Lene Povlsen

Are equity aspects communicated in Nordic public health documents

Aims: To explore if the term equity was applied and how measures for addressing social inequalities in health and reducing inequity were communicated in selected Nordic documents concerning public health. Methods: Documents from Denmark, Finland, Norway, and Sweden were collected and analysed by Nordic authors. Data included material from websites of ministries and authorities responsible for public health issues, with primary focus on steering documents, action programmes, and reports from 2001 until spring 2013. Results: Most strategies applied in Danish, Finnish, and Swedish documents focused on the population in general but paid special attention to vulnerable groups. The latest Danish and Finnish documents communicate a clearer commitment to address social inequalities in health. They emphasise the social gradient and the need to address the social determinants in order to improve the position of disadvantaged groups. Norwegian authorities have paid increasing attention to inequity/social inequalities in health and initiated a new law in 2012 which aims to address the social gradient in a more clear way than seen elsewhere in the Nordic countries. Conclusions: In the Nordic countries, redistribution by means of universal welfare policies is historically viewed as a vital mechanism to improve the situation of vulnerable groups and level the social gradient. To establish the concept of equity as a strong concern and a core value within health promotion, it is important to be aware how policies can contribute to enable reduction of social health differences.

The concept of ‘‘equity’’ in health-promotion articles by Nordic authors - A matter of some confusion and misconception:

Aims: This paper focuses on equity in health, one of the key principles of the Ottawa Charter. It aims at analysing and discussing how the concept was defined, applied, and integrated in health-promotion articles by authors with a Nordic affiliation. Methods: Abstracts were first identified by the search word ‘‘health promotion’’ as a key word. The search was limited to 1986—2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for the present study were subsequently selected from these abstracts using the search word ‘‘equity’’ and analysed by quantitative and qualitative content analysis. Findings: A majority of the 18 articles in the study did not include any proper definition of the term ‘‘equity in health’’. Most articles dealt with health in general or ‘‘Health for All’’ aspects and did not focus on specific strategies for vulnerable individuals or groups. The theoretical papers had a clear focus on equity aspects even though the concept of equity was sometimes included in an implicit way. In contrast, most papers reporting empirical studies did not specifically target equity aspects. Instead, the analysis gave the impression that many authors used the term ‘‘equity’’ synonymously with ‘‘equality in health’’. Conclusions: The findings may indicate that the concept of ‘‘equity in health’’ has been attenuated or even forgotten by Nordic health-promotion researchers and needs to be re-established as a strong concern within health promotion.

Time pressure among parents in the Nordic countries: A population-based cross-sectional study:

Aims: To estimate the prevalence of time pressure experienced by parents in the Nordic countries and examine potential gender disparities as well as associations to parents’ family and/or living conditions. Methods: 5949 parents of children aged 2–17 years from Denmark, Finland, Norway and Sweden, participating in the 2011 version of the NordChild study, reported their experience of time pressure when keeping up with duties of everyday life. A postal questionnaire addressed to the most active caretaker of the child, was used for data gathering and logistic regression analysis applied. Results: The mother was regarded as the primary caregiver in 83.9% of the cases. Of the mothers, 14.2% reported that they experienced time pressure “most often”, 54.7 % reported “sometimes” and 31.1 % reported they did “not” experience time pressure at all. Time pressure was experienced by 22.2 % of mothers in Sweden, 18.4% in Finland, 13.7% in Norway and 3.9% in Denmark, and could be associated to lack of support, high educational level, financial stress, young child age and working overtime. Conclusions: The mother is regarded as the child’s primary caregiver among the vast majority of families in spite of living in societies with gender-equal family policies. The results indicate that time pressure is embedded in everyday life of mainly highly-educated mothers and those experiencing financial stress and/or lack of social support. No conclusion could be made about time pressure from the “normbreaking” fathers participating in the study, but associations were found to financial stress and lack of support.

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.

How can we adapt education for children across different countries

The development of educational material as part of major changes in the service of the diabetic clinic in Glostrup University Hospital turned out to be a very rewarding process for the multidisciplinary team. This material includes age-appropriate goals and guidelines for teaching and learning about diabetes, and advice on coping with diabetes in hand-outs designed for diabetic educators, parents/adults and teenagers. The paper briefly describes the developmental process, the concepts and designs of the material, and makes recommendations on how it can be applied. Part of the material was later translated into Polish and Russian in connection with educational projects in these countries, and the material as a whole was recently incorporated into the Novo Care website at www.d4pro.com – Childhood Diabetes [1]. Growing Internet access by diabetes patients, their relatives and health care professionals creates almost overwhelming possibilities, but also brings up many new questions. The development of diabetes educational material of the more ‘traditional’ type is discussed with regard to content, ideas and design, and focuses on how these concepts and projects can be influenced and adapted across different countries by Internet communication.

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.

Immigrant Women's Clubs in a Health Promotion Perspective

Aims: To gain a deeper understanding of the conditions for and perceived benefits of regular participation in an immigrant women’s club, with special focus on the women’s wellbeing and the club’s potential for health promotion. Methods: A qualitative research approach was applied, including semi-structured interviews, which were analysed using the constructivist Grounded Theory method. Individual interviews of 15 women aged 40–59 years and from various ethnic backgrounds were conducted in 2010/2011. Findings: Four categories were identified during the analysis. These were labelled “Forming a place for coping with loneliness” (core category), “Learning the rules”, “Social bonding and support”, and “A space for wellbeing and health”. The categories describe how the members deal with the club’s status as a municipal association, the structure of the meetings, and the informants’ perceptions of being members of a club, as well as the effects of the membership. Conclusions: Immigrant women may find support and perceive increased wellbeing from gathering in clubs with women from a similar background. In addition, the clubs may provide society an opportunity and a space for adapted health-promotion initiatives.

Learning to live with type 1 diabetes from the perspective of young non‐western immigrants in Denmark

AIMS AND OBJECTIVES To explore how young adults with a non-western immigrant background and type 1 diabetes since childhood/adolescence have perceived learning to live with the disease, with special focus on health education and support. BACKGROUND A national Danish study found significantly poorer metabolic control in non-western immigrant children and adolescents as compared with ethnic Danes. Subsequent studies have primarily focused on immigrant parents, whereas little is known about how immigrant children/adolescents have perceived the diagnosis and the diabetes care and support provided. DESIGN A mixed quantitative and qualitative design was applied. This included data on metabolic control for 2002-2006 and semi-structured interviews in 2006 with eleven strategically selected young immigrants. Data were analysed using qualitative content analysis. FINDINGS The findings are described in three thematic categories: Perceptions and reactions at the time of diagnosis; Learning to manage the disease; Present and future life with diabetes. Some findings were similar to those in studies describing children and adolescents of western origin, but the participants also shared perceptions which appeared to be related to their immigrant background. Above all, they described their parents as having difficulty coping with the disease and providing them with sufficient support. CONCLUSIONS The diagnosis of diabetes in immigrant children and adolescents requires special pedagogic and psychosocial approaches to bridge the gaps related to culture and traditions and introduce the concept of diabetes management, not least to the parents, in a more optimum way. RELEVANCE TO CLINICAL PRACTICE Diabetes care should be a continuous and holistic process, constantly aiming to explore existing knowledge and the need for additional education and support for both the patient and his/her family. Special attention should be paid to the fact that immigrants may have limited pre-knowledge of chronic diseases in childhood, including the concept of selfcare.

Associations between parents’ subjective time pressure and mental health problems among children in the Nordic countries: a population based study

BackgroundThe home, the family and the parents represent a context of everyday life that is important for child health and development, with parent-child relationships highlighted as crucial for children’s mental health. Time pressure is an emerging feature of modern societies and previous studies indicates that parents with children living at home experience time pressure to a greater extent than people with no children living at home. Previous studies of children’s mental health in relation to parents’ time pressure are lacking. Hence, the purpose of this study was to examine the association between parents’ subjective time pressure and mental health problems among children in the Nordic countries as well as potential disparities between boys and girls in different age groups.Methods4592 children, aged 4-16 from Denmark, Finland, Norway and Sweden, participating in the 2011 version of the NordChild study, were included. The Strength and Difficulties Questionnaire was used to measure children’s mental health and associations to parents’ time pressure were assessed by multiple logistic regression analysis.ResultsAmong children of parents experiencing time pressure, 18.6% had mental health problems compared to 10.1% among children of parents experiencing time pressure not or sometimes. The odds of mental health problems were higher among both boys (OR 1.80 95% CI 1.32-2.46) and girls (OR 1.95 95% CI 1.42-2.66) if their parents experienced time pressure when adjusted for financial stress. The highest prevalence of mental health problems in the case of parental time pressure was found among girls 13-16 years old (23.6%) and the lowest prevalence was found among boys 13-16 years old (10.7%).ConclusionsIn this study an association between parents’ subjective time pressure and increased mental health problems among children was found. Given that time pressure is a growing feature of modern societies, the results might contribute to an explanation as to mental health problems are common among children in the Nordic countries in spite of otherwise favourable conditions. Additional research on the linkage between parents’ experienced time pressure and children’s and adolescents’ mental health problems is needed to confirm the novel findings of this study.

A joint Nordic Interdisciplinary Education Programme in Infection Control: A successful, but short-lived initiative

Introduction: Prevention of healthcare-associated infections and a restrictive antibiotics policy in the Nordic countries have contributed to a low prevalence of multi-drug resistant microorganisms, compared to many other countries. This requires professional competences acquired through education in infection control, both in hospitals and in primary health care. Methods: This paper describes a joint Nordic Interdisciplinary Education Programme in infection control, established at the Nordic School of Public Health NHV (NHV) in 2007. Results: The education programme was considered highly relevant and successful by students and their employers. Conclusions: The paper describes the background and contents of the programme, which may serve as inspiration in the development of future educational initiatives in other countries.