Karin C. Ringsberg

Developing lay health worker policy in South Africa: a qualitative study.

BackgroundOver the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process.MethodsThe study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically.ResultsConsiderations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system.ConclusionLHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.

Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke.

AIM This paper aimed to describe health related quality of life three and 12 months after mild stroke or transient ischemic attack, TIA, to describe the perceived changes from pre to post stroke status and to examine sociodemographic determinants for health related quality of life. METHODS 105 patients with mild stroke or TIA delivered self reported data on health related quality of life using the Stroke Specific Quality of Life Scale Danish Version, SSQOL-DK. The main outcome was perceived change in over all quality of life from pre to post stroke status. Non-parametric tests were used to examine change over time and differences between groupings of gender, age and life conditions. Logistic regression was used to model the change of all over quality of life changed at 12 months compared to pre stroke status. RESULTS Fifty seven percent (57%) of the patients felt that their pre stroke status concerning quality of life was regained. Those that rated all over quality of life deteriorated 12 months post stroke were more often working (48.9% vs. 31.7%), fewer had a diagnosis of TIA (13.3% vs. 30%), functional level was lower and the consumption of antidepressive medication was more frequent. In the regression model male sex (OR 3.77), working outside home (OR 2.84) and less than 5.00 (maximum score) on the domains Mood and Work/productivity at three months were significant predictors for rating health related quality of life deteriorated after stroke. CONCLUSION Rehabilitation efforts should include employment alternatives of a less demanding nature for male patients.

Children's Experiences of Living With Asthma: Fear of Exacerbations and Being Ostracized

The aim of the study was to explore childrens experiences of asthma to tailor a learning program based on their perspectives. Fifteen children (7-10 years) were interviewed, and they narrated the meaning behind their drawings; a phenomenological hermeneutical approach was used in the analysis. The findings are described in two themes with five subthemes: fear of exacerbation (bodily sensations, frightening experiences, and loss of control) and fear of being ostracized (experiences of being excluded and dilemma of keeping the asthma secret or being open about it). Drawings are a good tool for initiating a dialogue with children.

Health-Related Quality of Life After Stroke Reliability of Proxy Responses

A Danish version of the Stroke-Specific Quality of Life Scale (SSQOL-DK) has been developed for self-reporting; it contains 12 physical and psychosocial domains. The purpose of this study was (a) to assess the reliability of the proxy version of the SSQOL-DK and (b) to evaluate the influence of frequency of proxy contact on agreement. In all, 143 patients completed the SSQOL-DK 1 to 5 years post-stroke. A patient chosen proxy completed a proxy version of the same questionnaire. The proxy version showed satisfactory internal consistency (Cronbachs α = .85-.95). Agreement was generally high. Proxies rated the amount of trouble significantly smaller (higher score) than the patients only in the domain Social Roles. The amount of trouble in the domain Family Roles received significantly higher ratings from noncohabitant proxies when compared with patients (lower score). The proxy version of the SSQOL-DK appears to be reliable for use with stroke patients up to a few years following a stroke.

Being involved in an everlasting fight--a life with postnatal faecal incontinence. A qualitative study.

UNLABELLED The prevalence of women suffering from faecal incontinence as a complication to childbirth has been estimated to 0.6-6%. The aim of this study was to elucidate the life situation and the psychosocial processes of women suffering from this injury and to find out how they cope with being in that situation. Nine women were strategically and consecutively selected from a surgery outpatient department at a hospital, to be the participants of this study. Data collection and analysis were made according to the grounded theory approach. In the analysis a core category Being involved in an everlasting fight was identified. Three main categories Fighting to be like others, Fighting against attitudes and Striving for confirmation with six sub categories depict the constant struggle to not only keep up an appearance of a normal, healthy person, but also to feel like one. The women described feelings of shame and marginalization and expressed a strong need of support and confirmation from husbands and private network in order to cope better with their lives. CONCLUSIONS AND CLINICAL IMPLICATIONS Health care professionals must inform women at risk about the effects of the injury and inform them about treatment in case of future problems in order to prevent physical, psychological and social suffering. They should also, as a routine, question the patients with regard to problems with incontinence of urine, faeces and flatulence.

Promoting health in everyday settings: Opportunities and challenges

The 7th Nordic Health Promotion Research Conference (“Promoting health in everyday settings: Opportunities and challenges”) was held in Vestfold, Norway, on 17–19 June 2013, and it was hosted by Buskerud and Vestfold University College (www.hbv. no). The aim of the conference was to focus on ongoing Nordic health promotion research, as well as international research. The conference had a specific focus on settings and the settings approach to health promotion. In order to respond to the conference’s aim and content, and to reach an international audience, all the keynote speakers and some selected researchers were asked to write scientific articles based on their conference presentations. Thus, this supplement of the Scandinavian Journal of Public Health (SJP) represents the main themes addressed at the conference. The supplement provides articles discussing important challenges for health promotion in general, and for the settings approach to health promotion in particular, covering health promotion research in a wide variety of settings. The keynote speakers’ articles give an overview of research related to a particular topic or setting, and discuss extensively the opportunities and challenges for future health promotion. Moreover, empirical articles provide an evidence base for future discussions, and challenge previous knowledge and thinking of a given issue. All articles published in this supplement underwent a double-blind review process, in line with SJP’s high academic standards.

Swedish parents’ activities together with their children and children’s health: A study of children aged 2–17 years

Background: Nordic children’s health has declined. Studies show that parents’ engagement in children’s leisure-time activities might provide beneficial health outcomes for children. Aim: The aim of the present study was to examine the association between Swedish parents’ activities together with their children, the parents’ experiences of time pressure and their children’s health. Methods: Data of 1461 Swedish children aged 2–17 years old that were collected in the NordChild study of 2011 were used. We analyzed physical health, diseases and disabilities, psychosomatic health and well-being, and the parents’ experiences of time pressure; and we calculated the associations between parental activity together with the child and health indicators. Results: Activities that were significantly and positively associated with children’s health at ages 2–17 years of age were: playing and playing games; going to the cinema, theatre, and sporting events; reading books; playing musical instruments/singing; sports activities; watching TV/video/DVD. Playing video games or computer games, driving child to activities and going for walks were significantly and positively associated at age groups 7–12 years and 13–17 years. Activities that were negatively associated with health were: surfing/blogging on the Internet, going shopping and doing homework. Parents who were not experiencing time pressures had a higher level of activity together with their children. The parental experience of time pressure was associated with work time, with less homework activity and more symptoms in children. Conclusions: The family and home are important settings for the development of children’s health. We found eight parental activities together with their children that promoted the children’s health. Parents’ working time and their time pressure experiences affected their activities with their children. There is a need for an increased focus on parental activities that are positively associated with children’s health.

Responsiveness and sensitivity of the Stroke Specific Quality of Life Scale Danish version

Purpose. To test responsiveness and sensitivity to change of the Stroke Specific Quality of Life Scale Danish version (SSQOL-DK) scores in patients following stroke. Methods. A follow-up study of 150 patients with first-ever stroke was used. Questionnaires on quality of life, fatigue, depression, and functional level were completed. Direction of change was categorised as deterioration, no change or improvement. Proportion of concordant classification with external criteria was assessed. Associations between differences in SSQOL-DK domains and the other instruments were estimated using Spearmans rank order correlation coefficients. Paired t-test was used to assess change in the SSQOL-DK domains in patients affected in that domain. Effect size and standardised response mean (SRM) were used to express domain responsiveness. Results. SSQOL-DK classified concordantly in 42.2 to 58.1%%, and misclassified from zero to 31.3%%. Changes in SSQOL-DK and in the corresponding measures correlated from (rs) 0.08 to  −0.58. Fatigue and domain energy in SSQOL-DK were negatively correlated. Effect size ranged from  −0.03 to  −0.53, SRM from  −0.02 to  −0.56 reflecting mild-to-moderate responsiveness in eight out of 12 domains. Conclusion. SSQOL-DK is mildly to moderately responsive and sensitive and can be used for descriptive purposes over time in groups of patients with mild stroke.

Support and education of immigrants with chronically ill children: Identified needs from a case study of Turkish and Kurdish families

Objective The aim of the study was to analyse how parents of Turkish and Turkish/Kurdish children with diabetes and health care professionals perceived the education and support provided, and to assess what was required to improve the collaboration between the families and the team in order to optimize selfcare and metabolic control. Design A case study including semi-structured interviews, participant observation and information from medical records. Setting The study was carried out in Copenhagen, Denmark. Method The study included 11 children aged 4—17 years of Turkish and Kurdish origin, their parents, the Turkish interpreter and the paediatric diabetes team. Results The study identified the following factors that might contribute to improve the outcome: 1) Adjusted educational initiatives to promote a better understanding of concepts like chronic disease and selfcare, and to ensure that the content of the education is understood, implemented and maintained; 2) special support to enable parents to deal with practical and emotional problems and conflicts related to diabetes management; 3) closer contact and psychosocial support in order to promote learning and motivation for selfcare as well as promoting attendance at the clinics. Conclusion Non-western immigrants have a considerable need for special support to help them learn to manage a chronic disease. Health education should aim at bridging the gap between differences related to culture and traditions.

The Nordic Health Promotion Research Network (NHPRN)

The Nordic Health Promotion Research Network (NHPRN) was established in 2007 at the Nordic School of Public Health (NHV). This article aims to describe the foundation of the NHPRN, the development and the present status of the work of NHPRN. The NHPRN consists of about 50 senior and junior researchers from all Nordic countries. It is a working network that aims to develop the theoretical understanding of health promotion, to create research cooperation in health promotion from a Nordic perspective and to extend the scope of health promotion through education. Network members meet biannually to discuss and further develop research within the field and are also responsible for the Nordic conference on Health Promotion, organized every 3 years. The NHV hosted the network between 2007 and 2014; and the World Health Organisation (WHO) will assume this role in 2015.