| 1. |
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| 2. |
- Ehrsson, Ylva Tiblom, et al.
(författare)
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Self-reported sexually transmitted infections among female university students.
- 2016
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 121:1, s. 45-49
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.MATERIAL AND METHODS: Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.RESULTS: Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030-1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321-16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112-6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473-4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182-4.771, P = 0.015).CONCLUSIONS: Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.
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| 3. |
- Gottvall, Maria, et al.
(författare)
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Informed Consent for HPV Vaccination : A Relational Approach
- 2015
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Ingår i: Health Care Analysis. - : Springer Science and Business Media LLC. - 1065-3058 .- 1573-3394. ; 23:1, s. 50-62
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent's choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.
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| 4. |
- Gottvall, Maria, et al.
(författare)
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Parents' views of including young boys in the Swedish national school-based HPV vaccination programme : a qualitative study
- 2017
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys.DESIGN: Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis.SETTING: 11 strategically chosen municipalities in central Sweden.PARTICIPANTS: Parents (n=42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme.RESULTS: The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine.CONCLUSIONS: A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.
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| 5. |
- Grandahl, Maria, et al.
(författare)
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A school-based educational intervention can increase adolescents’ knowledge and awareness about HPV
- 2016
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Konferensbidrag (refereegranskat)abstract
- Background / ObjectivesBackground: In Sweden HPV vaccination is offered to girls aged 10-12 years within the school-based vaccination program, while older girls (13-26 years) are offered the vaccine through the primary care. The vaccination rates are substantially lower (59%) among the catch-up group compared to the younger age group (82%). Adolescents have low awareness and knowledge about HPV, especially regarding cancer risks. The providers - school nurses - play a key role in providing such information. Upper secondary school students, aged 16 years, are by the school nurse offered a health interview, which includes a dialogue regarding their health, including sexual health. The health interview does however not include systematic information about HPV.Objectives: To improve adolescents’ knowledge and awareness about primary prevention of high risk HPV infection.MethodsMethods: A cluster-randomised controlled trial among upper secondary schools (n=18) was performed. Schools were first randomised to an intervention or control group, after which individual classes were randomised. In total, 832 students, boys and girls aged 16 years attending theoretical or vocational programs were invited to participate. In the end, 741 (89.1%) students completed the256study. The intervention was based on the Health Belief Model (HBM). School nurses delivered 30 minutes of face-to-face structured information about HPV, including cancer risks and HPV prevention (i.e. condom use and HPV vaccination) to the intervention group. Students in both groups completed questionnaires at baseline and at follow-up after three months. The control group received standard treatment, i.e. the regular health interview with the school nurse. Generalized estimating equation analyses were used for examining the results of the intervention.ResultsResults: The intervention had positive effects on the adolescents’ knowledge (p<0.001), with a 0.582 higher score for the intervention group compared to the control group. There were no differences in knowledge due to sex (p=0.093) or immigrant background (p=0.592). The intervention also increased awareness (p<0.001), with a 0.590 higher score for the intervention compared to the control. Again, there were no differences in awareness due to sex (p=0.183) or immigrant background (p=0.319).ConclusionConclusions: The school-based intervention delivered by school nurses, had favourable effects on knowledge and awareness about primary prevention of HPV among adolescents aged 16 years.
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| 6. |
- Grandahl, Maria, et al.
(författare)
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Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:11
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Tidskriftsartikel (refereegranskat)abstract
- In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.
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| 7. |
- Grandahl, Maria, et al.
(författare)
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‘I also want to be vaccinated!’ – adolescent boys’ awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV)
- 2019
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Ingår i: Human Vaccines & Immunotherapeutics. - : Informa UK Limited. - 2164-5515 .- 2164-554X. ; 15:7-8, s. 1794-1802
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations.In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.
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| 8. |
- Grandahl, Maria, et al.
(författare)
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School-based intervention for the prevention of HPV among adolescents : a randomised controlled study
- 2016
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Konferensbidrag (refereegranskat)abstract
- Background: Vaccination against human papillomavirus (HPV) is one important factor for preconception health and care. In Sweden a national vaccination programme for girls was implemented in 2012.Aim: To improve primary prevention of HPV infection by promoting vaccination and increased condom use among upper secondary school students at time for the general health interview with the school nurse.Methods: Randomised controlled trial among upper secondary schools (n=18). Participant schools were first randomised to the intervention or the control group, after which individual classes were randomised to be included or not. 832 students, both boys and girls aged 16 were invited to participate and in the end, 741 (89.1%) students completed the study. The intervention was based on the Health Belief Model (HBM). According to HBM a person’s health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 minute face-to-face structured information about HPV, including cancer risks and HPV prevention, i.e. condom use and HPV vaccination. Students in both groups completed questionnaires at baseline and after three months.Results: The intervention had positive effect on behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). There was also a significant effect on HBM total score (p=0.003), students in the intervention group had more favourable beliefs compared to the controls. The influence on the HBM parameters susceptibility and severity were also significant (p<0.001 for both variables). In addition, the intervention had significant effect on the intention to use condom (p=0.004).Conclusion: The school-based intervention increased HPV vaccination rates and had favourable effects on beliefs towards primary prevention of HPV in a diverse population of adolescents. These resultss provide the scientific support for the implication of nation-wide educational interventions with the potential to improve preconception health.
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| 9. |
- Grandahl, Maria, et al.
(författare)
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School-based intervention for the prevention of HPV among adolescents : a cluster randomised controlled study
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.
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| 10. |
- Grandahl, Maria, et al.
(författare)
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School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate school nurses' attitudes towards, and experiences of vaccination against human papillomavirus (HPV), and compare the results with a similar study three years earlier. School nurses (n = 736) from all counties in Sweden completed a questionnaire in spring 2016, four years after the implementation of the national HPV vaccination programme, and three years after the previous survey. Overall, the school nurses had more favourable attitudes towards the HPV vaccination programme compared to the study in 2013 (p = 0.015). More than half of the nurses (n = 415, 56%) strongly agreed that boys should also be offered the vaccine (p<0.001). There were no differences in school nurses' perceived knowledge about HPV in order to inform and to answer questions about the vaccine from the girls or from the parents. More than half of the nurses (n = 409, 56%) reported that they needed more education about HPV. Almost all nurses (n = 659, 90%) had been contacted by parents with questions about the vaccine, and most questions were related to vaccine safety. School nurses have a more favourable attitude towards the vaccination programme against HPV compared to three years earlier, although almost all nurses had been contacted by parents with diverse questions and concerns. The nurses believed that they needed more education about HPV. Thus, it is essential to provide ongoing education and training for school nurses who are key healthcare professionals for providing information about HPV and HPV vaccination to parents and to pupils.
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| 11. |
- Paulsson Do, Ulrica, et al.
(författare)
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Health communication with parents and teachers and unhealthy behaviours in 15- to 16-year-old Swedes
- 2017
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Ingår i: Health Psychology and Behavioral Medicine. - : Informa UK Limited. - 2164-2850. ; 5:1, s. 229-257
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Tidskriftsartikel (refereegranskat)abstract
- Background: Unhealthy behaviours during adolescence constitute a major risk for numerous diseases in adulthood.Aim: To explore the associations between multiple unhealthy behaviours in adolescents and health behaviour information communicated by their parents and teachers, how much the adolescents cared about this information and whether adolescents went to schools with an annual health-themed week or not.Methods: In this cross-sectional study, a self-reported questionnaire was delivered to pupils aged 15 and 16 (n = 492). The results were analysed using Poisson regression.Results: The number of unhealthy behaviours was lower in adolescents whose parents encouraged them to adopt healthy behaviours. Adolescents at schools with an annual health-themed week reported more unhealthy behaviours than other adolescents. In addition, attendance at such schools did not compensate for a lack of health behaviour information communicated by parents. Caring about health behaviour information communicated by parents was associated with fewer unhealthy behaviours. In contrast, the opposite was found when adolescents cared about health information communicated by teachers.Conclusion: It is important for parents to encourage their adolescent children to adopt healthy behaviours because this is particularly effective at lowering the number of unhealthy behaviours in adolescents. It also appears to be important for parents and teachers to develop credibility among adolescents regarding information communicated about health issues. The results also indicate the importance of involving parents in the school health work to influence them to encourage their adolescent children to adopt healthy behaviours.
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| 12. |
- Paulsson Do, Ulrica, et al.
(författare)
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Psychosocial vulnerability underlying four common unhealthy behaviours in 15–16-year-old Swedish adolescents : a cross-sectional study
- 2017
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Ingår i: BMC Psychology. - : Springer Science and Business Media LLC. - 2050-7283. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Factors that influence unhealthy behaviours in adolescents may have different impacts in different sociocultural settings. There is lack of research on the association between psychosocial vulnerability and unhealthy behaviours in adolescents, particularly outside the United States. The aim was to investigate both direct and indirect relationships between psychosocial conditions (subjective well-being, social relationships and self-esteem) and four health-related behaviours (smoking, alcohol consumption, meal frequency and physical activity) in Swedish adolescents aged 15-16 years. Socio-demographic variables (socio-economic status, gender and age) were also investigated.METHODS: To study these associations, a hypothesised model was tested using structural equation modelling. In the hypothesised model, interrelated psychosocial conditions (low well-being, poor social relationships and low self-esteem) and socio-demographic factors (low self-perceived socio-economic status, being female and higher age) together represented a vulnerability underlying smoking, alcohol consumption, irregular meal frequency and low level of physical activity. In this cross-sectional study, self-report questionnaires were used to collect data from 492 adolescents.RESULTS: Hypothesised pathways between psychosocial conditions, socio-demographic factors and the four unhealthy behaviours were confirmed. Low well-being was strongly associated with unhealthy behaviours, and poor social relationships showed a strong indirect association with the unhealthy behaviours. Low self-esteem, low self-perceived socio-economic status and female gender were also vulnerability factors for the unhealthy behaviours.CONCLUSIONS: Vulnerability for four common unhealthy behaviours was found in Swedish adolescents. This study presents the interrelationships of psychosocial and socio-demographic factors and how they were related with unhealthy behaviours. The results bring new insight into how psychosocial factors are related to unhealthy behaviours in adolescents living in northern Europe.
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| 13. |
- Paulsson Do, Ulrica
(författare)
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Psychosocial Vulnerability Underlying Unhealthy Behaviours in Swedish Adolescents
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to examine the relationship between Swedish school adolescents´ health-related behaviours and psychosocial and socio-demographic factors, with the purpose of identifying vulnerability factors for unhealthy behaviours and exploring adolescents’ own experiences and thoughts about this.Three studies were quantitative cross-sectional studies and used data from two different questionnaires. The fourth study was a qualitative study based on focus group interviews. The sample in study I consisted of 13–18-year-old adolescents (n= 10,590) and 15–16-year-old adolescents in studies II (n=492), III (n=492) and IV (n=36). The quantitative data were analysed using a number of different statistical methods. Foremost, structural equation modelling was used in studies I and II and Poisson regression analysis in study III. Study IV used qualitative content analysis by Graneheim and Lundman.The results indicated that nearly 60 per cent of 15–16-year-old adolescents have at least two unhealthy behaviours. Interrelated psychosocial and socio-demographic factors constituted vulnerability for unhealthy behaviours in general in adolescents. Good psychosocial relationships were strongly related with high well-being, whereas poor social relationships and low well-being were associated with unhealthy behaviours in general. Low socio-economic group was associated with unhealthy behaviours in general but the strength of this association varied between the adolescent age groups. Encouragement from parents to adopt healthy behaviours was associated with less unhealthy behaviours. Having adolescents who cared about what their parents said regarding health-related behaviours was also associated with a lower number of unhealthy behaviours. The school and family were important social environments for adolescents´ health-related behaviours. Similarly, friends and social media were important social contexts. Fellowship, and close social relationships, in particular, was important to healthy behaviours. Fellowship with others was also stated to influence high well-being. The experience of feeling pressure was stated to be associated with low well-being and unhealthy behaviours in adolescents.The thesis brings new knowledge to the field of psycho-social and socio-demographic factors associated with unhealthy behaviours in Swedish adolescents. Findings may be useful in supporting adolescents to reach positive health-related behaviours.
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| 14. |
- Stenhammar, Christina, 1969-, et al.
(författare)
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Changes in intimate relationships following treatment for head and neck cancer : a qualitative study
- 2017
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Ingår i: Journal of psychosocial oncology. - : Routledge. - 0734-7332 .- 1540-7586. ; 35:5, s. 614-630
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to determine how patients with head and neck cancer experience changes within their intimate relationships at the end of treatment and detect detrimental and facilitating factors in the process of resuming intimate relationships. Interviews were conducted with 131 patients. A core category – "Being open vs. not sharing the cancer journey" – emerged from the patients' narratives and was based on the experiences of engagement/disengagement, openess/fear, and patronising attitudes/sharing the burden. The findings point to the necessity of patients being open about the disease trajectory and might be understood in the light of theories about potential changes in identity and self-concept.
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| 15. |
- Stenhammar, Christina, et al.
(författare)
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Sexual and contraceptive behavior among female university students in Sweden : repeated surveys over a 25-year period
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 94:3, s. 253-259
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo study female students' sexual and contraceptive behavior and compare these results with earlier surveys. DesignComparative, repeated cross-sectional surveys, started in 1989 and repeated every fifth year. SettingContraceptive counseling delivered at a Student Health Center in Sweden. PopulationFemale university students (n=359). MethodsMultiple-choice waiting-room questionnaire. Main outcome measuresSexual and contraceptive behavior. ResultsIn 1989, age at first intercourse was 17.6years vs. 16.7years in 2014, number of lifetime sexual partners was 4.0 vs. 12.1 in 2014, and number of sexual partners during the previous 12months was 1.0 vs. 2.8 in 2014. Condom use during first intercourse with the latest partner decreased from 49% to 41% (n=172 in 2009 vs. n=148 in 2014: p<0.001), and experience of anal sex increased from 39% to 46% (n=136 in 2009 vs. n=165 in 2014: p=0.038), and 25% (n=41 in 2014) always used a condom during anal sex. A total of 70% (n=251) made use of pornography, and 48% (n=121) considered their sexual behavior affected by pornography. Eighty-nine percent (n=291) wanted two to three children and 9% (n=33) had thought about freezing eggs for the future. The female students' knowledge about increasing age being correlated with decreased fertility varied. ConclusionsSexual behavior among female university students has gradually changed during the last 25years and behavior appears more risky today. As this may have consequences on future reproductive health, it is vital to inform women about consistent and correct condom use and about the limitations of the fertile window.
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