Stor og ung : om motivasjon og motivasjonelle oppfatninger som forutsetning for varig endring av helseatferd hos ungdommer med overvekt og fedme

Tema og problemstilling Temaet for denne oppgaven er overvektige og fete ungdommers motivasjon til endring av kost- og aktivitetsvaner. Oppgavens problemstilling er todelt og spør først om hvilke motivasjonelle oppfatninger som må ligge tilgrunn for å få til en varig endring av helseatferd hos disse ungdommene. Videre spørres det om i hvilken grad motivasjonsaspektet vektlegges i et spesifikt etablert behandlingsprogram. Den første delen av problemstillingen blir besvart gjennom presentasjon av sentrale elementer fra sosial-kognitiv teori og med eksempler fra forskning. Den andre delen belyses gjennom en kasusstudie av et etablert behandlingstilbud for overvektige barn og ungdom på et av landets sentralsykehus. Metodisk tilnærming Litteraturen som er benyttet i oppgaven omfatter primært sosial-kognitiv teori eller faglitteratur om sosial-kognitiv teori og sosial-kognitive modeller (helseatferdsmodeller). I tillegg inkluderes elementer fra selvreguleringsteori. Vitenskapelige artikler er hovedsakelig funnet gjennom søk i Cochrane og PubMed. Formelle dokumenter som offentlige rapporter og utredninger relatert til temaene ”overvekt og fedme”, ”kosthold” og ”fysisk aktivitet”, har også stått sentralt. Teorigjennomgangen resulterer i flere konkrete spørsmål eller delproblemstillinger som den empiriske undersøkelsen søker svar på. Disse delproblemstillingene er retningsgivende både for datainnsamlingen og for analyse av data. Selve undersøkelsen er lagt opp som en kasusundersøkelse. Gjennom dokumentanalyse, observasjoner og intervjuer er målet å avdekke hvordan motivasjonelle oppfatninger og andre betydningsfulle variabler inkluderes i et behandlingsprogram. Programmet baserer seg på tverrfaglig tilnærming der kontaktsykepleier, fysioterapeut og ernæringsfysiolog framstår som særlig sentrale. Disse tre behandlerne har derfor fått status som informanter. Ulike behandlingssituasjoner er filmet og transkribert. De samme tre informantene er intervjuet for å gi utfyllende informasjon om hvordan behandlingsprogrammet fokuserer på motivasjon i de tilnærmingene. Også intervjuene er filmet og transkribert. Sammen med tilgjengelig dokumentasjon om behandlingsprogrammet danner observasjoner og intervjuer grunnlag for analysen. Resultater og hovedkonklusjoner Teorigjennomgangen besvarer problemstillingens første ledd ved å vise at motivasjon til varig endring av helseatferd forutsetter de motivasjonelle oppfatningene mestringsforventning, forventning om utfall og målsetting/ målforpliktelse. Observasjon av modeller tillegges også avgjørende betydning. Samtidig er selvregulerende evner helt sentrale for å aktivere og vedlikeholde helseatferd. Eksempler fra forskning bidrar til å bekrefte dette. Kasusundersøkelsen tjener dermed til å avklare hvordan disse variablene inkluderes i behandlingsprogrammet. Når det gjelder endring av helseatferd viser teorien at det å ha klare målsetninger er helt avgjørende. Slike mål bør være kortsiktige, spesifikke og oppnåelige. Kasusundersøkelsen avdekker at det aktuelle behandlingsprogrammet i liten grad fokuserer på å avklare ungdommenes målsetninger eller hjelpe dem med å sette seg realistiske, hensiktsmessige mål. Forventning om positive eller negative utfall av kost- og aktivitetsvaner kan bidra til å lede fram mot en intensjon om endring av helseatferd. Imidlertid er det mestringsforventning som viser seg å være den av de motivasjonelle oppfatningene som har størst betydning for intensjon om endringer og for at disse blir varige. Behandlingsprogrammet legger ikke vekt på å kartlegge ungdommenes forventninger om å mestre endrede vaner. Det synes derimot som om de i noe større grad forsøker å bidra til å øke ungdommenes forventninger om mestring underveis. Sosial-kognitiv teori framhever modellers betydning for læring og videre for endring av helseatferd. Dette sammenfaller med behandlingsprogrammets ønske om å involvere foreldre. Det legges også til rette for innleggelse samtidig med en annen ungdom i samme situasjon. Dette gir muligheter for motivasjon gjennom andres framgang. Strategier for implementering av mål om vektreduksjon er avgjørende for varige resultater. Selvreguleringsteori fokuserer på planlegging, igangsetting, vedlikehold og håndtering av tilbakefall. Kasusanalysen viser at behandlingsopplegget først og fremst forsøker å etablere strategier for endring gjennom å øke ungdommenes kunnskap om temaer knyttet til overvekt og fedme. Oppgaven konkluderer med at det er manglende sammenfall mellom hvilke motivasjonelle aspekter sosial-kognitiv teori og selvreguleringsteori holder som forutsetning for en varig endring av helseatferd og den behandlingspraksisen som kasusundersøkelsen avdekker. En slik manglende overensstemmelse kan skyldes flere faktorer. For det første er dette programmet knyttet til et sykehus og får dermed i stor grad et medisinsk fokus. Videre kan knapphet på ressurser sammen med høyt arbeidspress føre til at denne pasientgruppen nedprioriteres. Ungdomstiden er en vanskelig tid med krav og forventninger på mange plan. Dette kan gjøre det vanskelig å skulle stimulere ungdommene til endring av etablerte vaner og nærme seg sensitive temaer som kropp og vekt. Ikke minst har det til nå vist seg problematisk å skulle dokumentere effektive behandlingsprogrammer med langvarig effekt for denne målgruppen. Behandlerne ved dette sykehuset har derfor få konkrete retningslinjer å følge. Det er imidlertid viktig å framheve at selv om behandlingsprogrammet synes å mangle en systematisk tilnærming for motivasjonsarbeidet, så er programmets og behandlernes intensjoner gode og engasjementet for de overvektige ungdommene stort

Confirmatory factor analysis of the proxy version of Kidscreen-27 and relationships between health-related quality of life dimensions and body mass index and physical activity in young schoolchildren

The aim of the study was to perform a confirmatory factor analysis (CFA) to investigate the psychometric properties of the proxy version of Kidscreen-27 in order to determine whether the instrument can be used to assess health-related quality of life (HRQoL) in young children (five to six years of age). Furthermore, we aimed to examine the relationships between the HRQoL dimensions and the body mass index (BMI), physical activity (PA), age, and gender. Altogether, 276 children from schools in eastern Norway were included (September 2016). HRQoL was measured using the Kidscreen-27 proxy version. CFA was conducted to examine the factorial validity of the five-dimension instrument. Structural equation modelling was used to estimate the relationship between the independent variables and the HRQoL subscales that showed an acceptable fit; physical well-being, social support and peers, and school environment. PA was positively, and BMI negatively associated with physical well-being (p < 0.5). Parents of the youngest children reported more negatively on the school environment subscale (p < 0.5). The full 27-item proxy version of Kidscreen should be used with caution for children as young as five to six years as two of the subscales were found to have unsatisfactory factor loadings. The physical well-being, the social support and peers, and the school environment subscales can provide valid and valuable data for research and practice. Even though the associations are small, it is worrying that adverse relationships between PA and BMI and physical well-being are detectable in such a young sample as included here.acceptedVersio

Development and Usability Testing of an Internet Intervention to Increase Physical Activity in Overweight Adolescents

Background: Internet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity. Research shows that overweight and obese adolescents are less physically active than their peers of normal weight. There are good reasons to believe that Internet-based interventions may be particularly suitable for motivating adolescents to increase physical activity, but we need to gain further knowledge of what features are effective and how to design such interventions. Objective: To describe the process of development and evaluation of usability of a Web-based program for increasing physical activity in overweight adolescents. Methods: Informed by the self-determination theory, motivational interviewing, and perspectives on self-regulation, this intervention was developed in a stepwise process by an interdisciplinary team of researchers, designers, developers, and representatives from the target group. An iterative qualitative usability testing approach (observation, survey, and interview) was applied in 2 sequences, first in the lab and second in the field, to assess how adolescents (aged 12-16 years) used and experienced the program and to make adjustments to the program based on evaluation of their response. Results: The following components were included in the program: self-monitoring through planning and registration of physical activity and graphical response on progress, autonomy supportive individual Web-based counseling, forum for social support, and relevant age-adjusted information about physical activity. The first usability test resulted in adjustments related mainly to making the content and aim of the different features more visible and explicit. The second test evaluated the program with adjustments from the first test, revealing that the program was well accepted by the participants and only small aesthetic adjustments had to be made to complete the final version of the Internet program, Young & Active. Conclusions: Thorough preparation, with clear theory foundation and close monitoring in the developmental phase, as well as contribution and iterative evaluation from the target group, is essential to create a user-friendly and engaging program. The efficacy of the program will be evaluated in a controlled trial

The ability of the Ages and Stages Questionnaire (ASQ) to indicate motor difficulties in infants in primary care

Introduction Delayed achievement of motor milestones may be an early indicator of motor difficulties. Parent-reported questionnaires may serve as an efficient, low-cost screening to identify infants in need of further clinical assessment, and thus be a helpful tool in busy health care centers. Purpose To examine the ability of the Ages and Stages Questionnaire, second edition (ASQ-2) to indicate motor difficulties in infants using the Infant Motor Profile (IMP) as the reference standard. Methods A cross-sectional design was applied to examine the correlation between parent-reported data of the ASQ-2 and data from physiotherapist assessment using IMP. Included were 432 mainly low-risk infants aged 3–12 months from primary care. Results Overall, ASQ-2 gross and fine motor scores did not correlate well with the IMP total or domain scores. The ASQ-2 gross motor cut point (> 2SD below the mean), showed 34.3% sensitivity and 96.7% specificity using the 15th percentile from IMP performance domain as reference standard. The positive predictive value to indicate motor difficulties was 48%. Conclusion The motor domains of ASQ-2 have poor ability to identify infants with motor difficulties as indicated by their IMP scores in low-risk infants.publishedVersio

The Outcomes of a 12-Week Internet Intervention Aimed at Improving Fitness and Health-Related Quality of Life in Overweight Adolescents: The Young & Active Controlled Trial

Background: Overweight and obesity among adolescents may have consequences, with potentially lasting effects on health and health-related quality of life (HRQoL). Excess weight is also associated with decreases in physical activity and cardiorespiratory fitness. The aim of the current study was to investigate the short-term effects of a 12-week Internet intervention in a primary care setting intended to increase cardiorespiratory fitness and HRQoL among overweight and obese adolescents. Methods: In this controlled trial, participants (13–15 years) were non-randomly allocated to an intervention- or a control group. The intervention group received 12- weeks access to an online program providing tailored physical activity counseling based on principles from Self-determination Theory and Motivational Interviewing. The control group received standard follow-up by the school nurses. The primary outcome measure of cardiorespiratory fitness was determined using a shuttle run test. The secondary outcomes: HRQoL, leisure time exercise, body image and self- determined motivation for physical activity and exercise, were assessed by self- report measures. Age- and gender-adjusted body mass index (BMI) was calculated based on measurements of height and weight. To compare pre-to post intervention differences within groups, a paired samples t-test was used while crude differences between groups were analyzed with an independent samples t-test. Results: Of the 120 participants, 108 completed the study, 75 in the intervention group and 33 in the control group. Exposure to the intervention had a small effect on cardiorespiratory fitness (0.14; 95% CI [0.01;0.28]; P 5 0.04), and a moderate effect on HRQoL (5.22; 95% CI [0.90; 9.53]; P 5 0.02). Moreover, the control group increased significantly in BMI, yielding a moderate preventive effect on BMI ( 2 0.39; 95% CI [ 2 0.74; 2 0.03]; P 5 0.03) for the intervention group. Conclusion: The results suggest that the Internet intervention with tailored physical activity counseling can have beneficial short-term effect on cardiorespiratory fitness, HRQoL and BMI among adolescents with overweight and obesity

Fostering pupils’ critical health literacy: examining the potential of physical education in lower secondary school

BackgroundIn Norway, the introduction of an interdisciplinary subject named Public Health and Life skills has brought about renewed attention to how health is conceptualized and taught within and across school subjects. Physical education (PE) is one subject that has traditionally been linked to health outcomes. However, a narrow focus on increased physical activity as the main outcome of PE could be counterproductive in the pursuit of health. Critical health literacy (CHL) is put forward as a resource for health that can be nurtured in the PE context; this study hypothesizes that academic achievement in PE is positively associated with some aspects of CHL.MethodsThis cross-sectional study included 521 pupils aged 13–15 years old from five lower secondary schools in Norway. Structural equation models were used as the primary statistical analysis to test the hypothesis. The study controlled for parents’ education, leisure physical activity, and participation in sports club activities.ResultsThe results confirm the hypothesis, showing a positive and significant association between PE and CHL. The association remains when controlling for parents’ education, leisure physical activity, and participation in sports club activities (β^PE→CHL−C1 = 0.264, p = 0.001; β^PE→CHL−C2 = 0.351, p &lt; 0.000).ConclusionIn our sample, academic achievement in PE was associated with higher levels of CHL. This study contributes to the ongoing discussion on the health benefits of PE. We argue that a resource-based health perspective can produce the appropriate aims for health in PE contexts and that the CHL concept contributes to illuminating key areas, promoting suitable teaching strategies, and bringing balance between an individual and collective focus for future health education, both within PE and across different subjects in school contexts

Making room for life and death at the same time – a qualitative study of health and social care professionals’ understanding and use of the concept of paediatric palliative care

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: The concept of pediatric palliative care (PPC) is applied diferently within the healthcare system and among healthcare professionals (HCPs). To our knowledge, no studies have investigated how multidisciplinary HCPs understand the concept of PPC and the aim of this study was to explore the concept of PPC from the view of HCP in a paediatric setting. Methods: We employed an explorative and descriptive design and conducted four focus groups with a total of 21 HCPs working in hospitals with children in palliative care. The data were analysed using qualitative content analysis. Results: The data analysis of the concept of pediatric palliative care resulted in two themes. The frst theme “A fright ening concept that evokes negative emotions,” contains categories to explore the meaning, named “An unfamiliar and not meaningful concept, “A concept still associated with death and dying” and “Healthcare professionals’ responsibility for introducing and using the concept and, to obtain a common meaning.” The second theme was named “A broad and complementary concept,” containing the categories “Total care for the child and the family,” “Making room for life and death at the same time” and “The meaning of alleviation and palliative care.” Conclusions: The included HCPs refected diferently around PPC but most of them highlighted quality of life, total care for the child and the child’s family and interdisciplinary collaboration as core elements. Attention to and knowl edge among HCPs might change the perception about PPC from a frightening concept to one that is accepted by all parties, implemented in practice and used as intended. However, our study reveals that there is still some work to do before PPC is understood and accepted by all those involved.publishedVersio

Young & Active: development and evaluation of an internet intervention to increase fitness and health-related quality of life in adolescents with overweight and obesity

Avhandling (doktorgrad) - Norges idrettshøgskole, 2015Overweight and obesity among adolescents may have consequences with potentially lasting effects on health and health-related quality of life (HRQoL). Excess weight is also associated with decreases in physical activity and cardiorespiratory fitness (CRF). Research presenting effective interventions for prevention and treatment of overweight and obesity in adolescents is limited. Internet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity (PA). The overall aim of the present study was to develop and evaluate an Internet intervention for motivating overweight and obese adolescents to increase and maintain self-determined physical PA and thereby enhance their CRF and HRQoL.Paper I: Riiser K, Løndal K, Ommundsen Y, Sundar T, Helseth S (2013) Development and usability testing of an Internet intervention to increase physical activity in overweight adolescents. JMIR Research Protocols 2: e7.Paper II: Tatt ut av filen i Brage p.g.a. copyright-restriksjoner. / Not in the file in Brage because of copyright issues.Paper III: Tatt ut av filen i Brage p.g.a. copyright-restriksjoner. / Not in the file in Brage because of copyright issues.Paper IV: Riiser K, Løndal K, Ommundsen Y, Småstuen MC, Misvær N, Helseth S (2014) The outcomes of a 12-week Internet intervention aimed at improving fitness and health-related quality of life in overweight adolescents: The Young & Active controlled trial. PLoS ONE (Accepted).Seksjon for coaching og psykologi / Department of Coaching and Psycholog

Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review

Background: Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. Objective: This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. Methods: We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ≤18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results: We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. Conclusions: The strengths of the conclusions are limited by the studies’ methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals

Integrating research in health professions education: a scoping review

Abstract Background Integrating teaching and research may boost students’ learning and improve future clinical practice when incorporated into education. Explorations of health professions students’ involvement in the research processes and their learning outcomes are sparse. Thus, the purpose of this scoping review is to explore the existing scientific literature on courses involving students from health professions education in research activities. The research questions are: Which parts of the research process are the health professions students involved in, and what are the students’ main learning outcomes related to the research process reported to be? Methods A scoping review following the six-step approach of Arksey and O’Malley was undertaken. We searched four electronic databases to identify studies focusing on research-based teaching in health professions education. Inspired by content analysis, we identified key concepts relating to the research process and learning outcomes. Results We screened 1084 abstracts, reviewed 95 full-text reports, and included 24 for analysis. Overall, the students were more involved in conducting and disseminating research than in the planning phases. Learning outcomes were most frequently reported as specific research skills, such as conducting literature reviews, writing academically, and presenting results, but also as improved understanding of research in general as well as improved motivation and confidence in conducting research. Conclusions The heterogeneity of educational programs, study designs, and measures makes it difficult to draw conclusions across the studies included in the review. More research is needed to conclude whether health professions students who actively engage in research gain a better understanding of the research process, become more likely to pursue research in their practice, or are more motivated to choose an academic career