Barriers and facilitators for leading nursing homes through the COVID-19 pandemic: A focus group study in Norway.

BACKGROUND: During the COVID-19 pandemic, nursing home leaders implemented infection control to protect residents and staff. AIM: To understand the barriers and facilitators for leading nursing homes through the COVID-19 pandemic. METHODS: We invited 34 nursing homes to participate, and 20 leaders (59%) attended focus group interviews. The COM-B model and the theoretical domains framework were used in design and analysis of the study. RESULTS: The barriers for infection control were organisational unpreparedness, high volumes of information, lack of clinical skills, protective equipment, and testing capacity, the nursing home's architectural design, health authorities' low priority of nursing homes, staff's fear, and mental pressure on the leaders over time. The facilitators were having a customised corona plan, change of routines, certification of new skills, access to the municipal quality system, the ability for crisis leadership, loyalty to the nursing home, and support from the environment. The number of part-time positions and the opportunity to outsource parts of the services were also important determinants for infection control. CONCLUSIONS: The results identify several barriers and facilitators for nursing home leaders' behaviour for infection control. The results confirm the importance of supporting the leaders' resilience and crisis leadership while working in the pressurised environment of a pandemic. RELEVANCE TO CLINICAL PRACTICE: The study provides important insights into barriers and facilitators for leading nursing homes through the COVID-19 pandemic, which could help to inform future strategies for infection control. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Healthy and unhealthy eating after a behaviour change intervention in primary care.

BACKGROUND: To prevent and reduce non-communicable diseases, the Norwegian Directorate of Health encourages Healthy Life Centres (HLCs) in all municipalities. AIMS: This study investigates whether the behaviour change interventions at HLCs positively affected participants' diet and to evaluate predictors for healthy and unhealthy eating. Our data are part of the Norwegian Healthy Life Centre Study, a 6-month, pragmatic randomised controlled trial (RCT). METHODS: Totally, 118 participants ≥18 years old were randomised to an intervention group (n 57), or a waiting list (control group) (n 61). Eighty-six participants met at the 6 months follow-up visit. We merged the participants to one cohort for predictor analyses, using linear regressions. FINDINGS: The RCT of the HLCs' interventions had no effect on healthy and unhealthy eating 6 months after baseline compared with controls. A short, additional healthy eating education programme produced a modest, statistically significant improvement in healthy eating compared with controls. This did not, however, reduce unhealthy eating. Higher income predicted unhealthier eating over time. Increasing body mass index and impaired physical functioning also led to an increase in unhealthy eating. Healthy eating at 6 months was predicted by self-rated health (SRH), vitality and life satisfaction, and hampered by musculo-skeletal challenges and impaired self-esteem (SE). SRH impacted improvement in healthy eating during the 6 months. The effect of interventions on healthier eating may be improved by an emphasis on developing positive self-concepts like better SRH, vitality, life satisfaction, and SE.

How body concerns, body mass, self-rated health and self-esteem are mutually impacted in early adolescence: a longitudinal cohort study.

BACKGROUND: Impaired self-rated health (SRH) and self-esteem (SE) in adolescents are associated with increased body mass index (BMI). These associations are often studied using cross-sectional designs; we performed a longitudinal cohort survey to examine them. METHODS: A longitudinal cohort study of 1225 Norwegian high school students, with SRH, SE and BMI as primary outcomes. We reported the results from temporal causal and residual change analyses separately, with odds ratios (ORs) and standardised regression coefficients (b) and 95% confidence limits. RESULTS: Body and weight concerns had unfavourable effects on SRH and SE, which both had favourable effects on each other. Increased BMI had unfavourable effects on SRH, but less so on SE. Body and weight concerns impacted SE change only among girls. Paradoxically, the intention of becoming thinner was associated with an increase in BMI, and the intention of becoming fatter predicted a decrease in BMI during the 2 years. SE and SRH were associated with a leaner body after 2 years. CONCLUSIONS: This study confirms that body concerns had unfavourable effects on subjective health, and that positive self-concepts predicted a leaner body. Health promotion strategies built on body acceptance should be increasingly emphasised in clinical and public health practice.

How are body mass and body attitude impacted by a behaviour change intervention in primary care? A pragmatic randomised controlled trial.

Aims:This study evaluated the effect of behaviour change interventions at Norwegian Healthy Life Centres on change in body mass index (BMI) and body attitude, and explored the predictors for change after 6 months. Methods: We randomised 118 participants to either an intervention or a control group. Eligible participants: ⩾18 years and able to take part in group-based interventions. Body attitude, weight, and height were assessed at inclusion and after 6 months. We analysed the data using simple and multiple regression. Results: Eighty-six participants completed 6-month follow-up. The study found no intervention effect on BMI or body attitude across the two groups. However, an interaction effect indicated that the leaner participants in the intervention group reduced their weight significantly (b 0.94, p < 0.001). BMI reduction was predicted by self-efficacy for physical activity and autonomous motivation for change. Weight loss was associated with impaired body attitude, body shape concern, impaired weight-related self-esteem, weight cycling, and controlled motivation for change. Improvement in body attitude was positively impacted by self-rated health, the experience of childhood respect, life satisfaction, and self-efficacy for physical activity. Impaired body attitude was predicted by body shape concern, impaired weight-related self-esteem, and controlled motivation. Conclusions: The interventions did not affect body mass on average, but promoted weight loss among the leaner participants. Because weight reduction was associated body shape concern and impaired body attitude, the study supports the claim that interventions should be weight neutral and aim to improve body image and psychological well-being rather than weight reduction.

The Norwegian Healthy Life Centre Study: A pragmatic RCT of physical activity in primary care.

AIMS: The aim of this study was to evaluate the effect of behaviour change interventions at Norwegian Healthy Life Centres (HLCs) on participants' moderate to vigorous intensity physical activity (MVPA) six months after baseline. We also explore predictors of change in MVPA, and if level of education and MVPA at baseline modify the effect. METHODS: A randomised controlled trial with inclusion criteria age ⩾ 18 years and ability to participate in group-based physical activity. Participants were randomised to either behaviour change interventions or a waiting list (control). Objective recordings of physical activity were the main outcome, analysed with simple and multiple linear regression. RESULTS: We recruited 118 participants from six HLCs. Participants with mental, musculoskeletal, or chronic somatic disease were more likely to drop out. We revealed no differences in MVPA or sedentary time between the groups. Types of motivation or several characteristics of disadvantage at baseline could not explain changes in MVPA. Across both groups, 83% achieved the recommended 150 minutes of MVPA per week, and participants with a lower level of education were less likely to improve. Participants in the intervention group who were least active at baseline significantly increased their MVPA. CONCLUSIONS: The study revealed that the intervention had no short-term effect on time spent on MVPA or sedentary. This study does not support a strong emphasis on behaviour change on an individual level as a way of targeting general health and risk reduction at a population level. Although less active people benefitted more from the HLC intervention, the intervention was unable to counteract widening of inequity across educational groups.

Participants at Norwegian Healthy Life Centres: Who are they, why do they attend and how are they motivated? A cross-sectional study.

AIMS: We examine the characteristics of participants entering Norwegian Healthy Life Centres, their reasons for attending and whether socio-economic status, motivation, self-efficacy and social support relate to physical activity and sedentary behaviour. METHODS: This cross-sectional study is part of a randomised controlled trial. Inclusion criteria are that participants should be ≥ 18 years old and able to take part in a physical activity group intervention. Exclusion criteria are severe mental illness and general learning disability. We analysed data using simple and multiple linear regression analyses. RESULTS: We recruited 118 participants from eight Norwegian municipalities between June 2014 and September 2015. Of these, 77% were female, mean (standard deviation) age 48.6 (13.4) years, body mass index 34.0 (5.8) kg/m2 and mean gross family income €61,000. The proportion of participants with upper-secondary school or less as their highest level of education was 55%. The most frequent reasons given for attendance at Healthy Life Centres were being overweight, increasing physical activity, improving diet and having musculoskeletal health challenges. Participants had high levels of autonomous motivation and 79% achieved national recommendations for physical activity. Respect and appreciation in childhood, self-esteem and self-rated health were associated with self-efficacy and social support for physical activity. CONCLUSIONS: Participants were predominantly obese, physically active, female and motivated for change. A high proportion had low educational attainment and low incomes. The trial will reveal whether interventions succeed in increasing physical activity further, or in decreasing sedentary behaviour, and whether health inequalities narrow or widen across groups.

Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses.

PURPOSE: This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. METHODS: The inclusion criteria specified RCTs with ≥ 12 weeks' duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. RESULTS: We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. CONCLUSION: There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. TRIAL REGISTRATION: PROSPERO CRD42015020624.

The Norwegian Healthy Life Study: protocol for a pragmatic RCT with longitudinal follow-up on physical activity and diet for adults.

BACKGROUND: The Norwegian Directorate of Health recommends that Healthy Life Centres (HLCs) be established in primary health care to support behaviour change and reduce the risk of non-communicable diseases. The aim of the present study protocol is to present the rationale, design and methods of a combined pragmatic randomized controlled trial (RCT) and longitudinal cohort study of the effects of attending HLCs concerning physical activity, sedentary behaviour and diet and to explore how psychological well-being and motivational factors may mediate short- and long-term effects. METHODS: The present study will combine a 6-month RCT with a longitudinal cohort study (24 months from baseline) conducted at six HLCs from June 2014 to Sept 2017. Participants are randomized to behavioural change interventions or a 6-month waiting list control group. DISCUSSION: A randomized trial of interventions in HLCs has the potential to influence the development of policy and practice for behaviour change interventions and patient education programmes in Norway. We discuss some of the important preconditions for obtaining valid results from a complex intervention and outline some of the characteristics of ecological approaches in health care research that can enable a pragmatic intervention study. TRIAL REGISTRATION: The study was retrospectively registered on September 19, 2014 and is available online at ClinicalTrials.gov (ID: NCT02247219 ).

Stakeholders' expectations of Healthy Life Centers: A focus group study.

AIMS: The aims of this study were to explore stakeholders' expectations of municipal Healthy Life Centers (HLCs) in Norway, and to evaluate whether these expectations were compatible with current guidelines and recommendations. METHODS: A multidisciplinary team of researchers arranged focus group sessions with Healthy Life Centre staff, municipality administration, county administration, general practitioners and representatives of three patient organizations. We audiotaped and transcribed the sessions verbatim. In analyses we used Systematic Text Condensation and an editing analysis style. RESULTS: Expectations spanned from primary prevention among children to rehabilitation of adults with established disease, depending on the stakeholders' assumptions of the role of HLCs. Healthcare providers emphasized person-centered advice based on the participant's willingness to change, and their impressions of the participant's presenting condition and life circumstances. Many participants represented underprivileged groups, not reached by population-based information strategies. Consistent with self-determination theory, participants who contacted the HLCs themselves more often expressed a will for lifestyle change than those referred from general practitioners, and less often dropped out. Participants with complex challenges and insufficient coping strategies often strived with follow-up. Among these, many suffered from mental health problems. CONCLUSIONS: The Norwegian HLC is still a concept in development and is trying to define its position in the public healthcare system. In accordance with national recommendations to reduce social health inequalities, the stakeholders emphasized providing effective, evidence-based HLC programs including underprivileged groups. They also expressed concern about prioritizing between an individual and population approach, and between different target groups and tasks.

Estimating the cost of professional developmental activities in health organizations.

Continuing professional development and a lifelong learning perspective are necessary as a consequence of ever-faster processes of development in nursing and medical knowledge, and changes in health care systems and strategies. The necessity to use time for professional development to secure and develop quality in care must be defended. As a consequence, there is a need for knowledge about the cost of professional development activities. The model presented in this study presents an overview of all costs involved in an activity. Being aware of these costs and pinpointing where they belong in the organization can help nursing leaders present accurate arguments when defending and promoting professional developmental activities.

Evaluation of clinical ladder participation in Norway.

PURPOSE: To evaluate nurses' reasons for joining a clinical ladder program, their experiences during participation, and how they use their new competence in practice. DESIGN AND METHODS: Cross-sectional survey design. Sample was 541 nurses who participated in clinical ladder programs at four hospitals in Norway. Data were analysed with descriptive and inferential statistics. FINDINGS AND CONCLUSIONS: Internal motivational factors were most important reasons for joining a clinical ladder. Nursing leaders were lacking in their engagement with the clinical ladder project and its participants. Perceived learning effect, use of competence, and intent to stay increased as nurses progressed in the ladder.

Job satisfaction in a Norwegian population of nurses: a questionnaire survey.

BACKGROUND: Although job satisfaction is a factor that influences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries. OBJECTIVES: To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses' job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin. DESIGN: In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors. RESULTS: Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital. CONCLUSIONS: Norwegian nurses' views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses' actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content defining nurses' working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses' overall job satisfaction. However, further education and the opportunity for professional development increased nurses' intention to stay in the organization.