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- Gustavsson, Catharina, 1961-, et al.
(author)
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Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare.
- 2023
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In: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions).METHODS: This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions.RESULTS: During the implementation intervention, the workplaces' readiness-to-change and the healthcare staff's confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method.CONCLUSION: The implementation intervention was not sufficient to produce sustained change of the healthcare staff's behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs' sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws.TRIAL REGISTRATION: Registered in the ISRCTN registry with study registration number: ISRCTN15551042 (Registration date: 12/01/2016).
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| 2. |
- Husdal, Rebecka, et al.
(author)
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Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study
- 2020
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In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 167
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Journal article (peer-reviewed)abstract
- Aims: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM). Methods: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied. Results: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895–0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM. Conclusions: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM. © 2020 Elsevier B.V.
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| 3. |
- Joffer, Junia, 1984-
(author)
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Health for future : self-rated health and social status among adolescents
- 2020
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to explore self-rated health, subjective social status and smoking in adolescents.This thesis consists of a qualitative and a quantitative study. The qualitative study was an interview study that included 58 participants in the 7th and 12th grades. The cognitive interviewing technique ‘think-aloud’ was employed to explore how adolescents interpret and reason when answering a question about self-rated health (‘A person may feel good sometimes and bad sometimes. How do you feel most of the time?’). Additionally, factors contributing to subjective social status in school and the different strategies adolescents used for positioning were explored. Qualitative content analysis and thematic network analyzes were used to analyze the data. The quantitative study was a cohort study involving 1046 adolescents who answered questionnaires about their health in the 7th, 8th, 9th and 12th grades. Data were used to investigate predicting factors in the 7th grade for smoking in the 12th grade, as well as to examine associations between subjective social status in school, socioeconomic status and self-rated health in boys and girls in the 12th grade. Data were analyzed using chi-square tests, binary logistic regression and ordinal logistic regression analyses.The results from the interviews showed that participants interpreted the self-rated health question in holistic terms including social, mental and physical aspects. Results from the quantitative study showed that boys rated their health higher than girls at all ages. In a multivariable analysis lower selfesteem, a less negative attitude towards smoking and ever using snus in the 7th grade were significant predictors of smoking in the 12th grade. In addition, girls had an increased risk of becoming smokers. Cross-sectional analyses in the 12th grade revealed that adolescents’ self-rated health was positively associated with subjective social status in school, mood in the family and self-esteem in both girls and boys. Boys rated their subjective social status higher than girls. When exploring subjective social status in school further through interviews, status hierarchies in school were confirmed by the participants, which were strongly influenced by norms linked to gender, age, ethnicity and parental economy, but also expectations about how to look, act and interact.In conclusion, this thesis demonstrates that the self-rated health question ‘How do you feel most of the time?’ is useful for capturing a multidimensional view of health. Early efforts to strengthen adolescents’ self-esteem, promote anti-smoking attitudes and avoid an early initiation of snus seem to be important components of smoking prevention in adolescence. The positive association between self-rated health and subjective social status in school indicates that the subjective social status question is a useful healthrelated measure of social position in adolescents. Because social desirability in the school hierarchy was defined by norms that left little room for diversity, the possible negative impact of status hierarchies on adolescents’ health should to be considered. Overall, gender differences in health and social status emphasize the need for a gender-sensitive understanding of factors that impact adolescents’ lives
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| 4. |
- Joffer, Junia, et al.
(author)
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Playing the complex game of social status in school – a qualitative study
- 2020
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In: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 13:1
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Journal article (peer-reviewed)abstract
- Background: Research suggests that social status in school plays an important role in the social lives of adolescents and that their social status is associated with their health. Additional knowledge about adolescents’ understanding of social hierarchies could help to explain inequalities in adolescents’ health and guide public health interventions.Objective: The study aimed to explore what contributes to subjective social status in school and the strategies used for social positioning.Methods: A qualitative research design with think-aloud interviews was used. The study included 57 adolescents in lower (7th grade) and upper secondary school (12th grade) in Sweden. Subjective social status was explored using a slightly modified version of the MacArthur Scale of Subjective Social Status in school. Data were analyzed using thematic network analysis.Results: The participants were highly aware of their social status in school. Elements tied to gender, age, ethnicity and parental economy influenced their preconditions in the positioning. In addition, expectations on how to look, act and interact, influenced the pursue for social desirability. The way these different factors intersected and had to be balanced suggests that social positioning in school is complex and multifaceted.Conclusions: Because the norms that guided social positioning left little room for diversity, the possible negative impact of status hierarchies on adolescents’ health needs to be considered. In school interventions, we suggest that norms on e.g. gender and ethnicity need to be addressed and problematized from an intersectional approach.
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| 5. |
- Krachler, Benno, 1966-, et al.
(author)
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Medical licensing examinations in both Sweden and the US favor pharmacology over lifestyle
- 2021
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In: Preventive Medicine Reports. - : Elsevier. - 2211-3355. ; 23
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Journal article (peer-reviewed)abstract
- Low priority of disease prevention and health promotion in medical education may contribute to lack of lifestyle-counseling in clinical practice. Pharmacology-related knowledge is valued 5 times higher compared to lifestyle-related knowledge in examinations on noncommunicable diseases (NCDs) in undergraduate medical education in Sweden. This study aims to establish (i) whether medical licensing examinations are biased to favor pharmacology- over lifestyle-related knowledge and (ii) whether such a bias is present in both Sweden and the US.We identified 204 NCD-related questions from previous Swedish licensing examinations, and 77 cases from a U.S. question bank commonly used to prepare for the United States Medical Licensing Examination® (USMLE®) Step 3. With the help of expected correct answers, we determined distribution of points attainable for knowledge in the respective category (lifestyle / pharmacology / other) for 5 major NCDs: coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and stroke.The percentage of points attainable for lifestyle-related knowledge was 6.7 (95% CI 4.1–9.3) in Sweden and 4.6 (95%CI 0.0–9.1) in the U.S. The respective percentages for pharmacology-related knowledge were 32.6 (95% CI 26.3–38.8) and 44.5 (95% CI 33.2–55.8) percent. The pharmacology vs. lifestyle-quotas were 4.9 in Sweden and 9.8 in the U.S. Likelihoods of equal emphasis on lifestyle and pharmacology in NCDs was < 0.001 in both countries.There is a marked preference for pharmacology over lifestyle in medical licensing examinations in both Sweden and the U.S. Newly qualified doctors may be inadequately prepared to address preventable causes of NCDs.
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| 7. |
- Tietjen, Anna Katharina, et al.
(author)
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Quality of life of type 2 diabetes mellitus patients in Ramallah and al-Bireh Governorate–Palestine : a part of the Palestinian diabetes complications and control study (PDCCS)
- 2021
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In: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 30:5, s. 1407-1416
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Journal article (peer-reviewed)abstract
- Purpose: Type 2 diabetes mellitus (T2DM) is a considerable impact on physical health as well as on emotional and social wellbeing. This study aimed to investigate the quality of life and its associated factors among Palestinians with T2DM. Methods: A cross-sectional study including 517 patients (68% female) was conducted in eleven primary health care clinics located in Ramallah and al-Bireh governorate of the West Bank. To assess socio-demographic data, risk factors and diabetes control, interviews, physical examinations, anthropometric measurements, and blood and urine tests were performed. The validated Arabic version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire was carried out on all patients to measure Quality of Life (QoL). A multivariable regression analysis was performed. Results: The average weighted impact (AWI) score was −3.38 (95% CI: −3.55 to −3.21, range: −9.00 to 0.12). This indicates that diabetes was perceived as having a considerable negative impact on the quality of life. The life domains 'freedom to eat', 'physical activities', and 'work-life' were the most negatively impacted. Males and individuals living with diabetes for a prolonged time were associated with a more significant negative impact on quality of life. Conclusion: The study showed that diabetes generally had a negative impact on QoL and identified the demand for diabetes management programs tailored to patient needs and different patient groups, as well as health policies that put patients in the center of diabetes care.
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