Kjell Sverre Pettersen

Experiences with nutrition-related information during antenatal care of pregnant women of different ethnic backgrounds residing in the area of Oslo, Norway

OBJECTIVE to explore experiences with nutrition-related information during routine antenatal care among women of different ethnical backgrounds. DESIGN individual interviews with seventeen participants were conducted twice during pregnancy. Data collection and analysis were inspired by an interpretative phenomenological approach. SETTING participants were purposively recruited at eight Mother and Child Health Centres in the area of Oslo, Norway, where they received antenatal care. PARTICIPANTS participants had either immigrant backgrounds from African and Asian countries (n=12) or were ethnic Norwegian (n=5). Participants were pregnant with their first child and had a pre-pregnancy Body Mass Index above 25 kg/m(2). FINDINGS participants experienced that they were provided with little nutrition-related information in antenatal care. The information was perceived as presented in very general terms and focused on food safety. Weight management and the long-term prevention of diet-related chronic diseases had hardly been discussed. Participants with immigrant backgrounds appeared to be confused about information given by the midwife which was incongruent with their original food culture. The participants were actively seeking for nutrition-related information and had to navigate between various sources of information. CONCLUSIONS the midwife is considered a trustworthy source of nutrition-related information. Therefore, antenatal care may have considerable potential to promote a healthy diet to pregnant women. Findings suggest that nutrition communication in antenatal care should be more tailored towards womens dietary habits and cultural background, nutritional knowledge as well as level of nutrition literacy.

Beyond Culture and Language: Access to Diabetes Preventive Health Services among Somali Women in Norway

Despite the high prevalence of type 2 diabetes in some immigrant and refugee communities in Norway, there is very little information available on their utilization of diabetes prevention interventions, particularly for women from Somali immigrant communities. A qualitative study of 30 Somali immigrant women aged 25 years and over was carried out in the Oslo area. Unstructured interviews were used to explore womens knowledge of diabetes, their access to preventive health facilities, and factors impeding their reception of preventive health programs targeted for the prevention of type 2 diabetes. The study participants were found to have a good knowledge of diabetes. They knew that a sedentary lifestyle and unhealthy diet are among the risk factors for diabetes. Regardless of their knowledge, participants reported a sedentary lifestyle accompanied with the consumption of an unhealthy diet. This was attributed to a lack of access to tailored physical activity services and poor access to health information. Considering gender-exclusive training facilities for Somali immigrant women and others with similar needs, in addition to access to tailored health information on diet, may encourage Somali women to adopt a healthy lifestyle, and it will definitely contribute to a national strategy for the prevention of diabetes.

Migration as a turning point in food habits: the early phase of dietary acculturation among women from South Asian, African, and Middle Eastern Countries living in Norway.

This article explores the early phase of dietary acculturation after migration. South Asian, African and Middle Eastern women (N = 21) living in Norway were interviewed about their early experiences with food in a new context. The findings pointed to abrupt changes in food habits in the first period after migration. To various degrees, women reported unfamiliarity with foods in shops, uncertainty about meal formats and food preparation and fear of eating food prohibited by their religion. Their food consumption tended to be restricted to food items perceived as familiar or safe. Our findings indicate that the first period after migration represents a specific phase in the process of dietary acculturation. Early initiatives aimed at enhancing confidence in food and familiarity with the new food culture are recommended.

Development and validation of an instrument to assess oral health literacy in Norwegian adult dental patients

Abstract Objective. To develop and validate an interview instrument to assess oral health literacy in Norwegian adult dental patients. Materials and methods. The instrument, Adult Health Literacy Instrument for Dentistry (AHLID), was based on an OECD instrument used to assess general literacy in adults. One hundred and thirty Norwegian adults (mean age = 48 years; 57% women) participated. AHLID included a selection of oral health-related printed texts that ranged from 1–5 with respect to difficulty. A questionnaire regarding socio-demographic variables and knowledge of risk factors for oral disease was used. DMFT, stimulated salivary flow rate and streptococcus mutans and lactobacillus in saliva was also examined. Results. The Cronbach’s alpha values of AHLID were 0.98 for internal consistency reliability (p < 0.01) and 0.81 for test–re-test reliability (p < 0.05). AHLID score 3 was most frequent while very few fulfilled the criteria for score 1 and 5. Linear multiple regression analysis showed that lactobacillus in saliva and knowledge of risk factors for periodontitis and caries were predictor variables of AHLID score. Conclusions. AHLID appears to be reliable and valid to assess oral health literacy in Norwegian adults and suggests a method for country-specific health literacy instruments.

Critical appraisal of health claims: science teachers’ perceptions and practices

Purpose – Critical appraisal skills are necessary to navigate the numerous contradictory and pseudo-scientific claims in the popular media. Health and science education in schools is essential for promoting these skills in students. The purpose of this paper is to explore lower secondary school science teachers’ perceptions and reported practices related to teaching critical appraisal of health claims. Design/methodology/approach – Interpretive description strategy guided the study process. A purposeful sample of 25 Norwegian teachers was interviewed individually or in groups. Interviews were analysed using the constant comparative method. Findings – One main theme, “unexploited opportunities for teaching critical appraisal”, and three sub-themes were identified: “inattentive to the relevance of critical appraisal”, “prioritise facts over critical appraisal”, “limited competency in critical appraisal”. Teachers’ descriptions of science sessions devoted to health education uncovered important opportunities...

Diabetes Risk by Length of Residence among Somali Women in Oslo Area

Type 2 diabetes represents a major health problem worldwide, with immigrants strongly contributing to the increase in diabetes in many countries. Norway is not immune to the process, and immigrants in the country are experiencing an increase in the prevalence of diabetes after arrival. However, the dynamics of these transitions in relation to the duration of residence in the new environment in Norway are not clearly understood. From this background, a cross-sectional quantitative study using a respondent-driven sampling method was conducted among 302 Somali women living in Oslo area. The results show that 41% of the study participants will be at risk for developing diabetes in the coming 10 years, which coincides with 85% of the study participants being abdominally obese. Significant associations were found between years of stay in Norway and the risk for diabetes with those who lived in Norway >10 years, having twofold higher odds of being at risk for developing diabetes compared to those who lived in Norway ≤5 years (OR: 2.16, CI: 1.08–4.32). Understanding the mechanisms through which exposure to the Norwegian environment leads to higher obesity and diabetes risk may aid in prevention efforts for the rapidly growing African immigrant population.

Attitudes and Motivations for Healthy Eating Among Pregnant Women of Different Ethnic Backgrounds Following Antenatal Care in Oslo, Norway

Background: Rising proportions of women enter their pregnancies as overweight or gain weight excessively, increasing their risk of diet-related diseases such as gestational diabetes and preeclampsia. A good understanding of pregnant women’s attitudes and motivations toward healthy eating is essential for effective nutrition communication in antenatal care. However, only few studies have investigated attitudes and motivations toward healthy eating during and after pregnancy, and little is known about women of different ethnic backgrounds. Objectives: To explore attitudes toward and motivations for healthy eating by pregnant women of different ethnic backgrounds. Methods: Individual interviews with 16 women were conducted twice during pregnancy and once three months postpartum. Ethnic Norwegian women (n=5), and women born in different African, Asian and South East European countries (n=11) participated in the study. An interpretative phenomenological approach inspired data collection and analysis. Findings were interpreted and discussed in relation to the Self-determination theory (SDT). Results: Attitudes toward healthy eating changed due to pregnancy, but not all of the participants became more concerned about healthy eating. Three patterns were observed: pregnancy as a turn to healthier eating, also after given birth; healthy eating only during the pregnancy; and pregnancy as a ‘time-off’ from healthy eating. All three groups had both ethnic Norwegian women and women with immigrant backgrounds represented. Participants’ attitudes could be interpreted as having motivations with different degrees of self-autonomy. Conclusions: Women seem to have heterogeneous patterns of change in attitudes and motivations toward healthy eating during and after their pregnancies. Tailored nutrition communication should assess and take into account women’s attitudes and motivations toward healthy eating and the extent to which these motivations are autonomously regulated.

En norsk pilotstudie av helsesøstres oppfatninger av pasienters health literacy: helsefremmende allmenndannelse

Bakgrunn Uttrykket “ansvar for egen helse” innebaerer ogsa evnen til kritisk evaluering av helseinformasjon. Slike kunnskaper og ferdigheter reflekterer health literacy (HL) – pa norsk; helsefremmende allmenndannelse, som handler om a forsta, kunne skaffe seg tilgang pa, kritisk vurdere og adekvat anvende helseinformasjon for ervervelse av god helse. Hensikt Formalet var a kartlegge helsesostres oppfatninger av brukeres tre hierarkiske nivaer av HL (Nutbeam 2000): functional HL (FHL), interactive HL (IHL) og critical HL (CHL). Metode Et sporreskjema bestod av Likert-skalerte holdningsutsagn (fra 1 = sterkt uenig, til 5 = sterkt enig) som reflekterte FHL, IHL og CHL. Totalt N = 515 responderte. Faktor- og reliabilitetsanalyser etablerte konstrukter av utsagnsindikatorene som gjenspeilte FHL, IHL og CHL. Konstruktscorene ble sammenlignet. Resultater Score pa CHL var lavere enn pa FHL og IHL. Enkelte nokkelindikatorer i de tre konstruktene oppnadde lave score. Konklusjon Brukernes HL-niva bor tas i betraktning under helsekommunikasjon med helsesostre .

Validating the functional, communicative and critical health literacy scale using rasch modeling and confirmatory factor analysis

Background and Purpose: The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. Methods: Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. Results: Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. Conclusion: This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.

Effects of the Conceptual Model of Health Literacy as a Risk: A Randomised Controlled Trial in a Clinical Dental Context

Numerous conceptual models of health literacy have been proposed in the literature, but very few have been empirically validated in clinical contexts. The aim of this study was to test the effects of the conceptual model of health literacy as a risk in a clinical dental context. A convenience sample of 133 Norwegian-speaking adults was recruited. Participants were randomly allocated to an intervention group (n = 64, 54% women, mean age = 50 years) and a control group (n = 69, 49% women, mean age = 46 years). Clinical measurements were conducted pre-intervention and six months post-intervention. In the intervention group, communication regarding patients’ oral health was tailored to their health literacy levels using recommended communication techniques, whereas the control group received brief information not tailored to health literacy levels. The ANCOVA showed significant between-group effects, finding reduced post-intervention mean gingival (p < 0.000) and mean plaque (p < 0.000) indices in the intervention group when controlling for baseline index scores. The adjusted Cohen’s d indicated large effect sizes between the intervention group and the control group for both the mean gingival index (−0.98) and the mean plaque index (−1.33). In conclusion, the conceptual model of health literacy as a risk had a large effect on important clinical outcomes, such as gingival status and oral hygiene. The model may be regarded as a suitable supplement to patient education in populations.