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  • 1.
    Carson, Dean B.
    et al.
    Centre for Tourism and Regional Opportunities, Central Queensland University, Cairns, Australia.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    A socially accountable health and care workforce in Northern Sweden: who should it contain, who is it for and what should it do?2020In: Dipping in to the North: living, working and traveling in sparsely populated areas / [ed] Linda Lundmark, Dean B. Carson, Marco Eimermann, Singapore: Palgrave Macmillan, 2020, p. 175-194Chapter in book (Refereed)
    Abstract [en]

    This chapter examines two myths affecting development of the health and care workforce in places like the rural north of Sweden. The first is that 'rural health' is primarily concerned with medical care, and the second is that the major challenge facing rural health and care systems is population ageing. We argue that a focus on ageing populations leads to a workforce that is poorly equipped to deal with the needs of youth, Indigenous people, migrants and others. Further, a workforce focused on medical care is limited in capacity to provide holistic and coordinated care for rural residents. We acknowledge that demanding a more knowledgeable and better prepared health and care workforce will increase the challenges of recruitment and retention, but this needs to be balanced against the benefits of having a 'socially accountable' workforce.

  • 2.
    Degerlund Maldi, Kinza
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Widespread and widely widening?: Examining absolute socioeconomic health inequalities in northern Sweden across twelve health indicators2019In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 18, article id 197Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic inequalities in health is a widely studied topic. However, epidemiological research tends to focus on one or a few outcomes conditioned on one indicator, overlooking the fact that health inequalities can vary depending on the outcome studied and the indicator used. To bridge this gap, this study aims to provide a comprehensive picture of the patterns of socioeconomic health inequalities in Northern Sweden over time, across a range of health outcomes, using an 'outcome-wide' epidemiological approach.

    Method: Cross-sectional data from three waves of the 'Health on Equal Terms' survey, distributed in 2006, 2010 and 2014 were used. Firstly, socioeconomic inequalities by income and education for twelve outcomes (self-rated health, self-rated dental health, overweight, hypertension, diabetes, long-term illness, stress, depression, psychological distress, smoking, risky alcohol consumption, and physical inactivity) were examined by calculating the Slope Index of Inequality. Secondly, time trends for each outcome and socioeconomic indicator were estimated.

    Results: Income inequalities increased for psychological distress and physical inactivity in men as well as for selfrated health, overweight, hypertension, long-term illness, and smoking among women. Educational inequalities increased for hypertension, long-term illness, and stress (the latter favouring lower education) in women. The only instance of decreasing income inequalities was seen for long-term illness in men, while education inequalities decreased for long-term illness in men and poor self-rated health, poor self-rated dental health, and smoking in women.

    Conclusion: Patterns of absolute socioeconomic inequalities in health vary by health and socioeconomic indicator, as well as between men and women. Overall, trends appear more stagnant in men while they fluctuate in women. Income inequalities seem to be generally greater than educational inequalities when looking across several different health indicators, a message that can only be derived from this type of outcome-wide study. These disparate findings suggest that generalised and universal statements about the development of health inequalities can be too simplistic and potentially misleading. Nonetheless, despite inequalities being complex, they do exist and tend to increase. Thus, an outcome-wide approach is a valuable method which should be utilised to generate evidence for prioritisations of policy decisions

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  • 3.
    Ferreira, Tatiana
    et al.
    School of Education, Polytechnic Institute of Santarém, Santarém, Portugal.
    Mauro Ellena, Adriano
    Università Cattolica del Sacro Cuore, Milan, Italy; CERISVICO - Research Centre on Community Development and Organisational Quality of Life, Brescia, Italy.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Barbosa, Belém
    University of Porto, Porto, Portugal.
    Uyan-Semerci, Pınar
    Istanbul Bilgi University, Istanbul, Turkey.
    Tuna, Emelj
    Ss. Cyril and Methodius University of Skopje, Skopje, North Macedonia.
    Kvieskienė, Giedrė
    Vytautas Magnus University, Kaunas, Lithuania.
    Marta, Elena
    Università Cattolica del Sacro Cuore, Milan, Italy; CERISVICO - Research Centre on Community Development and Organisational Quality of Life, Brescia, Italy.
    Unay-Gailhard, İlkay
    Leibniz Institute of Agricultural Development in Transition Economies (IAMO), Leibniz, Germany.
    Fernandes-Jesus, Maria
    University of Sussex, Brighton, United Kingdom.
    Building bridges: community-based projects for participation and social inclusion of rural neets2024In: NEETs in European rural areas: individual features, support systems and policy measures / [ed] Francisco Simões; Emre Erdogan, Springer, 2024, 1, p. 17-33Chapter in book (Other academic)
    Abstract [en]

    This chapter focuses on factors that facilitate community-based projects for providing effective and sustainable responses to the challenges faced by young people Not in Employment, Education, or Training (NEETs) in rural areas and more specifically to promote their quality of life and social inclusion. In line with Bronfenbrenner’s bioecological model (1977, 1979) and considering community-based projects as part of the exosystem, we aim to identify the barriers and constraints faced by projects targeting young NEETs in rural areas. As part of the collaborative research developed by the members of the “WG1—Rural NEETs Social Networks and Social Inclusion” of the Rural NEET Youth Network, we identified five promising community-based projects in Portugal, Italy, Sweden, North Macedonia, and Lithuania and conducted semi-structured interviews with the project coordinators. Our analysis showed that the identified projects take into account the different levels of the bioecological model and the need to involve how young people and local communities. Both these factors are crucial for their success and sustainability over time.

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  • 4.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gotfredsen, Anne
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Wernesjö, Ulrika
    Department of Culture and Society, Linköping University, Linköping, Sweden.
    The Promise of Belonging: Racialized Youth Subject Positions in the Swedish Rural North2023In: Journal of International Migration and Integration, ISSN 1488-3473, E-ISSN 1874-6365, Vol. 24, p. 695-713Article in journal (Refereed)
    Abstract [en]

    This article analyses how youth subject positions of the ‘racialized other’ are produced, and how these positions interconnect with the concept of belonging to the rural community. We do this by analysing 15 group discussions with 63 young people living in rural areas in northern Sweden taking a discursive psychology approach, and focusing on how discourses produce certain subject positions of ‘the racialized other’. Drawing on the concepts of the politics of belonging and the ‘stranger’, we argue that discourses on belonging to the (rural) community create boundaries that exclude ‘other’ youth, as well as resistance and contestation. The subject positions that such discourses produce represent racialized youth in stereotypical ways and imply a promise of belonging for certain ‘others’ based on their fulfilment of particular norms. However, such a depoliticized promise of belonging that places the responsibility for becoming integrated on the ‘others’ was also challenged. Firstly, in relation to criticisms of the welfare system, and secondly, in relation to racism as an unwelcome threat in rural communities.

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  • 5.
    Johansson, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rapo, Emil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Lundgren, Anna Sofia
    Umeå University, Faculty of Arts, Department of culture and media studies. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Let’s Try Social Prescribing in Sweden (SPiS): an Interventional Project Targeting Loneliness among Older Adults Using a Model for Integrated Care: A Research Protocol2021In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 21, no 2, article id 33Article in journal (Refereed)
    Abstract [en]

    Introduction: Loneliness and social isolation among older adults (≥65) are an emerging issue of public concern, associated with increased morbidity and mortality. Today there is no systematic intervention developed, implemented or evaluated in Sweden addressing loneliness. The overall aim for this project is to develop, test and refine a person-centred Swedish model for social prescribing (SPiS), and to assess whether and how it reduces loneliness, promotes health and improves well-being among older adults.

    Description: The focus will be to develop, culturally adapt, evaluate and refine the SPiS model. Following the sequential structure of realist evaluation in three consecutive phases qualitative and quantitative data along with subsequent analysis methods will be collected and utilized. The project will provide knowledge of what works with the social prescribing model, for whom, in what conditions and why, in relation to loneliness, health and well-being among older adults.

    Discussion: SPiS has the unique position of providing initial knowledge regarding how to reduce loneliness in the Swedish context. However, evaluation is complex as this research goes beyond the unidimensional question “Is it working?”.

    Conclusion: Developing, implementing and evaluating such a complex program needs systematic and close evaluation.

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  • 6.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The presence of the past: a life course approach to the social determinants of health and health inequalities in northern Sweden2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Positioned at the intersection between the social and life course epidemiological sub-fields, this thesis builds on the idea that the health implications of life and living conditions can extend over years and decades before becoming expressed in the population patterns of ill-health. The overall purpose was to assess how multiple types of social determinants of health across the life course may contribute to ill-health and health inequalities in midlife. Several gaps in knowledge served as the basis for four research questions that focused on: 1) the intermediate role of socio-economic, material and psychosocial factors in young adulthood, in the long-term association between adolescent socio-economic position and midlife ill-health; 2) the implications of poor social capital in adolescence and accumulated over the life course for midlife ill-health; 3) the consequences of intra-generational social mobility for midlife ill-health and 4) the contribution of socio-economic, material and psychosocial circumstances in adolescence, young adulthood and middle-age to midlife neighbourhood deprivation inequalities in ill-health.

    Methods: The setting of the thesis is Sweden spanning over nearly three decades, from the early 1980s and until the mid-2010s. With information drawn from the Northern Swedish Cohort the study population consists of 1,083 pupils (506 girls and 577 boys) who attended, or should have attended, the last year of compulsory school in 1981. The data used came from questionnaires answered by the participants in the follow-ups at the ages of 16 (in 1981), 21 (in 1986), 30 (in 1995) and 42 (in 2007). The attrition rate was low with 1,010 out of the 1,071 students who were alive over the 26-years participated in all waves (94.3%). Data was also included from the Swedish registers for the same ages as the surveys on the participants’ neighbourhoods and sociodemographic characteristics on all other residents in these areas. The health outcome was functional somatic symptoms, referring to the occurrence of common physical complaints such as musculoskeletal pain, headache, palpitations and fatigue. To capture various social determinants of health, socio-economic, material and psychosocial factors were operationalised as main exposures. The research questions were analysed using: 1) path analysis, 2) multiple linear regression, 3) diagonal reference models and 4) a decomposition analysis.

    Results: With regard to the four research questions, the results firstly indicated that the long-term association between adolescent socio-economic position and midlife ill-health was linked by socio-economic position in young adulthood and further via material and psychosocial factors in middle-age. Secondly, that poor social capital in adolescence also could play a role in the development of adult illhealth, but that this influence seem to be largely dependent on recent or current conditions in adulthood. Thirdly, that downward mobility in the socio-economic hierarchy during middle-age may have little to no health implications, while upward movements could have a small positive effect on health. Fourthly, that ill-health was concentrated in more socio-economically deprived neighbourhoods and that this inequality was to a small extent attributed to conditions in earlier life period and mainly to factors in adulthood.

    Conclusions: Based on patterns cutting across the original research questions, the findings from this thesis indicate broadly that socio-economic, material and psychosocial conditions may be meaningful for midlife ill-health and health disparities, jointly and independently from each other. The results also suggests that determinants in the present on the surface appear to be more important for midlife ill-health and health inequalities than those of the past, but at the same time that life circumstances in the earlier life course may not be irrelevant. Rather than representing permanent or resilient health implications, however, the long-term influence of adolescent conditions seem to reflect mainly social processes that are conditional on recent or concurrent adult factors. In sum, the results indicate that a continuum of various life and living conditions may be a key phenomenon underlying ill-health and health disparities in midlife. Specifically, this thesis illustrates how the past may become part of the present through the accumulation and chains of unfavourable circumstances over the life course and conversely, how the present health reflects and embodies a life-long past.

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  • 7.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Blåhed, Hanna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    More than meets the eye: a critical discourse analysis of a Swedish health system reform2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1226Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports.

    METHODS: Based on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi's "What's the Problem Represented to be?" (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four.

    RESULTS: The three problem representations connected the Swedish health system "problem" to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources.

    CONCLUSION: The results from this study indicate that as discursively framed within concrete proposals, government official reports in Sweden represent the health system problem in particular ways and with these problem representations overlooking several aspects that are central to a health system characterized by PHC principles and functions. In the continued reorientation towards good quality and local health care, these silences might need to be acknowledged.

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  • 8.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University. School of Business and Law, CQUniversity, Rockhampton, QLD, Australia.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden2022In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 11, no 1, p. 39-48Article in journal (Refereed)
    Abstract [en]

    Background: Unlike the large body of research that has examined the ‘success’ or ‘failure’ of eHealth in terms of patientand provider perceptions or cost- and clinical effectiveness, the current study teases out ways through which a noveleHealth initiative in rural northern Sweden might result in more distal or systemic beneficial outcomes. More specifically,this paper aims to explore how and under what circumstances the so-called virtual health rooms (VHRs) are expectedto improve access to person-centred care and strengthen community health systems, especially for elderly residents ofrural areas.

    Methods: The first phase of the realist evaluation methodology was conducted, involving qualitative interviews with 8key stakeholders working with eHealth, business development, digitalisation, and process management. Using thematicanalysis and following an abductive-retroductive analytical process, an intervention-context-actor-mechanism-outcome(ICAMO) configuration was developed and elicited into an initial programme theory.

    Results: The findings indicate that a novel eHealth initiative, which provides reliable technologies in a customizedfacility that connects communities and providers, might improve access to person-centred care and strengthencommunity health systems for rural populations. This is theorized to occur if mechanisms acting at individual (suchas knowledge, skills and trust) and collective (like a common vision and shared responsibilities) levels are triggered incontexts characterised by supportive societal transitions, sufficient organisational readiness and the harnessing of ruralcohesiveness and creativity.

    Conclusion: The elicited initial programme theory describes and explains how a novel eHealth initiative in ruralnorthern Sweden is presumed to operate and under what circumstances. Further testing, refinements and continuedgradual building of theory following the realist evaluation methodology is now needed to ascertain if the ‘VHRs’ work asintended, for whom, in what conditions and why.

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  • 9.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Arctic Research Centre at Umeå University.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, article id 2191Article in journal (Refereed)
    Abstract [en]

    Background: In the current study, the approach of ‘utopia as method’ was combined with the concept ‘landscapes of care’ to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions.

    Methods: The research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden.

    Results: The results indicated that caring landscapes should: ‘provide services responsive to young people’s wishes and needs’, ‘be organised around values of safety, equity and youth participation’, and ‘rework metro-centredness’ in order to care for, with and about rural youth.

    Conclusions: The findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a ‘good countryside’ where young people have the possibility to live a good life in decent health.

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  • 10.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    “We believe in you, like really believe in you”: Initiating a realist study of (re)engagement initiatives for youth not in employment, education or training with experiences from northern Sweden2020In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 83, article id 101851Article in journal (Refereed)
    Abstract [en]

    Due to a scarcity of rigorous evaluations and to commence a realist study addressing the lack of knowledge about the workings of interventions directed towards "NEET" youth, this research aimed to understand how and under what circumstances (re)engagement initiatives are expected to facilitate the social integration of young people who are in a situation that prevents them from entering into studies or work. By conducting the first phase in realist evaluation, qualitative interviews with five managerial stakeholders from two northern Swedish initiatives and reviews of documents were carried out for data collection. Using thematic analysis and retroductive reasoning, an intervention-context-actors-mechanisms-outcomes configuration was developed to elicit an initial programme theory that explained how the initiatives were presumed to operate and under what contextual contingencies. The results indicate that the intervention is expected to improve the youths’ wellbeing and engage them in work or studies by strengthening their competence and confidence in a caring and collaborative context. To incorporate the diverse voices and heterogeneous experiences of youth themselves, and ascertain whether the intervention works as intended, for whom, in what conditions and why, the results now need to be tested in selected cases and refined in subsequent phases of evaluation research.

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  • 11.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University. School of Business and Law, CQUniversity, Rockhampton, Australia.
    Wiklund, Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Landscapes of care and despair for rural youth: a qualitative study in the northern Swedish 'periphery'2020In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 19, no 1, article id 171Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises 'landscapes of care' for rural youth.

    METHODS: In this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish 'peripheral' inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14-27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, 'landscapes of care and despair', comprising the two themes: '(dis)connectedness' and 'extended support or troubling gaps'.

    RESULTS: The findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths' feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths' senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care.

    CONCLUSIONS: To gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating 'care-ful' and 'uncaring' aspects bounded up in dynamic and multi-layered landscapes.

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  • 12.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hjelte, Jan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Representing a Fading Welfare System that Is Failing Young People in 'NEET' Situations: a WPR Analysis of Swedish Youth Policies2022In: Journal of Applied Youth Studies, ISSN 2204-9193Article in journal (Refereed)
    Abstract [en]

    The situation of young people who are neither in employment, education nor training (referred to in political, scientific and public discourses as ‘NEETs’) has received widespread attention during the last decade. However, while policy responses to young people’s work- and school-related marginalisation have been analysed by international scholars in a variety of contexts, to the best of our knowledge, no study to date has scrutinised problem representations of ‘NEET’ young people in youth policies in Sweden. To bridge the current knowledge gap and uncover taken-for-granted assumptions about the otherwise largely unchallenged Nordic welfare model, the aim of this research was to explore how the ‘problem’ of ‘NEET’ young people is represented in Swedish policies and policy proposals. To facilitate this, a discursive approach to policy analysis was adopted, following Bacchi’s ‘What’s the Problem Represented to be?’ (WPR) methodology. By focusing on the solutions that have been proposed to reduce the size of the ‘NEET’ group in two selected policies, four problem representations were developed. These connect the ‘NEET’ problem in Sweden, at the general level, to the ‘vulnerability’ of young people on the margins of education and employment (especially certain sub-groups) and, more specifically, to the failure of a fading welfare system to provide services and support for these ‘vulnerable’ subjects. Beyond representing the ‘problem’ along these lines, the identified problem representations may contribute to silencing young people’s agency and ignoring the consequences of a growing labour-market precarisation in Sweden, while failing to provide a basis for equity and social justice.

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  • 13.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rural-urban differences in health among youth in northern Sweden: an outcome-wide epidemiological approach2019In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 78, article id 1640015Article in journal (Refereed)
    Abstract [en]

    The aim of this research was to contribute knowledge about rural-urban differences in health among young northern Swedish women and men. This study was based on the 2014 "Health on Equal Terms" survey, distributed in the four northernmost counties of Sweden, with complementary information on areas of residence classified as rural, semi-urban and urban from total population registers. The analytical sample included 2,691 individuals who were selected using a probabilistic sampling method. Prevalence ratios were calculated in multivariable log-binomial regression analyses to measure the association between place of residence and nine outcomes covering three health dimensions (general, mental and lifestyle behaviours). The results indicated that daily smoking and being overweight were more common, while feelings of stress and psychological distress were less prevalent, among youths in rural as compared to urban areas. After including covariates, this pattern appeared stronger for young women, although the direction of the results also applied to young men, albeit without revealing significant differences. In conclusion, the findings from this study indicate that for youths - particularly young women - the rural setting may imply an increased risk of poor general health and lifestyle behaviours, while simultaneously playing a partially protective role for mental health.

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  • 14.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Gotfredsen, Anne C.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    How can community-based (re)engagement initiatives meet the needs of ‘NEET’ young people? Findings from the theory gleaning phase of a realist evaluation in Sweden2022In: BMC Research Notes, E-ISSN 1756-0500, Vol. 15, no 1, article id 232Article in journal (Refereed)
    Abstract [en]

    Objective: There has been a lack of systematic and theoretically underpinned evaluations, internationally and in Sweden, of local multi-component initiatives delivered outside public employment services and formal education systems to young people who are not in employment, education or training (‘NEETs’). To bridge this knowledge gap, the objective of this study was to present findings from the theory gleaning phase of a realist evaluation aimed at assessing how Swedish community-based initiatives may work to (re)engage vulnerable ‘NEET’ young people in education or employment, under what conditions and why.

    Results: Based on insights gleaned and synthesised from various sources, three candidate programme theories were elicited drawing attention to the importance of community-based initiatives in Sweden adopting a ‘caring approach’, a ‘capability approach’ and a ‘collaborative approach’ to (re)engage ‘NEET’ young people in education or employment. While limited to the initial phase of theory gleaning, the study provides valuable insights into the potential functioning of (re)engagement initiatives directed towards vulnerable ‘NEETs’ in addition to increasing the transparency of a highly iterative research project.

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  • 15.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Social capital across the life course and functional somatic symptoms in mid-adulthood2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 7, p. 581-588Article in journal (Refereed)
    Abstract [en]

    Aim: To examine social capital across life and functional somatic symptoms in middle-age, according to life-course models of cumulative risk and sensitive periods.

    Methods: Data from the 26-year prospective study the Northern Swedish Cohort enabled complete case analyses on 940 individuals (451 women and 489 men) participating in questionnaire surveys at ages 16, 21, 30 and 42. Social capital was operationalized at the individual level, comprising items on social participation, social influence and social support. Functional somatic symptoms were a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties occuring during the 12 months prior to the data collection. Linear regression was used as the main statistical method, examining the relationship between functional somatic symptoms at age 42 and social capital across life.

    Results: Lower levels of social capital accumulated over the life course were associated with higher levels of functional somatic symptoms at age 42, for both women and men. Social capital was, especially among adolescent men, related to functional somatic symptoms at age 42, independently of social capital later in life and baseline material circumstances.

    Conclusions: The health impact of poor social capital may be due to accumulation across the life course and to adolescence being a particularly sensitive period. It is relevant for preventive work to acknowledge effects of social capital throughout life.

  • 16.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Pat, Puthy
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Mulubwa, Chama
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jegannathan, Bhoomikumar
    Mathias, Kaaren
    Conducting research with young people at the margins: lessons learnt and shared through case studies in Cambodia, India, Sweden and Zambia2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 2185Article in journal (Refereed)
    Abstract [en]

    Building on the value of engaging with and enabling the participation of marginalised young people in research, theaim of this article was to profle practical and procedural issues faced when conducting studies with young peoplewho experience some form of marginalisation. Drawing on observations and research experiences from four diversecase studies involving young people who were either imprisoned in Cambodia, living in informal urban communitiesin North India, residing in rural northern Sweden or attending school in rural Zambia, learnings were identifed underthree thematic areas. Firstly, a need exists to develop trusting relationships with stakeholders, and especially the participating young people, through multiple interactions. Secondly, the value of research methods that are creative andcontext sensitive are required to make the process equitable and meaningful for young people. Thirdly, it is importantto fatten power relations between adults and young people, researchers and the researched, to maximise participation. These fndings can inform future youth research in the feld of global public health by detailing opportunitiesand challenges of engaging in research with young people on the margins to promote their participation.

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  • 17.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis2018In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 52, p. 127-134Article in journal (Refereed)
    Abstract [en]

    This study explains neighbourhood deprivation inequalities in adult health for a northern Swedish cohort by examining the contribution of socio-economic and psychosocial determinants from adolescence (age 16), young adulthood (age 21) and midlife (age 42) to the disparity. Self-reported information from 873 participants was drawn from questionnaires, with complementary neighbourhood register data. The concentration index was used to estimate the inequality while decomposition analyses were run to attribute the disparity to its underlying determinants. The results suggest that socio-economic and psychosocial factors in midlife explain a substantial part, but also that the inequality can originate from conditions in adolescence and young adulthood.

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  • 18.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stromsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarstrom, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155963Article in journal (Refereed)
    Abstract [en]

    While research examining the health impact of early socioeconomic conditions suggests that effects may exist independently of or jointly with adult socioeconomic position, studies exploring other potential pathways are few. Following a chain of risk life course model, this prospective study seeks to examine whether pathways of occupational class as well as material and social adversities across the life course link socioeconomic disadvantage in adolescent to functional somatic symptoms in mid-adulthood. Applying path analysis, a multiple mediator model was assessed using prospective data collected during 26 years through the Northern Swedish Cohort. The sample contained 987 individuals residing in the municipality of Lulea, Sweden, who participated in questionnaire surveys at age 16, 21, 30 and 42. Socioeconomic conditions (high/low) in adolescence (age 16) were operationalized using the occupation of the parents, while occupational class in adulthood (manual/nonmanual) was measured using the participant's own occupation at age 21 and 30. The adversity measurements were constructed as separate age specific parcels at age 21 and 30. Social adversity included items pertaining to stressful life events that could potentially harm salient relationships, while material adversity was operationalized using items concerning unfavorable financial and material circumstances. Functional somatic symptoms at age 42 was a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties that had occurred during the last 12 months. An association between socioeconomic conditions at age 16 and functional somatic symptoms at age 42 (r = 0.068) which was partially explained by people's own occupational class at age 21 and then material as well as social adversity at age 30 was revealed. Rather than proposing a direct and independent health effect of the socioeconomic conditions of the family, the present study suggests that growing up in an unfavorable socioeconomic environment might be a source for a chain of adverse material and social living situations, which in turn affects adult health.

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  • 19.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sebastian, Miguel San
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models2017In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 16, article id 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of "being" in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories.

    METHOD: The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grace theory indicates that downward mobility is especially stressful. In contrast, the acculturation theory holds that the health implications of social mobility is not due to the movement itself but attributed to the class contexts in which people find themselves. Diagonal Reference Models were used on a sample of 924 individuals who in 1981 graduated from 9(th) grade in the municipality of Luleå, Sweden. Social mobility was operationalized as change in occupational class between age 30 and 42 (measured in 1995 and 2007). The health outcome was functional somatic symptoms at age 42, defined as a clustering self-reported physical symptoms, palpitation and sleeping difficulties during the last 12 months.

    RESULTS: Overall mobility was not associated with higher levels of functional somatic symptoms compared to being immobile (p = 0.653). After controlling for prior and current class, sex, parental social position, general health, civil status, education and unemployment, the association between downward mobility was borderline significant (p = 0.055) while upward mobility was associated with lower levels of functional somatic symptoms (p = 0.03).

    CONCLUSION: The current study did not find unanimous support for any of the theories. Nevertheless, it sheds light on the possibility that upward mobility may be beneficial to reduce stress-related health problems in mid-life over and above the exposure to prior and current class, while downward mobility can be of less importance for middle-age health complaints.

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  • 20.
    Meili, Kaspar Walter
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hjelte, Jan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Löfgren, Curt
    Månsdotter, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    NEET prevention through Sweden’s youth payroll tax cut: Evaluating cost-effectiveness using CALY-SWEManuscript (preprint) (Other academic)
  • 21.
    Norvell Gustavsson, Isa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Exploring the experiences of NEET‑situated young people within the context of the COVID‑19 pandemic using resonance theory2024In: Journal of Applied Youth Studies, ISSN 2204-9193Article in journal (Refereed)
    Abstract [en]

    This study explores the experiences of young people who are not in education, employment, or training (NEET) within the context of the COVID-19 pandemic in Sweden, using resonance theory as an analytical lens. It contributes knowledge about the importance of school and work (or lack thereof) for these youths during a time of uncertainty and gives insight into their quality of life and well-being from a social and relational perspective. The findings shed light on how the COVID-19 pandemic aggravated an already strained situation for this group while highlighting the importance of relationships, not only with friends and family, but with society as a whole. Adopting a non-materialistic approach to NEET situated young people's quality of life and well-being allowed resonant experiences to become evident in various aspects of their lives, which may be overlooked if the norms of an educationally underpinned work-centrism are in focus. The study calls for a broadened view on what constitutes or characterizes a good life for young people at the margins of the labor market and education system, while emphasizing the need to move beyond narrow concerns about integration into education or employment, towards focusing on their well-being.

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  • 22.
    Rapo, Emil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Johansson, Erika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundgren, Anna Sofia
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Critical components of social prescribing programmes with a focus on older adults - a systematic review2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 3, p. 326-342Article, review/survey (Refereed)
    Abstract [en]

    Aims: The aim of this study was to identify and evaluate critical components within social prescribing programmes that can impact loneliness, health, or well-being among older adults.

    Methods: A systematic review with a narrative synthesis was conducted by systematically searching five databases. A total of 1193 hits were identified, screened, and assessed. Twelve studies were included, with data being extracted and deductively analysed in an iterative manner and then tabulated together with outcomes in order to find common narratives.

    Results: Three critical components were identified: Assessment before prescription, matching participants with relevant activities, and individualised support from link worker. These critical components seemed important for the success of social prescribing programmes since they had an impact on loneliness, health, and well-being. All together, these results highlight the importance of person-centeredness in the prescribing process.

    Conclusions: The three critical components identified may prove useful in further research, evaluation, or implementation of social prescribing programmes. Important aspects for further evaluation are discussed.

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  • 23.
    San Sebastian, Miguel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Edin-Liljegren, Anette
    Umeå University, Faculty of Medicine, Department of Nursing. Centre for Rural Medicine, Region Västerbotten, Storuman, Sweden; Division of Innovative Care Research, Karolinska Institutet, Stockholm, Sweden.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rural-urban differences in suicide attempts and mortality among young people in northern Sweden, 1998-2017: A register-based study2020In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, no 8, p. 794-800Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to assess trends in suicide attempts and mortality between 1998 and 2017 by residential area and gender among northern Swedish youths.

    Methods: Events of suicide attempts and deaths for each municipality in the four counties of the northern Swedish region, stratified by gender, were retrieved for each year from 1998 to 2017. All cases identified within the registers with the diagnostic codes X60-X84 or Y10-Y34 (International Classification of Diseases, 10th revision) for individuals aged 15-24 years were included. Place of residence at municipal level was categorized into three groups: rural - municipalities with a population of <10,000 inhabitants; semi-rural - those between 10,000 and 50,000; and urban - those with >50,000 inhabitants.

    Results: The rates of attempted suicides in the northern region were higher in both men and women than in Sweden, while the rates of suicide deaths were slightly higher in young men but similar in young women compared to the national averages. Overall, the risk of suicide attempts was higher in semi-rural municipalities compared to urban ones, particularly among women. A significantly higher risk of mortality was also observed for men and women in semi-rural municipalities, but only in the period 2010-2013.

    Conclusions: The high rates of attempted and completed suicides among youth in northern Sweden and the higher risks in rural and semi-rural municipalities need close attention. The implementation of suicide prevention programs, especially in rural and semi-rural municipalities, should be intensified.

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  • 24.
    Tetui, Moses
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Pharmacy, University of Waterloo, Waterloo, ON, Canada; Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jonsson, Frida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Whyle, Eleanor
    School of Public Health & Family Medicine (SPHFM), University of Cape Town, Cape Town, South Africa.
    Zulu, Joseph
    School of Public Health & Family Medicine (SPHFM), University of Cape Town, Cape Town, South Africa.
    Schneider, Helen
    School of Public Health, University of the Western Cape, Cape Town, South Africa; South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa.
    Hernandez, Alison
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Centre for the Study of Equity and Governance in Health Systems, Guatemala City, Guatemala.
    Strengthening Research and Practice in Community Health Systems: A Research Agenda and Manifesto2022In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 11, no 1, p. 17-23Article in journal (Refereed)
    Abstract [en]

    While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a 'manifesto' on strengthening research and practice in the CHS. The CHS research agenda domains were developed through a modified concept mapping process with a team of 33 experts on the CHS including policy-makers, implementers and researchers from institutions in six countries: Uganda, Guatemala, South Africa, Sweden, Tanzania and Zambia. The process began remotely with brainstorming research priorities and concluded in a one-week workshop that was held in Zambia where priorities for strengthening CHS were discussed, grouped into domains, interpreted, and drafted into a collective declaration. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies forresearching the CHS. By harnessing a set of diverse and rich experiences and perspectives on CHS through a structured process, a multifaceted research agenda and manifesto that transcend context, disciplines and time were developed. We posit this as an entry into greater debate and diversity in the field as we continue to find ways to strengthen research and practice in the CHS. 

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