Tackling physical inactivity in Scandinavia: a narrative review of reviews supplemented by expert interviews.

Aims: This study aims to identify physical inactivity-related challenges and motives, based on reviews and supplemented by expert interviews with Danish national experts on physical inactivity, providing a general discussion of the subject ultimately generating knowledge useable in a Scandinavian context. Methods: This study is framed as a narrative review of scientific review literature on physical inactivity, limited to the general population. The review is supplemented by expert interviews with Danish national experts on physical inactivity. We used thematic coding of the included reviews, while using hermeneutic interpretation analysis for the expert interviews. Results: Based on 11 included reviews, we highlighted four themes based on our analysis of reviews: (a) socioeconomic determinants of physical activity; (b) life-course perspective; (c) physical inactivity and older adults aged 60+ years; and (d) intervention recommendations. The supplementary expert interviews revealed three additional themes: (a) the individual history with physical activity; (b) sporting organisation importance; and (c) society responsibility for physical inactivity. Conclusions: Collectively this study concludes, based on review and expert interviews, that a number of determinants and correlations for physical inactivity affect the individual from various socioecological levels. Based on this review, we suggest moving beyond the 'upstream' public health approach of randomised controlled trials and consider complex interventions targeting physical inactivity from several levels. Physical inactivity should be acknowledged as a 'wicked problem' that requires a systems-based approach instead of a single quick fix. Future work with physical inactivity would profit from focus on the life-course perspective, sporting clubs' responsiveness and physical literacy.

Self-reported measurements of physical literacy in adults: a scoping review.

Physical literacy (PL) is a comprehensive concept covering motivation, confidence, physical competence, knowledge and understanding of individuals' physical activity throughout life. PL has three overlapping domains, such as: an affective, a physical and a cognitive domain. So far, PL has not been measured in the adults and no complete measurement has been developed to date. OBJECTIVES: The aim of this scoping review was to review existing self-reported instruments measuring different elements of domains of PL. METHOD: We reviewed Education Research Complete, Cochrane, Medline, ScienceDirect, Scopus and SPORTDiscus. The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were coded using a thematic framework, which was based on the three domains of PL. The eligibility criteria were as follows: (1) age groups between 18 and 60 years; (2) meta-analyses, reviews or quantitative studies focusing on the measurement of at least one of the three domains of PL and (3) instrument that was self-reported. We finalised search on 1 August 2021 RESULTS: In total, 67 articles were identified as studies describing instruments reflecting the three domains of PL. Following full-text reading, 21 articles that met our inclusion criteria were included. Several instruments of relevance to PL are available for assessing motivation, confidence and the physical domain. However, few instruments exist that measure elements of the cognitive domain. CONCLUSION: This review showed that a range of existing and validated instruments exists, covering two out of the three domains of PL, namely affective and physical domains. However, for the knowledge domain no valid measurement tools could be found. This scoping review has identified gaps in the research (namely the cognitive domain) and also a gap in the research as no measures that consider the inter-relatedness of the three domains (holistic nature of the concept).

Newly arrived refugees' perception of health and physical activity in Denmark.

Refugees health status after receiving asylum in their new country is often poor, both physical and mentally. Despite that, European countries rarely offer programmes specifically targeted health and health behaviour for newly arrived refugees. This study investigated newly arrived refugees' perspective on health and in particularly physical activity (PA) upon granted asylum in Denmark. A transnational migration perspective provides the theoretical framework in this study. Semi-structured interviews with twenty newly arrived refugees provide data for the interpretative phenomenological analysis (IPA). Health manifests itself in varied ways to the newly arrived refugees and a broad and holistic perspective on health, was evident. Overall PA had important benefits, such as pain relief, better physical fitness, lose weight, a stronger body, to stay active, cater to mental health and in general something of interest to the newly arrived refugees. However, the informants experienced several barriers for doing PA and living healthy lives. Time, pain, low income, job insecurity, mental strain, discourse of health and PA (health promotion), external expectations and demands (municipality and government in Denmark), precariat living conditions and general worrying were amongst the most explicit barriers. In addition, the question of how the newly arrived refugees are positioned in their families seems vital, as patriarchal family structures seem to prevent some from doing PA. Based on the results, we underline the importance of involving refugees in developing health promotion activities while considering of their unique experiences and transnational background.

Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark.

OBJECTIVE: To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. DESIGN: Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman's Explanatory Models. Data were analysed using qualitative content analysis. RESULTS: A diagnosis of GDM entailed great worry for the future. Participants' fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women's perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants' challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. CONCLUSION: Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.

Improving Organizational Health Literacy Responsiveness in Cardiac Rehabilitation Using a Co-Design Methodology: Results from The Heart Skills Study.

For health services, improving organizational health literacy responsiveness is a promising approach to enhance health and counter health inequity. A number of frameworks and tools are available to help organizations boost their health literacy responsiveness. These include the Ophelia (OPtimising HEalth LIteracy and Access) approach centered on local needs assessments, co-design methodologies, and pragmatic intervention testing. Within a municipal cardiac rehabilitation (CR) setting, the Heart Skills Study aimed to: (1) Develop and test an organizational health literacy intervention using an extended version of the Ophelia approach, and (2) evaluate the organizational impact of the application of the Ophelia approach. We found the approach successful in producing feasible organizational quality improvement interventions that responded to local health literacy needs such as enhanced social support and individualized care. Furthermore, applying the Ophelia approach had a substantial organizational impact. The co-design process in the unit helped develop and integrate a new and holistic understanding of CR user needs and vulnerabilities based on health literacy. It also generated motivation and ownership among CR users, staff, and leaders, paving the way for sustainable future implementation. The findings can be used to inform the development and evaluation of sustainable co-designed health literacy initiatives in other settings.

What are the public health implications of the life course perspective?

During the past decades innovative research has shown that exposure to harmful events during pregnancy and early infancy ('the first 1000 days') has an impact on health at subsequent stages of the life course and even across generations. Recently it has been shown that even the pre-conception period is of outmost importance, and other scholars have made the case that the 1000 days should be extended to a period of 8000 days post-conception. The present contribution aims to bridge further the gap between research evidence and public health policy by applying a holistic 'full-cycle' perspective. Thus, a conceptual framework is suggested for guiding public health prioritization, including the variables of 'impact on the next generation', 'plasticity' and 'available interventions with documented impact'. This framework could guide decision makers in selecting at which stages of the life course to invest (and not), and furthermore it points to some pertinent research priorities.

Young Danes' experiences with unsafe sex.

INTRODUCTION: Surveying sexual behaviour of the general population serves to identify key points of preventive interventions, monitor the effect and interpret changes in patterns of disease. Validated questionnaires describing sexual behaviour can be adapted to some extent from other countries, but national adaption, refinement and validation are needed due to cultural differences. The aim of this study was to identify factors influencing sexual risk behaviour among Danish adolescents with a view to designing and -initiating a national sexual behaviour surveillance programme in Denmark. MATERIAL AND METHODS: We conducted four semi-structured focus group interviews with a total of 19 sexually -experienced adolescents aged 18-23 years who attended a Danish Folk High School. Data were transcribed verbatim and analysed using qualitative description. RESULTS: Four main categories of sexual risk behaviour were identified: 1) alcohol consumption which was associated with lack of condom use, 2) one-night stands after a night out partying, at festivals or on vacations, 3) low self-esteem which increased the risk of pushing one's personal boundaries, thus resulting in promiscuous sexual behaviour, 4) increased sexual experience which resulted in lack of condom use. CONCLUSION: This study identified four categories that may lead to unsafe sex. These results should be taken into consideration when planning future preventive programmes aiming to reduce sexually transmitted infections and unwanted pregnancies among adolescents and young adults. FUNDING: Not relevant. TRIAL REGISTRATION: Not relevant.