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

Masteroppgaver som viktige bidrag til kunnskapsbasert helsefremmende arbeid?

I denne kvalitative studien undersøkes hvordan masteroppgavene kan bidra til kunnskapsbasen i helsefremmende arbeid. Studien er basert på en gjennomgang av masteroppgaver i helsefremmende arbeid fra perioden 2008 – 2018 ved ett universitet i Norge, samt et fokusgruppeintervju med den akademiske faggruppen tilknyttet dette masterstudiet. Data er analysert ved hjelp av innholdsanalyse. Analysen viser at masteroppgavene speiler emnet som beskrevet i internasjonale konsensusdokumenter om undervisning og forskning i helsefremmende arbeid, og svarer på forskningsbehov relatert til helsefremmende praksis. For at masteroppgavene skal kunne bidra til fagets forskningsbase, kreves fagfellevurderte publikasjoner. Slike publikasjoner forutsetter innsats fra både studenten og veilederen, noe som kan være en utfordring for begge parter på grunn av mangel på ressurser. Det er behov for organisatorisk tilrettelegging for å skape en kultur for publisering av masteroppgaver i vitenskapelige tidsskrifter. Abstract Master’s theses as important contributions to knowledge-based health promotion? This qualitative study examines how master's theses can contribute to the knowledge base of health promotion.  The study is based on a review of master's theses published from 2008 – 2018 in one university in Norway, and a focus group interview with university academics working at the current health promotion program. Data were analyzed using content analysis. The analysis shows that the master's theses mirror the subject matter as described in international consensus documents on teaching and research on health promotion. In addition, they provide new knowledge about local health promotion practice and research needs. For master's theses to be able to contribute to the research base, peer-reviewed publications are required. Such publications require efforts from both the student and the supervisor and can be difficult to achieve due to lack of resources. There is a need for organizational support to create a culture for publishing master’s theses in scientific journals

Workplace Inclusion of People With Health Issues, Immigrants, and Unemployed Youths—A Qualitative Study of Norwegian Leaders’ Experiences

Aim: To explore leaders’ perceptions and experiences of facilitators and barriers for successful workplace inclusion of immigrants, unemployed youths, and people who are outside the labor market due to health issues. Methods: Semi-structured individual interviews with 16 leaders who actively engaged in inclusion work, representing different occupations, were conducted. Systematic Text Condensation was used to structure the analysis. Results: The participating leaders emphasized that job match, including their perception of workers’ motivation, respect for workplace policies, and the availability of appropriate accommodation at the workplace, facilitated work inclusion. An active public support system providing professional and financial support to workers and leaders was also an important facilitating factor. The leaders emphasized that their perception of workers’ lack of motivation for the job was the most important barrier in their own hiring and inclusion engagement. Successful inclusion depended on all workers acknowledging responsibility for and contributing to an inclusive work environment. Being open and willing to discuss challenges was an important part of making the inclusion work. In addition, leadership qualities, such as empathy, patience, and a non-judgmental attitude, appeared as a hallmark among these leaders who actively engaged in inclusion work. Conclusion: Workplace inclusion of this population of marginalized people was facilitated by job match, mutual respect, commitment, and trust, as well as financial and practical support from the public support system. Leaders’ inclusion practices were furthermore affected by personal attitudes and perceptions of social responsibility. Even so, successful workplace inclusion was presented as a two-way street. Leaders have the main responsibility in initiating a respectful and trusting relationship, but both the worker and the leader needs to contribute to make the relationship thrive.Workplace Inclusion of People With Health Issues, Immigrants, and Unemployed Youths—A Qualitative Study of Norwegian Leaders’ ExperiencespublishedVersio

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

Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups

Background Norway is internationally known today for its political and socio-economic prioritization of equity. The 2012 Public Health Act (PHA) aimed to further equity in the domain of health by addressing the social gradient in health. The PHA’s main policy measures were (1) delegation to the municipal level of responsibility for identifying and targeting underserved groups and (2) the imposition on municipalities of a “Health in All Policies” (HiAP) approach where local policy-making generally is considered in light of public health impact. In addition, the act recommended municipalities employ a public health coordinator (PHC) and required a development of an overview of their citizens’ health to reveal underserved social segments. This study investigates the relationship between changes in municipal use of HiAP tools (PHC and health overviews) with regard to the PHA implementation and municipal prioritization of fair distribution of social and economic resources among social groups. Methods Data from two surveys, conducted in 2011 and 2014, were merged with official register data. All Norwegian municipalities were included (N = 428). Descriptive statistics as well as bi- and multivariate logistic regression analyses were performed. Results Thirty-eight percent of the municipalities reported they generally considered fair distribution among social groups in local policy-making, while 70% considered fair distribution in their local health promotion initiatives. Developing health overviews after the PHA’s implementation was positively associated with prioritizing fair distribution in political decision-making (odds ratio [OR] = 2.54; CI: 1.12-5.76), compared to municipalities that had not developed such overviews. However, the employment of PHCs after the implementation was negatively associated with prioritizing fair distribution in local health promotion initiatives (OR = 0.22; CI: 0.05-0.90), compared to municipalities without that position. Conclusion Development of health overviews — as requested by the PHA — may contribute to prioritization of fair distribution among social groups with regard to the social determinants of health at the local level

Long-term work retention after treatment for cancer:a systematic review and meta-analysis

Purpose: Almost half of people diagnosed with cancer are working age. Survivors have increased risk of unemployment, but little is known about long-term work retention. This systematic review and meta-analysis assessed work retention and associated factors in long-term cancer survivors. Methods: We searched Medline/Pubmed, Embase, PsychINFO, and CINAHL for studies published 01/01/2000–08/01/2019 reporting work retention in adult cancer survivors ≥ 2 years post-diagnosis. Survivors had to be in paid work at diagnosis. Pooled prevalence of long-term work retention was estimated. Factors associated with work retention from multivariate analysis were synthesized. Results: Twenty-nine articles, reporting 21 studies/datasets including 14,207 cancer survivors, were eligible. Work retention was assessed 2–14 years post-diagnosis. Fourteen studies were cross-sectional, five were prospective, and two contained both cross-sectional and prospective elements. No studies were scored as high quality. The pooled estimate of prevalence of long-term work retention in cancer survivors working at diagnosis was 0.73 (95%CI 0.69–0.77). The proportion working at 2–2.9 years was 0.72; at 3–3.9 years 0.80; at 4–4.9 years 0.75; at 5–5.9 years 0.74; and 6+ years 0.65. Pooled estimates did not differ by cancer site, geographical area, or study design. Seven studies assessed prognostic factors for work retention: older age, receiving chemotherapy, negative health outcomes, and lack of work adjustments were associated with not working. Conclusion: Almost three-quarters of long-term cancer survivors working at diagnosis retain work. Implications for Cancer Survivors: These findings are pertinent for guidelines on cancer survivorship care. Professionals could focus support on survivors most likely to have poor long-term work outcomes

Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups

Abstract Background: Norway is internationally known today for its political and socio-economic prioritization of equity. The 2012 Public Health Act (PHA) aimed to further equity in the domain of health by addressing the social gradient in health. The PHA’s main policy measures were (1) delegation to the municipal level of responsibility for identifying and targeting underserved groups and (2) the imposition on municipalities of a “Health in All Policies” (HiAP) approach where local policy-making generally is considered in light of public health impact. In addition, the act recommended municipalities employ a public health coordinator (PHC) and required a development of an overview of their citizens’ health to reveal underserved social segments. This study investigates the relationship between changes in municipal use of HiAP tools (PHC and health overviews) with regard to the PHA implementation and municipal prioritization of fair distribution of social and economic resources among social groups. Methods: Data from two surveys, conducted in 2011 and 2014, were merged with official register data. All Norwegian municipalities were included (N=428). Descriptive statistics as well as bi- and multivariate logistic regression analyses were performed. Results: Thirty-eight percent of the municipalities reported they generally considered fair distribution among social groups in local policy-making, while 70% considered fair distribution in their local health promotion initiatives. Developing health overviews after the PHA’s implementation was positively associated with prioritizing fair distribution in political decision-making (odds ratio [OR] = 2.54; CI: 1.12-5.76), compared to municipalities that had not developed such overviews. However, the employment of PHCs after the implementation was negatively associated with prioritizing fair distribution in local health promotion initiatives (OR = 0.22; CI: 0.05-0.90), compared to municipalities without that position. Conclusion: Development of health overviews — as requested by the PHA — may contribute to prioritization of fair distribution among social groups with regard to the social determinants of health at the local level