Anna Paldam Folker

Leaping “Out of the Doubt”—Nutrition Advice: Values at Stake in Communicating Scientific Uncertainty to the Public

This article deals with scientific advice to the public where the relevant science is subject to public attention and uncertainty of knowledge. It focuses on a tension in the management and presentation of scientific uncertainty between the uncertain nature of science and the expectation that scientific advisers will provide clear public guidance. In the first part of the paper the tension is illustrated by the presentation of results from a recent interview study with nutrition scientists in Denmark. According to the study, nutrition scientists feel their roles as ‘‘public advisers’’ and ‘‘scientists’’ differ in that the former involves an expectation that they will provide unambiguous advice of the kind that might relegate scientific uncertainty to the background. In the second, more general, part of the paper we provide a normative analysis of different strategies of dealing with the tension. The analysis is structured around the extremes of either total concealment or full openness regarding scientific uncertainty. The result of analysis is that scientific advisers should not simply ‘‘feed’’ scientific conclusions to the public. They should rather attempt to promote the ability and willingness of the public to assess and scrutinize scientific knowledge by displaying uncertainties in the scientific basis of advice. On the other hand, scientific advisers must accommodate the public’s need for guidance. Such guidance should be restricted by careful consideration of what it is relevant for the public to know in order to evaluate scientific advice in practical terms.

Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five European internet services

Objective Internet-delivered cognitive behavior therapy programs have been developed and evaluated in randomized controlled trials during the past two decades to alleviate the rising demand for effective treatment of common mental health disorders such as anxiety and depression. While most of the research on internet-based cognitive behavior therapy (iCBT) has focused on efficacy and effectiveness only little attention has been devoted to the implementation of iCBT. The aim of this study was to identify the main implementation challenges perceived by therapists and managers involved in the practical operation of iCBT services in routine care settings in five European countries. Method The study was designed as a multiple comparative case study to explore differences and similarities between five different iCBT services in Sweden, Norway, Denmark, The Netherlands and Scotland. Field visits were carried out to each of the five services including interviews with the management of the service (n = 9), focus group interviews with key staff (n = 15) and demonstration of online programs. The data material was processed through thematic, comparative analysis. Results The analysis generated four transversal themes: 1) integration in the mental health care system; 2) recruitment of patients; 3) working practice of therapists; and 4) long-term sustainability of service. The main results concerned the need to address the informal integration in the health care systems related to the perceived skepticism towards iCBT from GPs and face-to-face therapists, the role of referral models and communication strategies for the stable recruitment of patients, the need for knowledge, standards and material for the training of therapists in the provision of online feedback, the need to improve the possibilities to tailor programs to individual patients, and the need for considerate long-term sustainability planning of the transitions from local projects to permanent regional or national services. Conclusion The present study gives an overview of the main implementation challenges regarding the practical operation of iCBT services perceived by the therapists and managers of the iCBT services. Future studies into specific details of each challenge will be important to strengthen the evidence base of iCBT and to improve uptake and implementation of iCBT in routine care.

Prospective Associations of the Short Form Health Survey Vitality Scale and Changes in Body Mass Index and Obesity Status

Objectives The objectives of the current study were to prospectively investigate the predictive value of the vitality scale of the Short Form Health Survey for changes in body mass index and development of obesity. Methods The study population comprised 2864 (81.5%) men and 648 (18.5%) women from the Metropolit Project and the Danish Longitudinal Study on Work, Unemployment and Health, who participated in a follow-up examination in 2009–2011 corresponding to a follow-up period of 3–7 years. Associations of vitality with body mass index and obesity were investigated separately for men and women in linear and logistic regression models adjusting for age, baseline body mass index, education, physical activity, smoking, and obesity-related diseases. Results Vitality was significantly associated with change in body mass index among men (p < 0.001) and women (p < 0.05) gaining weight after adjusting for age, baseline body mass index, education, physical activity, smoking, and obesity-related diseases. No significant associations of vitality with BMI change were observed among individuals maintaining or losing weight during the follow-up period. Furthermore, vitality significantly predicted development of obesity among women. Conclusion The study indicates that vitality is of predictive value for increases in BMI over time among individuals gaining weight and may further predict the development of obesity among women. This identification of poor vitality as a potential risk indicator for weight gain and development of obesity may be beneficial in clinical practice.

Using action learning to reduce health inequity in Danish municipalities

Purpose The aim of this study is to clarify how action learning can be used as a vehicle for promoting equal access to municipal health services for socially disadvantaged groups in a Danish context. It is the purpose of this paper to describe the methods for reducing health inequity developed in the study and to discuss how action learning methodologically contributed to achieving these results. Design/methodology/approach In the study, the front-line staff from 19 health and social service units in six different municipalities, in Denmark, each formed an action learning group to develop methods for reducing health inequity in a municipal health setting. Each group was guided by an external facilitator, according to an Action Learning Action Research phase model (ALAR-model), which structured the cyclical development of methods into four phases: diagnosing, planning action, taking action and evaluating action. Findings Two types of results of the study are reported in the paper. First, the authors present an overview of the results the 19 participating municipal units have achieved in their action learning processes, as well as two case examples of how two units have worked with action learning and the concrete methods and tools they have developed in this process. Second, they report the challenges and dilemmas the 19 units faced when working with action learning in the study. Originality/value With its use of action learning techniques and the ALAR-model, this study contributes to the development of practice-based methods to reduce unequal access to municipal health services for socially disadvantaged groups. Through the study, the front-line staff in the health and social service units has been involved in the problem-solving process, to a much greater extent than it has previously been adopted in a Danish municipal health setting.