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Health-promoting health services: personal health documents and empowerment
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 2003, the Swedish Parliament adopted a national public health policy that included the domain - “A more health-promoting health service”. Strategies and tools are needed in the work to reorient health services. Personal health documents are documents concerning a person’s health, and are owned by the individual. Several studies that have evaluated such documents indicate that they could be of interest in health-promotion work. However, there is insufficient knowledge concerning personal health documents that target adolescents, and little is known about the feasibility of such documents in a Swedish cultural context. The concept of empowerment is gaining increased interest for health services, but the associations between empowerment, self-rated health and health behaviour are sparsely studied.

The overall aim of the thesis is to explore a strategy - empowerment - and a tool - personal health documents - that might facilitate the work of the public health goal of a health-promoting health service. Specific aims are to examine the feasibility of using personal health documents in health promotion; to examine professionals’ experiences of working with health promotion and personal health documents; to examine the association between personal health documents and self-reported health behaviour change; and to examine the perception of empowerment in relation to self-rated health and health behaviour among adolescents.

Two personal health documents that targeted adults and adolescents were developed and evaluated. Distribution to adults in different settings was compared in a cross-sectional study (n = 1 306). Adolescents received the document in school, and surveys were performed at baseline and after one year (n = 339). Practical use and attitudes by document owners were studied by questionnaires. Teachers (n = 69) answered a questionnaire, and community health nurses were interviewed (n = 12). The interviews also explored nurses’ experiences of working with health promotion in general, and were analysed by qualitative methodology. Adolescents’ empowerment was examined by a questionnaire (n = 1 046).

Most participants reported reading in the documents; writing in the documents varied between 16% (distribution in occupational health) and 87% (adolescents). The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker and having a positive school experience. Community health nurses were striving for a balance of being a doer of practical, disease-oriented tasks and a health-promotion communicator. The structural organisation in health care centres was important for their work with health promotion and the health document. Teachers were generally in favour of continued work with the document. In different settings, between 10% and 26% of adults reported changes in their health situations as a result of reading the booklet. Self-reported changes in health situations were less likely using postal distribution, and there were no significant differences between the other types of distribution. Adolescents with low empowerment scores reported poorer self-rated health and more risk-taking behaviours such as smoking and binge drinking.

To conclude, personal health documents are feasible to use in different settings. Health promotion in health services needs active support from leaders as well as adequate support systems. Findings suggest that personal health documents can be tools for promoting self-reported lifestyle changes among adults in different settings. There is a close relation among adolescents between low empowerment in the domain of health, low self-rated health and health behaviours such as binge drinking and smoking.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2007. , 89 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1126
Keyword [en]
Empowerment, health promotion, health behaviour, self-rated health, medical records, adolescents, health services, primary health care, nursing, cost-effectiveness
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-1401ISBN: 978-91-7264-412-0 (print)OAI: oai:DiVA.org:umu-1401DiVA: diva2:140910
Public defence
2007-11-23, 135, 9A, NUS, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2009-10-20Bibliographically approved
List of papers
1. Does a patient-held health record give rise to lifestyle changes? A study in clinical practice.
Open this publication in new window or tab >>Does a patient-held health record give rise to lifestyle changes? A study in clinical practice.
2004 (English)In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 21, no 6, 651-653 p.Article in journal (Refereed) Published
Keyword
Adult, age distribution, community health centers, cross-sectional studies, female, health behavior, health promotion/methods, humans, life style, male, medical records, middle aged, pamphlets, patient participation/methods, primary health care, questionnaires, sex distribution, smoking cessation/psychology, Sweden
Identifiers
urn:nbn:se:umu:diva-13722 (URN)10.1093/fampra/cmh517 (DOI)15465882 (PubMedID)
Available from: 2007-05-15 Created: 2007-05-15 Last updated: 2017-12-14Bibliographically approved
2. Experiences of Swedish community health nurses working with health promotion and a patient-held record
Open this publication in new window or tab >>Experiences of Swedish community health nurses working with health promotion and a patient-held record
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2006 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, 448-454 p.Article in journal (Refereed) Published
Keyword
Adult, community health nursing, female, health promotion/methods/organization & administration, humans, medical records, middle aged, nurse-patient relations, patient care team/organization & administration, patient participation, Sweden
Identifiers
urn:nbn:se:umu:diva-2672 (URN)10.1111/j.1471-6712.2006.00427.x (DOI)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2017-12-14Bibliographically approved
3. Cost-effectiveness of a personal health document in different distribution settings
Open this publication in new window or tab >>Cost-effectiveness of a personal health document in different distribution settings
2008 (English)In: Health promotion journal of Australia, ISSN 1036-1073, Vol. 19, no 2, 125-131 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to compare the cost-effectiveness of different ways to distribute a personal health document that was primarily aimed at supporting behaviour change. Personal health documents have been widely used in health-promoting efforts but their effective use is rather sparsely studied. METHODS: Four types of distribution were tested in Sweden: primary health care centres (n=418); work site meetings (n=164); at an occupational health examination (n=279); by mail (n=445). Participant behaviour changes were measured by a questionnaire. Cost calculations were made based on the results of the study. RESULTS: Between 10% and 26% of participants reported behaviour changes as a result of reading the booklet. A change in health situation was less likely using postal distribution. There were no significant differences between the other types of distribution. Cost-effective distribution at work sites and in occupational health was superior to distribution in primary health care when direct costs were used. Distribution at work sites was the least cost-effective when indirect costs, i.e. productivity losses of participants, were included. CONCLUSIONS: Cost-effectiveness analyses support distribution of personal health documents in occupational health. In primary health care, high training costs in combination with low distribution rates might be problematic. Providing information during distribution at work sites is time-consuming and might therefore be a problem if productivity losses are taken into account.

Identifiers
urn:nbn:se:umu:diva-2673 (URN)18647126 (PubMedID)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2015-04-29Bibliographically approved
4. Empowerment: a key to a better understanding of adolescent health?
Open this publication in new window or tab >>Empowerment: a key to a better understanding of adolescent health?
Show others...
2008 (English)In: International journal of child and adolescent health, ISSN 1939-5930, Vol. 1, no 1, 61-68 p.Article in journal (Refereed) Published
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-2674 (URN)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2015-04-29Bibliographically approved
5. Personal health documents in school health education: a feasibility study
Open this publication in new window or tab >>Personal health documents in school health education: a feasibility study
Show others...
2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no 6, 662-665 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To examine the feasibility of a school intervention using a personal health document adapted for adolescents. Methods: The health document was developed in close cooperation with groups of adolescents and tested among seventh-grade students at two junior high schools (n=339). The document was presented to the students by their regular teachers. For evaluation, an adolescent questionnaire was used at baseline and after one year. Results: After one year, 87% of adolescents reported having written in the health document, and 77% reported having had classes with discussions on subjects in the document. The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker, and having a positive school experience. Conclusions: Implementation of a personal health document in junior high-school health education was feasible and well accepted.

Place, publisher, year, edition, pages
Sage Publications, 2007
Keyword
Adolescents, empowerment, feasibility, health education, records, schools
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-2675 (URN)10.1080/14034940701430397 (DOI)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2017-12-14Bibliographically approved

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