Nordic responses to covid-19 from a health promotion perspective.

On 30 January 2020, the disease covid-19 was declared by the World Health Organization to be an international threat to human health and on 11 March 2020, the outbreak was declared a pandemic. The aim of this study was to analyse policy strategies developed by the five Nordic countries during the first 3 months of the pandemic from a health promotion perspective in order to identify Nordic responses to the crisis. Although the Nordic countries have a long tradition of co-operation as well as similar social welfare policies and legislation, each country developed their own strategies towards the crisis. The strategies identified were analysed from a health promotion perspective emanating from five principles: intersectorality, sustainability, equity, empowerment and a lifecourse perspective. Denmark, Finland and Norway had lockdowns to varying degrees, whereas Sweden and Iceland had no lockdowns. Iceland implemented a test and tracking strategy from the very beginning. All countries based their recommendations and restrictions on appeals to solidarity and trust in institutions and fellow citizens. The analysis showed that the strategies in all countries could be related to health promotion principles with some differences between the countries especially regarding equity and sustainability. The Nordic governments took responsibility for protecting their citizens by developing policy strategies based on restrictions and recommendations congruent with the principles of health promotion. The findings also identified issues that will pose challenges for future pandemic strategies.

Factors related to the increasing number of seriously injured cyclists and pedestrians in a Swedish urban region 2003-17.

BACKGROUND: The number of seriously injured unprotected road users has increased during implementation of a road safety policy Vision Zero. The aim of the study is to identify factors associated with the increase in serious injuries among cyclists and pedestrians (even single pedestrian accidents) that occurred in an urban road space in a Swedish region 2003-17. The urban road space includes roads, pavements and tracks for walking and cycling. METHODS: Data were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) and NVDB (National Road Database). Descriptive statistics and logistic regression with odds ratios for sex, age and part of road space were assessed. RESULTS: The number of seriously injured cyclists and pedestrians more than doubled from 2003 to 2017, with the greatest increase for pedestrians. Older age increased the probability of serious injury since 2012 for the group ≥ 80 years and since 2015 for the group 65-79 years. No significant effect of sex. Most injuries occur in areas not transformed by Vision Zero. CONCLUSIONS: An increasing number of elderly persons in the generation born in the 1940s and increased life expectancy are important factors. There is a need to increase road safety measures that also promote active mobility.

Non-participation in mammographic screening - experiences of women from a region in Sweden.

BACKGROUND: Understanding women's life conditions regarding their non-participation in different health-promoting and disease-preventing activities is important as it may draw attention to potential areas for improvement in the healthcare sector. Mammographic screening, a disease-preventing service, facilitates early detection of any potential malignancies and consequently prompts initiation of treatment. The reasons for non-participation in mammographic screening can be understood from different perspectives, such as socioeconomic and lifestyle-related determinants of health. This study aims to gain a deeper understanding of women's experiences and perceptions about non-participation in mammographic screening in a Swedish region with a single mammographic facility. METHODS: Data from individual semi-structured interviews, conducted in 2018 with eleven women between the ages of 48 and 73, were analysed by a qualitative content analysis. RESULTS: The findings reveal three main categories: 1) doubts regarding mammographic screening and its organisation, 2) sense and sensibility in the decision to refrain from mammographic screening, and 3) dependency and options. These three categories indicate aspects, such as the individual's life situation, accessibility to the offered service, and the flexibility of the healthcare system, that need to be considered to improve the organisation of mammographic screening. CONCLUSION: Listening to the women's voices regarding their experiences and perceptions about mammographic screening is important as individual characteristics and social circumstances interact with healthcare and affect the degree of participation.

Incidence of seriously injured road users in a Swedish region, 2003-2014, from the perspective of a national road safety policy.

BACKGROUND: Since 1997 Sweden has a policy for road safety called Vision Zero. Given that Vision Zero is mainly used to reduce fatalities among car occupants, the question has been raised by the research community whether a Vision Zero approach promotes health for all road traffic users. The objective is to measure target fulfilment of the national road safety policy for a Swedish region by examining incidence of serious injury during 2003-2014 in rural and urban road spaces with or without implemented measures. METHODS: Data on seriously injured road users, defined as ISS > 8 (Injury Severity Score), were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) together with data from NVDB (National Road Database). These data are used to describe where road users are seriously injured in relation to implemented national policy and using a conceptual model of a road space comprising roads, pavements and tracks for walking and cycling. Seriously injured road users in single and multiple crashes with and without vehicles are included. The development of the incidence is analysed for different road users and places in the road space. RESULTS: Despite implemented road safety measures in the region, the incidence of seriously injured road users per 100,000 inhabitants in rural areas increased from 7.8 in 2003 to 9.3 in 2014 but doubled in urban areas from 8.0 in to 16.3 respectively. In areas not transformed by Vision Zero, only 36% were injured in rural areas while 64% were injured in urban areas. In contrast, in transformed areas 61% of injuries occurred in rural areas, whereas 39% occurred in urban areas. While the incidence decreased for car occupants on transformed national roads in rural areas, the incidence of serious injuries increased among unprotected road users in urban areas, in particular on pavements and tracks for cycling and walking than on the roads where Vision Zero had been implemented. CONCLUSION: The reduction in the incidence for car occupants in the region may not be adequate to contribute to fulfilling the national target. More needs to be done, especially in the urban areas, where more active mobility is desired.

Milestones in Nordic Health Promotion research.

Based on the storytelling tradition and analyses of conference material, this article provides an overview of the evolving Nordic Health Promotion Research Network (NHPRN) and its conferences over the last 20 years. The story goes from the planning of the first conference in Bergen, Norway, back in 1996 to the eighth conference in Jyväskylä, Finland, in 2016. There have been three phases of development. During the first phase, 1996-2007, the five first conferences were initiated and implemented by departments of public health in the Nordic countries. The World Health Organization (WHO) collaborative centres of Health Promotion in Bergen University and a group at Karolinska Institute, Department of Social Medicine, creating supportive environments for health in Stockholm played key roles in initiating and supporting NHPRN. During the second phase, 2007-2014, the network was strengthened and supported by the Nordic School of Public Health (NHV) in Gothenburg. The third phase started when NHV closed down in 2015 and networking activities were transferred to the European Office of WHO in Copenhagen. The Nordic Health Promotion Research Conference series has served several purposes and will continue to do so. They are important Nordic meeting places, stimulating Health Promotion research, as well as explicitly managing ongoing concerns in the international Health Promotion community. This is reflected in the shift of foci over time. The content of the conferences has been highly responsive to whatever challenges are particularly relevant at different points in time, while also contributing to developing Health Promotion as a discipline, given that every conference has built on the previous ones.

Thai people living with tuberculosis and how they adhere to treatment: A grounded theory study.

To develop a conceptual framework of adherence to treatment among Thai people living with tuberculosis, a grounded theory approach was used. A purposive sample of 20 Thai people living with tuberculosis, aged from 23 to 85 years, was interviewed. From the participants' perspective, a core category of social belonging was highlighted, with three categories of conditions connected: personal barriers, personal resilience, and social facilitation. Personal barriers encompassed fear of stigma, concealing the illness, and lack of knowledge and motivation to complete the treatment regime. Personal resilience encompassed positive thinking and self-awareness. Social facilitation encompassed the ease of access to health services, continuity in the health service's ability to choose a directly-observed therapy observer, and social support. This study contributes a deeper understanding of the perspective of Thai people living with tuberculosis with regards to adherence to tuberculosis treatment. It might improve how local healthcare workers provide tuberculosis care, and inspire them to tailor care to people living with tuberculosis in a local community to increase personal resilience and reduce stigma.

Thai district Leaders' perceptions of managing the direct observation treatment program in Trang Province, Thailand.

BACKGROUND: Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand. METHODS: A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories. RESULTS: The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines. CONCLUSION: Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.

Client/patient perceptions of achieving equity in primary health care: a mixed methods study.

INTRODUCTION: To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden's national Care on Equal Terms project. METHODS: Mixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used. RESULTS: The interview data were divided into two main categories and three subcategories. The first category "Perception of equitable health care" had two subcategories, namely "Health care providers' perceptions" and "Fairness and participation". The second category "To achieve more equitable health care" had four subcategories: "Encounter", "Access", "Interpreters and bilingual/diverse health care providers" and "Time pressure and continuity". Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful. CONCLUSIONS: Clients/patients perceived health care providers' perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter if needed. Employing bilingual/diverse kinds of health providers is a way of providing more equitable primary health care.

Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample.

BACKGROUND: Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance. METHODS: The study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county's municipalities, aggregated data for women in the age range 40-74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests. RESULTS: The results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening. CONCLUSIONS: Age and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.