The Danish Health Survey among Marginalized People: Study design and respondent characteristics.

AIM: The Danish Health Survey among Marginalized People is a nationwide health survey targeting people in marginalized life situations in Denmark. The aim of this paper is to present the study design, data collection methods and respondent characteristics of the survey, which was conducted in 2007, 2012, 2017 and 2022. METHODS: The survey applies an outreach data collection approach which entails reaching out to social services (public and private) asking for their help with distributing self-administered paper questionnaires among their users. Themes include self-rated health, mental health, morbidity, pain, oral health, health behaviours, gambling problems, social relations, violence, sexual harassment and assault, suicide, and source of income. RESULTS: The overall number of respondents has decreased slightly from 2007 (1290) to 2022 (1134). In all survey waves, men were overrepresented among the respondents. In 2007, women represented only 28%, which increased to 37% in 2022. There have been remarkable changes in the age distribution among respondents between 2007 and 2022. For example, the oldest age group (55-80 years) accounted for 15% of the respondents in 2007 and 40% in 2022. CONCLUSIONS: Conducting surveys among marginalized people entails methodological challenges and ethical considerations. However, continually attempting to reach marginalized people in surveys by tailoring data collection strategies to their specific life situation is essential to gain insight into their health and well-being.

Experiences and perceptions of patients with psoriatic arthritis participating in a trial of faecal microbiota transplantation: a nested qualitative study.

OBJECTIVES: Patients' first-hand experiences of faecal microbiota transplantation (FMT) performed in a rheumatological care setting have yet to be elucidated. The objectives were to explore participants' perceptions of being part of an FMT trial thereby identifying potential trial participation effects and enlightening the patient perspective on the outlook for future FMT trials in rheumatic diseases. DESIGN: In a qualitative study nested within a double-blind, randomised, placebo-controlled trial (RCT) testing FMT as a potential new antirheumatic treatment, semistructured telephone interviews were conducted following the trial participants' final 26-week visit. Qualitative researchers, who did not take part in the main trial, performed the interviews and the primary analysis. The experiences explored related to the conduct of the RCT and changes in the participants' everyday life. The analysis was carried out using a thematic approach. SETTING: A Danish rheumatology university outpatient clinic with nationwide inclusion. PARTICIPANTS: The study included 10 patients with psoriatic arthritis (PsA) who were unaware of their treatment allocation (FMT/sham transplantation) and completed the final 26-week trial visit. RESULTS: Participation in the RCT influenced the patients' understanding of PsA and induced positive changes in their everyday life. Renewed hopes for the future in addition to a feeling of enhanced care contributed to significant trial participation effects. FMT was deemed a tolerable and safe treatment. CONCLUSIONS: Discrepancies between the clinical and the research setting should be considered when discussing the clinical relevance of the results of the RCT. Overall, patients with PsA who have participated in an RCT testing FMT find the treatment acceptable and safe encouraging more research into the field of microbiota-targeted interventions in rheumatic diseases. TRIAL REGISTRATION NUMBER: NCT03058900; Pre-results.

Implementing Mental Health Promotion Initiatives-Process Evaluation of the ABCs of Mental Health in Denmark.

Treatment and prevention alone are unlikely to make a significant difference in reducing the burden of poor mental health and mental illness. Therefore, mental health promotion (MHP) initiatives are advocated. In 2014, the ABCs of mental health (ABCs) partnership was established in Denmark; in the partnership, partner organisations, e.g., municipalities and NGOs, use a research-based framework for MHP, the ABC-framework, to develop and implement MHP initiatives. This paper has two aims: (1) to outline the overall characteristics of these MHP initiatives; and (2) to explore local coordinator and stakeholder perceptions of the implementation processes and the impact of the MHP initiatives. Questionnaire surveys, individual interviews and group interviews were conducted during 2017-2020. The MHP initiatives were grouped according to three strategies: building MHP capacity, campaign activities to promote mental health awareness and knowledge and establishing and promoting opportunities to engage in mentally healthy activities. The ABC-framework was positively received and viewed as providing relevant knowledge for working with MHP as well as fostering intersectoral and interprofessional collaborations. However, using a bottom-up approach to develop and implement MHP initiatives can be time-consuming and resource demanding, and it requires a deliberate balancing of local adaptability and concrete guidance when engaging stakeholders and implementers. Overall, using the ABC-framework to develop and implement MHP initiatives holds great promise for advancing and promoting MHP practice.

Body therapy versus treatment as usual among Danish veterans with PTSD: Study protocol for a randomised controlled trial combined with a qualitative study.

BACKGROUND: Many veterans suffer from Post-Traumatic Stress Disorder (PTSD) after returning from military missions. This implies complex physical and psychosocial problems for veterans and their families. Treatment options today are primarily medically and psychologically founded but treatment response is incomplete. Body therapy for PTSD is scarcely researched though subject of increased attention. In 2015, a Danish pilot study was conducted exploring body therapy for PTSD. The study showed positive results and formed basis for a randomised controlled trial. This paper outlines the protocol for this trial. METHODS: The intervention will be evaluated in a two-arm randomised controlled trial (1:1). The trial will include 42 veterans with PTSD recruited by the Danish Military Psychiatric Centre. The intervention group receives treatment as usual and weekly body therapy treatment as add-on. The control group receives treatment as usual (TAU). Participants will complete four questionnaires assessing PTSD, depression, quality of life, function level and body awareness: at baseline, and at 3 months, 6 months and 12 months post baseline. Linear regression models and mixed effects models will be used to assess intervention effects. Furthermore, an ethnographic study will examine how the participants experience the treatment and changes in their everyday life. The ethnographic study is based on in-depth interviews, participant observations and focus groups. A mixed method, convergent parallel design will be applied. DISCUSSION: This study examines the efficacy of body therapy for veterans with PTSD and how the treatment is experienced and affects daily life. The study will contribute with important knowledge on an alternative treatment for PTSD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03777800.

How Do We Evaluate Health in All Policies? Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia".

It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed. Lawless and colleagues present an evaluation framework for HiAP in their article: "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia." This work is an important endeavor in addressing this problem (of uncertainty as to whether HiAP is effective) and represents an essential contribution to the HiAP literature. Nonetheless, in the spirit of encouraging ongoing reflection on this topic, we wish to highlight some challenges in the presented framework, which may pose difficulties in operationalization. We find that the evaluation framework faces two main limitations: its unclear causal logic and its level of complexity. We argue that in order to function as a tool for evaluation, the framework should be explicit about the mechanisms of change and enable us to trace whether the assumed causal relations resulted in changes in practice. Developing manageable evaluation frameworks, albeit simplified, may then be an important part of cumulating the theoretical insights aspired in theory-based evaluation. On this basis, we highlight how HiAP processes and healthy public policies respectively involve different mechanisms, and thus argue that different program theories are needed.

Morbidity, Self-Perceived Health and Mortality Among non-Western Immigrants and Their Descendants in Denmark in a Life Phase Perspective.

To enable preventive policies to address health inequity across ethnic groups, this review overviews the current knowledge on morbidity, self-perceived health and mortality among non-Western immigrants and their descendants in Denmark. A systematic search in PUBMED, SCOPUS, Embase and Cochrane as well as in national databases was undertaken. The final number of publications included was 45. Adult immigrants had higher morbidity, but lower mortality compared to ethnic Danes. Immigrant children had higher mortality and morbidity compared to ethnic Danes. Immigrants' health is critical to reach the political goals of integration. Despite non-Western immigrants' higher morbidity than ethnic Danes, no national strategy targeting immigrants' health has been implemented. Future research should include elderly immigrants and children, preferably employing a life-course perspective to enhance understanding of parallel processes of societal adaptation and health.

Survey nonresponse among ethnic minorities in a national health survey--a mixed-method study of participation, barriers, and potentials.

OBJECTIVES: The participation rate in the Danish National Health Survey (DNHS) 2010 was significantly lower among ethnic minorities than ethnic Danes. The purpose was to characterize nonresponse among ethnic minorities in DNHS, analyze variations in item nonresponse, and investigate barriers and incentives to participation. DESIGN: This was a mixed-method study. Logistic regression was used to analyze nonresponse using data from DNHS (N = 177,639 and chi-square tests in item nonresponse analyses. We explored barriers and incentives regarding participation through focus groups and cognitive interviews. Informants included immigrants and their descendants of both sexes, with and without higher education. RESULTS: The highest nonresponse rate was for non-Western descendants (80.0%) and immigrants 25 (72.3%) with basic education. Immigrants and descendants had higher odds ratios (OR = 3.07 and OR = 3.35, respectively) for nonresponse than ethnic Danes when adjusted for sex, age, marital status, and education. Non-Western immigrants had higher item nonresponse in several question categories. Barriers to non-participation related to the content, language, format, and layout of both the questionnaire and the cover letter. The sender and setting in which to receive the questionnaire also influenced answering incentives. We observed differences in barriers and incentives between immigrants and descendants. CONCLUSIONS: Nonresponse appears related to linguistic and/or educational limitations, to alienation generated by the questions' focus on disease and cultural assumptions, or mistrust regarding anonymity. Ethnic minorities seem particularly affected by such barriers. To increase survey participation, questions could be sensitized to reflect multicultural traditions, and the impact of sender and setting considered.