| 1. |
- Hiswåls, Anne-Sofie, et al.
(author)
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Experiences of unemployment and well-being after jobb loss during economic recession : results of a qualitative study in East Central Sweden
- 2017
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In: Journal of Public Health Research. - : SAGE Publications. - 2279-9028 .- 2279-9036. ; 6:3, s. 135-141
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Journal article (peer-reviewed)abstract
- Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.
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| 2. |
- Mälstam, Emelie, et al.
(author)
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Everyday managing and living with autoimmune Addison's disease : Exploring experiences using photovoice methods
- 2018
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 25:5, s. 358-370
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Journal article (peer-reviewed)abstract
- People with rare diseases are a minority group that faces risks for healthcare and work inequities because knowledge and resources on how to systematically support health or working life are limited. Integrating voices of persons living with rare diseases are an important aspect in inclusive and relevant healthcare practices. This study sought to actively involve persons with autoimmune Addison's disease (AAD), a rare condition, in exploring challenges and possibilities situated in everyday life. Photovoice methods were utilized to incorporate experiences through photographic documentation and group discussions with five persons over seven weeks. Data generated from group sessions were visually analyzed or transcribed and analyzed with thematic analysis. Five themes emerged: Individual and fine tuning in everyday life; It is not how it was; The power of knowledge and support; Becoming the expert in an uncertain context; and, Finding balance and paving new ways. The findings showed that everyday life with AAD was more complex than earlier portrayed; entailing several barriers and negotiations. In order to meet the needs of persons with AAD, more extensive and relevant information, support and self-management education is needed. Moreover, a complementary focus on everyday life to promote their health and wellbeing is also important.
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| 3. |
- Mälstam, Emelie, et al.
(author)
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Focusing on everyday life with Addison’s disease : Health promotion and secondary prevention
- 2017
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 27:Suppl. 3, s. 334-334
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Journal article (peer-reviewed)abstract
- The overal laim of this study was to generate knowledge about everyday life among people living with rare Addison’s disease (AD). Understanding experiences in contexts of everyday life are important for public health, equity in healthcare, and in order to design tailored health promotion programs, which are in line with EU policy. Addison’s disease is a rare disease and people with AD face challenges due to limited existing knowledge about the disease and often encounters health care providers who are not familiar with best practices in the area. Treatment and follow up of AD also vary greatly within Europe even though a European consensus exists and few reports of secondary and tertiary prevention have been published. AD is also usually monitored and treated in the specialist health care where individually delivered health care is dominant. In Sweden, it has been argued that all health care should integrate disease prevention and health promotion and that group-based self-management approaches could be compliments to traditional caring and curative health care. This study was conducted with qualitative methods and a participatory approach, engaging five participants with AD. Under seven weeks the participants photographed their everyday life and participated in weekly group-discussions. Preliminary results show that everyday life with AD can be more complex than previously thought and that extended information and self-management education about the disease and everyday life is perceived as important to maintain wellbeing. Also, participants perceived that health care could play a bigger role regarding health promotion and preventive actions through extended pharmacological and non-pharmacologica lparts of group-based interventions.Key messages:Specialist health care can play a role regarding preventive self-management schooling for persons with rare Addison’s disease to improve wellbeing in everyday life.Specialist health care can play a role regarding health promotion and disease prevention through extended self-management education for persons with rare Addison’s diseas.
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| 4. |
- Mälstam, Emelie, et al.
(author)
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Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app
- 2023
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In: Digital Health. - : SAGE. - 2055-2076. ; 9
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Journal article (peer-reviewed)abstract
- Background: Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app. Objective: The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme. Methods: Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory. Results: Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be. Conclusions: An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.
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| 5. |
- Mälstam, Emelie
(author)
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Make My Day : exploring engaging occupations in stroke prevention and promotion of health
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background: Stroke is one of the major causes of disease burden worldwide. Most stroke cases are attributed to modifiable risk factors, such as high blood pressure, overweight, smoking, physical inactivity, and poor diet, making promoting an overall healthy lifestyle an essential strategy for stroke prevention. While multifactorial lifestyle interventions in a primary healthcare setting have been useful in addressing risk factors to prevent cardiovascular diseases (CVDs), such approaches specifically designed for primary stroke prevention are scarce in a Swedish setting. Applying an occupational perspective, incorporating and sustaining engaging occupations in everyday life has not previously been explored, and such an approach's feasibility has not been evaluated. Engaging occupations have been characterized by their high meaningfulness, intense participation, and importance for a person’s well-being. They are therefore important to explore in the context of addressing and improving risk factors for stroke and as part of a model for stroke prevention in primary healthcare. Aim: To generate knowledge about engaging occupations in stroke prevention and promoting health among people at risk for stroke. To explore and evaluate the feasibility and implementation process of Make My Day (MMD), a digitally augmented stroke prevention intervention in primary healthcare. Methods: The Medical Research Council’s (MRC) guidance for developing and evaluating complex interventions has been used in this thesis. In the exploration and development of MMD, key theoretical underpinnings were studied. In Study I, interviews were conducted with persons at risk for stroke who also had been diagnosed with a transient ischemic attack (TIA) (n=6). Study II built on data from observations and interviews with persons at moderate to high risk for stroke (n=6) participating in Study III. In addition, data on the same topic from Study I was extracted and used to answer the aim of Study II. Data in both Studies I and II was analyzed using a constant comparative method. Study III was a pilot randomized controlled trial (RCT) evaluating the feasibility of MMD among persons at risk for stroke (n=29). Both descriptive and inferential statistics were used to analyze the data. Study IV was a process evaluation conducted alongside the pilot RCT evaluating the intervention's reach, fidelity, dose, and contextual factors derived from logbooks and reflective field notes. Descriptive statistics was applied. To analyze data on acceptability derived from interviews and reflective field notes, a constant comparative method was used. Results: Studies I-IV illustrate that the utilization of engaging occupations in stroke prevention is feasible. Engaging occupations as means and goals was supportive in promoting healthy lifestyle changes in everyday life among persons at risk for stroke. This was partly because of the motivational element of engaging occupations (Study I). Changing lifestyle habits was, however complex and imbued with barriers ranging from the individual to societal level. New ways of doing in everyday life could be facilitated by developing a self-monitoring routine in tandem with engaging in and reflecting on one’s occupations in everyday life (Study II). In learning and changing ways of doing, engaging in a personally relevant mHealth app was supportive. When the digital environment corresponds with literacy levels, previous experiences, and needs in terms of automatizations, self-monitoring became enjoyable and more accessible to integrate into everyday life for persons at risk for stroke. Moreover, Study III showed that the MMD intervention was feasible through its timely recruitment of participants, overall high response rates and study completion, and sensitivity to change in key outcomes, such as stroke risk reduction and occupational performance. In addition, Study IV illustrated the acceptability of MMD among persons at risk for stroke and health professionals. Key mediators were the high willingness to and belief in working with the framework of MMD. Key challenges were time management, heterogeneity in group compositions, and the reimbursement system. Conclusions: This thesis demonstrates the feasibility of a digitally augmented stroke prevention intervention and the usefulness of engaging occupations when promoting healthy lifestyle changes. The knowledge gained may be transferable to interventions addressing the prevention of other CVDs, also caused by modifiable risk factors. However, sustainable implementation of prevention like MMD relies on personally relevant approaches and on addressing aspects on the organizational and socio-political level so that preventative interventions such as MMD are reimbursed.
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| 6. |
- Mälstam, Emelie, et al.
(author)
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The Feasibility of Make My Day—A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare
- 2023
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:19
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Journal article (peer-reviewed)abstract
- Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.
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| 7. |
- Mälstam, Emelie, et al.
(author)
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'Weaving lifestyle habits' : Complex pathways to health for persons at risk for stroke.
- 2022
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In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 29:2, s. 152-164
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Journal article (peer-reviewed)abstract
- BACKGROUND: It is important to understand how healthy lifestyle habits can be developed as they are essential in cardiovascular disease (CVD) prevention. There is limited knowledge regarding whether, and how, engaging occupations (things that people do and occupy themselves with) can promote and help sustain healthy lifestyle habits for persons at risk for CVDs, including stroke.AIM: The aim was to develop knowledge of how engaging in occupations can contribute to changes in lifestyle habits among persons at risk for stroke.METHODS: Six adults presenting with stroke risk factors were interviewed on several occasions after participating in an occupation-focused stroke prevention programme. Grounded theory was utilised, and constant comparative methods guided the analysis.FINDINGS: Changing lifestyle habits was perceived as a complex process, much like weaving a fabric with many parallel and interlacing threads. Literacy of both health and occupations and participation in engaging occupations were important facilitators for promoting healthy lifestyle habits, yet engagement in health-promoting occupations was described as conditioned behaviour.CONCLUSIONS: CVD prevention programmes can benefit from incorporating engaging occupations to promote healthy lifestyle habits and literacy of health and occupations. However, contextual factors conditioning health and occupations should be considered when developing and implementing sustainable interventions.
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| 8. |
- Patomella, Ann-Helen, et al.
(author)
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Primary prevention of stroke : randomised controlled pilot trial protocol on engaging everyday activities promoting health
- 2019
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:11
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Journal article (peer-reviewed)abstract
- IntroductionStroke is a globally common disease that has detrimental effects on the individual and, more broadly, on society. Lifestyle change can contribute to reducing risk factors for stroke. Although a healthy lifestyle has direct benefits, sustaining and incorporating healthy activities into everyday life is a challenge. Engaging everyday activities have the potential to support lifestyle change and to promote sustainable activity patterns. Current healthcare is failing to reduce modifiable risk factors in people at risk, and in addition to current practice, there is a need for systematic and efficient non-pharmacological and non-surgical stroke-prevention strategies. The aim of the pilot study was to increase knowledge about the effects of a prevention programme and its feasibility to promote sustainable and healthy activity patterns among persons at risk of stroke.Methods and analysisThe proposed pilot study will be a two-armed randomised, assessor-blinded, parallel pilot trial. The study will include feasibility data, investigating acceptability and delivery of the intervention. Persons at risk of stroke (n=60) will be included in a mobile phone-supported prevention programme. The 10-week programme will be conducted at primary healthcare clinics, combining group meetings and online resources to support self-management of lifestyle change. Main outcomes are stroke risk, lifestyle habits and healthy activity patterns. Assessments will be performed at baseline and at follow-up (immediately following the end of the programme and at 6 and 12 months). Effects of the programme will be analysed using inferential statistics. Feasibility will be analysed using both qualitative and quantitative methods.Ethics and disseminationThe study has been approved by the Regional Ethical Review Board in Stockholm, Sweden, being granted reference numbers 2015/834-31, 2016/2203-32 and 2019/01444. Study results will be disseminated through peer-review journals and presentations to mixed audiences at regional and international conferences. Trial registration number NCT03730701.
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