| 1. |
- Absetz, Pilvikki, et al.
(författare)
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SMART2D-development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden
- 2020
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Ingår i: Translational Behavioral Medicine. - : OXFORD UNIV PRESS. - 1869-6716 .- 1613-9860. ; 10:1, s. 25-34
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Tidskriftsartikel (refereegranskat)abstract
- Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites.
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| 2. |
- De Man, Jeroen, et al.
(författare)
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Motivational determinants of physical activity in disadvantaged populations with (pre)diabetes : a cross-cultural comparison
- 2022
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model across samples from diverse populations with, or at risk of diabetes. Methods Measurement invariance of barrier identified regulation, barrier self-efficacy and social support was assessed in a rural Ugandan sample (n = 712) and disadvantaged samples with high proportions of immigrants in urban South Africa (n = 566) and Sweden (n = 147). These motivational determinants were then compared through multigroup structural equation modeling. Results The studied motivational constructs showed scalar invariance. Latent mean levels of perceived social support and barrier self-efficacy were lower in South Africa and Sweden. Structural models (for different PA outcomes) were not consistent across settings except for the association between perceived social support and identified regulation. Identified regulation was only associated with vigorous PA in Uganda and with moderate PA in South Africa. The association between social support and PA outcomes ranged from weak to not significant and the association between self-efficacy and PA was not significant. Self-reported PA was highest in Uganda and lowest in Sweden. Self-reported vigorous PA was significantly related to lower hemoglobin A1c levels, while moderate PA was not. Conclusions Findings suggest that: 1) it is feasible to compare a motivational process model across diverse settings; 2) there is lower perceived social support and self-efficacy in the urban, migrant samples; 3) identified regulation is a more promising determinant of PA than self-efficacy or social support in these populations; 4) associations between motivational determinants and PA depend on the perceived type and/or intensity of PA; 5) perceived relatedness functions as a basic psychological need across diverse settings; and 6) people's perception of the PA they perform depends on their perceived level of intensity of PA which would have major implications for health promotion.
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| 3. |
- Kohler, Stefan, et al.
(författare)
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Postpartum quality of life in Indian women after vaginal birth and cesarean section : a pilot study using the EQ-5D-5L descriptive system
- 2018
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: There has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.Methods: A convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.Results: Forty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0-3 days postpartum: 0.28 vs. 0.57, 3-7 days postpartum: 0.59 vs. 0.81; P<0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, painordiscomfort; P0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21-30 days postpartum: 0.85 vs. 0.93; P<0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P=0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P<0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.Conclusions: Vaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is asuitable instrumentto assess postpartum QOL in Indian women.
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| 4. |
- 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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| 5. |
- Sahoo, Krushna Chandra, et al.
(författare)
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Dynamics of Household Waste Segregation Behaviour in Urban Community in Ujjain, India : A Framework Analysis
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:12
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Tidskriftsartikel (refereegranskat)abstract
- Waste segregation practices must be socially acceptable, affordable, context-specific, and participatory, which is essential for promoting waste segregation. Therefore, this study explored the urban community members’ motivation, opportunity, and household waste segregation ability. We performed a qualitative study in Ujjain city, India. Ten focus group discussions and eight in-depth interviews were conducted with female and male household members in residential and slum areas. All interviews were digitally recorded, transcribed, and translated. We used the thematic framework technique using the Motivation-Opportunity-Ability-Behaviour theory for analysis. Three themes were constructed: motivation, where household members are motivated to sort waste yet fear the consequences of improper sorting; ability, where household waste segregation is rapidly gaining acceptance as a social norm; and opportunities, involving convenient facilities and a social support system for household members towards waste segregation. This study contributes to developing a knowledge base on waste segregation behaviour and a repertoire to facilitate evidence-based management and policymaking. There is a need for educational intervention and women’s self-help groups’ involvement to develop community orientation and waste segregation literacy. Finally, this study emphasizes the importance of all three behavioural change components, i.e., motivation, opportunity, and ability, in managing sustainable waste segregation practices.
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| 6. |
- Sidney Annerstedt, Kristi
(författare)
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'Nobody delivers at home now' : who and why women participate in a conditional cash transfer program to promote institutional delivery in Madhya Pradesh, India
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: One-fifth of global maternal deaths occur in India making this a serious public health challenge. It is well known that skilled birth attendance and access to quality emergency obstetric care reduces maternal mortality. However, up until 2005, efforts by the government at providing access to emergency obstetric care were thwarted by low uptake of facility-based delivery (39% in the same year). A cash incentive program, Janani Suraksha Yojana (JSY) was implemented in 2005 by the central government to increase facility-based births and reduce maternal mortality. It gave money directly to the women upon discharge from a public health facility after childbirth. Subsequently in 2009 an emergency transport model (Janani Express Yojana, JEY) was implemented to support the JSY program and eliminate physical access barriers to giving birth in a facility. Methods: Data for this thesis was collected between January 2011 and April 2015 from three districts (Ujjain, Shahdol and Panna) in the central Indian state of Madhya Pradesh. The thesis is organized into four studies (I-IV). In study I, a structured questionnaire was used to identify predictors of JSY program participation and reasons for non-participation in a population-based sample of 478 women. In study II, qualitative interviews with 24 JSY beneficiaries and non-beneficiaries explored reasons for their participation in the program. In study III, a facility-based study among 1,005 women was used to study predictors of emergency transport use. In study IV, another population-based survey assessed out-of-pocket expenditures (OOPE) among 2,615 women giving birth. Results: Program uptake was high (76%). Women who were uneducated, multiparous or lacked prior knowledge of the JSY program were more likely to deliver at home. Lack of transportation was the main reason for home births at this point in time (study I). The decision of most women to participate in the program reflected a change in social norms towards delivering in a health facility along with individual perceptions of a safe and easy delivery and pressure from an accredited social health activist (ASHA). Many women reported their behavior was influenced by receiving the incentive, but just as many said it did not play a role in their decision to deliver in a facility. Non-participation was often unintentional due to personal circumstances or driven by a perception of poor quality of care in public sector facilities (study II). JEY uptake was greater in women from lower socio-economic backgrounds: rural women were 4.46 times more likely to use JEY (95% CI: 2.38-8.37) compared to urban; and women belonging to scheduled tribes were 1.60 times more likely (95% CI: 1.18-2.16) than women from a general caste. A third of the JEY users experienced a delay in reaching the health facility (study III). The large majority (91%) of women reported OOPE. It was driven largely by indirect costs like informal payments (37%) and food and cloth items for the baby (47%), not direct medical payments (8%). Being a JSY beneficiary increased odds (AOR: 1.58; 95% CI: 1.11- 2.25) of incurring OOPE. However among women who had any OOPE, JSY beneficiaries had a 16% decrease (95% CI: 0.73 - 0.96) in OOPE compared to women who gave birth at home (study IV). Discussion/Conclusion: There was significant program uptake in our study area with a large majority of poor women participating in the program. There are multiple drivers influencing participation: (i) a number of supporting elements (ASHA, cash incentive, transportation support) and (ii) the program does not occur in a vacuum but in a context with dynamic social norms around childbirth. There were limits to the influence of the cash and behaviors may be as much influenced by social norms and social pressures for many. Even though the uptake to the emergency transport service was low, the JEY complemented the JSY program by providing some of the most vulnerable women transport to a health facility and decreasing the geographical barrier. Nevertheless, there are opportunities to expand the service to more women and improve the time it takes to reach the health facility. OOPE is still prevalent among women who deliver under the JSY program. However the cash incentive was large enough to defray the OOPE enabling the poorest women to have a net gain. The program seems to be effective in providing financial protection for the most vulnerable groups (i.e. women from poorer households and disadvantaged castes).
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| 7. |
- Timm, Linda, et al.
(författare)
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Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs and self-efficacy. The aims of this study were to develop and assess the psychometric properties of a measurement scale for acceptance of a telephone-facilitated health coaching intervention, based on the TFA; and to determine the acceptability of the intervention among participants living with diabetes or having a high risk of diabetes in socioeconomically disadvantaged areas in Stockholm.Methods: This study was nested in the implementation trial SMART2D (Self-management approach and reciprocal learning for type 2 diabetes). The intervention consisted of nine telephone-facilitated health coaching sessions delivered individually over a 6-month period. The acceptability of the intervention was assessed using a questionnaire consisting of 19 Likert scale questions developed using Sekhon's TFA. Exploratory factor analysis (EFA) was performed.Results: Ratings from 49 participants (19 with type 2 diabetes and 30 at high risk of developing diabetes) in ages 38-65 were analyzed. The EFA on the acceptability scale revealed three factors with acceptable reliabilities: affective attitude (alpha 0.90), coherence and understanding (alpha 0.77), perceived burden (alpha 0.85), explaining 82% of the variance. Positive affect and coherence had high median scores and small variance. Median score for perceived burden was low, but with significant variance due to younger individuals and those at high risk reporting higher burden.Conclusions: The telephone-facilitated health coaching intervention was perceived as acceptable by the study population using a questionnaire based on Sekhon's TFA, with a wider variation in perceived burden seen among high risk and younger participants.
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| 8. |
- Timm, Linda, et al.
(författare)
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Early detection of type 2 diabetes in socioeconomically disadvantaged areas in Stockholm - comparing reach of community and facility-based screening
- 2020
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Type 2 diabetes and its high-risk stage, prediabetes, are often undiagnosed. Early detection of these conditions is of importance to avoid organ complications due to the metabolic disturbances associated with diabetes. Diabetes screening can detect persons unaware of diabetes risk and the elevated glucose levels can potentially be reversed through lifestyle modification and medication. There are mainly two approaches to diabetes screening: opportunistic facility-based screening at health facilities and community screening. Objective To determine the difference in population reach and participant characteristics between community- and facility-based screening for detection of type 2 diabetes and persons at high risk of developing diabetes. Methods Finnish diabetes risk score (FINDRISC) is a risk assessment tool used by two diabetes projects to conduct community- and facility-based screenings in disadvantaged suburbs of Stockholm. In this study, descriptive and limited inferential statistics were carried out analyzing data from 2,564 FINDRISC forms from four study areas. Community- and facility-based screening was compared in terms of participant characteristics and with population data from the respective areas to determine their reach. Results Our study found that persons born in Africa and Asia were reached through community screening to a higher extent than with facility-based screening, while persons born in Sweden and other European countries were reached more often by facility-based screening. Also, younger persons were reached more frequently through community screening compared with facility-based screening. Both types of screening reached more women than men. Conclusion Community-based screening and facility-based screening were complementary methods in reaching different population groups at high risk of developing type 2 diabetes. Community screening in particular reached more hard-to-reach groups with unfavorable risk profiles, making it a critical strategy for T2D prevention. More men should be recruited to intervention studies and screening initiatives to achieve a gender balance.
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| 9. |
- Timm, Linda, et al.
(författare)
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Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes
- 2021
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 13:11
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Tidskriftsartikel (refereegranskat)abstract
- Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants' needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery.
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| 10. |
- Travert, Anne-Sophie, et al.
(författare)
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Built Environment and Health Behaviors : Deconstructing the Black Box of Interactions — A Review of Reviews
- 2019
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:8
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Forskningsöversikt (refereegranskat)abstract
- A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.
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