An Empowerment-Based Physical Activity Intervention for Older People with Advanced Age-Related Macular Degeneration: An Exploratory Qualitative Case Study Design.

Background: Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment and impacts daily life. There are benefits of physical activity for people who are affected with AMD; however, living with AMD is associated with lower levels of physical activity and social isolation. The aim of this study was to explore how older people with AMD in Sweden experienced participation in a 6-month empowerment-based physical activity intervention and how it influenced their physical abilities. Methods: The participants were nine individuals with AMD aged 70-87 years. The intervention comprised physical and social activities in a group twice a week and individual health coaching on three occasions. The study was based on an exploratory qualitative case study design. Results: The findings showed two themes: created meaningfulness in life and creative and playful ways to develop body movements. The findings also showed improved muscle strength after the intervention. Conclusions: The findings showed that participants had increased social connectedness, improved physical self-efficacy and physical ability, as well as improved muscle strength. The empowerment process of the intervention was appreciated by the participants and challenged them to participate in physical activity offered by the municipality for older individuals.

Bearing the burden of spill-over effects: Living with a woman affected by symptomatic pelvic organ prolapse after vaginal birth - from a partner's perspective.

INTRODUCTION: Symptomatic pelvic organ prolapse (sPOP) can have a negative impact on a woman's health. While research exists about the impact of sPOP on women, little is known about the effect on their partners. Therefore, this study aimed to explore, from the partner's perspective, what it means to live with a woman with symptomatic pelvic organ prolapse after vaginal birth. METHODS: A qualitative explorative design with a constructed grounded theory approach was taken to analyse the interviews of 13 partners who experienced living with a woman who had sPOP after vaginal birth. RESULTS: "The theory of bearing the burden of spill-over effects" was constructed based on a core category: "Facing a new restricted life", with related categories "Giving up valued activities"; "Struggling with added demands"; "Changing intimate behaviour" and "Redefining future family planning". The theory also contains factors constraining and enabling adjustment to the new reality. While the shortcomings of healthcare constrained the process of adjustment, getting competent treatment and the feeling of love for the family enabled it. CONCLUSION: This study demonstrated that women's sPOP had an apparently negative impact on partners' health behaviours, sexual health, relationship harmony, and psychological well-being. The partners indicated they were unprepared for post-birth adversities and distressed by the lack of treatment options. There is a need to develop prenatal information highlighting the potential risks of sPOP which may be accompanied by levator ani muscle injury, implement guidelines for the prevention and management of these conditions, and offer targeted support to partners if needed.

A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

Favorable Adaptation during SARS-CoV-2-Pandemic as Told by Student-Athletes-A Longitudinal and Behavioral Study.

(1) Background: The aim was to explore the impact of adaptive responses (resilience factors) on student-athletes' behaviors during a stressful period of life during the SARS-CoV-2-pandemic of 2020 and 2021. (2) Methods: A constructivist-based grounded theory (CGT) was used guided by a biopsychosocial approach. Based on purposeful sampling, 22 male and female student-athletes were divided into four focus group interviews (FGI) seven months after the outbreak of the SARS-CoV-2-pandemic (October 2020) and 18 of these were followed up by FGI seven months later (May 2021). The mean age was 17.65 and they represented golf and handball. (3) Results: The CGT contained four main categories seven months after the SARS-CoV-2-pandemic outbreak: Social support, Self-discipline, Physical practice and recovery and Management of everyday life. Fourteen months after the SARS-CoV-2-pandemic outbreak, four additional main categories emerged: More extensive social support, Belief in the future, Self-awareness and Responsibility and problem-solving. (4) Conclusions: The CTG suggests that student-athletes' favorable adaptations to the stressful SARS-CoV-2-pandemic period 2020-2021 are based on a gradually developed ability to take responsibility for one's own actions, insight into the importance of deepened social interaction, belief in a positive post-COVID future and increased awareness of physical activity and its relation to perceived health.

"This Group is Like a Home to Me:" understandings of health of LGBTQ refugees in a Swedish health-related integration intervention: a qualitative study.

BACKGROUND: When large numbers of asylum seekers immigrate to a country, civil society is encouraged to contribute to their integration. A subgroup of asylum seekers comprising lesbian, gay, bisexual, transgender, or queer (LGBTQ) refugees are specifically deemed vulnerable to developing health and integration problems due to the double stigma of being a sexual/gender minority and a refugee. The Swedish Federation for LGBTQ Rights (RFSL) is a civil societal organization that has established the support group "RFSL Newcomers," a health-related integration intervention that targets such refugees. The aim of the present study is reconstructing the subjective understanding of health of LGBTQ refugees. METHODS: Eleven participants in Newcomers and eight organizers were interviewed about LGBTQ refugees' experiences of migrating and participating in RFSL Newcomers. Qualitative content analysis was used to reconstruct subjective understandings of health that were constructed in these narratives. As the data did not originally concentrate on exploring understandings of health, a broad theoretical approach was used as a heuristic for the analysis, which focused on the common everyday approach of conceptualizing health as wellbeing. RESULTS: The narratives revealed three interconnected, interdependent categories of understanding health in which tensions occur between wellbeing and ill-being: belonging versus alienation, security and safety versus insecurity, and recognition versus denial. The categories contribute to an overarching theme of health as framed freedom - i.e., freedom framed by conditions of society. CONCLUSIONS: For our participants, belonging, recognition, and security/safety are conceptual elements of understanding health, not its social determinants. Thus, these understandings emphasize relational and existential meanings of health (theoretical implication). As for practical implications, the understandings of health were connected to being either inside or outside the Newcomers group and a new society, depending on whether LGBTQ refugees comply with social requirements. As a significant actor that is representative of the cultural majority and a facilitator of LGBTQ refugees' resettlement process, RFSL provides LGBTQ refugees with crucial orientations for becoming a "good migrant" and a "good LGBTQ person," yet a "bad bio-citizen." Generally, organizers of interventions may enhance the effectiveness of their interventions when relational, existential, and biomedical understandings of health are all incorporated.

From Hell to Heaven? Lived experiences of LGBTQ migrants in relation to health and their reflections on the future.

This paper explores the lived experiences of LGBTQ migrants participating in a civil society group in Sweden during the migration process and their reflections on the future. Eleven migrants who self-identified as LGBTQ (seven male/gay, one female/lesbian, one female/bi-sexual, and two transgender/gay persons) from three local support groups for LGBTQ migrants agreed to be interviewed. Participants came from Guinea, Iraq, Kurdistan, North Macedonia, Nigeria, Nicaragua, Pakistan, the Russian Federation, Syria, Uganda and Ukraine. Interpretative-phenomenological analysis resulted in three themes: Past: from daily stress to the fear of being killed; Present: safety, belonging and resources to support the transition to a new life; and Future: making a positive difference or being afraid of what's ahead. Participants' health-related journeys and reflections about the future were complex in terms of favourable and unfavourable lived experiences, which become resources and risks for personal development. Study findings offers an enhanced awareness of the complex landscape of, and interaction between, vulnerability and potentiality. Based on the findings, we suggest the adoption of a health promoting approach focusing on the LGBTQ migrants' strengths and personal resources.

Empowerment-Based Physical Activity Intervention for People with Advanced Dry Age-Related Macular Degeneration: Mixed-Methods Protocol.

Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment and impacts daily life. These impacts include loss of social activities, decreased functional independence, and reduced physical activity. This protocol aims to describe a prospective, mixed-methodology for studying a population with AMD before, during, and after an empowerment-based physical activity intervention (EPI). A study framework was also developed for EPI. The intervention will include 20 older individuals (age 65+ years) with AMD recruited in Sweden. The intervention period is six months and comprises adapted physical activity and social activities in a group twice a week and individual health coaching on three occasions. The quantitative pre-test and three follow-ups include physical functional tests, an accelerometer that monitors physical activity continuously for one week, and questionnaires. Individual and focus-group interviews and ethnographic observations will explore the experience of living with AMD and what it means to participate in the EPI for individuals with AMD. The chosen methodology offers a structured way for researchers to explore the experiences and factors that may provide insights into the potential of creative supervised, adapted physical activity in groups, health coaching, and socialising that are significant to enable well-being among older individuals with AMD.

Health-related integration interventions for migrants by civil society organizations: an integrative review.

Purpose: Migrants are a vulnerable group concerning health and integration. Civil society organizations are deemed important for the integration and health of migrants and have been encouraged to help. This study explored health and acculturation, as expressed in research into health-related integration interventions for migrant groups provided by civil society organizations.Methods: Databases, journal websites and reference lists were searched in an integrative review. Thirteen articles were found and analysed using concepts of health strategies/perspectives and of acculturation with regard to general and health culture.Results: Studies were divided between two primary spectrums: 1) assimilation-integration and 2) integration-separation spectrum. Spectrum 1 interventions tend to promote assimilation into the present host culture and into a Western view of health. They are mostly driven by representatives of the host culture. Spectrum 2 interventions are characterized by a greater openness concerning the home-culture understandings of health, alongside an appreciation of the home culture in general. They are mostly migrant-driven.Conclusions: The different acculturating approaches in migrant and native-driven civil society organizations call for an awareness of their guiding health and acculturation assumptions and their applied perspectives and strategies. This awareness is considered crucial in order to achieve desired health and acculturation outcomes.

Personal trainers' health advice in the fitness gym space from a gender perspective.

Purpose: This study aimed to describe and problematize the advice on exercise and diet that personal trainers (PTs) provide to their clients from a gender perspective.Method: The present study had an explorative design, and the interviews were analysed using an interpretative qualitative approach. Seven focus group discussions were conducted with 19 PTs (aged 23-47 years).Results: The findings indicated that the PTs had a gender-neutral health advice approach to both women and men, guiding them towards a relaxed attitude to exercise and diet, prioritizing and rationalizing their exercise and diet and eating a natural diet. PTs also had a gendered health advice approach as regards women who showed unhealthy exercise and eating behaviours; advising them to eat more and exercise less, to focus on performance rather than appearance and to avoid heavy weightlifting. Some PTs acted evasively and did not give advice to men.Conclusions: Both approaches include advice that reflect health as control and health as release. From a gender perspective, PTs health advice both challenged and reproduced the stereotypical male norm in the fitness gym space. However, PTs gendered health advice may create different opportunities for men and women to promote their health and well-being in the fitness gym.

Voices from Pupil Participation in the Health Promotion Intervention "Pulse for Learning and Health [PuLH]" in Primary and Middle School.

In order to improve the learning conditions and health of schoolchildren, the Pulse for Learning and Health [PuLH] program in Sweden has introduced additional mandatory moderate to vigorous physical activity [MVPA] that lasts for 30 min three times a week. The PE teachers used a child-centered coaching approach to support all pupils. The aim of this study was to explore pupils' perception and experience of PuLH that has been implemented in primary and middle schools in Sweden. We have taken into account children's rights perspectives and adopted an exploratory and interpretive approach. In total, 73 pupils (34 girls, 39 boys, grades 4-9) were recruited through purposive sampling. 13 focus group interviews (n = 71) and individual interviews (n = 2) were carried out. All interviews were analyzed using qualitative content analysis. The analysis resulted in three major themes: 'promotes academic performance and a learning school environment', 'promotes health and well-being', and 'individual and structural barriers'. From children's perspective, the results highlight the importance of teachers and principals taking into account the interests and needs of all pupils, to have a well-planned MVPA intervention and to deal with issues regarding body ideals.

Online reported women's experiences of symptomatic pelvic organ prolapse after vaginal birth.

BACKGROUND: Pelvic organ prolapse (POP) is a major public health problem with a relative high lifetime risk of surgery. The main risk factor for developing POP is vaginal birth. Many women become symptomatic later in life and most of the existing research on symptomatic pelvic organ prolapse (sPOP) predominantly concentrates on the effects of the condition on postmenopausal women. However bothersome symptoms of POP can be reported as early as in women's 20s and may occur shortly after vaginal birth. Limited studies provide an insight into daily life of fertile women with sPOP. Thus, we aimed to explore fertile women's experiences of symptomatic pelvic organ (sPOP) after vaginal birth. METHODS: An inductive, text-driven approach was taken by selecting thread posts from an internet forum written by 33 Swedish fertile women who had experienced sPOP after vaginal birth. RESULTS: The overarching theme "being irreparably damaged" was identified as representing an experience of being disabled by sPOP after vaginal birth. The fertile women experienced that their lives were ruined because of physical and psychological limitations caused by this unexpected, unfamiliar and unexplained condition. Living with sPOP impinged on sexual health, restricted daily and sports activities and affected the women's ability to fulfill everyday parental duties. This in turn compromised women's psychological health. In addition, the negligence of healthcare professionals who tended to trivialize and normalize the symptoms led to the belief that there were no sustainable treatments and that women would have to live with bothersome symptoms of POP for rest of their lives. CONCLUSIONS: This study found that sPOP had a significant negative impact on fertile women's lives. The women indicated that they had not had the opportunity to voice their concerns and had not been taken seriously by healthcare professionals. It is of the utmost importance to acknowledge this problem and develop guidelines for prevention and management of sPOP to improve the quality of life for women.

Effects of an Empowerment-Based Health-Promotion School Intervention on Physical Activity and Sedentary Time among Adolescents in a Multicultural Area.

Physical activity (PA) decreases with age, and interventions are needed to promote PA during adolescence, especially, among those in low-socioeconomic status (SES) areas. The aim of this study was to investigate whether a two-year, empowerment-based health-promotion school intervention had any effects on changes in (a) moderate-to-vigorous PA (MVPA), (b) sedentary time (SED), (c) exercise training (ET) frequency, and (d) ET duration, among adolescents. Participants (aged 12⁻13 years at baseline) from one intervention school and two control schools, were recruited from a multicultural area of Sweden, characterized by low-SES. During the course of the two-year intervention, a total of 135 participants (43% boys) were included in the study. The intervention was developed and implemented as a result of cooperation and shared decision-making among the researchers and the participants. MVPA and SED were measured with accelerometers, and ET frequency and duration was self-reported at the beginning of the seventh, eighth, and ninth grade, respectively. There were no significant effects of the two-year, empowerment-based health-promotion school intervention on changes in the accelerometer-measured MVPA and SED, or the self-reported ET frequency and duration, among the adolescents. Overall, the intervention was unsuccessful at promoting PA and reducing SED. Several possible explanations for the intervention's lack of effects are discussed.

Empowering aspects for healthy food and physical activity habits: adolescents' experiences of a school-based intervention in a disadvantaged urban community.

PURPOSE: This study aimed to describe adolescents' experiences of participating in a health-promoting school-based intervention regarding food and physical activity, with a focus on empowering aspects. Method: The school was located in a urban disadvantaged community in Sweden, characterized by poorer self-reported health and lower life expectancy than the municipality average. Focus group interviews with adolescents (29 girls, 20 boys, 14-15 years) and their teachers (n = 4) were conducted two years after intervention. Data were categorized using qualitative content analysis. RESULTS: A theme was generated, intersecting with all the categories: Gaining control over one's health: deciding, trying, and practicing together, in new ways, using reflective tools. The adolescents appreciated influencing the components of the intervention and collaborating with peers in active learning activities such as practicing sports and preparing meals. They also reported acquiring new health information, that trying new activities was inspiring, and the use of pedometers and photo-food diaries helped them reflect on their health behaviours. The adolescents' experiences were also echoed by their teachers. Conclusions: To facilitate empowerment and stimulate learning, health-promotion interventions targeting adolescents could enable active learning activities in groups, by using visualizing tools to facilitate self-reflection, and allowing adolescents to influence intervention activities.

Facilitators of Physical Activity: Voices of Adolescents in a Disadvantaged Community.

Despite increasing socioeconomic inequalities in the health and well-being of adolescents, the voices of adolescents in disadvantaged communities regarding facilitators of physical activity (PA) have received relatively little attention. In response, the purpose of this study was to illuminate what adolescents in a multicultural community of low socioeconomic status (SES) in Sweden convey concerning facilitators of PA. Adolescents (n = 53, aged 12-13 years) were recruited from a school in a multicultural community of low SES in Sweden. Following an interpretive approach, 10 focus group interviews were conducted to produce data for a qualitative content analysis. When the adolescents mentioned PA, they mostly referred to spontaneous PA rather than organized PA, and expressed that they enjoyed their PA engagement, which they stated was promoted by the variation of PA, available options for PA, their physical skills, and the presence of peers. They reported that social support from family and friends facilitated their PA, and they offered several suggestions regarding how the school environment could better support their PA. From the perspective of self-determination theory (SDT), the results stress the importance of facilitating intrinsic motivation with a supportive PA environment in which adolescents can satisfy their needs for autonomy, competence, and relatedness.

"If it's not Iron it's Iron f*cking biggest Ironman": personal trainers's views on health norms, orthorexia and deviant behaviours.

Orthorexia nervosa (ON) describes a pathological obsession with healthy eating to avoid ill health. In the Swedish context, ON is also understood in terms of unhealthy exercise. Fitness gyms are popular health-promoting places, but exercise-related problems, disordered eating and ON-like behaviour are increasing. Personal trainers (PTs) play an important role in detecting unhealthy behaviours. The aim of the present study was to illuminate PTs' understandings of healthy and unhealthy exercise and eating behaviours in relation to orthorexia nervosa in a fitness gym context. Five focus groups with 14 PTs were conducted. These were analysed using interpretative qualitative content analysis and Becker's model "Kinds of Deviance." In contrast to PTs' health norms (practicing balanced behaviours and contributing to well-being), ON was expressed mainly in terms of exercise behaviour and as being excessive and in total control. The PTs maintain that extreme behaviours are legitimized by an aggressive exercise trend in society and that they fear to falsely accuse clients of being pathological. Certain sport contexts (bodybuilding, fitness competitions and elite sports) and specific groups (fitness professionals) contribute to complicating PTs' negotiations due to a competition, performance and/or profession norm, making it difficult to determine whether or not to intervene.

"The individual at the centre" - a grounded theory explaining how sport clubs retain young adults.

PURPOSE: There is still a lack of knowledge regarding which social processes occur in sport clubs and what factors influence young adults to want to remain in a sport club context. Thus, the purpose of this study was to construct a grounded theory (GT) explaining how sport clubs can retain their young adults. METHOD: The study uses an intersectional approach. In line with constructivist GT methodology, data from 14 focus-group interviews (27 coaches and 28 young adults) were collected and analysed using a constant comparative method. RESULTS: The core category, "The individual at the centre of a community", summarizes a process, whereby the generated GT contains three main categories, namely (1) "Participation and influence", (2) "Social connectedness" and (3) "Good conditions". CONCLUSIONS: The coaches put the individual at the centre of a community and pay attention to the needs and interests of all the young adults, regardless of their background, ambitions, and skills. However, while the idea of a moral imperative to provide for diversity was not directly absent in the discussions with both the coaches and young adults, most of the diversity approaches seemed to be based on ambition and skills, gender, age and sexuality.

Balancing performance-based expectations with a holistic perspective on coaching: a qualitative study of Swedish women's national football team coaches' practice experiences.

PURPOSE: The purpose of this study was to explore how an exclusive sample of women's national football team coaches described how they implement careful coaching while facing social and organizational pressure to win medals. METHOD: To consider coaches' negotiations, we drew on Noddings' concept of caring. Using an interpretive research paradigm, we conducted in-depth interviews with five Swedish women's national football team coaches. An abductive approach was used to simultaneously process the theoretical framework of "ethics of care" and the empirical data. RESULTS: The coaches unanimously adopted a holistic perspective to coaching. The coaching strategies they described included promoting players' development, well-being, and sustainable elite performance; listening to the players' voices and engaging in dialogue; and creating a positive environment and promoting fair play. CONCLUSIONS: These findings demonstrate that the women coaches, despite performance pressure, adopt caring coaching in the form of Noddings' pedagogical modelling, dialogue, and confirmation strategies, and provide an example of how coaches can adopt caring, holistic, and athlete-centred coaching while working at the highest level of competitive sport and achieving competitive success.

What undermines healthy habits with regard to physical activity and food? Voices of adolescents in a disadvantaged community.

This study aimed to illuminate factors that undermine the healthy habits of adolescents from a multicultural community with low socioeconomic status (S.E.S.) in Sweden with regard to physical activity (P.A.) and food, as stated in their own voices. Adolescents (n = 53, 12-13 y/o) were recruited from one school situated in a multicultural community characterized by low S.E.S. Embracing an interpretive approach, 10 focus-group interviews were conducted to produce data for the study. The focus-group interviews were audio recorded, transcribed verbatim, and analysed using qualitative content analysis. The analysis resulted in two major themes: (1) the availability of temptations is large, and support from the surroundings is limited; and (2) norms and demands set the agenda. The adolescents' voices illuminate a profound awareness and the magnitude of tempting screen-based activities as undermining their P.A. and healthy food habits. Moreover, several gender boundaries were highlighted as undermining girls' P.A. and healthy food habits. The adolescents' stories illuminated that it is difficult for them, within their environment, to establish healthy habits with regard to P.A. and food. To facilitate the adolescents' healthy habits, we suggest that support from family, friends, the school, and society at large is essential.

Health Promotion in Nursing Education: attitudes among nurse students.

BACKGROUND: The World Health Organization (WHO) European Strategy for Nursing and Midwifery has called for the explicit inclusion and application of health promotion in all nursing curricula. However, research indicates that there are deficiencies in nursing education regarding health promotion in both the theoretical and practical elements of education. Insight into the experiences of European nursing students' attitudes, positive or negative, about working in health promotion may provide a clue whether health promotion will be regarded as an important task and to what extent it will have priority in different parts of Europe. AIM: The aim of this study was to compare Italian and Swedish nursing students' attitudes towards health promotion practice on matriculation to nursing school and after a three-year nursing education, and to explore whether attitudes towards health promotion practice correlate with BMI and smoking. METHOD: The study involved students who started their nursing education in autumn 2009 (n =240). Data were collected via a questionnaire. RESULTS: The results show that the Swedish students had a more positive stance on health promotion than Italian students did. After completion of a three-year nursing education programme, Italian students' attitudes on health promotion had improved, while no such development was seen in Sweden. Further, no correlation between lifestyle issues and attitudes to health promotion was found. CONCLUSION: Health promotion in nursing education may have important influence on students' attitudes and thereby on the quantity and quality of future health promotion practice.