A Health game as an intervention to support tobacco-related health literacy among early adolescents

The aim of this study was to develop and evaluate the feasibility of a health game intervention supporting tobacco-related health literacy in 10 to 13-year-old early adolescents. The study had two phases. During the development phase, we explored the determinants of tobacco-related health literacy with a qualitative descriptive study with early adolescents (n=39, focus groups, data analyzed using thematic analysis). We also conducted a review of reviews (n=15, narrative synthesis) of existing evidence on health games among children and adolescents. Furthermore, we explored the views of (n=39, focus groups and n=83, online questionnaire, thematic analysis) and collected feedback from adolescents (n=10+44 questionnaires, statistical analysis) while producing a health game called Fume. In the second phase, we evaluated feasibility (demand, acceptability, short-term effectiveness) of Fume using validated instruments, questionnaires and by tracking its actual use. We conducted the study with 151 early adolescents using a single-blind, three-armed cluster randomized design. The McNemar, Fisher exact, and non-parametric tests were used to test differences within and between groups. The results gathered during the development phase suggest that supporting tobacco-related health literacy among early adolescents requires being aware of the multidimensional nature of the determining factors, and paying attention to the mediating role of the interpretation process of health messages. Based on existing literature health games hold potential among children and adolescents, but further research is needed. The adolescent participants pointed several aspects regarding the acceptability of Fume during its development process, including the game’s positive approach to tobacco non-use, and its high-quality graphics. The feasibility study with the game showed that, compared to a non-gamified website, there was a higher usage rate for Fume during the two-week study period (P ≤ 0.001 for all the values) as well as greater interest in Fume (P ≤ 0.001). The opinions of adolescents about the interventions did not differ in a statistically significant way. Favorable changes were found within the Fume group regarding positive (P=0.002) and negative (P=0.02) smoking outcome expectations and attitudes towards cigarette smoking (P=0.01). We did not find statistically significant differences in the changes of the theory-based determinants of tobacco-related health literacy between the Fume, website and control groups. The gathered results highlight several aspects of tobacco-related health literacy as well as of health games. Fume was found to be more feasible among early adolescents than the non-gamified website, but there is still room for improvement.Terveyspeli tupakkaan liittyvää terveydenlukutaitoa tukevana interventiona varhaisnuorilla Tämän tutkimuksen tarkoituksena oli kehittää ja arvioida terveyspeliä tupakkaan liittyvää terveydenlukutaitoa tukevana interventiona 10–13 -vuotiailla varhaisnuorilla. Tutkimus toteutettiin kaksivaiheisena. Kehittämisvaiheessa tarkastelimme varhaisnuorten (n=39, fokusryhmähaastattelut) näkökulmasta tupakkaan liittyvää terveydenlukutaitoa määrittäviä tekijöitä laadullisella kuvailevalla tutkimuksella. Koostimme yhteenvedon kirjallisuuskatsauksissa (n=15) esitetystä tutkimusnäytöstä koskien terveyspelejä lasten ja nuorten terveyden edistämisen menetelmänä. Lisäksi tarkastelimme nuorten näkemyksiä (n=39, fokusryhmähaastattelu ja n=83, kysely, temaattinen analyysi) ja keräsimme nuorilta palautetta (n=10+44 kyselyt, tilastolliset analyysimenetelmät) terveyspelin nimeltä Fume kehitysprosessin aikana. Tutkimuksen toisessa vaiheessa arvioimme Fumen soveltuvuutta (käyttö, hyväksyntä, lyhytaikainen vaikuttavuus) terveysohjauksen menetelmänä. Osatutkimus toteutettiin ryppäittäin satunnaistetulla, kokeellisella tutkimusasetelmalla. Tähän osatutkimukseen osallistui 151 varhaisnuorta. McNemar, Fisher´s exact ja ei-parametrisiä testejä käytettiin ryhmien välisten ja sisäisten erojen analysointiin. Kehittämisvaiheen tulosten perusteella tupakkaan liittyvän terveydenlukutaidon tukeminen edellyttää terveydenlukutaitoa määrittävien tekijöiden monimuotoisuuden ja terveysviestien tulkintaprosessin roolin huomioimista. Terveyspelit osoittautuivat aiemman kirjallisuuden perusteella potentiaalisiksi lapsilla ja nuorilla, mutta tutkimusta tarvitaan lisää. Nuorten näkemykset toivat esille, että Fumen kehittämisessä huomiota tulee kiinnittää muun muassa tupakoimattomuuden positiivisten puolien korostamiseen ja korkealaatuisiin peligrafiikoihin. Soveltuvuustutkimuksessa kahden viikon ajanjaksona Fumen käyttö (P ≤ 0.001 kaikille arvioille) ja nuorten kiinnostus Fumea kohtaan (P ≤ 0.001) olivat suurempaa verrattuna eipelillistettyyn internetsivustoon. Varhaisnuorten mielipiteet interventioista eivät eronneet toisistaan tilastollisesti merkitsevästi. Havaitsimme myönteisiä muutoksia Fumea käyttäneessä ryhmässä seuraavissa muuttujissa: positiiviset (P=0.002) ja negatiiviset (P=0.02) savukkeisiin liittyvät mielikuvat ja asenteet savukkeiden polttamista kohtaan (P=0.01). Emme havainneet tilastollisesti merkitseviä eroja tapahtuneissa muutoksissa Fume-, internetsivusto- ja kontrolliryhmien välillä. Tutkimus tuotti uutta tietoa tupakkaan liittyvän terveydenlukutaidon tukemisesta ja terveyspeleistä. Tutkimus osoitti, että Fume on soveltuvampi interventio varhaisnuorilla kuin ei-pelillistetty internetsivusto, mutta peli vaatii jatkokehitystä

Encountering sexual and gender minority youth in healthcare : an integrative review

Aim: To describe the encounters with sexual and gender minority (SGM) youth in healthcare based on the existing research. Background: The development of sexual orientation and gender identity can create challenges in an SGM youth's life, and they may need support from health professionals. Heteronormativity has been recognised as a barrier to the identification of diversity in sexuality and gender, and no previous literature review has studied heteronormativity thoroughly. Methods: An integrative review following Whittemore and Knafl was conducted. A literature search was systematically undertaken in six databases (PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO, Eric, and Academic Search Premier). Finally, 18 research articles were included. Data were analysed deductively with the theoretical framework from Stevi Jackson's (2006) article to understand the role of heteronormativity in the healthcare of SGM youth. Findings: The encounters with SGM youth consisted of two simultaneous themes. Heteronormative care included three elements: (1) the effect of heteronormativity on health professionals' competence to work with SGM youth, (2) false assumptions about SGM youth, and (3) the influence of heteronormativity on encounters with SGM youth. Diversity-affirming care included two elements: (4) the considerateness of health professionals towards SGM youth and (5) inclusive care of SGM youth. Conclusion: This review summarised how SGM youth were encountered in healthcare and how heteronormativity was affecting their healthcare. Furthermore, this review identified elements that supported diversity-affirming care. With diversity-affirming care, SGM youth may access the information and support they need from healthcare. Further research is needed about how diversity-affirming care can be applied to the healthcare of SGM youth and how elements of heteronormative care are occurring globally in the healthcare of SGM youth. The perceptions of transgender and other gender minority youth were under-represented in the studies and research needs to focus more on how they are encountered in healthcare.Peer reviewe

LGBTQ plus Students' Experiences of Junior High School Nursing in Finland : A Qualitative Study

Previous research shows that lesbian, gay, bisexual, transgender, queer/questioning, and other (LGBTQ+) students can experience substantial emotional- and health-related issues at school, but research into LGBTQ+ students' experiences of school nursing is limited. This qualitative study describes the experiences of Finnish LGBTQ+ students engaging with junior high school nurses. Data were collected from 35 LGBTQ+ students using an online survey tool comprising of a set of open-ended questions. Two interconnecting themes were identified following thematic analysis: (1) junior high school nurse engagement: a mixed or unsatisfactory experience and (2) LGBTQ+ students' needs for diversity-affirming junior high school nursing. Findings show that LGBQT+ students felt junior high school nurse engagement was often unsupportive with issues around their sexuality and gender identity. LGBTQ+ students expressed the need for diversity-affirming information and support in school settings. Further research from school nurses' perspective is needed to increase understanding of this topic.Peer reviewe

Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross‐sectional study

The aim of this correlational, cross‐sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self‐reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence‐based pressure ulcer prevention practices should be promoted

INSTRUMENTS FOR ASSESSING TOBACCO-RELATED HEALTH LITERACY: TRANSLATION AND ADAPTATION TO EUROPEAN PORTUGUESE

Objetivo: traducir y adaptar culturalmente al portugués europeo los instrumentos de evaluación de la alfabetización en salud sobre el tabaco Attitudes Towards Tobacco Use, Tobacco-Use Motives y Motivation to Decline Tobacco Use in the Future, y Smoking Outcome Expectation Scale y Anti-Smoking Self-Efficacy Scale, y realizar una validación preliminar. Método: traducción y adaptación transcultural según las recomendaciones del Institute for Work and Health y validación preliminar en 144 adolescentes de dos escuelas públicas de la región central de Portugal, en abril y mayo de 2019. Resultados: se eliminaron los artículos relacionados con la snus, ya que no eran relevantes en el contexto portugués. De este modo, dos instrumentos se componen de un solo ítem. Los valores del alfa de Cronbach de las versiones en portugués europeo fueron 0,799, 0,673, 0,905 y 0,890. Conclusión: contribuye a la existencia de instrumentos de evaluación de la alfabetización en salud sobre el tabaco, adaptados al portugués europeo, para la población adolescente.Objectives: To translate and culturally adapt to European Portuguese the tobacco-related health literacy assessment instruments “Attitudes Towards Tobacco Use,” “Tobacco-Use Motives,” “Motivation to Decline Tobacco Use in the Future,” “Smoking Outcome Expectation Scale,” and “Anti-Smoking Self-Efficacy Scale”; and to conduct the preliminary validation of the translated versions. Methodology: Translation and cross-cultural adaptation in accordance with the Institute for Work & Health recommendations and preliminary validation study using a sample of 144 adolescents from two public schools in central Portugal in April and May 2019. Results: Snus-related items were removed due to their lack of relevance in the Portuguese context. Thus, two instruments consisted of only one item each. The European Portuguese versions of the instruments presented Cronbach’s alpha scores of 0.799, 0.673, 0.905, and 0.890. Conclusion: The present study contributed to developing European Portuguese versions of instruments for assessing tobacco-related health literacy among adolescents.Objetivo: traduzir e adaptar culturalmente para português europeu os instrumentos de avaliação da literacia em saúde acerca do tabaco Attitudes Towards Tobacco Use, Tobacco-Use Motives e Motivation to Decline Tobacco Use in the Future, e Smoking Outcome Expectation Scale e Anti-Smoking Self-Efficacy Scale, e realizar validação preliminar. Método: tradução e adaptação transcultural de acordo com as recomendações do Institute for Work and Health e validação preliminar em 144 adolescentes de duas escolas públicas da região central de Portugal, em abril e maio de 2019. Resultados: foram retirados itens relativos a snus, por não apresentarem relevância no contexto português. Assim, dois instrumentos passaram a ser constituídos apenas por um item. Os valores de alfa de Cronbach das versões em português europeu foram 0,799, 0,673, 0,905 e 0,890. Conclusão: contribui para a existência de instrumentos de avaliação da literacia em saúde acerca do tabaco, adaptados para português europeu, para a população dos adolescente

Factors determining nurses' knowledge of evidence-based pressure ulcer prevention practices in Finland: a correlational cross-sectional study

Background Pressure ulcers cause economic burden, human suffering, pain and decreased health-related quality of life in patients. Pressure ulcers are preventable in most cases, and nursing staff knowledge is a key factor in successful pressure ulcer prevention. Further evidence is needed to better tailor pressure ulcer prevention training programmes to the nursing staff.Aim To evaluate the level of nursing staff knowledge about evidence-based pressure ulcer prevention practices in both primary and specialised care, and to identify what factors determine nurses' knowledge levels.Methods A correlational, cross-sectional study was conducted from 2018 to 2019 in two hospital districts in Finland. The Pressure Ulcer Prevention Knowledge test was used to collect data, and the Attitude towards Pressure ulcer Prevention (APuP) instrument was used as a background variable. The data were statistically analysed with Wilcoxon and Kruskal-Wallis tests, Spearman correlations and multiple linear regression.Results The pressure ulcer prevention knowledge of the participating registered nurses, practical nurses and ward managers (N = 554) was on average 24.40 (max. 35.00). There was no difference in the participants' knowledge based on the type of unit in which they were working (primary or specialised care). The participants' attitudes (p Conclusions Special attention needs to be paid to the knowledge of those nurses working in positions that require lower levels of education and those who rarely take care of patients with pressure ulcers. Supporting nurses' positive attitudes towards pressure ulcer prevention should be an essential part of pressure ulcer prevention training. Nurses' self-evaluations of their training needs can be used to target training. The limitations of the study should be considered when generalising the results.</div

Encountering sexual and gender minority youth in healthcare: an integrative review

AimTo describe the encounters with sexual and gender minority (SGM) youth in healthcare based on the existing research.BackgroundThe development of sexual orientation and gender identity can create challenges in an SGM youth’s life, and they may need support from health professionals. Heteronormativity has been recognised as a barrier to the identification of diversity in sexuality and gender, and no previous literature review has studied heteronormativity thoroughly.MethodsAn integrative review following Whittemore and Knafl was conducted. A literature search was systematically undertaken in six databases (PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO, Eric, and Academic Search Premier). Finally, 18 research articles were included. Data were analysed deductively with the theoretical framework from Stevi Jackson’s (2006) article to understand the role of heteronormativity in the healthcare of SGM youth.FindingsThe encounters with SGM youth consisted of two simultaneous themes. Heteronormative care included three elements: (1) the effect of heteronormativity on health professionals’ competence to work with SGM youth, (2) false assumptions about SGM youth, and (3) the influence of heteronormativity on encounters with SGM youth. Diversity-affirming care included two elements: (4) the considerateness of health professionals towards SGM youth and (5) inclusive care of SGM youth.ConclusionThis review summarised how SGM youth were encountered in healthcare and how heteronormativity was affecting their healthcare. Furthermore, this review identified elements that supported diversity-affirming care. With diversity-affirming care, SGM youth may access the information and support they need from healthcare. Further research is needed about how diversity-affirming care can be applied to the healthcare of SGM youth and how elements of heteronormative care are occurring globally in the healthcare of SGM youth. The perceptions of transgender and other gender minority youth were under-represented in the studies and research needs to focus more on how they are encountered in healthcare.</div

Supporting LGBTQ+ Students: A Focus Group Study with Junior High School Nurses

LBGTQ+ students often miss the support and information they need in the school nursing, but little is known about junior high school (JHS) nurses’ work with LGBTQ+ students. 15 JHS nurses were interviewed in focus groups about their perceptions of supporting LGBTQ+ students. Four interconnected themes were identified with inductive thematic analysis: (1) JHS nurses’ professional identity and practice; (2) Recognition of sexual and gender diversity in school; (3) Family acceptance process; and (4) LGBTQ+ students as school nursing clients. JHS nurses self-identified as accepting professionals, but having limited skills, knowledge, and education needed in supporting LGBTQ+ students. Supporting LGBTQ+ students is a complex phenomenon, and to enhance JHS nurses’ competence in providing care for these students, sexual and gender diversity needs to be included in evidence-based nursing information sources, covered in nursing education, and the school needs to be secured as LGBTQ+ safe place.</p

Feasibility of mobile health game “Fume” in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

Objective: New interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10–13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website.Methods: In total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n=61), a group with access to the website (n=47), and a group with no intervention (n=43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests.Results: Statistically significant favorable changes during the study period were found for positive (P=0.002)and negative (P=0.02) smoking outcome expectations and attitudes towards cigarette smoking (P=0.01) within the group using Fume. No statistically significant changes were detected within the website or controlgroups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P Conclusions: The intervention with embedded game elements, the health game Fume, was found to be morefeasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking selfefficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.</p