Umeå University's logo

Background: Physical activity and exercise are promoted worldwide as effective interventions for healthy ageing. Various exercise initiatives have been developed and evaluated for their efficacy and effectiveness among older populations. However, a deeper understanding of participants’ experiences with these initiatives is crucial to foster long-term activity and exercise among older persons.

Methods: A constructivist grounded theory study was conducted to explore the experiences of older persons participating in a supervised group supramaximal high-intensity training (HIT) programme. Four focus groups were held, involving 28 persons aged 65 to 78. The focus groups were analysed inductively, followed by an iterative process of abstraction, abduction, and theory generation using a constant comparative method. A conceptual framework comprising three theoretical concepts—stereotype embodiment, ageist practices, and self-efficacy—was employed during the abductive phase as an analytical lens.

Results: The core category of our grounded theory, Negotiating a physically active life in tune with ageing, encapsulates the complex processes and actions influencing older persons as they engage in physical activities in their daily lives and in relation to HIT. This core category was created from the conceptual framework and the four categories: Grit in the moment and overall life, Empowered by the training group, Navigating one’s physically active self, and Committing to exercise for duty and pleasure. Participants reported feeling invigorated by the exercise, enjoying the challenge, and valuing the group setup for its social connectedness and structure. The generated theory illustrates how participants’ engagement with physical activity and exercise is shaped by various perspectives accumulated over their lifespan. The findings provide a plausible explanation of how participation in HIT groups can challenge negative age stereotypes and ageist practices while enhancing self-efficacy for high-intensity exercise.

Conclusions: Our grounded theory underscores that physical activity and exercise should be regarded as multifaceted processes, which must be considered when promoting physical activity initiatives for older persons. By considering the older person and societal norms and values, we can gather knowledge to design physical exercise interventions that are not only effective but also enjoyable and capable of transforming how individuals perceive themselves as exercising persons.

This study aimed to explore school nurses’ experience of using physical activity on prescription with children in Swedish compulsory school. Semistructured interviews were conducted with 24 school nurses who had the educational qualification to prescribe physical activity. The analysis resulted in one overarching theme, “A delicate process of tailoring physical activity on prescription to a child's social context,” and two categories: “Promoting joyful physical activity through individualization and support” and “Dealing with dilemmas and challenges,” with related subcategories. The results demonstrate the importance of tailoring prescribed physical activity to each individual child, their living conditions, and the school context. In addition, they highlight the nurses’ working conditions and collaborations as important prerequisites when initiating physical activity on prescription. In conclusion, the results suggest that school nurses perceive physical activity on prescription as a useful tool in the school context, but it needs to be tailored to each individual child.

Background: Supramaximal high-intensity interval training (HIT) programmes can be challenging to replicate outside research settings. This study aimed to explore its feasibility for older adults in a community setting, incorporating perspectives from exercise participants and instructors.

Methods: A pragmatic feasibility study using a convergent mixed- methods design involving four exercise instructors from one training facility and 21 older adult exercise participants (14 women, age-range 65–78). The previously used HIT programme consisted of 20-minute sessions that included a warm-up, ten 6-second intervals, and cool-down. Instructors first adapted the programme around these core components to their setting and then conducted 25 sessions. Both qualitative (individual interviews) and quantitative (estimated maximal oxygen consumption, estimated 6-second power, exercise- related motivation, and self-efficacy) data were collected and analysed (content analysis and descriptive statistics) in parallel. A taxonomy for implementation outcomes was used as an analytical matrix.

Results: Experiences of both participants and instructors revealed that the structure of the training was regarded as engaging, enjoyable, and supportive for establishing routines and promoting ownership of training progression. Participants found personalised and motivating approaches to engage with the programme and confidence in their abilities grew. Changes in exercise-related motivation and self-efficacy showed individual variation without a group trend. Participants who completed the intervention showed a positive median change in estimated 6-second power and maximal oxygen consumption, although individual responses varied. Experienced challenges included coordinating tasks during intervals and confidence in managing the programme. Barriers to fidelity and to scale-up were related to the practical complexity and fixed structure.

Conclusions: Supramaximal HIT can be implemented for older adults in a community setting with appropriate support, including individualised watt-based intensity and structured progression. The findings highlight how participants took ownership of their intensity progression, enabling them to challenge their limits. However, the fixed structure and complexity in managing short intervals may pose barriers to broader adoption. To enhance feasibility and scalability, simplifying interval management and providing clear, structured guidance are recommended. These insights help refine and optimize supramaximal HIT implementation for older adults in community settings.

Trial registration: Open Science Framework 31 January 2023 (https://doi.org/10.17605/OSF.IO/B7T2G).

School nurses are in a key position to promote children's physical activity. They engage all children in health dialogues and use different approaches to inform children about physical activity and motivate them to change their physical activity level. In a school context, it is important to explore and problematize school nurses' views of children's physical activity and the influence of these views on their professional practice in the school health service. Identifying and problematizing school nurses' views of physical activity would enable them to create improved guidelines and equivalent ways of working in the future. Therefore, this study aims to discursively explore Swedish school nurses' views on school children's physical activity and its promotion and elucidate them through a discursive framework based on sensitizing concepts. This study uses a qualitative research design with a constructivist grounded theory approach. Semi-structured interviews were conducted with 24 school nurses. The analysis resulted in a core category describing how school nurses use intertwined views to lead children from sedentarity to physical activity. Furthermore, the school nurses' practices were identified in three categories: fostering everyday movement as a tool for health, battling children's sedentarity under difficult conditions, and promoting everyday movement and compensating for unequal access. The results indicate that school nurses lack common and clear guidelines for their mission to promote physical activity to children, which may lead to inequality in access to physical activity for children and young people.

Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionalsand managers in the youth mental health system in Sweden. Interviews explored participants’ experience andunderstanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergentstudy design using reflexive thematic analysis.

Results: The analysis produced three themes. The first shows that collaboration is considered as essential andimportant, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles andresponsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, andtarget levels, and the third captures the challenges and criticisms in collaborating across the youth mental healthlandscape, but also in growing possibilities for future development.

Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

In Swedish school health services, local initiatives have been taken to use physical activity on prescription (PAP) to encourage physically inactive children to become more active. Previous research shows that interprofessional collaboration plays a crucial role in promoting physical activity in children, as well as in promoting health in schools. However, there is a lack of knowledge about PAP for children in the school setting, including how medical and educational staff can work together to encourage children who have been recommended PAP. Therefore, this study aims to explore the perceived facilitators and barriers concerning interprofessional collaboration regarding physical activity on prescription in the school setting, as viewed from the professionals’ perspectives. Semi-structured interviews were conducted with 21 professionals who work with the method in school settings. The data were analyzed using Reflexive Thematic Analysis. The results reveal both barriers and facilitators for interprofessional collaboration on PAP in the school setting, as perceived by professionals. Organizational and structural obstacles within school institutions hinder collaboration, while a shared commitment to PAP, characterized by consensus-building, acts as a facilitating factor. PAP for children in a school setting is still an unexplored area and further research is required.

BACKGROUND: During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.

METHODS: In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.

RESULTS: Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.

CONCLUSIONS: Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Purpose: The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness".

Methods: Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke.

Results: The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'.

Conclusion: This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health

Introduction: Mental disorders, such as depression and anxiety with interlinked suicidality, are the leading cause of health-related disability among young men. Knowledge of the interaction between emotional, bodily, social and gendered mental health processes in young men is limited and therefore needed.

Aim: This study aimed to explore young men's lived embodied experiences of mental disorders and suicidality, and to conceptualise these by integrating affective–emotional, physiological, social and gendered processes.

Methods: Semistructured individual interviews were conducted with 13 young men who had sought professional help for mental disorders and suicidality. Grounded theory (GT) was used with a social constructivist perspective.

Results: The results comprise one core category - Living (dys)regulated and alienated young masculinity - with related categories “battling with the emotional body,” “suffering in social silence” and “balancing embodied darkness and distress.” The GT illustrates how young men navigate and manage their embodied and emotional suffering in a context of “regulative” masculine and social norms alongside insufficient social support.

Conclusion: Our results suggest that young men's lived embodied experiences of mental disorders and suicidality can be understood as a dynamic process of internal and external “(dys)regulation and alienation.” The generated GT provides a broad tentative explanation model, contributing to theory development, and serves as a basis for gender-sensitive interventions - in both psychotherapy and physiotherapy - integrating body, mind and the social context.

Background: In Sweden, persistent physical and psychological health problems occur in about three in ten women who sustain severe perineal trauma (SPT) during childbirth. As most Swedish women work outside the home, the question of if and how SPT-related morbidity influences working life needs exploration. This study aims to qualitatively explore how women with persistent SPT-related morbidities experience and conceptualise their problems concerning working life. Further, we theorise the findings by applying Simone de Beauvoir’s feminist framework of immanence and transcendence as well as authentic and inauthentic life.

Methods: Ten interviews with women recruited via a Swedish social media community for perineal trauma were analysed according to Charmaz’s constructivist approach to grounded theory.

Results: The theoretical model and related core category ‘Negotiating the ambiguity of an (in)authentic working life’ reflected the women’s negotiations of immanence as ‘the silent covert object’ versus transcendence as the ‘the resourceful overt subject’. The model also mirrored the conflict of (in)authenticity in working life. An inauthentic working life was experienced when women were denied their subjectivity at work or constructed themselves as subjects in denial of their SPT. On the other hand, women who acknowledged their SPT and were constructed as subjects by ‘others’ achieved an authentic working life despite SPT.

Conclusions: The conflicting gendered process of ‘the silent covert object’ versus ‘the resourceful overt subject’ problematised women’s vulnerability at work. Aspects that enable subjectification and transcendence are essential for policymakers, employers, healthcare services, and society to eradicate the taboo of SPT and create a working environment characterised by understanding, support, and flexibility. Further, access to adequate care, sick leave, and occupational rehabilitation are essential. Such measures support transcendence towards an authentic working life and, consequently, a more gender-equal working environment that does not deprive women of career opportunities due to a physical ailment.