Experiences of a Therapeutic Equine-Assisted Group Intervention for People with Common Mental Disorders on Sick-Leave.

Common mental disorders such as anxiety, depression and stress-related disorders are increasing worldwide, resulting in long-term sick leave and lower quality of life. Traditional treatment is often insufficient to facilitate the recovery process, and the need for holistic interventions that enable successful recovery is evident. Equine-assisted interventions have shown promising results in health promotion among people with mental disorders, and further research is needed to implement them within the range of available care. The aim of the study is therefore to describe experiences of a therapeutic equine-assisted group intervention for people with common mental disorders on sick leave. The study has a descriptive qualitative design with an inductive approach. Ten participants with common mental disorders on sick leave were interviewed after participating in a 12-week equine-assisted intervention and the data were analysed with conventional content analysis. The analysis generated the overall theme "The equine-assisted group intervention facilitates recovery," which summons the four categories "The environment of the horses contributes to relaxation and an ability to be in the present," "The presence of the horses facilitates supportive relationships in the group," "Interplay with the horses entails physical activity and bodily improvements" and "Emotional interactions with the horses strengthen inner power." In conclusion, equine-assisted interventions have the potential to facilitate recovery for people with common mental disorders by providing relaxation, promoting the ability to be in the present, cultivating supportive relationships and providing physical activity and bodily improvements as well as emotional interactions that strengthen the participants' inner power.

Taking control of one's everyday life - a qualitative study of experiences described by participants in an occupational intervention.

BACKGROUND: Sick leave due to stress-related ill-health is increasing and is often caused by occupational imbalance. These types of issues tend to affect both the ability to work and cope with everyday life, as well as the overall experience of health, negatively. There is still little knowledge on how to prepare people and workplaces for the return-to-work process after participation in a work rehabilitation program due to stress and occupational ill-health. Therefore, this study aimed to describe what is needed to achieve a balanced everyday life that includes paid work as experienced by individuals who had participated in a ReDO® intervention due to occupational imbalance and ill-health. METHODS: The concluding notes from 54 informants' medical records were used for qualitative content analysis. The informants had participated in an occupational therapy group intervention to promote occupational health and regain full work capacity. RESULTS: The analysis resulted in one major theme and four categories describing how the informants perceive that they must take control of their everyday life as a whole. By doing so, they need to work with structurization and prioritization, social interaction, boundary setting, and occupational meaningfulness. CONCLUSION: The study indicates a highly relational process, where it is impossible to divide life into private and work, and presupposes balance in everyday life in multiple dimensions. Its contribution includes the formulation of perceived needs in the transition between intervention and return to work and could, through further research, be used to generate a more effective and sustainable return- and rehabilitation models.

Health promotion partnership to promote physical activity in Swedish children with ASD and ADHD.

Children with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) have a higher risk of inactivity, and efforts to promote physical activity among this population have been limited. Physical activity on prescription (PAP) may be a suitable tool for motivating participation in physical activity among children with these diagnoses. However, PAP calls for synergy and partnership between health care and other sectors of the community. The aim of this study was to describe a health promotion partnership for physical activity targeting children with ASD or ADHD. Data were obtained through individual interviews with professionals at CAP (n = 11) and three focus-group interviews with coaches from local sports clubs. We used the Bergen Model of Collaborative Functioning as the theoretical framework and used qualitative content analysis as the method of analysis to study partnerships between professionals from the Child and Adolescent Psychiatry outpatient clinic (CAP) and coaches from local sport clubs. The findings demonstrate that the partnerships included both positive and negative processes. Although the two partners shared values regarding the project, such as working for a good cause for the children and seeing the potential in the collaboration, there were doubts about sharing common resources and uncertainties about the sustainability of the PAP project. Challenges remain and further research is needed into developing, monitoring and evaluating health promotion partnerships when promoting physical activity for all.

Relatives' experiences of an equine-assisted intervention for people with psychotic disorders.

PURPOSE: The aim of this study was to describe relatives' experiences of an equine-assisted intervention for people with psychotic disorders. METHODS: The study has a qualitative and descriptive design. Ten semi-structured interviews were performed with relatives of people with a psychotic disorder who had participated in an equine-assisted intervention. A conventional content analysis was used to analyse the data. RESULT: The overall category "Being with the horses strengthens health capabilities" summarizes the four identified subcategories "The horses contribute to a context with a common focus", "Interaction with the horses enhances self-confidence and motivation", "The interplay with the horses nurtures positive emotions" and "Being with the horses encourages physical activity". CONCLUSIONS: The result of this study contributes to the growing body of research about the potential outcomes of equine-assisted interventions. The result also indicates that equine-assisted interventions may improve health capabilities among people with psychotic disorders. The generated knowledge may be useful in mental health services when developing equine-assisted interventions.

"Womanhood," a shared experience of participating in a lifestyle intervention with a focus on integration and physical activity to promote health among pregnant women: perspectives from pregnant women, midwives, and cultural interpreter doulas.

PURPOSE: Migrating women, have an overall increased risk of adverse outcomes and poorer health during pregnancy and childbirth. In addition, they do not participate in planned antenatal care to the same extent as natives. These disparities among migrants and native pregnant women point to the need for interventions to improve equal health and care during pregnancy and childbirth. This study aimed to explore the experiences of participating in a lifestyle intervention, named "Dancing for birth," focusing on integration and physical activity, from the perspectives of the participating pregnant women, midwives, and cultural interpreter doulas. METHOD: Qualitative interviews were conducted from March 2019 to December 2020, with ten women who participated in a lifestyle intervention in Sweden: four pregnant women, three midwives, and three cultural interpreter doulas. Thematic analysis was used to analyse the data. RESULTS: The lifestyle intervention "Dancing for birth" provided positive shared Health-promoting experiences among the participants with social inclusivness and a commitment to supporting each other. This seemed to encourage the sense of strength as a woman- a strengthboth for the individual woman and as a kind of women´s power. CONCLUSIONS: Interventions targeting physical activity, social inclusiveness, and health literacy are of utmost importance in promoting positive pregnancy experiences and equal healthcare during pregnancy. Further research is needed on how to implement antenatal education that includes all women in society.

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.

Two-year weight, risk and health factor outcomes of a weight-reduction intervention programme: Primary prevention for overweight in a multicentre primary healthcare setting.

Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities.Design: Prospective two-armed randomised intervention.Setting: Three PHC centres in south west of Sweden.Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails.Main outcome measures: Weight, quality of life, risks and health factors.Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012).Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key pointsBoth groups had a consisting weight- reduction after two years.High intensity did not lead to a significant difference in weight reduction between the groups.The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle.

How to Promote Workplace Health in order to Work into Old Age: Experiences from Employees in an Industrial Setting.

BACKGROUND: Health is important in workplaces. A good organisational climate in a workplace plays a major role in the employees' well-being at work and is also associated with increased productivity. Today, employees are expected to work into older age and it is a challenge for companies to promote health and well-being for this growing group. PURPOSE: The purpose of this study was to explore how to promote workplace health at present time and for the end of working life in the perspective of employees. DESIGN/METHODOLOGY/APPROACH: The study had an explorative design, and a thematic analysis was chosen. The inclusion criteria were persons 50 years and older, working in the company and planning to continue working into old age. A total of 21 coworkers (14 men) participated in the study. Three focus group interviews were conducted. FINDINGS: The results from the focus group interviews are presented in four themes: handle change in a changeable workplace, take responsibility for health concerns, get confirmation for feeling needed, and support and tolerance adapted for each employee. PRACTICAL IMPLICATIONS: Promoting health should be an urgent mission for employees themselves as well as for managers in order to support employees in working into old age. The health promotion must be suitable for each employee and should be designed in such a way as to avoid inequality in workplace health. ORIGINALITY/VALUE: There is a need for more health-promoting behaviours, support, and activities for employees in order to work into old age.

Characteristics of patients seeking a health promotion and weight reduction program in primary care.

PURPOSE: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC. PATIENTS AND METHODS: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40-65 years, body mass index [BMI] 28-35 kg/m2) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization. RESULTS: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population. CONCLUSION: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups.

Future challenges for occupational health services can be prevented by proactive collaboration with the companies using the services: a participatory and reflection project.

BACKGROUND: There is clearly a need for research in the field of occupational health service (OHS) for applying new perspectives. Proactive collaboration is needed between the OHSs and the companies. The customers of the companies using the services should be able to safeguard themselves from the health problems caused by the work environment through proactive collaboration with the OHSs. OBJECTIVE: The main purpose of this interdisciplinary study was to explore how the stakeholders reflected to create and agree on core values for future challenges in OHS, as seen from the perspectives of OHS professionals and customer companies. METHODOLOGY: An action research process was conducted. This study was divided into three phases. In phase I, the data were collected from interviews and diaries of interdisciplinary occupational health professionals (n=12). A focus group that sampled the eight managers of the customer companies was also included. In phase II, a questionnaire was developed with 24 questions focusing on examining the future challenges for OHS. The questionnaire was sent to customer companies (n=116). In phase III, a scoping review was undertaken. RESULTS: Three categories emerged from the analysis: "Balancing complex situations" clarified the complexity regarding senior employees; "Working with a proactive approach" indicated the need for working with a new proactive approach supporting sustainable health; and "Collaborate internally and externally" showed good relationships between the customer and the OHS, which is a mutual responsibility to both the partners. CONCLUSION: The results outlined that it is necessary to take action to apply new proactive health promotions, with a focus on workplace health promotion. The results also indicated that interventions for senior employees are of importance. This study was done in collaboration with the stakeholders from the occupational health care service center and the managers from the customer companies. The use of a participatory research design, including close collaboration with the participants, allows the researchers to see the challenges.

Dietary advice on prescription: experiences with a weight reduction programme.

AIMS AND OBJECTIVES: To describe overweight persons' experiences with weight reduction and participation in the dietary advice on prescription. BACKGROUND: Approximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress. DESIGN: The study used a descriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden. METHODS: The first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis. RESULTS: The participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends. CONCLUSIONS: To achieve sustainable weight reduction, it is important to individualise the programme in order to address each person's life situation and the unique difficulties they may encounter. RELEVANCE TO CLINICAL PRACTICE: Motivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patient's partners should also be offered the opportunity to participate in the programme.

Thoughts and feelings of future working life as a predictor of return to work: a combined qualitative and quantitative study of sick-listed persons with musculoskeletal disorders.

PURPOSE: The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person's actual working situation 1, 5 and 10 years after a rehabilitation period. METHODS: This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline. RESULTS: Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories. CONCLUSIONS: The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person's needs and facilitating RTW.

Return or no return--psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study.

PURPOSE: The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago. METHODS: This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups. RESULTS: In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups. CONCLUSIONS: Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.

Predictive factors of sustained return to work for persons with musculoskeletal disorders who participated in rehabilitation.

Musculoskeletal disorders (MSD) account for the majority of total morbidity cases in the working-age Swedish population. These disorders are thought to be the reason given for one-third of total certified sick leave requests. In addition to the high cost to society, MSD involve both physical and emotional suffering, pain and financial and social problems for the injured persons. The aim of this study was to identify predictive multidimensional factors for sustainable return to work (RTW) in a long-term follow-up persons with MSD. During the period 1992-1999, 385 persons participated in a rehabilitation program. Ten years later, 354 of these took part in a prospective follow-up study. The average post-rehabilitation time was ten years (range=7-13 years) and 243 persons (69%) completed a questionnaire. The "working full-time" group (n=110) and the "sick-listed" group (n=73) were included in the study. The two groups were compared in terms of predictors for RTW. Multiple stepwise logistic regression and bivariate analysis, as well as parametric and non-parametric tests, were used to identify predictive factors. The number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level and light physical labor were predictors of long-term RTW. Return to work an be facilitated by planning at an early stage of the certified sick leave period using instrument that take these predictors into account.

Evaluation of a school-based health promotion programme for adolescents aged 12-15 years with focus on well-being related to stress.

OBJECTIVE: The aim of this study was to evaluate a school-based adolescent health promotion programme with focus on well-being related to stress. STUDY DESIGN: Interventional and evaluative with tests before and after the intervention. The study was performed in two secondary schools in a town on the west coast of Sweden. METHODS: A health promotion programme comprising massage and mental training was implemented for a single academic year in one school (intervention school, 153 participants) in order to strengthen and maintain well-being. No intervention was implemented in the other school (non-intervention school, 287 participants). A questionnaire was developed and tested, resulting in 23 items distributed across the following six areas: self-reliance; leisure time; being an outsider; general and home satisfaction; school satisfaction; and school environment. RESULTS: A pre- and postintervention comparison of the six areas was made within each school. In the intervention school, the boys maintained a very good or good sense of well-being related to stress in all six areas, while the girls' sense of well-being was maintained in five areas and deteriorated in one area. In the non-intervention school, the boys maintained a very good or good sense of well-being related to stress in four areas and deteriorated in two areas, while the girls' sense of well-being was maintained in two areas and deteriorated in four areas. CONCLUSION: Massage and mental training helped to maintain adolescents' very good or good sense of well-being related to stress. A questionnaire with acceptable validity and reliability was developed and tested in order to evaluate the health promotional approach. However, there is a need for further study to develop both the intervention and the questionnaire for young people.

Predictive factors for work capacity in patients with musculoskeletal disorders.

OBJECTIVE: To identify predictive factors for work capacity in patients with musculoskeletal disorders. DESIGN: A descriptive, evaluative, quantitative study. SUBJECTS/PATIENTS: The study was based on 385 patients who participated in a rehabilitation programme. METHODS: Patients were divided into 2 groups depending on their ability to work. The groups were compared with each other with regard to sociodemographic factors, diagnoses, disability pension and number of sick days. The patient's level of exercise habits, ability to undertake activities, physical capacity, pain and quality of life were compared further using logistic regression analysis. RESULTS: Predictive factors for work capacity, such as ability to undertake activities, quality of life and fitness on exercise, were identified as important independent factors. Other well-known factors, i.e. gender, age, education, pain and earlier sickness certification periods, were also identified. Factors that were not significantly different between the groups were employment status, profession, diagnosis and levels of exercise habits. CONCLUSION: Identifying predictors for ability to return to work is an essential task for deciding on suitable individual rehabilitation. This study identified new predictive factors, such as ability to undertake activities, quality of life and fitness on exercise.