Learning evidence-based practice by writing the bachelor's thesis - A prospective cohort study in undergraduate nursing education.

BACKGROUND: Evidence-based practice has been the desirable healthcare standard for decades. To ensure evidence-based healthcare in the future, nursing education curricula must include strategies for teaching evidence-based practice to nursing students. Learning outcomes about evidence-based practice might be incorporated into courses like the bachelor's thesis. AIM: This study investigates whether writing a bachelor's thesis influences nursing students' practice, skills, and attitudes towards evidence-based practice, and explores whether there are differences between students writing the thesis as a literature study and students conducting empirical studies. DESIGN: This Nationwide Prospective Cohort Study collects data on students' practice, skills, and attitudes towards evidence-based practice through the Student Evidence-Based Practice Questionnaire and two questions from the Norwegian version of the Evidence-Based Practice profile questionnaire. PARTICIPANTS: The sample consists of 314 nursing students writing their bachelor's thesis in the last term of their nursing education. The responding students represent all institutions of higher education in Norway. METHODS: Paired t-tests were used to examine changes in the subscales practice, retrieving/reviewing, sharing/applying, attitudes and total scale for the Student Evidence-Based Practice Questionnaire from before they started to submission of the bachelor's thesis. Linear multiple regression analyses were conducted to explore differences between students writing a literature study and students conducting empirical studies. RESULTS: The analysis showed that the nursing students significantly increased in the three subscales practice, retrieving/reviewing, and sharing/applying, in addition to the total scale for the questionnaire, while writing the bachelor's thesis. Further, the analysis showed no difference on the scales between the groups of students writing a literature study or conducting an empirical study. CONCLUSIONS: The results indicate that writing the bachelor's thesis leads to increased learning about evidence-based practice and does not depend on the kind of thesis the students write.

Supervising Undergraduate Nursing Students on Their Bachelor's Thesis. A Qualitative Study.

Introduction: The bachelor's thesis (BT) in undergraduate education is often an autonomous and individual assignment. It aims to demonstrate knowledge gained through education, to be an assessment tool, and to give new learning outcomes through working on the thesis. The process of working with the BT most often includes individual supervision. There is an absence of support for teachers supervising undergraduate nursing theses, which includes a lack of national or institutional guidelines, role definitions and research material. Objective: Given the lack of helpful guidelines, this study aims to explore what the teachers emphasize as important regarding their supervision of nursing students writing their BT. Methods: The study has a qualitative approach, featuring individual semi-structured interviews with nursing teachers supervising nursing students on the BT. Reflexive thematic analysis is used as the method of analysis. Results: The analyses resulted in two generated themes, each with two subthemes, describing the patterns the teachers emphasize as important aspects of their supervision of nursing students writing their BT. The themes were "The pedagogical approach to the supervision" and "The advantages of the bachelor's thesis to the nursing profession." Conclusions: The teachers balanced different roles in the supervision of the students. They wanted the students to grow through challenging them, grounded in a relationship of trust and confidence. They were role models for how to be critical thinkers and incorporated critical thinking as a pedagogical implement in supervision, wanting to raise the students to become nurses who think critically. The teachers sought to combine clinical relevance with academic literacy to secure a new generation of nurses able to be a part of the future development of the profession. They wanted to equip the students with knowledge, skills, and confidence to speak up and communicate nursing. Last, the teachers combined their clinical and academic identities in the supervision of the BT.

Involvement of service user representatives on a healthcare organizational level at Norwegian Healthy Life Centres: A qualitative study exploring health professionals' experiences.

BACKGROUND: The involvement of service user representatives in planning, delivering, and evaluating health care services is regarded as essential in Healthy Life Centres (HLCs) to ensure high-quality services. However, information on how HLC-professionals involve service user representatives at a healthcare organizational level at HLCs remains sparse. OBJECTIVE: To explore HLC professionals' experiences involving service user representatives in planning, delivering, and evaluating the HLC services. METHODS: Five qualitative semi-structured focus group interviews with 27 health professionals from 27 Norwegian HLCs were conducted. Data were analysed using systematic text condensation. RESULTS: The involvement of service user representatives at the HLCs varied from well-integrated and systematized to the opposite. The professionals' primary rationale for involving service user representatives was to include the representatives' unique experiential knowledge to ensure the quality of the service. Experiential knowledge was seen as a 'different' competence, which came in addition to professional competence. The professionals' choice of service user representatives depended on the purpose behind the involvement initiative. The HLC professionals often hand-picked former service users according to their health problems, motivation, and the HLC's need. The professionals said they were responsible for initiating the facilitation to accomplish genuine involvement. Support from their leaders to prioritize these tasks was essential. CONCLUSION: To meet the demand for adequate service user representatives, the HLCs need access to different service user representatives, representing both diagnose-based and generic service user organisations and the public. To achieve genuine involvement, the rationale behind the involvement and the representatives' role must be clarified, both for the HLC professionals and service user representatives. This will require resources for continuous organizational preparation and facilitation.

Chronic pain self-management interventions in primary care - does it make any difference? A qualitative study.

BACKGROUND: Total recovery from chronic pain is difficult. It is therefore important for those who are suffering from chronic pain to find ways to self-manage their pain in daily life. Several chronic pain self-management interventions have been established, but more knowledge is needed to find out what and how it works. This study aimed to explore how the participants in two chronic pain self-management interventions in primary health care experienced the different components of the interventions, and whether the interventions induced any positive changes in the participants' everyday lives. METHODS: A qualitative study nested within a randomized controlled study using semi-structured individual face-to-face interviews with 17 informants were conducted three months after the interventions. The data were analysed thematically using Systematic Text Condensation. RESULTS: The main finding was that the informants, from both interventions, self-managed their chronic pain differently in a positive way after they had participated in the self-management interventions. The participants gained new insight from lectures, learning from peers by sharing experiences and belonging to a group, and by recognizing the importance of being physically active. CONCLUSION: This study shows that chronic pain self-management interventions consisting of components that learn the participants about chronic pain and include physical activity in a socially supportive environment, may contribute to a positive change in the lives of people living with chronic pain.

Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts.

OBJECTIVES: This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research. METHODS: Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles. RESULTS: Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill. CONCLUSIONS: Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

Nurses experience increased clinical and organisational competence by working with a medical quality register, RevNatus - a qualitative study.

BACKGROUND: RevNatus is a consent-based, nationwide medical quality register that collects data on patients with inflammatory rheumatic diseases during pregnancy and one year postpartum. The entering of data takes place in outpatient clinics in rheumatology wards in hospitals. The aim of this study is to explore how rheumatology nurses experience organizing and working with the medical quality register RevNatus in addition to their normal clinical patient-care tasks. METHODS: Qualitative focus group interviews and individual in-depth interviews were conducted in 2018 to gain insights into how nurses organize performing quality register work and clinical work simultaneously. Data were analysed using systematic text condensation. RESULTS: The informants represented seven different rheumatology outpatient clinics in Norway. The analyses showed that working with RevNatus increased the nurses' knowledge about pregnancy and rheumatic diseases, improved the content of their nurse consultations and found the 'register form' as a useful template to structure the nurse consultations. The nurses took the main responsibility for RevNatus, but lack of routines and uncoordinated collaboration with the rheumatologists and secretaries made the nurses spend too much time verifying the accuracy of data or post-registering missing data. CONCLUSION: The nurses experienced work with RevNatus as time-consuming, but the register work increased both their clinical and organisational competences. Routines and collaboration within the registry team are important to ensure the data quality and reduce the workload.

Undergraduate Nursing Students' Experiences of Conducting Clinical Research Projects in Their Bachelor Theses - a Qualitative Study.

Introduction: The aim of educational institutions in the field of nursing is to educate nurses with the competences to provide high-quality care to their patients, meaning that students need to learn about evidence-based practice and how to translate the knowledge, skills, competency, beliefs, attitudes, and behaviours into daily practice. The bachelor thesis is the ultimate test for undergraduate nursing students to present what they have learned. Objective: The aim of this study was to explore undergraduate nursing students' experiences of conducting clinical projects in their bachelor theses. Methods: We used qualitative focus-group interviews to gain a deeper understanding of the students' experiences of conducting clinical projects in their bachelor theses as an approach to learn about evidence-based practice. The analyses focused on meaning according to Brinkmann and Kvale. Results: Eighteen out of 22 eligible students who had chosen to participate in ongoing clinical research projects and write an academic paper as their bachelor thesis were included in this study. The students were all females and divided into three focus groups. The clinical projects were conducted in a public hospital, a private hospital, nursing homes, or within home-care nursing. The analyses showed that conducting clinical projects in the bachelor thesis provided the students with important knowledge for providing evidence-based care and it. motivated them to want to initiate future clinical projects as nurses., They got valuable hands-on experience for how to conduct research, and made the students aware of the importance of keeping themselves updated on the latest knowledge. Conclusion: Conducting clinical research projects on a bachelor level provide undergraduate nursing students with important knowledge of how to provide evidence-based nursing care to their patients. Learning how to conduct clinical research projects is also important for motivating future nurses to initiate research aiming to improve clinical nursing practice.

A longitudinal study of educational needs among patients with inflammatory arthritis.

INTRODUCTION: Patient education is important in the follow-up and disease management for patients with chronic inflammatory arthritis. Patients' needs for education and information varies, and it is important that the education is tailored to the individual patient. Hence, the aim of this study is to investigate whether patients' educational needs change over time, and which demographic, disease-related or self-management characteristics that are associated with patients' educational needs. METHODS: The Mann-Whitney U-test was used to study patients' longitudinal educational needs and whether their needs change over time, while multivariable linear regression analyses were used to investigate associations between patients' educational needs and demographic variables, disease-related and self-management characteristics. RESULTS: There were no changes in patients' educational needs in the domains of managing pain, movement, feelings, arthritis process and treatment from health professionals during the study period of seven years. A small decrease in educational needs in the domains self-help measures (p-value 0.047) and support from others (p-value 0.010) was detected. The regression analyses showed that higher educational needs were associated with being female, lower educational level, shorter disease duration, and a lower level of patient activation. CONCLUSIONS: Patients with chronic inflammatory arthritis have continual needs for patient education throughout their disease trajectory. Nurses and health care professionals must therefore ask their patients what kind of education they need at every follow-up throughout the disease course.

Are We Transitioning Toward Person-centered Practice on Self-management Support? An Explorative Case Study Among Rheumatology Outpatient Clinic Nurses in Norway.

INTRODUCTION: There are only a few studies investigating nurses' views on self-management in the care of patients with rheumatic diseases. OBJECTIVE: The aim of this study is to explore how Norwegian rheumatology outpatient nurses describe their ways of supporting patients' self-management focusing on the core dimensions of person-centered self-management support. METHODS: Ten individual semistructured interviews with rheumatology outpatient nurses were conducted in Norway from March to September 2017. The interviews were audiorecorded and transcribed verbatim. NVIVO was used to support a systematic analysis of themes and patterns. RESULTS: Nurses' views on self-management support fell into three approaches; (1) narrowly biomedically orientated, (2) biomedically and holistic, and (3) person-centered. The nurse's views of self-management support varied and did not fully align with the core dimensions of person-centered practice. CONCLUSION: The findings indicate that the biomedical paradigm continues to influence Norwegian rheumatology outpatient clinic nurses' approach to self-management support. If person-centered principles of self-management support are to be translated into standard nursing practice, including identifying and supporting patient-defined self-management goals and processes, there is a need to challenge established structures in health care systems.

"Joy of life" in nursing homes. Healthcare personnel experiences of the implementation of the national strategy. A qualitative study with content analysis of interviews.

BACKGROUND: Nursing homes are under strong pressure to provide good care to the residents. In Norway, municipalities have applied the 'Joy-of-Life-Nursing-Home' strategy to increase a health-promoting perception that focuses on the older persons` resources. Implementations represent introducing changes to the healthcare personnel; however, changing one's working approaches, routines and working culture may be demanding. On this background, we explored how the 'Joy-of-Life-Nursing-Home' strategy is perceived by the employees in retrospective, over a period after the implementation and which challenges the employees experience with this implementation. METHOD: We used a qualitative approach and interviewed 14 healthcare personnel working in nursing homes in one Norwegian municipality, which had implemented the 'Joy-of-Life-Nursing-Home' strategy. The analysis was conducted following Kvale's approach to qualitative content analysis. RESULTS: The main categories were: (a) the characteristics of care activities before implementations of 'Joy-of-Life-Nursing-Home', (b) how 'Joy-of-Life-Nursing-Home' influenced the care activities, and (c) challenges with the implementation of 'Joy-of-Life-Nursing-Home'. Some of the informants spoke well about the implementation concerning the care quality stating "to see the joy in the eyes of the resident then I feel we have succeeded". For informants who experienced resistance toward the implementation, they felt it was too much to document, it was too complicated, and the requirements were too many. CONCLUSIONS: Quality of care seems to have increased after the implementation, as perceived by the informants. Nevertheless, the fact that the informants seemed to be divided into two different groups related to their main perspective of the implementation is concerning. One group has positive experiences with the implementations process and the benefits of it, while the other group focuses on lack of benefits and problems with the implementation process. To understand what facilitates and hinders the implementation, research on contextual factors like work environment and leadership is recommended.

Rehabilitation in warm climate for young adults with inflammatory arthritis: A 12-month randomized controlled trial.

OBJECTIVES: To investigate if an intensive rehabilitation programme, including intensive exercise and patient education, for young adults with inflammatory arthritis, conducted in a warm climate, has long-term effects on general health status compared with usual care. DESIGN: Open randomized controlled trial. PATIENTS: A total of 64 patients with inflammatory arthritis, aged 20-35 years. METHODS: Patients underwent randomized allocation to an intensive 17-day rehabilitation programme in a warm climate (intervention group) or to usual care with no structured rehabilitation (control group). The primary outcomes were physical function, assessed by the "30-second Sit to Stand test"(30sSTS), and coping, measured by the "Effective Musculoskeletal Consumer Scale" (EC17). RESULTS: A total of 64 patients (mean age 27.5 years, 62.5% female) were randomized. Thirty out of 32 patients completed the intervention. At 12-month follow-up, 7 patients were lost to follow-up; 4 from the intervention group and 3 from the control group. The intervention group showed significant improvement in the physical function test at 3 months; estimated mean difference (95% confidence interval): 5.5 (2.8-8.1), 6 months 3.6 (0.4-6.8) and 12 months 4.0 (0.0-7.9), compared with the control group. There were no differences in coping between the 2 groups at 3, 6 or 12 months. CONCLUSION: Rehabilitation in a warm climate improves physical functioning, but not coping, in young adults with inflammatory arthritis.

Outcomes in patient education programmes for people with rheumatic diseases: Results from a Delphi process and a study of feasibility and responsiveness.

BACKGROUND: Patient education (PE) is recommended as an integral part of disease management for people with chronic inflammatory arthritis (IA). There is no consensus on how PE should be evaluated and which outcome measures should be used. OBJECTIVES: This study had three aims: (a) to identify core aspects that PE for patients with IA may impact on; (b) to identify outcome measures to assess changes in these aspects; (c) to test the feasibility and responsiveness of the identified outcome measures. METHODS: A Delphi process was conducted to identify core aspects and outcome measures. Feasibility and responsiveness were tested in a pre-/post-test study with 3 months follow-up, including 104 patients attending PE programmes. RESULTS: Seven core aspects were identified: communication with health professionals, coping strategies, empowerment, knowledge about healthy life style, self-efficacy, understanding disease and treatment, and sharing experiences. Four outcome measures were identified; Arthritis Self Efficacy Scale (ASES-11), Effective Consumer scale (EC-17), Health Education Impact Questionnaire (heiQ) and Patient Activation Measure (PAM). At baseline, all measures had low rates of missing data. All measures except two heiQ subscales exhibited ceiling effects. Internal consistency was acceptable. At follow-up, statistically significant, but small improvements were found in EC-17 and three heiQ subscales. CONCLUSION: ASES and EC-17 were found to be the most valid and feasible outcome measures to evaluate the identified core aspects of PE and can be recommended as outcome measures to assess PE programmes for patients with IA.

Health status and self-management in patients with inflammatory arthritis-A five-year follow-up study after nurse-led patient education.

Aim: The aim of this study was to investigate changes in patients' self-management and health status five years after nurse-led patient education. Design: A longitudinal study. Methods: We collected self-reported data on physical function, pain, tiredness, disease activity, psychological status, patient activation and self-efficacy from a sample of Norwegian-speaking adults with inflammatory arthritis that had participated in a randomised controlled study investigating the effects of nurse-led patient education. Changes and associations in patients' health status and self-management were analysed with paired sample t tests and multivariable linear regression analyses, respectively. Results: Except from a small deterioration in patients' physical function, there were no changes in patients' health status 5 years after the nurse-led patient education. Patients' self-management skills were improved after 5 years. Self-efficacy was positively associated with female gender, patient activation, less tiredness and less psychological distress.

Respect, trust and continuity: A qualitative study exploring service users' experience of involvement at a Healthy Life Centre in Norway.

BACKGROUND: To meet the challenges caused by non-communicable diseases, Norway has established Healthy Life Centres within primary care to encourage a healthy lifestyle. To promote people's health and ensure high-quality services, user involvement in contemporary health care is regarded as essential. OBJECTIVE: To explore the experience of user involvement among Healthy Life Centre users participating in individual health consultations, followed by physical activity groups and/or diet courses. METHODS: This was a qualitative study based on twenty semi-structured individual interviews conducted between September 2015 and May 2016 at a Healthy Life Centre in Norway. Data were analysed using systematic text condensation. RESULTS: Being respected and having a trustworthy relationship with the professionals were found to be essential for the service users' involvement. Building a trustworthy relationship was disrupted for some service users by a lack of relational continuity. This lack of continuity jeopardized the continuation of professionals' awareness of the service users' challenges and personal goals. The service users' preferred levels of user involvement varied. Some service users did not always want to play an active part and instead wanted the professionals, as "experts," to decide. CONCLUSIONS: The findings imply that the professionals need to assess each service user's desires for involvement and consider how these can be met. Thus, user involvement cannot be understood without considering the particular setting and each individual service user's preferences for involvement. Relational continuity is needed to maintain the service users' challenges and goals throughout the services and to promote health behaviour changes.

Participants and developers experiences with a chronic pain self-management intervention under development: A qualitative study.

BACKGROUND: Non-pharmacological interventions aim to promote health and self-management for people with chronic pain. OBJECTIVE: The aim of this study was to explore if the participants' experiences with a self-management intervention under development were aligned with the developers' rationale and desired outcome of the intervention. METHODS: This was a qualitative study interviewing both participants and developers of a chronic pain self-management intervention. Seven participants, six females and one male in the age from early thirties to mid-seventies attended the chronic pain self-management intervention developed by the staff at a Healthy Life Centre. The data were analysed by the systematic text condensation method. RESULTS: The analyses showed that the participants evaluated the intervention as valuable. They described using coping techniques to manage their chronic pain better, and the developers stated that the aim with the intervention was to provide the participants with coping techniques. The intervention was built upon the developers' professional knowledge and experience in cognitive techniques, health theories, models for behavioural change, and service user involvement. CONCLUSION: This study found that the chronic pain self-management intervention was in concordance with theory of health promotion and empowerment. The participants experienced the intervention as targeting their resources, capacities, and fulfilling social needs, which aligned with the developers aim with the intervention. The participants found the intervention evocative; they learned new ways to manage their pain through theory/education, movement exercises, homework, and sharing their experiences with each other.

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial.

BACKGROUND: To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care. METHODS: An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model. RESULTS: After twelve months, there were no statistically significant differences between the intervention group (n = 60) and the control group (n = 61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p = 0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test. CONCLUSIONS: No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02531282 . Registered on August 212,015.

Short-term effect of a chronic pain self-management intervention delivered by an easily accessible primary healthcare service: a randomised controlled trial.

OBJECTIVES: To investigate the effects on persons with chronic pain after 3 months of a group-based chronic pain self-management course compared with a drop-in, low-impact outdoor physical group activity on patient activation and a range of secondary outcomes. DESIGN: An open, pragmatic, parallel group randomised controlled trial. Analyses were performed using a two-level linear mixed model. SETTING: An easily accessible healthcare service provided by Norwegian public primary healthcare. PARTICIPANTS: A total of 121 participants with self-reported chronic pain for 3 months or more were randomised with 60 participants placed in the intervention group and 61 placed in the control group (mean age 53 years, 88% women, 63% pain for 10 years or more). INTERVENTIONS: The intervention group was offered a group-based chronic pain self-management course with 2.5-hour weekly sessions for a period of 6 weeks. The sessions consisted of education, movement exercises and emphasised group discussions. The control group was offered a low-impact outdoor group physical activity in 1-hour weekly sessions that consisted of walking and simple strength exercises for a period of 6 weeks. MAIN OUTCOMES: The primary outcome was patient activation assessed using the Patient Activation Measure. Secondary outcomes measured included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30 s chair to stand test. RESULTS: There was no effect after 3 months of the group-based chronic pain self-management course compared with the control group for the primary outcome, patient activation (estimated mean difference: -0.5, 95% CI -4.8 to 3.7, p=0.802). CONCLUSIONS: There was no support for the self-management course having a better effect after 3 months than a low-impact outdoor physical activity offered the control group. TRIAL REGISTRATION NUMBER: NCT02531282; Results.

Psychological distress in elderly people is associated with diet, wellbeing, health status, social support and physical functioning- a HUNT3 study.

BACKGROUND: The increasing proportion of people growing old, demands expanded knowledge of how people can experience successful aging. Having a good life while growing old is dependent on several factors such as nutrition, physical health, the ability to perform activities of daily living, lifestyle and psychological health. Furthermore, unhealthy food intake is found to be a modifiable risk factor for depression in elderly people. To promote elderly's health and wellbeing, the influence of nutrition, lifestyle, physical functioning, and social support on psychological distress needs exploring. Therefore, the purpose of this present study is to investigate the associations between psychological distress and diet patterns when adjusting for other life style behaviors, wellbeing, health status, physical functioning and social support in elderly people. METHODS: The present study is cross sectional, using data from wave three of the Nord-Trøndelag Health Study (2006-2008). Data include psychological distress measured by the Hospital Anxiety and Depression Scale (HADS), sociodemographic information, measurements of lifestyle behaviours (including diet patterns), wellbeing, health status, social support and physical functioning. RESULTS: The sample consisted of 11,621 participants, 65 years or older. Cluster analysis categorized the participants in two food clusters based on similarities in food consumption (healthy N = 9128, unhealthy N = 2493). Stepwise multivariable linear regression analyses revealed that lesser psychological distress in the elderly was dependent on gender, diet, smoking, better scores on health and wellbeing, social support and less problems performing instrumental activities of daily living. CONCLUSION: Knowledge about the influence of diet patterns in relation to psychological distress provide valuable insights into how society can promote healthy lifestyles to an ageing population, e.g. by increasing older people's food knowledge.

Individual user involvement at Healthy Life Centres: a qualitative study exploring the perspective of health professionals.

The aim of this study was to explore how professionals experience user involvement at an individual level and how they describe involving users at Healthy Life Centres. Four focus group interviews were conducted with a total of 23 professionals. Data were analysed using systematic text condensation. Four themes were identified: (1) Involving users through motivational interviewing; (2) Building a good and trustful relation; (3) Assessing and adjusting to the user's needs and life situation; and(4) Strengthening the user's ownership and participation in the lifestyle change process. Motivational interviewing was described by the professionals as a way to induce and ensure user involvement. However, seeing motivational interviewing and user involvement as the same concept might reduce user involvement from being a goal in itself and evolve into a means of achieving lifestyle changes. The professionals might be facing opposing discourses in their practice and a dilemma of promoting autonomy and involvement and at the same time promoting change in a predefined direction. Greater emphasis should thus be put on systematic reflection among professionals about what user involvement implies in the local Healthy Life Centre context and in each user's situation. ABBREVIATIONS: HLC: Healthy Life Centre; MI: Motivational Interviewing; NCD: Non-communicable diseases; STC: Systematic Text Condensation. SDT: Self-determination theory.