Struggling with Fitting in: Clients Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway.

PURPOSE: To explore clients' experiences of receiving job support from employment specialists (ESs) working with individual placement and support (IPS) in Norway. IPS is developed to help people with severe mental illness (SMI) into competitive employment as an integral component of mental health services. METHODS: Using a hermeneutic phenomenological methodology, this study comprises individual semi-structured interviews with ten participants engaged in IPS at two districts psychiatric centers. Data analysis was conducted according to systematic text condensation. RESULTS: Three themes emerged: (1) ES-a door opener? (2) Striving to sidestep a "spider web" of triggers at and away from work; and (3) Calling for a safer route. CONCLUSION: This study highlights the importance of ESs offering IPS clients' opportunities to try out diverse jobs and focusing more on assessing the work environment in the jobs they place people into. Our findings imply that ESs should spend more time on building a good working alliance with both clients and employers, and pay more attention on understanding individuals' vocational capacities and support needs at the worksite. The ES training should focus not simply on the technical processes of job development and placement, but more directly on empowering clients to stay focused on their vocational ambitions and prospects. The salutogenic model of health can help ESs to analyze whether clients experience workplaces as meaningful, manageable, and comprehensible.

Experiences of the Quality of the Interplay between Home-Living Young Adults with Serious Mental Illness and Their Social Environments.

The purpose of this study is to explore the experiences of the interplay between home-living young adults in the community with a serious mental illness (SMI) and their social environment and how this experience influence their mental health and well-being in light of the theory of salutogenesis. In a qualitative study, nine young adults with SMI were interviewed. The interviews were transcribed and subjected to reflexive thematic analysis. The following three overarching themes characterized these young adults' experiences of such interplay: (1) a sense of shame and feeling less valued in society, (2) challenges in engagement and maintaining relationships, and (3) the significance of social support in one's family. Accordingly, the young adults experienced both the presence of good, constructive interplay with their social environment and deficits in this reciprocal feedback loop. Overall, this study illuminates the need for more tolerant health-promoting public attitudes to ensure that individuals with a SMI might experience better interplay by feeling that they are valued members of a nurturing society and that they can contribute to their local community. Participation in society should not be limited by one's illness or expectations of being recovered before one can fully participate in society. Experiencing social support and inclusion in society is essential to strengthen self-identity and fight against stigma, thus promoting a sense of coherence, health and well-being.

Rethinking long-term condition management: An actor-level framework.

To understand the complexities of managing long-term conditions and develop appropriate responses, micro-, meso- and macrolevels must be considered. However, these levels have not been combined in a single analytical framework of long-term condition management (LTCM). This article aims to describe a framework of LTCM practice and research that combines societal levels and key agents. The actor-level framework, based on the works of Abram De Swaan and Randall Collins, provides a broader understanding of LTCM as an interdisciplinary research field compared to previous contributions. The framework has three main advantages. First, it encourages knowledge production across levels and actors that address the complexity of long-term illness management. Second, it broadens the scope of LTCM as an interdisciplinary research field and practice field. Finally, it facilitates the integration of knowledge production from different disciplines and research traditions. The framework could stimulate interdisciplinary research collaboration to enhance knowledge of processes and interactions influencing the lives of individuals with long-term conditions.

Self-management and health related quality of life in persons with chronic obstructive pulmonary disease.

PURPOSE: Although it is well-known that persons with COPD experience lower health related quality of life (HRQoL), little is known about the importance of self-management related domains on HRQoL in persons with COPD. Therefore, the purpose of this study is to examine associations between self-management related domains and HRQoL, adjusting for sociodemographic and clinical characteristics, self-efficacy, and sense of coherence. METHODS: Cross-sectional data of 225 persons with COPD, recruited from a hospital register, were analyzed. Self-management related domains were measured using the Health education impact questionnaire (heiQ) and HRQoL was measured using the St. George's Respiratory Questionnaire (SGRQ). Multiple linear regression analysis was used. RESULTS: The final models showed significant associations between the self-management domains constructive attitudes and approaches and emotional distress and HRQoL. Dyspnea, number of comorbidities, self-efficacy, and the various self-management related domains explained 51.3 to 55.1% of the variance in HRQoL. CONCLUSIONS: The findings suggest that addressing self-management related domains, in addition to self-efficacy, dyspnea, and comorbidities, may be of importance for enhancement of HRQoL in persons with COPD.

The effect of sucrose as pain relief/comfort during immunisation of 15-month-old children in health care centres: a randomised controlled trial.

AIMS AND OBJECTIVES: To investigate the effect of 30% sucrose compared with a placebo (water) as pain relief and comfort during immunisation of 15-month-old children in health care centres. BACKGROUND: Children experience different levels of pain and distress during immunisation. Sweet solutions function as pain relief during immunisation for infants up to one year of age. However, there are few studies of older children. DESIGN: An experimental design in which the participants (15-month-old infants) were randomly assigned to an intervention group that received a 30% sugar solution or a control group that received a placebo (water). METHODS: The study was performed at three health care centres in a large Norwegian municipality. The parents of all 15-month-old infants who were recommended for vaccination (for measles, mumps and rubella) between 5 September 2013 and 31 March 2014 were invited to have their infant participate. Duration of crying was the outcome measure. RESULTS: A total of 114 children were included (59 in the intervention group, 55 in the control group). The intervention group infants' crying was shorter (18 seconds mean) compared with the control group infants (33 seconds mean). The difference in crying duration between the groups was both statistically and clinically significant. CONCLUSION: This trial revealed that 30% sucrose orally has a calming and pain-relieving effect on 15-month-old infants during immunisation. RELEVANCE TO CLINICAL PRACTICE: Public health nurses should use a 30% sucrose solution for pain relief during immunisation of 15-month-old infants.

Positive changes in self-management and disease severity following climate therapy in people with psoriasis.

The aim of this study was to investigate the impact of climate therapy on self-management in people with psoriasis. This was a prospective study of 254 adults with chronic psoriasis who participated in a 3-week climate therapy (CT) programme. The 8-scale Health Education Impact Questionnaire (heiQ) was completed at baseline, after 3 weeks of CT, and 3 months later. Change was assessed using paired sample t-tests mean (95% confidence interval) change scores (range 1-4). All heiQ scales showed statistically significant improvement after 3 weeks of CT. The greatest improvement was in Health-directed activity, followed by Emotional distress, and Skill and technique acquisition. At the 3-month follow-up, only the Emotional distress scale remained improved. In addition, disease severity (self-administered PASI; SAPASI) improved significantly from before CT to 3 weeks and 3 months after CT. This study suggests that CT provides a range of benefits that are important to people with psoriasis, particularly in the short term. A challenge is how to achieve long-term benefits.

Study protocol for a multicenter investigation of reablement in Norway.

BACKGROUND: Reablement is a promising new rehabilitation model, which is being implemented in some Western countries to meet current and future needs for home-based services. There is a need for further investigation of the effects of reablement among community-dwelling adults in terms of clinical and economic outcomes. This study will investigate the effectiveness of reablement in home-dwelling adults compared with standard treatment in terms of daily activities, physical functioning, health-related quality of life, coping, mental health, use of health care services, and costs. METHODS/DESIGN: The study is a multicenter controlled trial. In total, 44 Norwegian municipalities will participate, including eight municipalities as a control group. For three municipalities with two zones, one will be assigned to the control group and the other to the intervention group. The experimental group will be offered reablement and the control group standard treatment. The sample will comprise approximately 750 participants. People will be eligible if they are home-dwelling adults, understand Norwegian, and have functional decline. Participants will be assessed at baseline, and after 10 weeks, 6 months, and 12 months. The primary outcome will be activity and participation measured by the Canadian Occupational Performance Measure. Physical functioning will be measured by the Short Physical Performance Battery and health-related quality of life by the European Quality of Life Scale. Coping will be measured by the Sense of Coherence questionnaire and mental health by the Mental Health Continuum Short Form. Costs will be generated based on registered working hours in different professions. Data analyses will be performed according to intention to treat. Univariate analysis of covariance will be used to investigate differences between the groups at baseline and the end of intervention. The data will be organized into two levels using a multilevel structure, i.e., individuals and municipalities, which will be analyzed using linear mixed-effects models. The working hours data (panel data) will be analyzed with random mixed-effects regression models. The cost-effectiveness of reablement will be evaluated according to the incremental cost-effectiveness ratio and uncertainty will be explored via the bootstrap method. DISCUSSION: The findings will make an important contribution to knowledge of rehabilitation approaches for community-dwelling adults. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on October 24, 2014, identifier: NCT02273934 .

Breastfeeding surveyed using routine data.

BACKGROUND: The purpose of this study was to investigate breastfeeding as a health indicator through routine data registered at public child health centres. The prevalence and course of breastfeeding were surveyed, as well as factors that affect breastfeeding. MATERIAL AND METHOD: Breastfeeding status at six weeks and six months of age and other routine data were systematically recorded in a newly developed electronic medical records system (Health Profile 0-20 years) for infants attending public child health centres in Bergen in the period 2010-11. This information was linked to data from the Medical Birth Registry. RESULTS: Of 6,093 infants, 73.6% were exclusively breastfed at six weeks of age and 18.9% at six months. In adjusted analyses, there was an association between breastfeeding cessation before six months and the factors smoking, low maternal age, marital status as single, unsatisfactory family situation and social network, and birth weight under 2,500 g. Attendance at a specialist breastfeeding centre and uncertain/abnormal sleep patterns in infants were associated with continued breastfeeding after six months. INTERPRETATION: The medical records system «Health Profile 0-20 years¼, linked to the Medical Birth Registry, was well suited to studying factors that can affect breastfeeding. Mothers and infants with increased need for follow-up were identified.

Clinical characteristics associated with illness perception in psoriasis.

Knowledge of illness perception may aid the identification of groups of patients with a higher risk of coping poorly with the demands of their illness. This study aims to investigate associations between illness perception, clinical characteristics, patient knowledge, quality of life and subjective health in persons with psoriasis. The present study was based on cross-sectional data from patients awaiting climate therapy in Gran Canaria. We included 254 eligible patients (74%) who completed a questionnaire including the revised Illness Perception Questionnaire, the Psoriasis Knowledge Questionnaire, and the Dermatological Life Quality Index. Disease severity was measured using the Psoriasis Area and Severity Index. Several statistically significant associations between clinical characteristics, knowledge and various illness perception dimensions were found. Illness perception was also significantly related to disease-specific quality of life and subjective health. These findings contradict previous findings, which suggested that objective disease factors are not relevant to illness perception in psoriasis.

Exploring Goals and Functional Changes in Reablement for People with Fractures and People with Dizziness and Balance Problems.

Background: Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited. Aim: To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals. Material and Methods: The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired t-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation. Results: Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups. Conclusion: The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program. Significance: Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement.

Experiences with physical activity, health and well-being among young adults with serious mental illness.

PURPOSE: To explore how young adults with serious mental illness (SMI) experience physical activity and how these experiences influence their perceived health and well-being. METHODS: Nine young adults with SMI who had participated in an aerobic high-intensity interval training program were interviewed in depth. The interviews were transcribed and subjected to reflexive thematic analysis. RESULTS: The results indicated that people with SMI mainly experience physical activity as a meaningful activity that contributes to an increased sense of well-being and better health. However, to overcome various barriers, it is crucial to experience social support and encouragement. The following three main themes were identified through reflexive thematic analysis: (1) positive changes in focus and an increase in well-being occur through physical activity; (2) increased mental strength results from physical activity; and (3) a lack of support and feelings of safety prevent physical activity. CONCLUSIONS: This study shows that adapted physical activity is an important resistance resource that can promote stronger self-identity, increased mental well-being and social engagement and thus contribute to an improved ability to manage stressors. Furthermore, the findings reveal that to engage in physical activity and promote sustainable life changes, it is important for individuals to choose a physical activity based on personal interest and meaning.

Evaluation of self-management interventions for chronic obstructive pulmonary disease.

AIM: To evaluate the benefits of self-management interventions on the quality of life of patients with chronic obstructive pulmonary disease. BACKGROUND: Chronic obstructive pulmonary disease is one of the most widespread chronic conditions worldwide, and it is predicted to increase over the next decade. Although previous review studies have demonstrated the benefits of self-management interventions on health-care utilisation, their benefits on quality of life are still unclear. METHOD: In this systematic review, we examined four randomised controlled trials undertaken between 2000 and 2011 to evaluate the benefits of chronic obstructive pulmonary disease self-management interventions on patient quality of life. RESULTS: The main theme that emerged was that self-management interventions improved patient well-being, with three minor themes: reducing the burden on patients, improved patient activity and improved total patient health. CONCLUSION: Self-management interventions tend to improve the quality of life of patients with chronic obstructive pulmonary disease. Further randomised controlled trials are recommended to evaluate self-management interventions in chronic obstructive pulmonary disease to confirm these benefits. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management in health services is involved in caring for patients with chronic obstructive pulmonary disease and is responsible for liaising with other members of the health-care team. We recommend that nursing management be engaged in health-care services to develop and implement self-management interventions for chronic obstructive pulmonary disease patients to improve their quality of life.

Development of salutogenic coping skills: experiences with daily challenges among young adults suffering from serious mental illness.

PURPOSE: The purpose of this study is to explore experiences with daily challenges and the development of salutogenic copings skills among young adults with serious mental illness. METHODS: Nine young adults with serious mental illness were interviewed. The interviews were transcribed and subjected to reflexive thematic analysis. RESULTS: Two main themes were identified through the analysis: "The influence of symptoms in everyday life and challenges with participating in the community" and "Making the small things matter." The findings show that different life experiences, or on-going challenges, often can affect or interfere their lives on a daily basis, and that previous experiences with psychosis can contribute to the development of salutogenic coping skills. CONCLUSIONS: This study shows the importance of increased knowledge and awareness of different life experiences and challenges among people with serious mental illness such as schizophrenia spectrum disorders. It is significant to strengthen the ability to identify and use appropriate resistance resources to promote salutogenic coping skills and thus better health. Furthermore, it is important to be aware that the development of salutogenic coping skills must be personalized to cultural contexts and society as well as supported by local communities, families and services.

'We expected more about sex in the sex week' - A qualitative study about students' experiences with a sexual health education programme, from a health-promotion perspective.

PURPOSE: The purpose of this study is to explore adolescents' experiences with participation in a sexual health education programme named «Week 6¼, from a health-promotion perspective. METHODS: Six focus group interviews were conducted with adolescents aged 15-16 in Norway. Qualitative content analysis was used to analyse the data material. RESULTS: The results can be summed up by the main theme: "We like «Week 6¼ but … we expected more about sex in the sex week". The main theme consisted of two main analysis-derived themes: "The students want a topical sexual health education, with realistic and relevant learning subjects and exercises", and "The students want to contribute to the content and implementation, in order to improve the learning outcomes of «Week 6¼". Further, four categories were identified: organization and content, positive experiences, the potential for improvement, and learning outcome. «Week 6¼ is desirable, but students expect to learn more. Teaching should have a positive approach, and adolescents do not want their educators to get embarrassed. CONCLUSION: Although the teaching methods with active participation are enjoyable, it is necessary with more time for discussions and questions. Student participation in planning and implementation of the programme seems crucial for promoting salutogenic teaching processes.

Recovery at the Clubhouse: challenge, responsibility and growing into a role.

Purpose: To explore how people with mental illness experience recovery in the Clubhouse context, and which ingredients of the model they find active in promoting recovery.Methods: Hermeneutic-phenomenological design. Individual, semi-structured interviews with 18 Norwegian Clubhouse members. Systematic text condensation was used in analysis.Results: Three main themes emerged: "Balancing unlimited support with meeting challenges", with two sub-themes: "Unlimited membership: space for self-agency or hindering development?" and "Becoming a Clubhouse member: concerns and positive experiences". The second main theme was: "Learning how to build new skills and roles in the community". The third main theme was: "Getting better through and for work", with two sub-themes: "Work at the Clubhouse as a means to recovery" and "Preparing for a working life in society". Overall, participants experienced improved mental and social wellbeing and work readiness.Conclusions: Recovery in the Clubhouse context requires members' personal initiative, thus people having poor mental health might struggle with utilizing the Clubhouse. However, participants reported that lack of challenges within the community thwarted their recovery. Based on Salutogenesis, conscious application of challenge in Clubhouse activities might enhance members' recovery. Furthermore, participants' all-round involvement in their recovery journeys suggests the importance of shared decision-making in recovery-oriented services.

Adolescent siblings of children with cancer: a qualitative study from a salutogenic health promotion perspective.

PURPOSE: To explore the experiences of adolescents with a sibling suffering from cancer from a salutogenic health promotion perspective. METHODS: Seven female siblings aged 13-17 years were interviewed. The interviews were transcribed and subjected to qualitative content analysis. RESULTS: The analysis findings adhered largely to one main theme: new challenges and needs in everyday life, consisting of the two domains cancer into life and helpful resources to cope. Categories related to the cancer into life domain were new routines and concerns, fear, loneliness, and growing up. Helpful resources to cope were categorized as support from others, understanding, faith and hope, and normal activities. CONCLUSION: Prominent in the siblings' descriptions were the challenging changes in everyday life including difficult feelings such as loneliness, and a need for understanding. Social support appeared as a crucial salutogenic coping resource to achieve understanding, faith and hope, and identity-crucial spheres to achieve meaning in life. This study has demonstrated the significance of salutogenesis in a new setting, and the findings could be of relevance to teachers and health professionals consulting with the siblings of children with cancer. Further research should be conducted to pinpoint concrete health-promoting measures that might benefit this group.

Everyday occupations prioritised by older adults participating in reablement. A cross-sectional study.

Background: Little knowledge exists regarding which occupations older adults prioritize as rehabilitation goals in reablement and what factors are associated with their preferences.Objectives: To explore which occupations older people with functional decline find important to improve, which of these they prioritize as their rehabilitation goals, and what factors are associated with these priorities.Materials and methods: A cross-sectional study was undertaken with a sample of 738 older adults from a nationwide trial evaluating the effects of reablement in Norway. The nine occupational sub-areas of the Canadian Occupational Performance Measure were used as a framework for analyses.Results: Participants identified a multitude of occupations as challenging. Functional mobility was the most frequently identified and prioritized sub-area. Significant associations were found between prioritized occupations and health condition, sex, living status, education, walking speed and motivation.Conclusions: This study found both abundance and diversity in the occupational problems and prioritized goals of older adults, with mobility being a key priority regardless of health condition.Significance: It is important that reablement continues to be a person-centered intervention embracing the possibility to choose meaningful occupations. Occupational Therapists and other health professionals should address mobility when improving occupational performance in older adults.

"Finally, I belong somewhere I can be proud of" - Experiences of being a Clubhouse member in Norway.

Purpose: The number of psychosocial Clubhouses is growing rapidly in Norway. However, more knowledge is needed about the subjective experience of Clubhouse members in terms of their recuperation processes and experiences in the Clubhouse context. Therefore, this qualitative study explored what it is like to be a Clubhouse member in Norway, and further discuss it in light of the theory of Salutogenesis on successful pathways to coping and well-being.Methods: Using a hermeneutic-phenomenological approach, the present study included in-depth, semi-structured individual interviews with 18 Clubhouse members from three accredited Norwegian Clubhouses. Analysis was conducted using systematic text condensation.Results: Three main themes emerged from the analysis: "Finally, I belong somewhere I can be proud of," "I feel more like an ordinary citizen, just different," and "I feel somewhat equal to others." Overall, the participants experienced improved mental and social well-being owing to their membership of a Clubhouse.Conclusions: Our findings correspond with previous international research. Owing to the positive effect participation in the Clubhouse seem to have on members' motivation, Salutogenesis might help explain helpful processes within the model. Moreover, the model might be a relevant example for policy and service development in mental health care and the labour market.

Salutogenesis as a theoretical framework for psychosocial rehabilitation: the case of the Clubhouse model.

Purpose: This study explored whether the holistic theory of salutogenesis may be a suitable theoretical framework for the Clubhouse model of psychosocial rehabilitation, a pioneer among psychosocial rehabilitation programmes.Methods: A systematic examination of elements of the Clubhouse model, as prescribed by the Clubhouse standards, was performed within the context of the theory of salutogenesis including its basic salutogenic orientation and the main concepts of sense of coherence and resistance resources.Results: We found that several standards and practices within the Clubhouse model can be understood as applications of salutogenesis. We have hypothesized that the Clubhouse model promotes peoples' sense of coherence and mental health. However, our investigation also showed that, to enhance the recovery of Clubhouse members, more explicitly incorporating some salutogenic principles, such as "appropriate challenges" and "active adaptation as the ideal in treatment", may benefit Clubhouse practice.Conclusions: The Clubhouse model of psychosocial rehabilitation is very consistent with the salutogenic orientation and main salutogenic concepts. The present study suggests that salutogenesis may be a suitable theoretical framework for the Clubhouse model and possibly in the psychosocial rehabilitation field in general.