"It's not like a fat camp" - A focus group study of adolescents' experiences on group-based obesity treatment

Background: The health burden related to obesity is rising among children and adolescents along with the general population worldwide. For the individual as well as the society this trend is alarming. Several factors are driving the trend, and the solution seems to be multifaceted because long-lasting treatment alternatives are lacking. This study aims to explore adolescents’ and young adults’ motivation for attending group-based obesity treatment and social and environmental factors that can facilitate or hinder lifestyle change. Methods: In this study, we arranged three focus groups with 17 participants from different obesity treatment programs in the west and south of Norway. The content in these programs differed, but they all used Motivational Interviewing as a teaching method. We conducted a data-driven analysis using systematic text condensation. Self-determination theory has been used as an explanatory framework. Results: We identified four major themes: 1) motivation, 2) body experience and self-image, 3) relationships and sense of belonging, and 4) the road ahead. Many of the participants expressed external motivation to participate but experienced increasing inner motivation and enjoyment during the treatment. Several participants reported negative experiences related to being obese and appreciated group affiliation and sharing experiences with other participants. Conclusion: Motivation may shift during a lifestyle course. Facilitating factors include achieving and experiencing positive outcomes as well as gaining autonomy support from other course participants and friends. Obstacles to change were a widespread obesogenic environment as well as feelings of guilt, little trust in personal achievements and non-supporting friends.publishedVersio

Video consultation in general practice: a scoping review on use, experiences, and clinical decisions

Background The coronavirus disease 2019 pandemic forced healthcare workers to use alternative consultation approaches. In general practice, the use of video consultations (VCs) increased manyfold as countries were locked down. This scoping review aimed to summarize scientifc knowledge concerning the use of VC in general practice and focused on (1) the utilization of VC in general practice, (2) the experiences of the users of VC in general practice, and (3) how VC afected the clinical decision-making of general practitioners (GPs). Methods A scoping review was conducted in accordance with the methodology of Joanna Briggs Institute. Review questions were formulated to match each focus area. A three-step search strategy was employed to search scientifc and gray literature sources. MEDLINE, Embase, Scopus, OpenGrey, Google Scholar, and ClinicalTrials.gov were searched from 2010 to March 11th, 2021, and the search was re-run on August 18th, 2021. The extracted data were deductively coded into pre-defned main themes, whereas subthemes were inductively synthesized. The data within each subtheme were analysed through descriptive content analysis and presented in a narrative synthesis. Results Overall, 13 studies were included after screening 3,624 studies. Most patients were satisfed with VCs. VCs were most suitable for simpler issues, often shorter than face-to-face consultations, and were more likely to be used by younger patients. GPs enjoyed the fexibility and shorter duration of VCs; however, they felt an unsatisfactory deterioration in the GP-patient relationship. Despite the loss of clinical examination, diagnostic assessment was mostly successful, with little fear of missing serious illness. Prior clinical experience and a preexisting relationship with the patient were important factors for successful assessment via VC. Conclusions Both GPs and patients can be satisfed with VC in general practice in specifc contexts, and adequate clinical decision-making is possible. However, disadvantages such as a diminishing GP-patient relationship have been highlighted, and the use of VC in non-pandemic settings is limited. The role of VC in the future of general practice remains unclear, and further research is needed on the long-term adoption of VC in general practice.publishedVersio

Changes in dietary habits and BMI z-score after a 6-month non-randomized cluster-controlled trial among 6–12 years old overweight and obese Norwegian children

Background: Effective prevention programs to address the high prevalence of childhood overweight and obesity and the concomitant health consequences have been warranted. Objective: To improve dietary habits and weight status among Norwegian children with overweight/obesity in the primary care setting. Design: A 6-month non-randomized cluster-controlled intervention among 137 children, aged 6–12 years, with overweight/obesity and their parents. Intervention and control groups were recruited by public health nurses and followed-up by 12 Healthy Life Centers across Norway. The intervention group received individual family counseling and participated in nutrition courses and physical activity groups. A frequency questionnaire assessing sociodemographic characteristics and dietary habits was completed by the parents. Trained public health nurses measured height and weight using standardized methods to calculate body mass index (BMI) and BMI z-scores. Results: The intervention resulted in an increased odds of consuming evening meals (OR: 3.42), a decreased availability of salty snacks (β = –0.17), a decreased intake of salty snacks (−0.18), an increased consumption of water (β = 0.20), and a decreased estimated total intake of energy (β = –0.17), carbohydrates (β = –0.17), mono- and disaccharides (β = –0.21), sucrose (β = –0.24), and saturated fatty acids (β = –0.17). The intervention directly predicted lower BMI z-score (β = –0.17), and post-treatment levels of energy (β = –0.65), saturated fat (β = 0.43), and total carbohydrates (β = 0.41) were directly linked to BMI z-score after intervention. Age and sex were indirectly associated with BMI after intervention through energy and saturated fat intake. Conclusions: The intervention had a beneficial impact on nutrient intake and weight status among children with overweight/obesity. These findings provide support for implementing complex intervention programs tailored to local primary care settings.publishedVersio

The road to equitable healthcare: A conceptual model developed from a qualitative study of Syrian refugees in Norway

Background Refugees in high-income countries face barriers to healthcare access even when they have the same rights and entitlements as the host population. Disadvantages in healthcare access contribute to differences in health outcomes and impact acculturation. This study explores perceived changes in health status and experiences with the Norwegian healthcare system of Syrian refugees living in Norway, using a trajectory perspective. Methods We conducted 15 semi-structured interviews in April 2020 among purposefully recruited adult refugees from Syria resettled in Norway. Interviews were carried out in Arabic and analysed with Systematic Text Condensation using NVivo software. We used Lévesque's access model and Edberg's migration trajectory perspective as theoretical frameworks. A conceptual model was developed – The Migrant Sensitive Access Model - that highlights the factors contributing to a positive versus negative healthcare journey. Results Findings were summarized under three main themes: changes in health and well-being, expectations, and trust. Perceived changes in health status and attributed causes for change were related to the resettlement phase, gender, and were highly informed by pre-migration and migration experiences. The users’ perception of the caregiver, communication, and time were identified as key factors in the care-access journey in inspiring trust or distrust in the caregiver. Conclusion Syrian refugees in Norway appreciate the Norwegian healthcare system but are impeded in their access to care. Many of the barriers can be bridged during the doctor-patient interaction with a diversity sensitive caregiver. The model we propose gives a comprehensive overview of key areas determining the healthcare experience of this population. The results of this study can be useful to policymakers and healthcare providers when addressing disparities in healthcare access for forced migrants.publishedVersio

Do young people who are not in education, employment or training (NEET) have more health problems than their peers? A cross-sectional study among Norwegian adolescents

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Health-related quality of life of children from low-income families : the New Patterns study

Acknowledgements The authors thank the participating families, municipalities, and family coordinators for their commitment to the New Patterns project. Funding The study was supported by the Norwegian Research Council (Grant # 295686).Peer reviewedPublisher PD

Physical education teachers' and public health nurses' perception of Norwegian high school students' participation in physical education - a focus group study

Background: High quality physical education programs in high schools may facilitate adoption of sustainable healthy living among adolescents. Public health nurses often meet students who avoid taking part in physical education programs. We aimed to explore physical education teachers’ and public health nurses’ perceptions of high school students’ attitudes towards physical education, and to explore physical education teachers’ thoughts about how to facilitate and promote students’ participation in class. Methods: Prior to an initiative from physical education teachers, introducing a new physical education model in two high schools in the South of Norway, we conducted focus groups with 6 physical education teachers and 8 public health nurses. After implementation of the new model, we conducted two additional focus group interviews with 10 physical education teachers. In analyses we used Systematic Text Condensation and an editing analysis style. Results: In general, the students were experienced as engaged and appreciating physical education lessons. Those who seldom attended often strived with other subjects in school as well, had mental health problems, or were characterized as outsiders in several arenas. Some students were reported to be reluctant to expose their bodies in showers after class, and students who seldom attended physical education class frequently visited the school health services. Although the majority of students were engaged in class, several of the students lacked knowledge about physical fitness and motoric skills to be able to master daily activities. The participants related the students’ competence and attitude towards participation in physical education class to previous experiences in junior high school, to the competence of physical education teachers, and to possibility for students to influence the content of physical education programs. Conclusions: The participants suggested that high school students’ attitudes towards participation in physical education is heterogeneous, depends on the students’ previous experiences, and on their present health and quality of life. All participants recommended adolescents to take part in program development, and selecting activities that generate competence, fun and enjoyment.publishedVersio

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.publishedVersio

Self-reported and parent-reported mental health in children from low income families in Agder, Norway : results from baseline measurements of New Patterns project participants

Acknowledgments We would like to thank master’s students Vilde Johanna Solheim Lie, Hedda Andrea Struksnæs Sørdal and HAO whose theses in clinical psychology at the University of Bergen functioned as a first draft to this article. We would like to thank the participants and acknowledge the New Patterns project family coordinators who conducted the mapping and supported the participants over time. Funding The work was partly funded by a grant from the Research Council of Norway (number 295686).Peer reviewedPublisher PD

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.publishedVersio