From shaky grounds to solid foundations: a salutogenic perspective on return to work after cancer

Background: Almost a third of employed individuals of working age fall out of work after cancer treatment. Aim: To explore cancer survivors’ successful return to work, focusing on assets and resources utilized to resolve cancer- and work-related obstacles to achieve long-term employment. Methods: We interviewed eight cancer survivors who had remained at work for at least 3 years after cancer treatment. We performed interpretative phenomenological analysis and applied Antonovsky’s salutogenic model of health as a framework. Results: The participants experienced uncertainty regarding cancer recurrence, impairments, and long-lasting effects on work ability. They utilized a wide range of resistance resources at personal, interpersonal, and social levels. Their determination to return to work was generally strong, but the time needed to find sustainable work and strategies to return to work varied. All participants prioritized activities that energized them and adapted actively to their new situation. When unsure about outcomes, they focused on the best alternative and controlled fear cognitively. Conclusions/Significance: Finding meaningful activities, testing actual work ability, and focusing on the best possible outcome seemed important to remain in work after cancer. It may be helpful to identify available resources and utilize them to resolve tensions resulting from cancer and cancer treatmentacceptedVersionpublishedVersio

Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study

Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. female persons who survived cancer were in education more often than male persons who survived cancer. Conclusions:Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and controlspublishedVersio

Positive mental health - from what to how A study in the specialized mental healthcare service

Abstract Background: The reorientation of the health services in a health promotion direction has been requested since 1986 when the Ottawa charter (WHO) was launched. A theoretical framework based on salutogenesis is recommended for health promotion development. This study emanated from a mental health hospital, where it was relevant to know how people with mental disorders perceive positive mental health and mental health promotion. Service user involvement in health research has been argued to hold the potential to make research more relevant to clinical practice, and further that it might result in effective improvements in the healthcare services. Aims: The purpose of the study ‘Positive mental health – from what to how’ was to contribute to the knowledge base of health promotion by exploring experiences of persons with mental health disorders. The present study evolved into two parts. The first aim was to explore how mental health and mental health promotion are experienced by adults affected by severe mental disorders. The next aim was to explore former inpatients’ experiences of mental health promotion in a mental healthcare hospital setting. In the second part of the study, the aim was to explore the applied process of involving mental healthcare service users in the entire research process of the study, in our case as part of an advisory team. Thereafter, how service user involvement may contribute to the development of the methodology Interpretative Phenomenological Analysis (IPA), and in turn enhance the research quality, was examined. Methodology: In the first part of the study, IPA was used to explore lived experiences of twelve participants. These former inpatients with mental disorders were interviewed in-depth. Analysis of the data was case focussed and then cross case focussed. As part of the study design service user involvement was applied in all stages of the research process. In the second part of the study, a case study design was used to explore the process of collaboration between five members of the advisory team and the researcher. Research data was collected from documentation, by multi-stage focus group interviews, and participant observations.Important concepts, insights and common opinions were identified by the advisory team and the researcher in analytical discussions, and further developed into understandings formulated in texts and illustrations that helped display and present our findings. Findings: The first of four papers included in this thesis shows how mental health is perceived as a dynamic phenomenon and an ever-present aspect of life. Mental health is perceived as a process, a constantly ongoing movement, like walking up or down a staircase and expressed through body language and everyday spoken language. The movement is nourished by experiences in the emotional, physical, social and spiritual domains of life, and accompanied by a sense of energy. The second paper focuses on the prominent finding of an appetite for learning. The participants perceive the learning processes that occur in the healthcare settings as health promoting. They are craving knowledge in order to cope with the mental disorder and to increase their mental health and wellbeing in daily life. The third paper discusses the applied service user involvement process. The level of involvement was dynamic and six features facilitated contributions from service users; role clarification, a predictable meeting structure, a safe and supportive setting through leadership, focus on possibilities, being a team member and being seen and treated as a whole person. These features helped the service users see themselves as valuable and competent. The fourth paper argues that the multiple perspectives of service users and researchers gave more insightful interpretations of nuances, complexity, richness and ambiguity in the participants' accounts. The power of multiple perspectives in service user involvement reinforced the IPA methodology and vice versa. Conclusions: This thesis shows that lived experiences by persons with severe mental disorders, constitute a rich and important source of knowledge to the field of health promotion. According to the participants, mental health is a dynamic, ever present aspect of life, with improvement or deterioration in their condition being likened to moving up or downa staircase. The learning processes that occurred in the hospital, including both salutogenic and pathogenic knowledge, were perceived as mental health promoting. The participants support the development of educational activities to complement the curative focus in mental healthcare hospitals. When it comes to service user involvement in the present study, the levels of involvement were dynamic and varied throughout the research process. The research advisors experienced certain features of the collaboration process as essential to facilitating their contributions to the research and to seeing themselves as competent. The power of multiple perspectives came across in the collaboration process and this gave us more insightful interpretations of nuances, complexity, richness or ambiguity in the interviewed participants’ accounts. The advisory team became ‘the researcher’s helping hand’

Mental health promotion as perceived by Norwegian adolescents with somatically ill parents – an interpretative phenomenological analysis

ABSTRACTObjective Having a somatically ill parent can influence adolescents’ daily lives and mental health. This study aimed to explore the lived experiences of mental health promotion among adolescents with a somatically ill parent, based on a salutogenic orientation.Methods Individual interviews with 11 adolescents (13–18 years of age) with a somatically ill parent were conducted. The data were analysed according to interpretative phenomenological analysis.Results A superordinate theme, feeling at home in a house of mental health–promoting conversations, frames the participants’ perceptions of a prominent mental health promotion experience, including decisive characteristics of the significant conversation partners and different important conversation contexts. The metaphor of feeling at home expresses that the participants ascribe the conversations taking place there as promoting mental health. The themes elucidate the superordinate theme: (a) significant conversation partners characterised by the three subthemes: (i) being available, (ii) being competent and (iii) being caring and (b) rooms reflecting conversation contexts containing four subthemes: (i) room of increased knowledge, (ii) room of disclosure, (iii) room for meeting points and (iv) room for breaks.Conclusion Adolescents with a somatically ill parent perceived that conversations about important topics with significant others with special characteristics in distinct contexts promoted mental health

Mental health as perceived by Norwegian adolescents living with parental somatic illness: Living in an earthquake zone

Purpose - Severe parental somatic illnesses can influence the entire family, including adolescents’ everyday life, psychosocial functioning and health. Within salutogenesis, it is highlighted that stressor life events, such as parental somatic illness, might lead to a chain of events that can produce tension. There is a lack of in-depth understanding regarding how adolescents living in a situation with a severely somatically ill parent (SIP) perceive their own mental health. The aim of this study was therefore to explore the lived experience of Norwegian adolescents living with an SIP, and their perception of the parental illness’ influence on their mental health. Methods - Interpretative phenomenological analysis was used. In-depth interviews were conducted with 11 adolescents (aged 13–18 years) who had an SIP. Two adolescents with an SIP participated in study preparation and data analysis. Results - Adolescents perceived parental somatic illness as a multifaceted influence on their mental health as it represented both personal and relational strain and growth. Their perceptions can be conceptualized by the super-ordinate theme “living in an earthquake zone”, and by two themes, “inner shakes—but not falling apart” and “relational aftershocks—gains and losses”. Conclusion - For adolescents, parental somatic illness means personal and relational strain and growth

Mental health as perceived by Norwegian adolescents living with parental somatic illness: Living in an earthquake zone

Purpose: Severe parental somatic illnesses can influence the entire family, including adolescents’ everyday life, psychosocial functioning and health. Within salutogenesis, it is highlighted that stressor life events, such as parental somatic illness, might lead to a chain of events that can produce tension. There is a lack of in-depth understanding regarding how adolescents living in a situation with a severely somatically ill parent (SIP) perceive their own mental health. The aim of this study was therefore to explore the lived experience of Norwegian adolescents living with an SIP, and their perception of the parental illness’ influence on their mental health. Methods: Interpretative phenomenological analysis was used. In-depth interviews were conducted with 11 adolescents (aged 13–18 years) who had an SIP. Two adolescents with an SIP participated in study preparation and data analysis. Results: Adolescents perceived parental somatic illness as a multifaceted influence on their mental health as it represented both personal and relational strain and growth. Their perceptions can be conceptualized by the super-ordinate theme “living in an earthquake zone”, and by two themes, “inner shakes—but not falling apart” and “relational aftershocks— gains and losses”. Conclusion: For adolescents, parental somatic illness means personal and relational strain and growth

Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study

Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. female persons who survived cancer were in education more often than male persons who survived cancer. Conclusions:Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and control

Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study

Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. female persons who survived cancer were in education more often than male persons who survived cancer. Conclusions: Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and controls

Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study

Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. female persons who survived cancer were in education more often than male persons who survived cancer. Conclusions:Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and control

Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study

Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. female persons who survived cancer were in education more often than male persons who survived cancer. Conclusions:Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and control