Monitoring the normal body:ideals and practices among normal-weight and moderately overweight people

Introduction: An extensive body of literature is concerned with obese people, risk, and weight management. However, little is known about weight management among people not belonging to the extreme BMI categories. Management of weight among normal-weight and moderately overweight individuals provides us with knowledge about how to prevent future overweight or obesity. This paper investigates body size ideals and monitoring practices among normal-weight and moderately overweight people. Methods: The study is based on in-depth interviews combined with observations. 24 participants were recruited by strategic sampling based on self-reported BMI 18.5-29.9 kg/m2 and socio-demographic factors. Inductive analysis was conducted. Results: Normal-weight and moderately overweight people have clear ideals for their body size. Despite being normal weight or close to this, they construct a variety of practices for monitoring their bodies based on different kinds of calculations of weight and body size, observations of body shape, and measurements of bodily firmness. Biometric measurements are familiar to them as are health authorities' recommendations. Despite not belonging to an extreme BMI category, they translate such measurements and recommendations in meaningful ways to fit their everyday life. Conclusions: Normal-weight and moderately overweight people are concerned with their body size and continuously monitor it. Future health promotion work should consider the kind of practices already established in daily life when recommending ways of conducting body management

Initial programme theory development:The first step in a realist evaluation of a cross-sectoral intervention for expectant Danish parents living with psychosocial risks

A distinct inequality in maternity care exists, and women with psychosocial risks are at a greater risk of adverse birth outcomes. In several high-income countries, a psychosocial risk assessment early in pregnancy is recommended so that expectant parents are offered an appropriate level of care which facilitates relevant, tailored interventions for those in need. In 2017, a cross-sectoral and interdisciplinary intervention for expectant parents with psychosocial risks was developed and implemented in the North Denmark Region. The development process of the intervention has not been reported and theory-based knowledge about how supportive interventions bring about change for expectant parents with psychosocial risks is scarce. Through the initial phase of a realist evaluation, we aimed to elicit key contexts and mechanisms of change regarding the intervention for expectant parents with psychosocial risks. Through an initial programme theory, this article illustrates how, for whom and in which contexts the intervention is intended to work. Data is comprised of intervention documents, 14 pilot observations and 29 realist interviews with key stakeholders. A thematic analytical approach inspired by retroductive thinking was applied to identify and analyse patterns related to the incentive of the intervention, its structure, intended outcomes, generative mechanisms and contextual matters. Generative mechanisms responsible for bringing about change in the intervention were identified as healthcare professionals' approach, continuity, trust, early intervention and social network. Cross-sectoral collaboration and healthcare professionals' competencies were assumed to be central stimulating contextual factors. The initial programme theory developed in this study will serve as the basis for further refinement via empirical testing in a later phase of the realist evaluation.</p

Adaptation and validation of the short version WHOQOL-HIV in Ethiopia

BACKGROUND: Quality of life of patients is an important element in the evaluation of outcome of health care, social services and clinical trials. The WHOQOL instruments were originally developed for measurement of quality of life across cultures. However, there were concerns raised about the cross-cultural equivalence of the WHOQOL-HIV when used among people with HIV in Ethiopia. Therefore, this study aimed at adapting the WHOQOL-HIV bref for the Ethiopian setting. METHODS: A step-wise adaptation of the WHOQOL-HIV bref for use in Ethiopia was conducted to produce an Ethiopian version—WHOQOL-HIV-BREF-Eth. Semantic and item equivalence was tested on 20 people with HIV. One hundred people with HIV were interviewed to test for measurement equivalence (known group validity and internal consistency) of the WHOQOL-HIV-BREF-Eth. Confirmatory factor analysis was conducted using data from 348 people with HIV who were recruited from HIV clinics. RESULTS: In the process of adaptation, new items of relevance to the context were added while seven items were deleted because of problems with acceptability and poor psychometric properties. The Cronbach’s α for the final tool with twenty-seven items WHOQOL-HIV-BREF-Eth was 0.93. All six domains discriminated well between symptomatic and asymptomatic people with HIV (p < 0.001). Using confirmatory factor analysis, a second order factor structure with six first order indicator factors demonstrated moderate fit to the data ((χ(2) = 627.75; DF = 259; p < 0.001), CFI = 0.82, TLI = 0.77 and RMSEA = 0.064). CONCLUSION: The WHOQOL-HIV-BREF-Eth has been shown to be a valid measure of quality of life for use in clinical settings among people with HIV in Ethiopia

Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

INTRODUCTION: First-line treatment for behavioral and psychiatric symptoms of dementia is non-pharmacological. Still, psychotropic medication is widely used, despite its limited effect and harmful side-effects. More than half of all nursing home residents with dementia receive antidepressants, even though deprescribing is safe and feasible. Interventions to promote deprescribing of antidepressants in nursing homes are few and complex. To optimize the deprescribing process through an intervention, transparency for the development of the intervention is needed. We aim to describe the steps in the development and tailoring of an intervention targeting GPs, nursing home staff, and relatives to enhance collaboration on reducing the use of antidepressants in institutionalized older persons with dementia in Denmark. METHOD: A step-wise process guided by the core elements in the Medical Research Council constituted the tailoring process. Five steps were included; 1) a literature search, 2) interviews with stakeholders, 3) drafting the intervention prototype, 4) professionals’ assessment of the intervention, and 5) refinement of the intervention. The steps were conducted from June 2020 to June 2022. RESULTS: Based on the literature search, interviews with stakeholders, and professionals’ assessment of the intervention, four main themes were identified; 1) focusing on antidepressants, 2) importance of professional qualifications, 3) collaboration and communication, and 4) patient and relative involvement. They guided intervention development and refinement of the final intervention, which included 1) a case-based training course and 2) a dialog tool including a symptom assessment scale to be used in a structured consultation at the nursing home. CONCLUSION: This study presents a detailed account of the tailoring process for a complex intervention to optimize deprescribing of antidepressants for older persons with dementia at nursing homes. By presenting a thorough development process, we expect to achieve increased adherence to the intervention which is currently being tested in an ongoing cluster randomized controlled trial. The transparency of the process will also increase the future development of other similar complex interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08961-9