight in-depth interviews among those at risk, patients with type 2 diabetes and the general community members without diabetes mellitus. Data was coded and entered into Atlas ti version 7.5.12 and interpreted using thematic analysis. We identified three main themes, which revealed, the perceptions on food and diet concerning health; the social dimensions of food and influence on diet practices; and food as a gendered activity. Participants noted that eating and cooking practices resulted in unhealthy diets. Their practices were affected by beliefs, poverty and food insecurity. Women determined which foods to prepare, but men prepared only some of the foods such as delicacies like a rice dish "pilau." New commercial and processed foods were increasingly available and consumed even in rural areas. Participants linked signs and symptoms of illness to diet as they narrated changes from past to current food preparation behaviours. Their view of overweight and obesity was also gendered and linked to social status. Participants' perception of disease influenced by diet was similar among those with and without type 2 diabetes, and those at risk. People described what is a healthy diet was as recommended by the health workers, but stated that their practices differed greatly from their knowledge. There was high awareness about healthy and balanced diets, but food is entrenched within social and gendered paradigms, which are slowly changing. Social and gender dimensions of food will need to be addressed through interventions in communities to promote change on a society level.
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| 10. |
- Oumrait, Nuria Güil, et al.
(författare)
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Can Self-Determination Explain Dietary Patterns Among Adults at Risk of or with Type 2 Diabetes? : A Cross-Sectional Study in Socio-Economically Disadvantaged Areas in Stockholm
- 2020
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- Type 2 Diabetes (T2D) is a major health concern in Sweden, where prevalence rates have been increasing in socioeconomically disadvantaged areas. Self-Determination Theory (SDT) is posited as an optimal framework to build interventions targeted to improve and maintain long-term healthy habits preventing and delaying the onset of T2D. However, research on SDT, T2D and diet has been widely overlooked in socio-economically disadvantaged populations. This study aims to identify the main dietary patterns of adults at risk of and with T2D from two socio-economically disadvantaged Stockholm areas and to determine the association between those patterns and selected SDT constructs (relatedness, autonomy motivation and competence). Cross-sectional data of 147 participants was collected via questionnaires. Exploratory Factor Analysis was used to identify participants' main dietary patterns. Multiple linear regressions were conducted to assess associations between the SDT and diet behaviours, and path analysis was used to explore mediations. Two dietary patterns (healthy and unhealthy) were identified. Competence construct was most strongly associated with healthy diet. Autonomous motivation and competence mediated the effect of relatedness on diet behaviour. In conclusion, social surroundings can promote adults at high risk of or with T2D to sustain healthy diets by supporting their autonomous motivation and competence.
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