| 1. |
- Huyghe, Jeroen R., et al.
(author)
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Discovery of common and rare genetic risk variants for colorectal cancer
- 2019
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In: Nature Genetics. - : Nature Publishing Group. - 1061-4036 .- 1546-1718. ; 51:1, s. 76-
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Journal article (peer-reviewed)abstract
- To further dissect the genetic architecture of colorectal cancer (CRC), we performed whole-genome sequencing of 1,439 cases and 720 controls, imputed discovered sequence variants and Haplotype Reference Consortium panel variants into genome-wide association study data, and tested for association in 34,869 cases and 29,051 controls. Findings were followed up in an additional 23,262 cases and 38,296 controls. We discovered a strongly protective 0.3% frequency variant signal at CHD1. In a combined meta-analysis of 125,478 individuals, we identified 40 new independent signals at P < 5 x 10(-8), bringing the number of known independent signals for CRC to similar to 100. New signals implicate lower-frequency variants, Kruppel-like factors, Hedgehog signaling, Hippo-YAP signaling, long noncoding RNAs and somatic drivers, and support a role for immune function. Heritability analyses suggest that CRC risk is highly polygenic, and larger, more comprehensive studies enabling rare variant analysis will improve understanding of biology underlying this risk and influence personalized screening strategies and drug development.
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| 2. |
- Huyghe, Jeroen R, et al.
(author)
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Genetic architectures of proximal and distal colorectal cancer are partly distinct
- 2021
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In: Gut. - : BMJ Publishing Group Ltd. - 0017-5749 .- 1468-3288. ; 70:7, s. 1325-1334
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Journal article (peer-reviewed)abstract
- Objective: An understanding of the etiologic heterogeneity of colorectal cancer (CRC) is critical for improving precision prevention, including individualized screening recommendations and the discovery of novel drug targets and repurposable drug candidates for chemoprevention. Known differences in molecular characteristics and environmental risk factors among tumors arising in different locations of the colorectum suggest partly distinct mechanisms of carcinogenesis. The extent to which the contribution of inherited genetic risk factors for CRC differs by anatomical subsite of the primary tumor has not been examined.Design: To identify new anatomical subsite-specific risk loci, we performed genome-wide association study (GWAS) meta-analyses including data of 48 214 CRC cases and 64 159 controls of European ancestry. We characterised effect heterogeneity at CRC risk loci using multinomial modelling.Results: We identified 13 loci that reached genome-wide significance (p<5×10-8) and that were not reported by previous GWASs for overall CRC risk. Multiple lines of evidence support candidate genes at several of these loci. We detected substantial heterogeneity between anatomical subsites. Just over half (61) of 109 known and new risk variants showed no evidence for heterogeneity. In contrast, 22 variants showed association with distal CRC (including rectal cancer), but no evidence for association or an attenuated association with proximal CRC. For two loci, there was strong evidence for effects confined to proximal colon cancer.Conclusion: Genetic architectures of proximal and distal CRC are partly distinct. Studies of risk factors and mechanisms of carcinogenesis, and precision prevention strategies should take into consideration the anatomical subsite of the tumour.
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| 3. |
- Thomas, Kristin, 1978-, et al.
(author)
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Organizational readiness to implement a care model in primary care for frail older adults living at home in Sweden.
- 2022
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- BACKGROUND: The demographic change of an aging population constitutes a challenge for primary care organizations worldwide. The systematic implementation of preventative and proactive care models is needed to cope with increased care demands.OBJECTIVE: To investigate the organizational readiness in primary care to implement a new care model to prevent hospitalization among frail older adults.METHOD: Individual qualitative interviews with health care staff investigated organizational readiness at seven primary care units in Sweden. A semi-structured interview guide was used during the interviews and included broad questions on individual and collective readiness to change. Directed content analysis and organizational readiness to change theory were used in data analysis.RESULTS: Positive beliefs among staff such as perceived benefits and compatibility with existing values contributed to a strong commitment to implement the new care model. However, perceptions such as unclear task demands, limited resources and concerns about new collaborative structures challenged implementation.CONCLUSIONS: The findings emphasize implementation as an inter-organizational phenomenon, especially for holistic practices that span across multiple health care providers and disciplines. Furthermore, implementing care models in healthcare may require a change of culture as much as a change of practice.
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| 4. |
- Bendtsen, Marcus, 1982-, et al.
(author)
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A Mobile Health Intervention for Mental Health Promotion Among University Students : Randomized Controlled Trial
- 2020
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In: JMIR mhealth and uhealth. - Toronto, ON, Canada : J M I R Publications, Inc.. - 2291-5222. ; 8:3
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Journal article (peer-reviewed)abstract
- Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population.Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design.Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones.Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables.Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion.Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632
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| 5. |
- Bendtsen, Marcus, 1982-, et al.
(author)
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Mental health promotion among university students using a mobile health intervention: longitudinal findings from a randomized controlled trial
- 2021
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In: European Journal of Applied Positive Psychology. - : National Wellbeing Service. - 2397-7116. ; 5
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Journal article (peer-reviewed)abstract
- Background: Research shows that positive psychology interventions have a small to medium effect on wellbeing, depression, anxiety, and stress. However, few studies have investigated long-term mental health outcomes.Methods: This paper reports on the 6- and 12-month effects of a mobile phone based positive psychology intervention on wellbeing among university students in Sweden. A 2-arm, single blind (researchers), parallel groups, randomized controlled trial was employed.Results: In total 654 individuals (25 years median age, 78% female) were randomized to the intervention (n=348) or control group (n=306). Primary outcome was positive mental health (Mental Health Continuum-Short Form). Secondary outcomes were depression and anxiety symptomatology (Hospital Anxiety and Depression Scale). A lasting effect on wellbeing was observed. An immediate positive effect was observed on anxiety and depression outcomes which waned over time.Discussion and conclusions: The findings suggest that mobile phone-based interventions could be an important tool in a wider strategy for mental health promotion. Future research could improve on the effects observed in this study by finding ways to optimise person-activity fit and tailor the intervention content.
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| 6. |
- Bendtsen, Marcus, 1982-, et al.
(author)
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mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth) : Protocol for a randomised controlled trial
- 2021
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In: Public Health Nursing. - : BMC. - 0737-1209 .- 1525-1446 .- 1471-2458. ; 21:1
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Journal article (peer-reviewed)abstract
- BackgroundNational surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden.MethodsA 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation.DiscussionThe findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally.Trial registrationRegistered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623).
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| 7. |
- Bendtsen, Marcus, 1982-, et al.
(author)
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The Mobile Health Multiple Lifestyle Behavior Interventions Across the Lifespan (MoBILE) Research Program : Protocol for Development, Evaluation, and Implementation
- 2020
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In: JMIR Research Protocols. - Toronto, Canada : JMIR Publications Inc. - 1929-0748. ; 9:4
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Journal article (peer-reviewed)abstract
- Background: Clustering of multiple lifestyle risk behaviors has been associated with a greater risk of noncommunicable diseases and mortality than one lifestyle risk behavior or no lifestyle risk behaviors. The National Board of Health and Welfare in Sweden reported in 2018 that it is important to provide additional support to individuals with multiple lifestyle risk behaviors, as risks from these behaviors are multiplicative rather than additive. However, the same report emphasized that there is a lack of knowledge regarding interventions that support changes to unhealthy lifestyle behaviors.Objective: The MoBILE (Mobile health Multiple lifestyle Behavior Interventions across the LifEspan) research program has brought together two Swedish research groups supported by international collaborators. Through this collaboration, we aim to design and evaluate a number of novel and tailored mobile health (mHealth) multiple lifestyle behavior interventions across the life span of different health care populations. In addition, the MoBILE research program will extend ongoing research to include mHealth interventions for migrant pregnant women and children.Methods: Each project within the MoBILE program will focus on a specific group: pregnant women, preschool children, high school and university students, and adults in primary and clinical care. All the projects will follow the same 4 phases: requirements, development, evaluation, and implementation. During the requirements phase, implementers and end users will aid the design of content and functionality of the interventions. In the development phase, findings from the first phase will be synthesized with expert domain knowledge and theoretical constructs to create interventions tailored to the target groups. The third phase, evaluation, will comprise randomized controlled trials conducted to estimate the effects of the interventions on multiple lifestyle risk behaviors (eg, alcohol, nutrition, physical activity, and smoking). The final phase will investigate how the interventions, if found effective, can be disseminated into different health care contexts.Results: The research program commenced in 2019, and the first results will be available in 2020. Projects involving pregnant women, preschool children, and high school and university students will be completed in the first 3 years, with the remaining projects being planned for the program’s final 3 years.Conclusions:The development of evidence-based digital tools is complex, as they should be guided by theoretical frameworks, and requires large interdisciplinary teams with competence in technology, behavioral science, and lifestyle-specific areas. Individual researchers or smaller research groups developing their own tools is not the way forward, as it means reinventing the wheel over and over again. The MoBILE research program therefore aims to join forces and learn from the past 10 years of mHealth research to maximize scientific outcomes, as well as the use of financial resources to expand the growing body of evidence for mHealth lifestyle behavior interventions.
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| 8. |
- Gupta, Verena Kristin, et al.
(author)
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Using DFTB to Model Photocatalytic Anatase-Rutile TiO2 Nanocrystalline Interfaces and Their Band Alignment
- 2021
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In: Journal of Chemical Theory and Computation. - : American Chemical Society (ACS). - 1549-9618 .- 1549-9626. ; 17:8, s. 5239-5247
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Journal article (peer-reviewed)abstract
- Band alignment effects of anatase and rutile nanocrystals in TiO2 powders lead to electron-hole separation, increasing the photocatalytic efficiency of these powders. While size effects and types of possible alignments have been extensively studied, the effect of interface geometries of bonded nanocrystal structures on the alignment is poorly understood. To allow conclusive studies of a vast variety of bonded systems in different orientations, we have developed a new density functional tight-binding parameter set to properly describe quantum confinement in nanocrystals. By applying this set, we found a quantitative influence of the interface structure on the band alignment.
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| 9. |
- Karlsson, Nadine, 1965-, et al.
(author)
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Relationship Between Educational Level and Attitudes Towards Alcohol Conversations in Healthcare : A Cross-Sectional Survey Conducted in Four European Countries
- 2023
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In: International Journal of Public Health. - : Frontiers Media S.A.. - 1661-8556 .- 1661-8564. ; 68
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Journal article (peer-reviewed)abstract
- Objectives: To examine the association between educational level and attitudes towards alcohol conversations in healthcare using population-based surveys of adults in England, the Netherlands, Norway, and Sweden; and to compare attitudes towards alcohol conversations in healthcare between these four countries. Methods: Cross-sectional surveys were conducted amongst adults in the general population in England (n = 3,499), the Netherlands (n = 2,173), Norway (n = 1,208), and Sweden (n = 3,000). Logistic regression analysis was used to examine associations between attitudes towards alcohol conversations in healthcare and educational level, key demographic variables, alcohol consumption, and country of residence. Results: In all four countries, low educational level (p < 0.001) and male gender (p < 0.001) were associated with holding negative attitudes towards discussing alcohol in healthcare. Risky drinkers had more negative attitudes than low risky drinkers towards discussing alcohol in healthcare (p < 0.001) in all countries except England (p = 0.48), and also reported low levels of perceived honesty and confidence in healthcare (p < 0.001). Conclusion: These findings highlight the importance of considering patients’ socio-economic status when developing and implementing alcohol prevention interventions in healthcare. Copyright © 2023 Karlsson, Skagerström, O’Donnell, Abidi, Thomas, Nilsen and Lid.
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| 10. |
- Müssener, Ulrika, 1974-, et al.
(author)
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High School Students’ Preferences and Design Recommendations for a Mobile Phone–Based Intervention to Improve Psychological Well-Being: Mixed Methods Study
- 2020
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In: JMIR Pediatrics and Parenting. - Toronto, ON, Canada : J M I R Publications, Inc.. - 2561-6722. ; 3:2
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Journal article (peer-reviewed)abstract
- Background:Young adults’ mental health is characterized by relatively high rates of stress and anxiety and low levels of help-seeking behavior. Mobile health (mHealth) interventions could offer a cost-effective and readily available avenue to provide personalized support to young adults. More research needs to be directed at the development of mHealth interventions targeting youths specifically, as well as at determining how to reach young people and how to effectively intervene to improve psychological well-being.Objective:The objective was to gather perceptions from high school students to inform the development of a prototype mHealth intervention aiming to promote psychological well-being.Methods:A mixed methods design was used to (1) investigate high school students’ perceptions about stress and its consequences in daily life, as well as their ability to cope with stress, and (2) explore their preferences and design recommendations for an mHealth intervention to improve psychological well-being. Students from two high schools in the southeast of Sweden were invited to take part in the study. Recruitment of high school students was completed over a 6-week period, between October 25 and December 7, 2018. Recruitment entailed inviting students to complete a stress test (ie, screening and feedback) on their mobile phones. After completing the stress test, all participants were invited to complete a follow-up questionnaire and take part in telephone interviews.Results:A total of 149 high school students completed the stress test, of which 68 completed the questionnaire. There were 67 free-text comments distributed across the items. The majority of participants (55/68, 81%) stated that they coped with stress better or in the same way after engaging in the stress test, due to time management, dialogue with others, and self-refection. A total of 4 out of 68 participants (6%)—3 female students (75%) and 1 male student (25%)—took part in telephone interviews. Three main themes were identified from the interview data: perceptions about stress, design features, and intervention features.Conclusions:Stress was described by the students as a condition caused by high demands set by oneself and the social environment that impacted their physical health, personal relationships, school performance, and emotional well-being. Participants claimed that mHealth interventions need to be clearly tailored to a young age group, be evidence based, and offer varied types of support, such as information about stress, exercises to help organize tasks, self-assessment, coping tools, and recommendations of other useful websites, literature, blogs, self-help books, or role models. Mobile phones seemed to be a feasible and acceptable platform for the delivery of an intervention.
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| 11. |
- Müssener, Ulrika, 1974-, et al.
(author)
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mHealth smoking cessation intervention among high school students : 3-month primary outcome findings from a randomized controlled trial
- 2020
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In: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 15:3
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Journal article (peer-reviewed)abstract
- BackgroundSmoking among adolescents remains a global public health issue as youth continue to maintain high prevalence rates. The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well established, yet there is still a need for studies targeting high school students. The aim of the study was to determine the effectiveness of a text-based smoking cessation intervention among high school students in Sweden.MethodsThe study was a two-arm randomized trial conducted from January 10 2018 to January 11 2019, data were analysed from April 12 2019 to May 21 2019. Inclusion criteria were high school students who were daily or weekly smokers willing to attempt to quit smoking and owned a mobile phone. The study invited all students at 630 high schools units throughout Sweden. The intervention group received text messages based on components of effective smoking cessation interventions for 12 weeks. The control group were offered treatment as usual. The primary outcomes were self-reported prolonged abstinence (not having smoked more than 5 cigarettes over the last 8 weeks) and 4-week point prevalence of smoking abstinence.FindingsA total of 535 participants, with a median age of 17 (IQR 16–18), were randomized into the study; 276 (164 [59.4%] women) were allocated to the intervention and 259 (162 [62.5%] women) to the control group. The outcomes of the trial were analyzed on a total of 212 (76.8%) participants in the intervention group and 201 (77.6%) participants in the control group. Prolonged abstinence at the 3-month follow-up was reported by 49 (23.1%) individuals in the intervention group and 39 (19.4%) individuals in the control group (adjusted OR, 1.21; 95% CI, 0.73–2.01; P value, .46). Four-week point prevalence of complete smoking cessation was reported by 53 (25.0%) individuals in the intervention group and 31 (15.4%) individuals in the control group (adjusted OR, 1.87; 95% CI, 1.12–3.17; P value, .018).ConclusionsEstimates of 4-week point prevalence of complete cessation was 10 percentage points higher in the group that were given access to the intervention compared to the control. Findings provide confirmation that text messaging-based smoking cessation programs can affect quit rates among adolescents.Trial registrationISRCTN15396225; registration date October 13, 2017, https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3028-2.
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| 12. |
- Seiterö, Anna, 1982-
(author)
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mHealth Targeting Physical Activity, Diet, Alcohol, and Smoking among Swedish High School Students : Processes and Outcomes of a Multiple Health Behavior Change Intervention (LIFE4YOUth)
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Background: Effective health promotion and disease prevention strategies are required to achieve societies where preventable diseases are effectively prevented. Physical activity, diet, alcohol consumption, and tobacco use are all determinants for high-prevalent diseases such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. The cumulative risk of multiple health risk behaviors exceeds the combined risk of each individual behavior. Because health behaviors are formed during childhood and adolescence and occur in clusters that overall affect health, interventions targeting multiple health behaviors in these populations may have a lasting impact on public health. Schools are important for health promotion and disease prevention in children and adolescents. Nevertheless, the literature indicates that school-based interventions that involve school staff to address health-risk behaviors tend to be short-term projects due to barriers that impede long-term implementation. Mobile phones can provide resources for adolescents to promote their health, such as health applications and short text messages that do not rely on school personnel. However, more research is required to better understand whether stand-alone mobile phone-delivered interventions that target multiple health behaviors are a viable way to encourage health-promoting behaviors in adolescents.Aim: This thesis aims to gain knowledge about health behavior change among Swedish high school students, including the use and effects of an mHealth intervention (LIFE4YOUth) targeting four health behaviors (physical activity, diet, alcohol consumption, and cigarette smoking). The overall aim was addressed through four sub-studies, which specifically aimed to: identify and describe how high school students perceive health behavior change and how mobile phones are used in the process of change (Paper I), explore how high school students understand, interpret, and apply the content of LIFE4YOUth and describe consequences on psychological resources relevant to behavior change (Paper II), investigate explanations for engagement among high school students with access to LIFE4YOUth (Paper III), and estimate the two- and four-month effectiveness of LIFE4YOUth on individual health behaviors (physical activity, diet, alcohol consumption, and cigarette smoking) compared to a waiting list control condition (Paper IV).Intervention: The LIFE4YOUth intervention gave participants four-month access to weekly prompts for recording health behaviors and receiving feedback based on national guidelines, a four-module interactive dashboard with content structured around two main questions: why change and how to change health behaviors, and text message services for each targeted behavior.Methods: All studies were conducted between 2019 and 2023 and included approximately 800 students from high schools all over Sweden. Two studies had a qualitative approach, with data collected through focus groups (Paper I) and individual interviews with "think aloud" techniques (Paper II). Data were analyzed using thematic analysis (Paper I) and qualitative content analysis (Paper II). One study (paper III) had a mixed-methods design with data collected from participants in the intervention arm of the LIFE4YOUth trial. The analysis included statistical analyses, qualitative content analysis, and qualitative comparative analysis. Finally, a two-armed randomized controlled trial (1:1) with an intervention group and a waiting list control group was enrolled (Paper IV). Data was collected through web-based questionnaires at baseline and after two and four months. All primary outcomes were analyzed using regression models with inferences drawn from Bayesian analysis and null hypothesis testing.Results: The process of health behavior change was understood as a learning process facilitated by independence, an open approach, and self-acceptance while striving for social ideals such as togetherness with friends. Participants engaged with LIFE4YOUth to varied extent, which can be explained by varied interest in behavior change, experiences with the intervention, and circumstances in their social environment. Most participants responded to the weekly prompts in ≤ 2 out of 16 weeks, with 58% engaging with the intervention at least once. The dashboard content had the potential to provide participants with insights that facilitate health behavior change, but participants understood, interpreted, and applied the content in varied ways depending on whether they deliberately acknowledged their interpretation of concepts, took their prior knowledge into consideration to comprehend what was not explicitly outlined, and placed themselves in the center by accounting for their personal needs when interacting with the content.After two months, the intervention group participants had on average 50 minutes more of moderate to vigorous physical activity per week compared with the control group participants (95% CI = -0.19; 99.73, probability of effect = 97.4%, P=.05), and on average 0.32 more daily portions of fruits and vegetables (95% CI = 0.13; 0.53, probability of effect = 99.9%, P=.001). Furthermore, the probability of effect on weekly consumption of sugary drinks was 86% (IRR = 0.89, 95% CI = 0.73; 1.1, P=.29) and 94% on monthly frequency of heavy episodic drinking (IRR = 0.77, 95% CI = 0.55; 1.07, P=.14). The evidence for effect was weaker after four months. There was no marked evidence for an effect on weekly alcohol consumption or smoking cessation.Conclusion: The findings of this thesis indicate that the LIFE4YOUth intervention can raise Swedish high school students’ awareness of their health behaviors, encourage them to change their health-risk behaviors, and facilitate their process of adopting new behaviors. Nonetheless, the intervention’s potential may vary depending on high school students' interest in and cognitive processing of the intervention content. The strongest evidence for effect was on the weekly time spent in moderate to vigorous physical activity and the daily number of portions consumed of fruit and vegetables. These findings should encourage further research to gain more robust evidence on whether and how stand-alone mHealth multiple behavior change interventions are effective in promoting healthy behaviors among adolescents.
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| 13. |
- Thomas, Kristin, 1978-, et al.
(author)
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Effectiveness of a Text Messaging-Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial
- 2018
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In: JMIR mhealth and uhealth. - : JMIR PUBLICATIONS, INC. - 2291-5222. ; 6:6
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Journal article (peer-reviewed)abstract
- Background: Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message-based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. Objective: The objective of this study was to test the effectiveness of a behavior change theory-based 6-week text message intervention among university students. Methods: This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. Results: A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. Conclusions: The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies.
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| 14. |
- Thomas, Kristin, 1978-
(author)
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Implementation of coordinated healthy lifestyle promotion in primary care : Process and outcomes
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Background: Implementation of healthy lifestyle promotion in routine primary has been suboptimal. There is emerging evidence that coordinating care can improve the efficiency and quality of care. However, more research is needed on the implementation of coordinated care in healthy lifestyle promotion, the role of patients in implementation and the long-term outcomes of implementation efforts.Overall aim: To investigate the implementation of coordinated healthy lifestyle promotion in primary care in terms of process and outcomes, from the perspectives of both staff and patients.Methods: In 2008, Östergötland county council commissioned primary care centres to implement a coordinated care initiative, lifestyle teams, to improve healthy lifestyle promotion routines. A lifestyle team protocol stipulated centres to: (1) create multi-professional teams, (2) appoint team managers, (3) hold team meetings, and (4) create in-house referral routines for at-risk patients. Paper I investigated the implementation process of three lifestyle teams during a two year period using a mixed method, convergent parallel design. A proposed theory of implementation process was used to analyse data from manager interviews, documents and questionnaires. Paper II explored patients’ role in implementation using grounded theory. Interview data from patients with varied experience of promotion was used. Paper III investigated implementation outcomes using a quasi-experimental, cross-sectional design that compared three intervention centres (lifestyle teams) with three control centres (no teams). Data were collected by staff and patient questionnaires and manager interviews at 3 and 5 years after commissioning. The RE-AIM framework was modified and used to define outcome variables: Reach of patients, Effectiveness (attitudes and competency among staff), Adoption among staff, Implementation fidelity to the lifestyle team protocol, and Maintenance of the results at 5-year follow-up.Results: Paper I: The implementation process was complex including multiple innovation components and groups of adopters. The conditions for implementation, e.g. resources varied between staff and team members which challenged the embedding of the teams and new routines. The lifestyle teams were continuously redefined by team members to accommodate contextual factors, features of the protocol and patients. The lifestyle team protocol presented an infrastructure for practice at the centres. Paper II: A grounded theory about being healthy with three interconnected subcategories emerged from data: (1) conditions, (2) managing, and (3) interactions regarding being healthy. Being healthy represented a process of approaching a health ideal which occurred simultaneously with, and could contradict, a process of maximizing well-being. A typology of four patient types (resigned, receivers, co-workers, and leaders) illustrated how processes before, during and after healthy lifestyle promotion were interconnected. Paper III: Reach: significantly more patients at control centres received promotion compared to intervention centres at 3-year (48% and 41% respectively) and 5-year followups (44% and 36% respectively). Effectiveness: At 3-year follow-up, after controlling for clustering by centres, intervention staff were significantly more positive concerning perceived need for lifestyle teams; that healthy lifestyle promotion was prioritized at their centre and that there was adequate competency at individual and centre level regarding lifestyle promotion. At 5-year follow-up, significant differences remained regarding prioritization of lifestyle promotion at centre level. The majority of both intervention and control staff were positive towards lifestyle promotion. Adoption: No significant differences were found between control and intervention centres at 3 years (59% and 47% respectively) or at 5 years (45% and 36% respectively). Implementation fidelity: all components of the lifestyle team protocol had been implemented at all the intervention centres and at none of the control centres.Conclusions: The implementation process was challenged by a complex interaction between groups of staff, innovation components and contextual factors. Although coordinated care are used for other conditions in primary care, the findings suggest that it is difficult to adopt similar routines for healthy lifestyle promotion. Findings suggest that the lifestyle team protocol did not fully consider social components of coordinated care or the varied conditions for change exhibited by adopters. Patients can be seen as coproducing implementation of healthy lifestyle promotion.
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| 15. |
- Thomas, Kristin, 1978-, et al.
(author)
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Mental Health Promotion Among University Students Using Text Messaging : Protocol for a Randomized Controlled Trial of a Mobile Phone–Based Intervention
- 2019
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In: JMIR Research Protocols. - Toronto, Canada : J M I R Publications, Inc.. - 1929-0748. ; 8:8
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Journal article (peer-reviewed)abstract
- Background: There is a growing understanding that well-being and mental illness are 2 separate dimensions of mental health. High well-being is associated with decreased risk of disease and mental illness and increased longevity.Objective: This study aims to test the efficacy of a mobile phone–based intervention on positive mental health.Methods: We are conducting a 2-armed randomized controlled trial of university students in Sweden. Recruitment will last for 6 months by digital advertising (eg, university websites). Participants will be randomly allocated to either an intervention (fully automated mobile phone–based mental health intervention) or control group (treatment as usual). The primary outcome will be self-assessed positive mental health (Mental Health Continuum Short Form). Secondary outcomes will be self-assessed depression anxiety symptomatology (Hospital Anxiety Depression Scale). Outcomes will be investigated at baseline, at 3, 6, and 12 months after randomization. Mediators (positive emotions and thoughts) will be investigated at baseline, midintervention, and at follow-ups using 2 single face-valid items.Results: Data will be collected between autumn 2018 and spring 2019. Results are expected to be published in 2020.Conclusions: Strengths of the study include the use of a validated comprehensive instrument to measure positive mental health. Mechanisms of change are also investigated. A potential challenge could be recruitment; however, by setting a prolonged recruitment period, we believe that the study will recruit a sufficient sample.
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- Thomas, Kristin, 1978-, et al.
(author)
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Mobile phone-based lifestyle support for families with young children in primary health care (MINISTOP 2.0) : Exploring behavioral change determinants for implementation using the COM-B model.
- 2022
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In: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 2
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Journal article (peer-reviewed)abstract
- BACKGROUND: Obesity in childhood is a public health concern worldwide and mobile phone-based interventions (mHealth) has shown to facilitate obesity prevention. However, more research is needed on the implementation of digital tools in routine primary care. This study explored behavior change determinants for implementing a health promotion mHealth intervention (MINISTOP 2.0 app) targeting parents of 4-year-olds.METHODS: Secondary data from telephone interviews (n = 15) with child health care nurses working within primary child healthcare in Sweden was analyzed using directed content analysis and the COM-B model.RESULTS: Barriers for implementation included: limited knowledge about using technology and reservations about how and to what extent parents would use mHealth. Potential facilitators included nurses' openness to learn and try new tools, confidence in their role and engagement in reaching parents as well as beliefs that the app could improve practice by prompting dialogue and being a shared platform. Nurses expressed a strong professional identity and shared understanding of their practice, mechanisms that could potentially inhibit or facilitate implementation.CONCLUSIONS: Findings suggest cautious optimism regarding implementing mobile phone-based tools in child primary healthcare in terms of capability, opportunity and motivation among stakeholders. Implementation strategies such as educational outreach visits and making the intervention testable among stakeholders could further facilitate implementation in this clinical context. However, more research is needed on behavior change determinants in different stages of real-world implementation.
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