Development of an intervention for the social reintegration of adolescents and young adults affected by cancer.

BACKGROUND: In Denmark, around 500 adolescents and young adults (AYAs) aged 15-29 are diagnosed with cancer each year. AYAs affected by cancer constitute a vulnerable group in need of special support in pursuing everyday life as young people. These needs are, however, not currently being adequately met. This study explores the distinctive needs of AYAs aged 15-25 and affected by cancer with the aim of developing and designing an intervention that accommodates these needs and allows AYAs to pursue everyday life following active cancer treatment. METHODS: We combined multiple qualitative methods to conduct six sub-studies: 1) participant observation among support groups for AYAs affected by cancer, 2) field visit at a large Danish hospital, 3) qualitative interviews with AYAs currently or previously diagnosed with cancer, 4) qualitative interviews with practitioners working with young cancer patients or AYAs with chronic conditions, 5) an interactive workshop with practitioners, and 6) an interactive workshop with AYAs. The empirical material was collected between May 2016 and April 2019. The empirical material was read, analysed thematically and coded into the themes; 1) diagnosis and treatment, 2) form of education and 3) age, financial challenges and legal entitlements. RESULTS: Across the empirical material, we found that AYAs' cancer experience was heterogeneous. The needs of AYAs differed according to 1) diagnosis and treatment, 2) type of education and 3) age, financial situation and legal entitlements. The findings demonstrate a need for a tailored intervention accommodating the variety of opportunities, requirements and challenges of AYAs with cancer. We propose an intervention consisting of a multidisciplinary team sited at the hospital where the individual AYA receives treatment. The team's main task will be to maintain AYAs' social competences and ease their return to everyday life after serious illness by balancing educational requirements with cancer treatment. CONCLUSION: Based on the perspectives of practitioners and AYAs affected by cancer, this study outlines an intervention designed as a care pathway in which a multidisciplinary team provides individual and tailored support to AYAs with cancer from the time of diagnosis during and beyond active cancer treatment.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review.

BACKGROUND: Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders. METHODS: We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. RESULTS: A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. CONCLUSIONS: The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

A qualitative study of mechanisms influencing social inequality in cancer communication.

OBJECTIVE: To understand and describe mechanisms influencing social inequality in cancer communication between patients, companions and healthcare professionals. METHODS: The study was based on observations of 104 encounters and 30 semi-structured interviews with nurses and medical doctors on three Danish oncology wards. Observations, interviews and subsequent analysis were guided by the theoretical framework of cultural health capital developed by Shim to investigate mechanisms that may generate social inequality in cancer communication. The analysis addressed both interactive processes and interpretative meanings. RESULTS: Information exchange was affected by (1) patient insight and preparation, (2) the presence of companions, and (3) communicating on patients' "home ground." Patients who, on the basis of language and hygiene, were assessed to have low capacity, received less information. Lack of mutual exchange of information left healthcare professionals and patients with fewer opportunities to provide-or receive-the best treatment. CONCLUSION: Exchange of information between patients, companions and healthcare professionals is co-constructed in a mutual dynamic. To avoid social inequality in cancer communication, it is crucial that questions and answers allow proportionate insight into disease and treatment both for patients and for healthcare professionals.

'Motivational work': a qualitative study of preventive health dialogues in general practice.

BACKGROUND: The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention 'TOF' (a Danish acronym for 'Early Detection and Prevention') carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. METHODS: The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of 'motivational work' as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. RESULTS: While the health dialogues in TOF sought to reveal patients' motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners' perceptions of their professional position as well as the patients' understanding of prevention -in an interplay-diminished the motivational work carried out in the health dialogues. CONCLUSION: The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

Targeted prevention in primary care aimed at lifestyle-related diseases: a study protocol for a non-randomised pilot study.

BACKGROUND: The consequences of lifestyle-related disease represent a major burden for the individual as well as for society at large. Individual preventive health checks to the general population have been suggested as a mean to reduce the burden of lifestyle-related diseases, though with mixed evidence on effectiveness. Several systematic reviews, on the other hand, suggest that health checks targeting people at high risk of chronic lifestyle-related diseases may be more effective. The evidence is however very limited. To effectively target people at high risk of lifestyle-related disease, there is a substantial need to advance and implement evidence-based health strategies and interventions that facilitate the identification and management of people at high risk. This paper reports on a non-randomized pilot study carried out to test the acceptability, feasibility and short-term effects of a healthcare intervention in primary care designed to systematically identify persons at risk of developing lifestyle-related disease or who engage in health-risk behavior, and provide targeted and coherent preventive services to these individuals. METHODS: The intervention took place over a three-month period from September 2016 to December 2016. Taking a two-pronged approach, the design included both a joint and a targeted intervention. The former was directed at the entire population, while the latter specifically focused on patients at high risk of a lifestyle-related disease and/or who engage in health-risk behavior. The intervention was facilitated by a digital support system. The evaluation of the pilot will comprise both quantitative and qualitative research methods. All outcome measures are based on validated instruments and aim to provide results pertaining to intervention acceptability, feasibility, and short-term effects. DISCUSSION: This pilot study will provide a solid empirical base from which to plan and implement a full-scale randomized study with the central aim of determining the efficacy of a preventive health intervention. TRIAL REGISTRATION: Registered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016 ). Registered 29 April 2016. The study adheres to the SPIRIT guidelines.

Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities.

This paper examines the organisational dynamics that arise in health promotion aimed at reducing health inequalities. The paper draws on ethnographic fieldwork among public health officers in Danish municipalities and qualitative interviews from an evaluation of health promotion programmes targeting homeless and other marginalised citizens. Analytically, we focus on 'boundary work', i.e. the ways in which social and symbolic boundaries are established, maintained, transgressed and negotiated, both at the administrative level and among frontline professionals. The paper discusses three types of boundary work: (i) demarcating professional domains; (ii) setting the boundaries of the task itself; and (iii) managing administrative boundaries. The main argument is that the production, maintenance and transgression of these three types of boundaries constitute central and time-consuming aspects of the practices of public health professionals, and that boundary work constitutes an important element in professional practices seeking to 'tame a wicked problem', such as social inequalities in health. A cross-cutting feature of the three types of boundary work is the management of the divide between health and social issues, which the professionals seemingly seek to uphold and transgress at the same time. The paper thus contributes to ongoing discussions of intersectoral action to address health inequalities. Furthermore, it extends the scope and application of the concept of boundary work in the sociology of public health by suggesting that the focus in previous research on professional demarcation be broadened in order to capture other types of boundaries that shape, and are shaped by, professional practices.

Comparison of health behaviors among women brothel workers to those of the general population of women in Denmark.

Previous research on behavioral risk factors for illness among sex workers has been limited and based on mixed, poorly defined groups of sex workers. The aim of the present study was to compare the health behaviors and weight of women brothel workers with women in the general population in Denmark. Logistic regression analyses were used to compare data from eighty-eight women working in brothels in 2010 with data from 3,225 women of similar age from the nationally representative Danish Health Survey 2010. Compared to Danish women, the prevalence of daily and heavy smoking was higher among brothel workers, but the prevalence of wanting to quit smoking was lower. The prevalence rates of exceeding the Danish high-risk level of alcohol consumption, binge drinking, and illicit drug use were higher among women brothel workers compared to Danish women. The prevalence of underweight was higher and overweight and obesity lower among brothel workers compared to Danish women. These differences were significant when adjusted for age and educational level. Few differences were noted regarding dietary habits and no differences regarding physical activity. Findings suggest the need for health-promotion initiatives, particularly for smoking, alcohol consumption, and drug use, targeted at women brothel workers.