Complementary elements of support after gastric-bypass surgery perceived by adults with previous type 2 diabetes: A qualitative study 2 years after bariatric surgery.

Bariatric surgery is the most medically and cost-effective treatment for adults with obesity and type 2 diabetes mellitus (T2DM). Our findings suggest initial improvements in health-related quality of life that may decline as support from follow-up care ends. How patients experience long-term support is not well described. This study therefore aimed to investigate how adults with previous T2DM perceived different sources of support 2 years after bariatric surgery. In this qualitative study, individual interviews were conducted with 13 adults (10 women) 2 years after surgery. Using thematic analysis, one overarching theme (compiling complementary elements of support after gastric-bypass surgery), four themes and nine subthemes emerged. The results show that support was given and received from various sources, support needs varied over time depending on where the patient was in the process and that the sources of support were complementary. To conclude, our results show that support needs change in adults who have undergone bariatric surgery. Long-term professional and day-to-day support from family and other networks are essential and complementary elements of support. Healthcare staff should consider these findings, especially during the early follow-up period.

Efficacy of a school-based intervention to influence attitudes about future parenting among Swedish youth with intellectual disability: An RCT study.

BACKGROUND: The study aim was to investigate the efficacy of an intervention designed to provide a basis for informed choices about future parenthood to special upper secondary school students with intellectual disabilities. METHODS: A randomised trial with a waiting list control group was used. In total, 108 special upper secondary school students with mild or moderate intellectual disabilities, age 16-21 years, provided informed consent and participated. The intervention included education using the Parenting Toolkit and a Real Care Baby simulator. The analyses included 91 students (intervention group n = 46, 24F/22M; control group n = 45, 26F/19M). RESULTS: The result showed that intervention group changed their attitudes to future parenting, from 'do not know' to 'know', significantly more than control group. The intervention increased knowledge levels in the intervention group. CONCLUSIONS: The intervention group showed increased ability to make informed choices and decisions about parenthood.

Social workers' perceptions of assessing the parental capacity of parents with intellectual disabilities in child protection investigations.

Parental capacity is one of the main aspects assessed by social workers as part of child protection investigations. The aim of this study is to explore the social workers' perceptions of assessing the parental capacity of parents with intellectual disabilities in child protection investigations. Four focus group interviews were conducted with twelve social workers in May-October 2021. Data were analysed using an inductive, conventional qualitative content analysis. One overarching theme, "Parental capacity in relation to the child's needs was assessed, not disability of parents" was created. Three main categories and ten sub-categories were identified exploring the social workers' perceptions of assessing parental capacity. The study shows that social workers perceive the assessment of parental capacity in parents with intellectual disabilities as demanding and complex, in which the assessment of what is good enough is perceived as the most difficult task.

Child health nurses' experiences of using the Safe Environment for Every Kid (SEEK) model or current standard practice in the Swedish child health services to address psychosocial risk factors in families with young children - A mixed-methods study.

BACKGROUND: Child maltreatment (CM) is often hidden, and the youngest children are often those most exposed. CM can be prevented through programs that address risk factors, but few primary prevention strategies have been evaluated. OBJECTIVE: To examine the experiences of nurses using the Safe Environment for Every Kid (SEEK) model compared to nurses using current standard practice in the Swedish child health services (CHS) to address psychosocial risk factors in the family environment. PARTICIPANTS AND SETTING: Nurses at 27 child health centers in the CHS in the county of Dalarna, Sweden participated in the study. A survey was answered by 55 nurses and 18 nurses participated in focus-group interviews. METHODS: A convergent mixed methods research design with focus-group interviews and survey data was used. Qualitative Content Analysis was used to analyze the interview data and Mann Whitney U test was used to analyze the survey data. RESULTS: The qualitative analysis identified four categories - "Framing the prerequisites for successful practice"; "Managing the mission of the CHS"; "Meeting the family as a professional"; and "Working with psychosocial risk factors can be emotional" - under the overarching theme "Universal application of a structured method adds value to experience-based knowledge when addressing psychosocial risk factors". Survey data showed that SEEK nurses rated to a greater degree that they possessed adequate knowledge, competence and sense of security to address psychosocial risk factors in their work. CONCLUSIONS: This study indicates that using SEEK can strengthen the nurses in identifying and responding to families in need of psychosocial support.

A sense of health and coherence in young rural schoolchildren in Sweden.

Background: Little is known about how younger schoolchildren in a rural setting experience their sense of coherence (SOC), how they think and reason about health and what they perceive as important to achieve health goals. This study aimed to investigate children's SOC and their health perceptions.Method: In this mixed-method study 94 children (8-12 years) from three rural schools answered several questionnaires: The Child-SOC (CSOC), Positive Health Scale (PHS) and Cantril's ladder of life scale. Another 23 children (of 94) participated in four focus group interviews. Thematic analysis was used to identify themes from the interview transcripts.Results: High SOC was reported by 48% of the boys and 22% of the girls. However, no significant gender differences were found. Four themes were generated from the qualitative analysis: Understanding health, Managing health, Doing bodily health and Socialising health. Both younger and older children had a holistic view of health in which health was seen as an individual's living habits in which social contacts mattered.Conclusion: In a rural context children need to adapt to activities that exist in their immediate environment. Thus, activities during school hours can be an important complement in health promotion.

A school-based intervention can promote insights into future parenting in students with intellectual disabilities-A Swedish interview study.

BACKGROUND: Few studies have focused on how youth with intellectual disability (ID) can be facilitated in reasoning about future parenthood. This study aimed to explore an intervention using the Toolkit "Childrenwhat does it involve?" and the Real-Care-Baby (RCB) simulator among students with ID. METHOD: Sixteen students with ID who participated in an intervention with 13 educational sessions, with adapted knowledge and a three-day caring session with the RCB simulator, were individually interviewed after the intervention. Qualitative content analysis was used. RESULTS: Participants reported that the intervention provided important thoughts and insights on future parenting, providing a basis for informed decisions. The ability to be responsible and have autonomy in life and in caring for a future child were described as important. CONCLUSION: After an intervention, with structured and adapted knowledge and experiences of the RCB simulator, students with ID reported an understanding of the importance of informed decisions about future parenthood.

Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients' experiences during 2 years of follow-up.

BACKGROUND: To examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods. METHODS: Thirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed. RESULTS: Significant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme "Finding a balance between the experience of the new body weight and self-confidence". CONCLUSIONS: The improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.Trial registration ClinicalTrials.gov Identifier NCT02729246. Date of registration 6 April 2016 - Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02729246?term=bariglykos&draw=2&rank=1.

Playing the complex game of social status in school - a qualitative study.

BACKGROUND: Research suggests that social status in school plays an important role in the social lives of adolescents and that their social status is associated with their health. Additional knowledge about adolescents' understanding of social hierarchies could help to explain inequalities in adolescents' health and guide public health interventions. OBJECTIVE: The study aimed to explore what contributes to subjective social status in school and the strategies used for social positioning. METHODS: A qualitative research design with think-aloud interviews was used. The study included 57 adolescents in lower (7th grade) and upper secondary school (12th grade) in Sweden. Subjective social status was explored using a slightly modified version of the MacArthur Scale of Subjective Social Status in school. Data were analyzed using thematic network analysis. RESULTS: The participants were highly aware of their social status in school. Elements tied to gender, age, ethnicity and parental economy influenced their preconditions in the positioning. In addition, expectations on how to look, act and interact, influenced the pursue for social desirability. The way these different factors intersected and had to be balanced suggests that social positioning in school is complex and multifaceted. CONCLUSIONS: Because the norms that guided social positioning left little room for diversity, the possible negative impact of status hierarchies on adolescents' health needs to be considered. In school interventions, we suggest that norms on e.g. gender and ethnicity need to be addressed and problematized from an intersectional approach.

Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study.

BACKGROUND: Social position, traditionally measured by objective data on socioeconomic status (SES), is linked to health status in adults. In adolescents, the association is more uncertain and there are some studies suggesting that subjective social status (SSS) might be more adequate in relation to health. This study aimed to examine associations between SSS in school, SES and self-rated health (SRH) in adolescent boys and girls. METHODS: A descriptive cross-sectional research design with quantitative survey data was used. The study involved 705 Swedish adolescents in upper secondary school (17-18-year-olds). SRH was measured with a single-item question and SSS by a question where adolescents were asked to assess their social position within their school. Formal education level of the parents was used as a proxy for objective SES. Univariable and multivariable ordinal regression analyses were conducted to assess the associations between SRH and SSS in school and SES. RESULTS: In the multivariable analysis, SSS in school was positively associated with SRH, whereas no significant association between SES and SRH was found. The proportion of adolescents with high SRH increased with higher steps on the SSS ladder. Significant gender differences were found in that boys rated their SRH and SSS in school higher than girls did. CONCLUSIONS: The study shows that self-rated health in adolescents is related to perceived social position in school. Subjective social status in school seems to be a useful health-related measure of social position in adolescents.

Pride, shame and health among adolescents - a cross-sectional survey.

Background Pride and shame are important emotions known to influence identity development and psychological well-being in adolescence. Research evidence indicates that self-rated health (SRH) is a strong predictor of future health. This cross-sectional study, conducted during 2008-2009, aimed to investigate the associations between pride, shame and SRH among adolescent boys and girls. Methods The study sample comprised 705 adolescents in Sweden aged 17-18 years (318 boys and 387 girls) who completed a questionnaire that included items on SRH, shame and pride (participation rate 67%). Logistic regression analyses (univariable and multivariable) were used to investigate the associations between pride and shame as separate and combined constructs on SRH, adjusting for potential confounders (country of birth, parental educational level, school experience, having enough friends, mood in family and being active in associations). Results Pride and shame separately were significantly associated with SRH in both genders. Logistic regression analysis of the pride-shame model showed that the odds of having lower SRH were highest in boys and girls with lower pride-higher shame. In a multivariable logistic regression analysis of the pride-shame model the odds of having lower SRH remained significant in boys and girls with lower pride-higher shame [boys: odds ratio (OR) 3.51, confidence interval (CI) 1.40-8.81; girls: OR 2.70, CI 1.22-5.96] and in girls with lower pride-lower shame (OR 2.16, CI 1.02-4.56). Conclusion The emotions of shame and pride are associated with SRH in adolescence. Experiencing pride seems to serve as a protective mechanism in SRH in adolescents exposed to shame. We believe that this knowledge should be useful in adolescent health promotion.

What is Health and What is Important for its Achievement? A Qualitative Study on Adolescent Boys' Perceptions and Experiences of Health.

UNLABELLED: Few qualitative studies have explored adolescent boys' perceptions of health. AIM: The aim of this study was therefore to explore how adolescent boys understand the concept of health and what they find important for its achievement. METHODS: Grounded theory was used as a method to analyse interviews with 33 adolescent boys aged 16 to 17 years attending three upper secondary schools in a relatively small town in Sweden. RESULTS: There was a complexity in how health was perceived, experienced, dealt with, and valued. Although health on a conceptual level was described as 'holistic', health was experienced and dealt with in a more dualistic manner, one in which the boys were prone to differentiate between mind and body. Health was experienced as mainly emotional and relational, whereas the body had a subordinate value. The presence of positive emotions, experiencing self-esteem, balance in life, trustful relationships, and having a sense of belonging were important factors for health while the body was experienced as a tool to achieve health, as energy, and as a condition. CONCLUSION: Our findings indicate that young, masculine health is largely experienced through emotions and relationships and thus support theories on health as a social construction of interconnected processes.