Ina Borup

Schoolchildren Who Are Victims of Bullying Report Benefit from Health Dialogues with the School Health Nurse.

Background School health services are important tools for health promotion among schoolchildren, but little is known about their effects. This article addresses the effects of dialogues with school health nurses among schoolchildren who were victims of bullying. Study population and methods Cross-sectional and school-based survey, the Danish contribution to the international Health Behaviour in School-aged Children (HBSC) study. The study included all students in the fifth, seventh, and ninth grade (11, 13, and 15 year olds) in a random sample of schools. The participation rate was 98 per cent of the students present on the day of data collection and 88 per cent of the enrolled students, n = 5205. Measurements Bullying was measured as recommended by Olweus. Outcome of the dialogue with the school health nurse was measured as self-reports of five responses: (1) reflected on the dialogue, (2) discussed the content with parents, (3) followed the advice from the school health nurse, (4) did what he (she) himself (herself) thought was best, and (5) visited the school health nurse again. Results All outcome measures were more prevalent among students who were victims of bullying. The most pronounced association was that the odds ratio for visiting the school health nurse again was 1.8 (95 per cent CI 1.3–2.5) for students who were bullied at least weekly. Conclusion Schoolchildren who are victims of bullying benefit from health dialogues with the school health nurse.

Older people’s perception of and coping with falling, and their motivation for fall-prevention programmes

Aims: This study aims to investigate older people’s perceptions of and coping with falls, and what motivates them to join such programmes. Method: We used semi-structured interviews to collect data on 14 individuals (65 years +) who contacted an emergency department because they had fallen. Data were analyzed using a phenomenographic approach that traces older people’s perception of the phenomenon of ‘‘falling’’. Results: Five categories and 15 subcategories emerged from the interviews. The five main categories were: emotional perceptions of falling; falling has consequences; coping with the situation; support from the social network; motivation and demotivation. To fall was shameful and embarrassing and could be explained by old age. To some, ‘‘fear of falling’’ was the dominant feeling. These people did not see falls as a risk factor they ought to care about. Instead, to prevent future falls, they restricted their activities or stopped certain activities altogether. If demands exceeded their resources, they asked their relatives or their general practitioner for help. Elderly people were motivated by autonomy, competence, and relatedness and preferred activities that spread happiness and joy, preferably in a social atmosphere, but they encountered elements in their surroundings that curbed their motivation. Conclusions: Future fall-prevention programmes must target older people’s needs and acknowledge that there are many ways of perceiving falling. Moreover, elderly individuals’ coping strategies are not necessarily productive. Social networks and general practitioners can actively encourage older people to participate in fall-prevention programmes. Such programmes must support older people’s need for autonomy, competence and social relations.

Re-visit to the school nurse and adolescents’ medicine use

Objective: To examine if students who re-visit the school nurse use medicines differently than other students when exposed to aches and psychological problems. Methods: The study includes all 11-, 13- and 15-year-old students from a random sample of schools in Denmark, response rate 87 per cent, n = 5,205. The data collection followed the internationally standardized HBSC questionnaire. This study includes an item about students’ re-visits to the school nurse, items about frequency of four complaints (headache, stomach-ache, difficulties in getting to sleep, and nervousness) and medicine use in the past month for these four complaints. Results: In total, 8.6 per cent of the students had re-visited the school nurse. There was a strong and graded association between frequency of complaints and medicine use for the relevant complaint. Students who re-visited the school nurse had higher odds for medicine use than other students. The association between frequency of complaints and medicine use was stronger among students who had not re-visited the school nurse as compared to the students who had re-visited the school nurse. One example is the OR (95 per cent CI) for medicine use for headache among students who experienced headache monthly vs. seldom/never and at least weekly vs. seldom/never. Among students who did not re-visit the school nurse, the OR estimates were 5.32 (4.61–6.14) and 13.6 (10.5–17.6) and among students who did, OR estimates were 3.65 (2.32–5.75) and 7.07 (3.58–14.0). Conclusion: The school nurse may reduce the students’ proneness to use medicine when they experience complaints.

Fathers of Children With Type 1 Diabetes: Perceptions of a Father’s Involvement From a Health Promotion Perspective

This study describes how fathers of children diagnosed with type 1 diabetes understand their involvement in their child’s daily life from a health promotion perspective. Sixteen Swedish fathers of children living with type 1 diabetes were interviewed. Manifest and latent content analysis was used to identify two themes: the inner core of the father’s general parental involvement and the additional involvement based on the child’s diabetes. The former was underpinned by the fathers’ prioritization of family life and the fathers being consciously involved in raising the child, and the latter by the fathers promoting and controlling the child’s health and promoting and enabling the child’s autonomy. The results highlight that the quality of the fathers’ involvement is essential in the management of a child’s chronic illness. It is important for pediatric diabetes health care professionals to assess the quality of fathers’ involvement to promote the child’s health.

The role of health promotion in the transition of the Nordic welfare states

The 6th Nordic Health Promotion Research Conference: The Role of Health Promotion in the Transition of the Nordic Welfare States was held in Gothenburg, Sweden in August 2009. The aim of the conference was to focus on and share results from ongoing Nordic as well as international research in health promotion. The conference themes reflected current aspects of changes in research and work within health promotion locally, nationally and internationally. The Nordic School of Public Health, NHV, hosted the conference. www.nhv.se/hpconference09. The Ottawa Charter (1986) and the seven principles of Rootman et al. (2001) were the guiding principles for the conference presentations [1–3]. The action means of the Ottawa Charter are to build healthy public policy, create supportive environments, strengthen community action, develop personal skills and re-orient health services. The seven key principles of Rootman et al. are empowerment, participation, holism, intersectorality, equitability, sustainability and multistrategy. In order to reach a greater audience both in the Nordic countries and outside some of the researchers who participated in the conference were asked to write scientific articles that covered the theme they presented at the conference. The results are in this Supplement to the Scandinavian Journal of Public Health. A way to understand health promotion is to look upon the research in the field. The action means from the Ottawa Charter are touched upon in the articles. Vallgarda and Ollila address the concepts of building of a healthy public policy and re-orientation of health services. Vallgarda concludes that there is no common Nordic political approach to public health, and Ollila argues that health in all policies is necessary and that implementation of intersectoral health policies in practice remains challenging. Thorlindsson speaks of multistrategy and argues for the necessity to develop a transdisciplinary approach that integrates various elements from different disciplines and various levels of analysis. Johansson and Tillgren discuss whether there are financial incentives of collaborating organizations and illustrate with two examples. Torp, Guldbergsson, Dahl, Fossa and Flotten address creating supportive environments and strengthening community action. Equitability is one of the seven principles of Rootman et al. and is a focus in the majority of the articles. It is also central in the papers of Edwards and Di Ruggiero, who conclude that it is necessary to examine the effect of historical, global and dynamic contextual influences on health inequities in population-based interventions; Povlsen, Fosse and Borup find that the concepts of inequity and inequality are used synonymously by Nordic authors. Abel, Fuhr, Bisegger, Ackerman Rau and the European Kidscreen group highlight three forms of capital, namely economic, social and cultural resources in adolescents’ health, and Due, Krolner, Rasmussen, Andersen, Damsgaard, Graham and Holstein present a model of pathways and mechanisms from adolescence to adult health inequalities. Health education is central within health promotion. Hauge and Hem focus on health promotion education developed into a Masters programme and analyze the Galway Consensus Conference Statement (GCCS) according to health, health promotion and health promotion ethics. They conclude that the

Family Relations and Outcome of Health Promotion Dialogues with School Nurses in Denmark

The purpose of this study was to examine if family structure and family relations were associated with childrens perceived outcome of the contact with the school nurse. Methods: Danish school survey (1998) with a study population of 11-, 13- and 15-year-olds, response rate 88.0%, n=5,205, data collection by the internationally standardised HBSC questionnaire. Independent variables were family structure and confident relations with father and mother; outcome measures were student-reported outcomes of the dialogue. Results: The OR for having discussed the health dialogue with parents was 0.63 (0.51–0.78) among boys who did not have confident relations with their mother and 0.43 (0.35–0.52) for girls who had no confident relations with their mother. Discussion and conclusion: Lack of confident relations with parents were associated with less positive outcome of the dialogue with the school nurse. The practical implications of the study are that school nurses organise their health promotion efforts in order to support students and their families in develop mutual positive relations.

Self-reported symptoms and outcome of health promotion at school: cross-sectional study of 11-15-year-olds

Introduction and aim: This paper examines whether students with common symptoms perceive positive outcome of the health dialogue with the school health nurse. Methods and study population: This study included all students in the fifth, seventh and ninth grade classes (average age 11.8, 13.8 and 15.8 years) in a random sample of schools in Denmark, response rate 87%, n=5.205. The data collection took place in the classroom by a standardised questionnaire. The dependent variables were four aspects of perceived outcome of the health dialogue with the school health nurse and the independent variables were eight common symptoms. Results: The majority of the students had thought about the health dialogue, discussed it with their parents, and had followed the advice from the nurse. A minority also visited the nurse again. Students with frequent physical and psychological symptoms had more often than other students thought about the health dialogue, followed the advice and visited the nurse again. Conclusion: The study suggests that students with high symptom load perceive more benefit from the dialogue with the school health nurse.

Health Promotion: A developing focus area over the years

In 1953 when the Nordic School of Public Health was founded, the aim of public health programmes was disease prevention more than health promotion. This was not unusual, since at this time health usually was seen as the opposite of disease and illness. However, with the Ottawa Charter of 1986, the World Health Organization made a crucial change to view health not as a goal in itself but as the means to a full life. In this way, health promotion became a first priority and fundamental action for the modern society. This insight eventually reached NHV and in 2002 – 50 years after the foundation – an associate professorship was established with a focus on health promotion. Nevertheless, the concept of health promotion had been integrated with or mentioned in courses run prior to the new post. Subsequently, a wide spectrum of courses in health promotion was introduced, such as ‘Empowerment for Child and Adolescent Health Promotion’, ‘Salutogenesis – from theory to practice’ and ‘Health, Stress and Coping’. More than half of all doctoral theses undertaken at NHV during these years had health promotion as their theme. As a derivative, the Nordic Health Promotion Research Network (NHPRN) was established in 2007 with bi-annual meetings at NHV.

Mothers’ groups initiated by health visitors: Why do some groups continue over years? A qualitative study with a phenomenographic approach

Aim To describe mothers’ perceptions of what characterized mothers’ groups that continued over many years and to explore how the mothers benefitted from participating. Background Scarce knowledge about mothers’ groups in a long term perspective. Methods A qualitative research design was applied. Data were obtained by focus group discussions in three mothers’ groups that had lasted for 13, 16 and 21 years, respectively. Data was analysed using a phenomenographic approach. Findings The analysis revealed three descriptive categories and nine sub-categories. The categories were: Structure and contents over the years; Diverse backgrounds and views, with respect; and Revitalization, continuation and outcome of the groups. The underlying structure was found to be that the mothers’ groups had developed from baby-oriented to life-oriented forums and constituted a free space built upon confidentiality and trust, and with respect for differences. Conclusion The study concludes that mothers’ groups may result in social support and new coping strategies. Health professionals should encourage established groups to continue on their own. More research on the drop-outs from the groups is needed.