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Exploring self-rated health among adolescents: a think-aloud study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Clinical Research Dalarna-Uppsala University.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Clinical Research Dalarna-Uppsala University; School of Education, Health and Social Studies, Dalarna University.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).ORCID iD: 0000-0003-3083-106S
School of Education, Health and Social Studies, Dalarna University.
2016 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 156Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health.

METHODS: A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden.

RESULTS: Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described.

CONCLUSIONS: The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

Place, publisher, year, edition, pages
BioMed Central, 2016. Vol. 16, article id 156
Keywords [en]
Self-rated health, Subjective health, Health assessment, Feel, Adolescence, Qualitative, Think-aloud interview, Cognitive interviewing, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-117585DOI: 10.1186/s12889-016-2837-zISI: 000370407800001PubMedID: 26880571OAI: oai:DiVA.org:umu-117585DiVA, id: diva2:908414
Available from: 2016-03-02 Created: 2016-03-02 Last updated: 2020-04-20Bibliographically approved
In thesis
1. Health for future: self-rated health and social status among adolescents
Open this publication in new window or tab >>Health for future: self-rated health and social status among adolescents
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Hälsa för framtiden : Självskattad hälsa och social status bland ungdomar
Abstract [en]

The overall aim of this thesis was to explore self-rated health, subjective social status and smoking in adolescents.

This thesis consists of a qualitative and a quantitative study. The qualitative study was an interview study that included 58 participants in the 7th and 12th grades. The cognitive interviewing technique ‘think-aloud’ was employed to explore how adolescents interpret and reason when answering a question about self-rated health (‘A person may feel good sometimes and bad sometimes. How do you feel most of the time?’). Additionally, factors contributing to subjective social status in school and the different strategies adolescents used for positioning were explored. Qualitative content analysis and thematic network analyzes were used to analyze the data. The quantitative study was a cohort study involving 1046 adolescents who answered questionnaires about their health in the 7th, 8th, 9th and 12th grades. Data were used to investigate predicting factors in the 7th grade for smoking in the 12th grade, as well as to examine associations between subjective social status in school, socioeconomic status and self-rated health in boys and girls in the 12th grade. Data were analyzed using chi-square tests, binary logistic regression and ordinal logistic regression analyses.

The results from the interviews showed that participants interpreted the self-rated health question in holistic terms including social, mental and physical aspects. Results from the quantitative study showed that boys rated their health higher than girls at all ages. In a multivariable analysis lower selfesteem, a less negative attitude towards smoking and ever using snus in the 7th grade were significant predictors of smoking in the 12th grade. In addition, girls had an increased risk of becoming smokers. Cross-sectional analyses in the 12th grade revealed that adolescents’ self-rated health was positively associated with subjective social status in school, mood in the family and self-esteem in both girls and boys. Boys rated their subjective social status higher than girls. When exploring subjective social status in school further through interviews, status hierarchies in school were confirmed by the participants, which were strongly influenced by norms linked to gender, age, ethnicity and parental economy, but also expectations about how to look, act and interact.

In conclusion, this thesis demonstrates that the self-rated health question ‘How do you feel most of the time?’ is useful for capturing a multidimensional view of health. Early efforts to strengthen adolescents’ self-esteem, promote anti-smoking attitudes and avoid an early initiation of snus seem to be important components of smoking prevention in adolescence. The positive association between self-rated health and subjective social status in school indicates that the subjective social status question is a useful healthrelated measure of social position in adolescents. Because social desirability in the school hierarchy was defined by norms that left little room for diversity, the possible negative impact of status hierarchies on adolescents’ health should to be considered. Overall, gender differences in health and social status emphasize the need for a gender-sensitive understanding of factors that impact adolescents’ lives

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2020. p. 87
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2081
Keywords
Adolescent, health, self-rated health, smoking, self-esteem, social status, subjective social status, gender, social norms, think-aloud interview
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-169729 (URN)978-91-7855-245-0 (ISBN)978-91-7855-246-7 (ISBN)
Public defence
2020-09-04, Föreläsningssalen, Falu lasarett, Falun, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-04-21 Created: 2020-04-20 Last updated: 2020-04-21Bibliographically approved

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Joffer, JuniaÖhman, Ann

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