Existential Well-Being in Nature: A Cross-Cultural and Descriptive Phenomenological Approach.

Exploring the putative role of nature in human well-being has typically been operationalized and measured within a quantitative paradigm of research. However, such approaches are limited in the extent to which they can capture the full range of how natural experiences support well-being. The aim of the study was to explore personal experiences in nature and consider how they might be important to human health and well-being. Based on a descriptive phenomenological analysis of fifty descriptions of memorable moments in nature from England, Indonesia, and Norway, our findings illustrate a common structure presented under three themes: 1. serenity that gives rise to a growing awareness of how the body is stimulated by the senses; 2. admiration and appreciation for the sensation of beauty; 3. an emerging sense of togetherness and deep emotional bonding. The findings are discussed using the concepts of ecological time and the ecological body, which foreground being in nature as constituted as an interdependent and dynamic human process. We conclude by understanding well-being in terms of human responsiveness to their surroundings and thus as rooted in the human condition.

Pasung: A qualitative study of shackling family members with mental illness in Indonesia.

Use of coercion on people with mental illness is a deeply embedded practice around the world. Not only does the practice raise human rights issues, it also leads to further mental, physical, and emotional harms. In Indonesia, 'pasung' is a common practice of physical restraint, which involves lay people using a variety of illegal methods to tie a person. In this article, we explore the meanings families attach to their actions when using pasung by asking the question: to what extent does the use of pasung by families emerge from socioculturally prescribed norms and conventions? To explore this question, we conducted and analysed eight interviews with family members from Nias Island, Indonesia using Giorgi's descriptive phenomenological method. Our findings reveal that pasung emerges in the disjunction between sociocultural demands and the family's capacity to meet these demands. Struggling to understand the behaviour of a family member with mental illness, the family tries to cope with neighbourhood reactions to ever more visible behavioural signs alongside managing their everyday life. These struggles, in turn, make their social situation increasingly stressful, which initiates a process of depersonalization as a response. Moreover, the prevailing sociocultural values convey a need to act according to expected norms. As such, pasung materializes as a socioculturally accepted practice that allows families to take back control in stressful social situations. In sum, when families feel overwhelming emotional stress and a sense of powerlessness, they try to resolve their situation by using pasung to regain control and thus manage their lives.

Mapping the digital food environment: A systematic scoping review.

Food environments are directly linked to diets and health outcomes such as overweight, obesity, and noncommunicable diseases. The digitalization of food environments is becoming a central issue in public health, yet little is known about this emerging field. We performed a systematic scoping review to map the research on the digital food environment and investigate how the eight dimensions of the food environment, according to an established framework (availability, prices, vendor and product properties, marketing and regulation, accessibility, affordability, convenience, and desirability), might be shifting in the context of a digital society. We searched MEDLINE, EMBASE, Scopus, and Web of Science for studies published between 2000 and 2019, using search terms covering digital technology and food environment, which yielded 13,580 unique records. Our analysis of 357 studies shows that digitalization is taking place in all dimensions of the food environment, and enabling the emergence of new forms of buying and selling food, such as online grocery shopping and online food delivery, which may be changing availability of foods and affecting the physical distance to shops and time allocated for shopping. Systematic reviews identified indicated that digital food marketing and social media can influence food choices, preferences and consumption. Our findings suggest that digital and physical food environments are interconnected and influencing one another, but the impact of the digital on health and nutrition is yet unclear.

The longitudinal association between objectively measured physical activity and mental health among Norwegian adolescents.

BACKGROUND: Mental health among young people in many countries, including Norway, seems to be deteriorating. Physical activity (PA) has been positively associated with mental health. However, methodological issues related to study design and measurement of PA and mental health outcomes currently limits our understanding of the relationship. The purpose of the present study is to explore the prospective relationship between objectively measured PA and mental health outcomes. More specifically, volume (total PA), intensity (moderate-to-vigorous PA [MVPA]) and sedentary behaviour (SED) were explored in relation to mental health problems (MHP) and mental wellbeing (MWB). METHODS: Data from 599 adolescents (54.4% female, mean age at baseline ±SD 13.3 ± 0.3 years) were collected annually during their 3 years (T1, T2 and T3) at lower secondary school. PA was measured using accelerometry. MWB was measured using the 'Warwick-Edinburgh Mental Wellbeing Scale' and MHP by the 'Strengths and Difficulties Questionnaire'. Multiple linear regression was performed to explore relationships between changes in PA/SED (between T1-T3) and MWB/MHP (at T3). The term 'movement categories' was used to refer to components on the movement continuum and includes volume (total PA), intensity (MVPA) and SED. RESULTS: Among boys, any increase in SED was positively associated with MWB (ß = 0.05, 95% CI: 0.01 to 0.10), whereas a small positive association between an increase in total PA (volume) and MWB was found among girls (ß = 1.13, 95% CI: 0.05 to 2.21). There were no associations between changes in any movement categories [total PA (volume), MVPA, SED] and score on MHP at T3, neither for girls nor boys. CONCLUSION: This study provided no clear evidence of any association between change in volume or intensity of PA and MHP among an overall healthy adolescent study sample. There was, however, evidence of a relationship between increased SED and MWB among boys and increased volume of PA and MWB among girls. The relationship between movement categories and mental health may depend on the measurement used to assess both PA/SED and variables of mental health. Future research would be strengthened by researchers clarifying what construct of mental health is being used and measured.

Physical activity and academic achievement among Norwegian adolescents: Findings from a longitudinal study.

Regular physical activity (PA) has been associated with academic achievement, but the evidence is mainly based on cross-sectional research and self-reported measures of PA. The purpose of the current study was to explore the longitudinal relationship between objectively measured PA and academic achievement among a cohort of adolescents in Norway between 2016 and 2018. As a secondary aim, an indirect relationship via waist circumference (WC) and sleep duration was assessed. Data from 599 adolescents (54.4% female, mean age at baseline ± SD 13.3 ± 0.3 years) were collected annually during their three years at lower secondary school. PA was measured objectively using accelerometry. Academic achievement was assessed using grade point average (GPA) from school records. Linear regression analysis was performed to explore associations between longitudinal changes in measures of PA (Total PA and moderate-to-vigorous PA [MVPA]) and academic achievement directly or via mediators. Results showed no significant associations between Total PA or MVPA and academic achievement, either in the main analyses or through mediation of WC and sleep duration. The results contribute to a growing evidence base of studies showing no association between objectively measured PA and academic achievement among adolescents.

Mapping the digital food environment: a scoping review protocol.

INTRODUCTION: Food environments are the interface through which people interact with the broader food system. They are a key determinant of healthy and sustainable diets. The widespread use of digital technology in late modernity and the shift towards a digital society have posed new challenges for nutrition and health, with a concomitant surge in research on social media, digital health promotion interventions, and more recently, increasing interest in digital food marketing. While the literature is abundant on studies linking food, nutrition and digital technology, the effort to conceptualise and describe the digital food environment is new. This scoping review aims to support the development of a definition of the digital food environment and characterise it, along with key thematic research trends on this topic and potential consequences for nutrition and health. METHODS AND ANALYSIS: The planned scoping review will be supported by the methodological framework proposed by Arksey and O'Malley and further developed by Levac et al. Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and MetaAnalyses-Extension for Scoping Reviews (PRISMA-ScR) checklist and guidelines. The development of the search strategy was guided by the food environment conceptual framework developed by Turner et al. Four databases will be searched: MEDLINE, EMBASE, Scopus and Web of Science. Citation searching will be applied to identify additional studies, through checking of reference lists of primary studies and reviews. Studies in English, published from the year 2000 onwards, will be included. No geographical or population limits will be applied. Data will be extracted and analysed using a standardised charting tool. ETHICS AND DISSEMINATION: No ethical approval is required for this study. The results will be submitted to an international peer-reviewed journal and scientific conferences. They will be disseminated through digital science communication platforms, including academic social media, to amplify its reach and usefulness.

Do "Girls Just Wanna Have Fun?" Participation Trends and Motivational Profiles of Women in the Birkebeiner Races, Norway's Ultimate Mass Participation Ski Event.

Mass participation sporting events (MPSEs) are viewed as encouraging regular exercise in the population, but concerns have been expressed about the extent to which they are inclusive for women. This study focuses on an iconic cross-country skiing MPSE in Norway, the Birkebeiner race (BR), which includes different variants (main, Friday, half-distance, and women-only races). In order to shed light on women's participation in this specific MPSE, as well as add to the understanding of women's MPSEs participation in general, this study was set up to: (i) analyze trends in women's participation, (ii) examine the characteristics, and (iii) identify key factors characterizing the motivational profile of women in different BR races, with emphasis on the full-distance vs. the women-only races. Entries in the different races throughout the period 1996-2018 were analyzed using an autoregressive model. Information on women's sociodemographic characteristics, sport and exercise participation, and a range of psychological variables (motives, perceptions, overall satisfaction, and future participation intention) were extracted from a market survey and analyzed using a machine learning (ML) approach (n = 1,149). Additionally, qualitative information generated through open-ended questions was analyzed thematically (n = 116). The relative prevalence of women in the main BR was generally low (< 20%). While the other variants contributed to boosting women's participation in the overall event, a future increment of women in the main BR was predicted, with women's ratings possibly matching the men's by the year 2034. Across all races, most of the women were physically active, of medium-high income, and living in the most urbanized region of Norway. Satisfaction and future participation intention were relatively high, especially among the participants in the women-only races. "Exercise goal" was the predominant participation motive. The participants in women-only races assigned greater importance to social aspects, and perceived the race as a tradition, whereas those in the full-distance races were younger and gave more importance to performance aspects. These findings corroborate known trends and challenges in MPSE participation, but also contribute to greater understanding in this under-researched field. Further research is needed in order to gain more knowledge on how to foster women's participation in MPSEs.

Psychological distress among Norwegian adolescents: Changes between 2001 and 2009 and associations with leisure time physical activity and screen-based sedentary behaviour.

AIMS: The aim of this work was to examine psychological distress among Norwegian adolescents in relation to changes over time and the associations with leisure time physical activity and screen-based sedentary behaviour. METHODS: This cross-sectional study was based on data retrieved from the Norwegian Youth Health Surveys in 2001 and 2009 in Hedmark County. Adolescents aged 15-16 years old completed a questionnaire regarding physical activity, sedentary behaviour, psychological distress and other health and lifestyle variables. The self-report Hopkins Symptom Checklist-10 was used to assess psychological distress. Multinomial logistic regression was used to analyse the associations between psychological distress, physical activity and sedentary behaviour. RESULTS: Self-reported psychological distress increased significantly from 2001 to 2009 (from 19.4 to 28.2%), with the proportion of girls reporting psychological distress being twice as large as the proportion of boys. The proportion of adolescents who were physically active for ⩾11 hours per week increased significantly over the same period (from 6.0 to 10.4%). Sedentary behaviour ⩾6 hours per school day increased significantly among both sexes between 2001 and 2009. Physical activity (⩾11 hours) and sedentary behaviour (⩾6 hours) were both significantly associated with psychological distress. CONCLUSIONS: The association between physical activity, sedentary behaviour and psychological distress was weak; only high amounts of physical activity and high amounts of screen-based sedentary behaviour were associated with psychological distress. Longitudinal studies are needed to provide further insights into these associations and to understand the extent to which these variables might be causally related.

Leisure-time physical activity among adolescents and subsequent use of antidepressant and hypnotic drugs: a prospective register linkage study.

In this prospective study, the association between physical activity and subsequent use of antidepressant and hypnotic drug use in adolescents aged 15-16 years was examined. This study is based on information retrieved from the Norwegian Youth Health Surveys (2000-2003) and linked to prescription data from the Norwegian Prescription Database (2004-2013). In total, the study included 10711 participants with a participation rate of 87%. Adolescents were asked how many hours per week they spent on physical activity that made them sweat and/or be out of breath outside of school. Incident psychotropic drug use (outcome measure) was defined as ≥ 1 prescription of one of the following psychotropic drugs: hypnotics and antidepressants registered in the Norwegian Prescription Database. In the crude model for the time period 2004-2007, the odds of incident hypnotic use were lower for those who were physically active 1-2 h per week (OR 0.48-0.64), compared to those who were physically inactive (< 1 h per week). However, the association become non-significant 4-year post-baseline (2008-2010 and 2011-2013). In the crude model for the time periods 2004-2007, 2008-2010 and 2011-2013, the odds of incident antidepressant use were lower for physically active adolescents (2004-2007: OR 0.46-0.71, 2008-2010: OR 0.40-0.67 and 2011-2013: OR 0.37-0.58, compared to those who were physically inactive < 1 h. However, after adjustment for confounders, the association became non-significant in all time periods except in physical activity 5-7 and 8-10 h in the period 2008-2010. Physical activity does not indicate any association with later use of antidepressants, and the significant association with incident hypnotic drug use was for short-term follow-up only and disappeared on longer term follow-up periods. Given the scarcity of longitudinal studies examining the association between physical activity and mental health as well as psychotropic drug use among young people, the current study adds to previous research.

The association between physical activity and symptoms of depression in different contexts - a cross-sectional study of Norwegian adolescents.

BACKGROUND: The purpose was to analyse the association between physical activity taking place in different contexts (sports club, gym, exercise independently and other organized physical activities) and symptoms of depression. METHODS: The study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2017 by the Norwegian Social Research (NOVA) institute in cooperation with regional centres for drug rehabilitation. The target group comprised 5531 15-16 years old adolescents (Grade 10 students) and 11,655 students in grades 8 and 9 in Norway. Based on Rasch analysis, six items on depressions symptoms were used to create a composite measure of depression. Binomial logistic regression was used to analyse the association between physical activities in different contexts and symptoms of depression. RESULTS: In the crude model, the odds for symptoms of depression were lower for those who were physically active in a sports club (OR: 0.40, 95% CI: 0.30-0.53), in a sports club and gym (OR: 0.40, 95% CI: 0.28-0.56), in a sports club and exercise or keep fit independently (OR: 0.52, 95% CI: 0.38-0.72) and in a sports club, gym and exercise or keep fit independently (OR: 0.58, 95% CI: 0.41-0.81). After adjustment for potential confounders, the association became significant only for those who were physically active in a sports club (OR: 0.57, 95% CI: 0.40-0.81) and other organized physical activities, e.g. dance, martial arts (OR: 0.52, 95% CI: 0.31-0.86). Analysis for grade 8 and 9 showed the same patterns for the associations between sports club and symptoms of depression (grade 8: crude model, OR: 0.47, adjusted model, OR: 0.63, grade 9: crude model, OR: 0.44, adjusted model, OR: 0.49). CONCLUSIONS: Physical activity in a sports club was associated with significantly lower odds for symptoms of depression, suggesting a possible role for social interaction in addition to physical activity per se. It is important, therefore, to consider in which types of contexts physical activities take place, not only focusing on physical activity frequency and volume when investigating the association between adolescents' physical activity and mental health. Additional research is needed to further explore these associations as well as measures of physical activity and mental health.

Experiencing Nature through Immersive Virtual Environments: Environmental Perceptions, Physical Engagement, and Affective Responses during a Simulated Nature Walk.

By combining physical activity and exposure to nature, green exercise can provide additional health benefits compared to physical activity alone. Immersive Virtual Environments (IVE) have emerged as a potentially valuable supplement to environmental and behavioral research, and might also provide new approaches to green exercise promotion. However, it is unknown to what extent green exercise in IVE can provide psychophysiological responses similar to those experienced in real natural environments. In this study, 26 healthy adults underwent three experimental conditions: nature walk, sitting-IVE, and treadmill-IVE. The nature walk took place on a paved trail along a large river. In the IVE conditions, the participants wore a head-mounted display with headphones reproducing a 360° video and audio of the nature walk, either sitting on a chair or walking on a manually driven treadmill. Measurements included environmental perceptions (presence and perceived environmental restorativeness - PER), physical engagement (walking speed, heart rate, and perceived exertion), and affective responses (enjoyment and affect). Additionally, qualitative information was collected through open-ended questions. The participants rated the IVEs with satisfactory levels of 'being there' and 'sense of reality,' but also reported discomforts such as 'flatness,' 'movement lag' and 'cyber sickness.' With equivalent heart rate and walking speed, participants reported higher perceived exertion in the IVEs than in the nature walk. The nature walk was associated with high enjoyment and enhanced affect. However, despite equivalent ratings of PER in the nature walk and in the IVEs, the latter were perceived as less enjoyable and gave rise to a poorer affect. Presence and PER did not differ between the two IVEs, although in the treadmill-IVE the negative affective responses had slightly smaller magnitude than in the sitting-IVE. In both the IVEs, the negative affective responses were mainly associated with cyber sickness, whereas PER was positively associated with enjoyment. From the qualitative analysis, it emerged that poor postural control and lack of a holistic sensory experience can also hinder immersion in the IVE. The results indicate that IVE technology might in future be a useful instrument in green exercise research and promotion, but only if image quality and cyber sickness can be addressed.

The NHS health check programme in England: a qualitative study.

Despite an extensive evidence-base linking patterns of health with social determinants, recent public health policy has emphasized 'lifestyle diseases' and risk factor modification through behavioural and pharmacological intervention. In England, one manifestation of this has been the launch of the National Health Service Health Check programme. This paper reports findings from a small-scale qualitative study exploring experiences of engaging with a community-based health check in Knowsley, England, among 17 males and 19 females, with varying levels of risk for cardiovascular disease, who agreed to be contacted for the purpose of research at the time they underwent their check. Analysis revealed that the community-based nature of the checks provided opportunities for people to find out more about their health who might not otherwise have done so. Participants expressed a range of responses to the communication of the risk score, often revealing their confusion about its meaning. Changes in behaviour were identified, which participants connected with having had a check. This study raises questions about where, how and by whom health checks are delivered. Emphasis on health checks reflects the dominant individualist ideology, but this study also suggests that the process provides opportunities to enable and empower individuals, albeit in small ways. However, they remain a 'downstream' approach to public health, emphasizing medical and behavioural options for risk factor reduction rather than focussing on primary prevention through changes to the wider environment. Furthermore, although developed as a central feature of the UK's strategy to reduce health inequalities, health checks may widen them.

Local status and power in area-based health improvement partnerships.

Area-based initiatives have formed an important part of public policy towards more socio-economically deprived areas in many countries. Co-ordinating service provision within and across sectors has been a common feature of these initiatives. Despite sustained policy interest in area-based initiatives, little empirical work has explored relations between area-based initiative providers, and partnership development within this context remains under-theorised. This article addresses both of these gaps by exploring partnerships as a social and developmental process, drawing on concepts from figurational sociology to explain how provider relations develop within an area-based initiative. Qualitative methods were used to explore, prospectively, the development of an area-based initiative targeted at a town in the north west of England. A central finding was that although effective delivery of area-based initiatives is premised on a high level of co-ordination between service providers, the pattern of interdependencies between providers limits the frequency and effectiveness of co-operation. In particular, the interdependency of area-based initiative providers with others in their organisation (what is termed here as 'organisational pull') constrained the ways in which they worked with providers outside of their own organisations. 'Local' status, which could be earned over time, enabled some providers to exert greater control over the way in which provider relations developed during the course of the initiative. These findings demonstrate how historically constituted social networks, within which all providers are embedded, shape partnership development. The theoretical insight developed here suggests a need for more realistic expectations among policymakers about how and to what extent provider partnerships can be managed.

Introduction of the primary care cancer nursing role in a GP practice.

Nurses have always had an important role in the care of cancer patients and many specific nursing roles in cancer services have been developed. A qualitative research strategy using semi-structured interviews was adopted in this case-study of the implementation of a primary care cancer nurse (PCCN) role in a general practice. The implementation of the PCCN role is reported in order to shed light on the extent to which integration of the role into existing systems of care had taken place; and to explore facilitating factors and barriers to the implementation of a new primary care role. Three major themes emerged from the data: the management of change; systems of care; and the complexity of professional interfaces. It is evident that the effective implementation of innovative nursing roles in primary care can present many challenges to the role holder and to the health and social care professionals with whom they come into contact. The importance of communication and consultation in the role implementation are emphasized.

Time for Me: the arts as therapy in postnatal depression.

Time for Me describes a creative arts group for mothers with children under two years of age, who were experiencing mild to moderate postnatal depression or anxiety. This paper reports on findings from a small-scale qualitative study designed to explore and evaluate the extent to which the brief intervention of eight weekly sessions of creative arts was able to support these women. Traditionally, severe postnatal depression has been treated with medication or cognitive behavioural therapy and in mild to moderate postnatal depression non-directive counselling ('the listening visit'), extra social and emotional support and group psychological therapies have been used. More recently, the use of complementary therapies in the treatment of depression has been explored and it has been reported that the arts can have positive effects on patients with mental health problems; for example, by helping their relationships, providing new ways of expression and by bringing about behavioural changes. There is, however, limited research relating specifically to postnatal depression and complementary therapies. The study found that the Time for Me programme created a relaxed, safe space which was experienced as supportive by women who participated in the sessions. Work in various areas of mental health care suggests that creative arts can be used to complement conventional therapy and that complementary therapies may a valuable adjunct to conventional interventions for women with postnatal depression and anxiety. It would, however, be naïve to imagine that a brief intervention such as Time for Me could be a solution for women with more severe depression but it does offer an area worth exploring in more detail.

The nurse practitioner in primary care: alleviating problems of access?

Improving access to primary care services is an essential component of the NHS modernization plan and the advent of independent nurse practitioners in primary care has focused attention on the extent to which this group of nurses can effectively substitute for GPs. This study was designed to explore the role of a nurse practitioner in primary care, particularly whether the provision of a nurse practitioner facilitated access to care that met the needs of patients. Semistructured interviews were conducted with 14 patients who had consulted with the nurse practitioner, 10 staff within the practice who had knowledge of the role, and the nurse practitioner herself. With the permission of interviewees, interviews were audiotaped, the tapes transcribed verbatim, and the data were coded by theme. It was perceived by both groups of interviewees that access to care had been improved in that there were more appointments available, appointments were longer than they had been previously and were available at different times of the day. However, some areas in which access was 'restricted' were articulated by staff interviewees, such as limitations to the nurse practitioner's prescribing and problems with referring patients to secondary care. Additionally, while access to a member of the primary healthcare team was improved for many patients, access to a specific member of the team, such as a GP, was not always improved. Concerns were also expressed about how the role of the nurse practitioner needed to be developed in the practice. It can be concluded from this study that, potentially, the role of nurse practitioner has much to offer in terms of addressing problems of access in primary care for some patients. However, this is not a straightforward solution and in order for the role to be effective several issues highlighted in this study require addressing.

Adherence to exercise in later life: how can exercise on prescription programmes be made more effective?

A broad consensus has emerged in relation to the desirability of promoting exercise among a variety of 'at risk' groups via 'exercise on prescription' (EoP) schemes, as an alternative to orthodox, biomedical approaches to the management of health problems. Underpinning the rationale for such schemes is the notion that they can act as vehicles for encouraging long-term adherence to exercise. Whilst there is a common sense appeal to using EoP schemes to promote exercise, research to date suggests that evidence of their impact is limited. This paper attempts to make sense of these findings in the light of recent debates about adult lifestyles and exercise. More specifically, it brings work in the sociology of leisure to bear on the topic, on the premise that any study of adults' propensity towards sustainable physical activity needs to be viewed as an aspect of their lives 'in the round'. Such an analysis points up the value of synthesizing perspectives from across the disciplinary divide in order to shed light on particular 'problems', which obviate the necessity for further empirical work. The paper concludes by identifying a number of implications for public health policy and practice with respect to the matter of encouraging lifelong participation in sport and exercise in general, and via EoP schemes in particular. One such implication is the development of a model for understanding participation that shifts the emphasis away from a focus on motivation and behaviour change per se towards satisfaction and enjoyment through the development of skills and relationships. Reconceptualizing the matter of participation in this way is likely to lead not only to a more realistic appreciation of what can be expected from EoP schemes, but also a more adequate understanding of adherence to exercise in later life.

Involvement and detachment in researching sexuality: reflections on the process of semistructured interviewing.

In this article, the authors reflect on the utility of the concept of involvement-detachment for researchers involved in a study of the lifeworlds of gay, lesbian, and bisexual young people where one of the researchers was lesbian. They focus in particular on the process of semistructured interviewing in qualitative research and the analysis of material generated by the interviews, noting that complete detachment from the subject of study is neither achievable nor desirable. They discuss the benefit of teamwork in supporting researchers and enhancing the integrity of the research, particularly when the subject is sensitive, the importance of researchers' active management of their own ideological leanings, and the understanding of project management as a conceptual and cognitive process that is fundamental to enhancing research rigor.