Background

The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO).

Method

The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness.

Result

The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits.

Conclusion

This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA.

Trial registration

Not applicable.

BACKGROUND: In Sweden, population-based targeted health dialogues are an important part of health promotion and disease prevention in primary health care. Targeted health dialogues are performed with a pedagogical approach to allow individuals to reflect over their resources, situation and motivation to change lifestyle habits together with a healthcare professional.

AIM: The aim of this study was to explore healthcare professionals' experiences of targeted health dialogues in primary health care.

METHODS: Three focus group interviews were conducted with 20 healthcare professionals. The interviews were analysed using qualitative content analysis.

RESULTS: The main category A possibility to promote healthy behaviours and prevent disease describes how the targeted health dialogues were experienced as a valuable opportunity to promote health among inhabitants. The significance of the primary healthcare centre's health promotion and prevention strategies was emphasised to enable the targeted health dialogues as a part of the assignment to promote health. These strategies were expressed as shared focus and organisational space and support making it possible for example to reach all socioeconomic groups. The work with targeted health dialogue was described as a complex task requiring extensive competence. Furthermore, the pedagogical tool including the visual health profile was experienced to have an important impact on the dialogue offering direction for actions to promote health and prevent disease.

CONCLUSIONS: Targeted health dialogues can be a valuable opportunity for healthcare professionals in primary health care to promote a healthy lifestyle among inhabitants. Certain preconditions at both the meso- and the micro level is however required for this to come about.

It is well known that physical activity (PA) has a major positive impact on health and that the performance of PA is lower in low socioeconomic groups. However, more knowledge about the relationship between PA and health is needed especially between and within socioeconomic groups.

This thesis aimed, from a salutogenic perspective, to increase the understanding of the relationship between physical activity and health in the adult population, with a particular focus on people with economic difficulties. A further aim was to validate questions about physical activity and to explore the people’s experiences of PA from a sense of coherence perspective, all in the context of targeted health dialogues.

The first study in this thesis is a validation study. It validates a PA interview form and questions about sedentary time used in the targeted health dialogues. Studies II and III comprise quantitative analyses of PA, health and psychological factors in the population, especially in groups with low socioeconomic status (SES). Study IV is a qualitative deductive study based on interviews with participants with low SES in the targeted health dialogues. The deductive analysis contains the participants’ experiences of PA from a sense of coherence perspective.

The findings in study I showed that the interview form and the single-item question about sedentary time could be considered as acceptable to use in Swedish targeted health dialogues. In study II, physically active people with low SES were shown to have the same odds of reporting good self-rated health compared to those with low PA and high SES. The findings in study III showed that within the group of people with self-reported economic difficulties, higher levels of PA were related to better mastery and more vitality. Study IV showed that it is essential for the participants to have an awareness of the health benefits of PA and their challenges in performing PA. The participants also constructed a plan to follow while utilising their resources, and their intrinsic motivation to achieve the PA recommendations and the PA benefits.

This thesis brings a deeper knowledge and understanding of the healthperspective of PA. This knowledge can be used to further develop thetargeted health dialogues in a salutogenic way. It will give people,especially those with lower SES, the opportunity to use their resourcesto increase PA and thereby improve their future health.

Background: It is important that easy-to-use measures like subjective questions about physical activity (PA) and sedentary behaviour are valid and reliable providing accurate measures, when they are used in health promotion work aiming to support people to improve their lifestyle habits such as PA. The aim of this study was to evaluate the concurrent validity of a structured interview form estimating self-reported PA and a question about sitting time used in Swedish targeted health dialogues in the context of primary health care. Method: The study was conducted in the southern part of Sweden. To evaluate concurrent validity of the interview form, time spent in moderate-to-vigorous physical activities (MVPA) and energy expenditure related to MVPA estimated by an interview form was compared with the same measures assessed by an ActiGraph GT3X-BT accelerometer. To evaluate a question about sitting time, the Swedish School of Sport and Health Sciences’ single-item question about sitting time (SED-GIH) was compared with measures from an activPAL inclinometer. Statistical analyses included deriving Bland‒Altman plots and calculating Spearman’s rank correlation coefficients. Result: Bland‒Altman plots indicated lower absolute variation in the difference between self-reported and device-based PA measures for lower PA levels, both for energy expenditure and time spent in MVPA. No systematic over- or underestimation was observed. The Spearman’s correlation coefficient between self-reported and device-based PA measures was 0.27 (p = 0.014) for time spent in MVPA and 0.26 (p = 0.022) for energy expenditure. The correlation coefficient between the single item question and device-based sitting time measures was 0.31 (p = 0.002). Sitting time was underestimated by 74% of the participants. Conclusion: The PA interview form and the SED-GIH question on sitting time may be of value in targeted health dialogues in primary health care with the intention to support sedentary and insufficiently physically active persons in increasing their physical activity and limiting their sitting time. The questionnaires are easy to use and are more cost effective than device-based measures, especially regarding population-based interventions conducted in primary health care for thousands of participants such as targeted health dialogues. Clinical trial registration: Not applicable.

BACKGROUND: People with low socio-economic status report lower levels of physical activity (PA). There is insufficient knowledge about the availability of psychological resources for those who are physically active despite having a low socio-economic status. The aim of this study is to investigate the association between PA level and mastery and vitality, respectively, within an adult population with self-reported economic difficulties.

METHOD: Data from a cross-sectional, population-based study (n = 817) were used. Linear regression was used to estimate the unstandardised regression coefficient (β) with 95% confidence intervals (95% CI), describing associations between PA levels (independent variable) and scale scores of psychological resources in terms of mastery and vitality (outcome variables). Three models were constructed: Model I unadjusted; Model II adjusted for sex and age; and Model III adjusted for sex, age, smoking and food quality.

RESULT: After adjusting for sex, age, smoking and food quality and using low-level PA as the reference, high-level PA, but not intermediate-level PA, was related to higher scale scores of mastery (β = 0.72 [95% CI 0.08 to 1.37]). For vitality, both high-level PA and intermediate-level PA were related to higher scale scores (β = 9.30 [95% CI 5.20 to 13.40] and β = 6.70 [95% CI 1.40 to 12.00] respectively).

CONCLUSION: In an adult population with self-reported economic difficulties, higher levels of physical activity were related to higher mastery and vitality. Our results support that the association between physical activity and psychological resources in terms of mastery and vitality should be considered in the context of targeted health dialogues.

BACKGROUND: Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

AIM: To investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.

METHOD: Data from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.

RESULT: Participants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20-2.54] and 1.81 [1.25-2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96-5.34] compared to those with low PA and high education (OR 1.46 [0.89-2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42-3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89-6.63].

CONCLUSION: Physically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.

The aim of this study was to explore child health care nurses’ experiences of conducting health dialogues with non-native-speaking parents. In Sweden, it is not routine that all non-native-speaking parents are invited to a health dialogue. Regardless of language and cultural background, it is important that all parents have the same opportunities to participate. The data were obtained through two focus-group interviews and analysed using qualitative content analysis. The results revealed one theme Need for cultural awareness in the health dialogue and two categories: Overcoming feelings of uncertainty, with a need for more transcultural knowledge regarding what health and health promotion mean in other cultures; and Adapting the process of the health dialogue, whereby interpreters need knowledge about the intention of health dialogues and the content of the tool used in the encounter. Transcultural competence is needed in encounters with parents from other cultures.