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- Johansson, Lisbeth
(författare)
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To do or not to do? Physical activity in relation to socioeconomic status and health – a salutogenic perspective in the context of targeted health dialogues
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is well known that physical activity (PA) has a major positive impact on health and that the performance of PA is lower in low socioeconomic groups. However, more knowledge about the relationship between PA and health is needed especially between and within socioeconomic groups.This thesis aimed, from a salutogenic perspective, to increase the understanding of the relationship between physical activity and health in the adult population, with a particular focus on people with economic difficulties. A further aim was to validate questions about physical activity and to explore the people’s experiences of PA from a sense of coherence perspective, all in the context of targeted health dialogues.The first study in this thesis is a validation study. It validates a PA interview form and questions about sedentary time used in the targeted health dialogues. Studies II and III comprise quantitative analyses of PA, health and psychological factors in the population, especially in groups with low socioeconomic status (SES). Study IV is a qualitative deductive study based on interviews with participants with low SES in the targeted health dialogues. The deductive analysis contains the participants’ experiences of PA from a sense of coherence perspective.The findings in study I showed that the interview form and the single-item question about sedentary time could be considered as acceptable to use in Swedish targeted health dialogues. In study II, physically active people with low SES were shown to have the same odds of reporting good self-rated health compared to those with low PA and high SES. The findings in study III showed that within the group of people with self-reported economic difficulties, higher levels of PA were related to better mastery and more vitality. Study IV showed that it is essential for the participants to have an awareness of the health benefits of PA and their challenges in performing PA. The participants also constructed a plan to follow while utilising their resources, and their intrinsic motivation to achieve the PA recommendations and the PA benefits.This thesis brings a deeper knowledge and understanding of the healthperspective of PA. This knowledge can be used to further develop thetargeted health dialogues in a salutogenic way. It will give people,especially those with lower SES, the opportunity to use their resourcesto increase PA and thereby improve their future health.
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| 2. |
- Andersson, Elin M., 1978-
(författare)
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From risk communication to lifestyle modification : interactions of reactions for actions
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: From a health psychological perspective, the great need of effective cardiovascular disease (CVD) prevention and the potential of pictorial presentation of subclinical atherosclerosis as part of risk communication implies two important lines of inquiry which constitute the overall aims of this thesis: 1) To explore and assess psychological intervention response in terms of cognitive and emotional reactions to health risk communication about subclinical atherosclerosis, 2) To assess associations between psychological intervention response and lifestyle modification.Methods: The pragmatic population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. Study 1 assessed cognitive and emotional reactions to the intervention, and how reactions were associated to lifestyle modification, measured with a lifestyle index based on physical activity, diet, smoking and alcohol consumption. To gain deeper understanding of why the intervention is effective, Study 2 qualitatively explored reactions evoked by the intervention as well as attitudes to any implemented lifestyle changes among VIPVIZA participants in the intervention group with improved health status. Study 3 assessed risk perception and efficacy beliefs in the intervention group and the control group after one and three years. Furthermore, this study assessed whether risk perception increased with message severity. Study 4 assessed the impact of the VIPVIZA intervention on participants' risk perception accuracy, and also whether risk perception accuracy after one and three years was associated with sustained lifestyle change.Results: The result letter was easy to understand and the intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification. Informants perceived risk messages to be clear, accurate, reliable and emotionally engaging. Study 1 and Study 2 suggest that an interplay between cognitive and emotional reactions is crucial from early reactions to risk messages, through the decision-making process of behavioural change to maintenance of a healthy lifestyle. The intervention group perceived their cardiovascular disease risk as higher after one year, compared to the control group, with the effect persisting after three years. Within the intervention group, differences in CVD risk perception were found among participants receiving different color-coded risk messages on atherosclerosis status. The intervention had an impact on accuracy of risk perception. Accuracy of risk perception was associated with long-term behaviour change. Underestimating risk was associated with a decrease in health behaviours.Conclusions: As captured by the idiom "A picture says more than a thousand words", the results indicate that pictorial communication of atherosclerosis is easy to understand, enhances comprehension of risk, and evoke a powerful response. In other words: the communication is effective. Furthermore, in line with the idiom "Seeing is believing", which suggests that seeing something first-hand makes it more credible or believable, the results suggest that pictorial communicating on atherosclerosis status increase understanding of CVD risk since being perceived as accurate, reliable and convincing. In other words: pictorial communication is trustworthy and convincing. Future CVD interventions should acknowledge the role of accuracy of risk perception for behaviour change and focus on strengthening efficacy beliefs.
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| 3. |
- Bengtsson, Anna, 1973-
(författare)
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Pictorial presentation of subclinical atherosclerosis : a measure to reduce the risk for cardiovascular disease
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was improved cardiovascular disease (CVD) prevention through the VIPVIZA intervention. This includes the provision of pictorial information of subclinical atherosclerosis to participants and their general practitioners (GPs), follow-up phone call, and written information to the participant. VIPVIZA is a Prospective Randomized Open Blinded End-point (PROBE) trial nested within VIP, a CVD prevention program in primary health care in Västerbotten county, Sweden. Middle-aged individuals at low/intermediate CVD risk were enrolled to VIPVIZA and randomized 1:1 to an intervention (n=1749) or control group (n=1783 who received no pictorial or other information). Preventive measures were managed within primary health care.At baseline, clinical risk factors were measured and carotid ultrasound examination was performed. The prevalence of subclinical atherosclerotic disease was assessed as intima media thickness and presence of plaque. The association between clinical risk factors and measures of subclinical atherosclerosis was investigated. In addition to conventional risk factor-based risk evaluation, the impact of the VIPVIZA intervention on CVD risk, traditional risk factors and pharmacological treatment was evaluated after 1 and 3 years. Individual interviews were conducted with 15 GPs to explore how a pictorial representation of subclinical atherosclerosis affects physicians in their perception and communication of CVD risk. The interviews were analyzed by qualitative content analysis.The plaque prevalence was 44.7% in this population. Clinical risk factors explained more of the variation in a combined ultrasound measurement than single measurements. The results up to three years showed a VIPVIZA intervention effect, with lower and sustained CVD risk in the intervention as compared to the control group. The effect was partly mediated by differences in intake of lipid-lowering medication and partly by lifestyle behaviour. The GPs described their risk assessment and patients’ risk perception as more accurate with the VIPVIZA intervention. Informing patients about examination results prior to a consultation can facilitate shared decision-making and enhance adherence to preventive measures.The results show that the VIPVIZA intervention reduces CVD risk over three years. In the long run this has the potential to reduce the incidence of CVD events.
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