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HUS, hållbar utevistelse vid storförskolor är ett nationellt forskningsprojekt i samverkan med Umeå kommuns förskoleverksamhetunder åren 2021–2025. Projektet är tvärvetenskapligt, vilket innebär att vi som medverkar kommer från olika områden såsom utbildningsvetenskap,pedagogiskt arbete, miljöpsykologi, samhällsmedicin, idrottsvetenskap och landskapsarkitektur och att vi här arbetar gemensamt med flera olika perspektiv och kunskaper.

Många förskolor i Sverige byggdes under 70-talet vilket betyder att de snart är 50 år, och är därför i behov av renovering eller heltersättas av nya. Samtidigt har vi i dag en ökad befolkning i städerna och behovet av nya platser på förskolorna har ökat. Att ge alla barnen plats på förskolan, och att bygga förskolor med rymliga och funktionella förskolegårdar i städer där grönytor har minskat som följd av förtätning kan därför vara utmanande. I vårt forskningsprojekt vill vi undersöka vad den förändring som svensk förskola genomgår med sina förändrade byggnader, utegårdar och begränsad tillgång till natur innebär för barnen som vistas där dagligen. Vi vill lyfta både det positiva och det som kan vara problematiskt och behöver utvecklas.

Vårt samarbetsprojekt är finansierat av FORMAS, en statlig förvaltare som stödjer forskningsprojekt i samverkan med aktörer i praktiken och som vill bidra till en hållbar samhällsutveckling. Det är också vårt mål med HUS projektet - att den kunskap vi kan skapa gemensamt med förskolorna i Umeå kan bidra till att skapa utemiljöer, och förhållningssätt till dessa, som stimulerar barns rörelse och hälsa, relationsskapande med varandra och naturen för en hållbar utveckling.

En del av vårt projekt har handlat om att dokumentera de medverkande förskolornas utemiljöer och den verksamhet som bedrivs där, utifrån pedagogernas perspektiv. Vi har också låtit barnen själva berätta om, och visa vilka platser på sina gårdar som de helst leker vid. I denna projektdokumentation finns därför alla de medverkande förskolorna beskrivna med sina berättelser tillsammans med våra olika forskningsresultat från de olika delstudierna och övergripande slutsatser. Förhoppningsvis kan våra exempel och lärdomar också fungera som inspiration för andra kommuner och förskolor som vill arbeta med,och utveckla sina utemiljöer på ett hållbart sätt. Den här projektboken har under de första åren fungerat som ett levande dokument och som en tidig återkoppling till våra deltagare. Nu när projektet avslutas i december år 2025 har vi adderat resultat och slutsatser från våra delstudier samt summerat våra erfarenheter av detta mångåriga projekt.

Som projektledare vill jag uttrycka min tacksamhet och glädje över förmånen att få ha arbetat tillsammans med dels forskarkollegor från många olika fält och olika delar av landet och dels er inom Umeå kommuns förskoleverksamhet samt Teknik och fastighetsförvaltningen. Det har varit värdefullt och inspirerande att vi under flera år har fått samlas och uppmärksamma aktuella och relevanta frågor för förskolans uteverksamhet som ett bidragtill en mer hållbar samhällsutveckling.

Tack till er alla!

Annika Manni, projektledare Umeå universitet

Purpose: The Workplace Dialogue is a digitalized method directed at managers. The purpose of this study was to explore managers’ experiences of using the digital Workplace Dialogue in cases of employee ill-health.

Design/methodology/approach: The Workplace Dialogue provides an easy and accessible method for managers, including text, short films, client examples and concrete guides that provides support in how managers can act in the event of ill-health, for example, by creating dialogue and adjustments at work. A total of five public and private organizations participated in a cohort study, implementing and using the Workplace Dialogue for one year. We interviewed 22 managers to explore their experiences of using the Workplace Dialogue. The interviews were analyzed using Qualitative Content Analysis.

Findings: The experiences of using the Workplace Dialogue are presented in one overall theme: Supports and strengthens managers’ leadership and ability to handle and act on work-related health, and four sub-themes: Requires organizational legitimacy, Facilitates management of work-related health, Strengthens manager–employee collaboration and Contributes to leadership development. The Workplace Dialogue was described as a method that contributed to better work-related health by emphasizing the early identification of problems. Manager–employee collaboration was improved, and responsibilities were made clearer. Using the method enabled personal development among managers. Some prerequisites were pointed out, such as a need for time and support from the organization.

Originality/value: The Workplace Dialogue can support managers in addressing and acting on cases of employee ill-health.

Background: Outdoor time and play are crucial for children’s learning and development, impacting various physical, cognitive, and social aspects of their well-being and socio-emotional growth. In Sweden, new preschools are increasingly built as multi-story facilities, accommodating larger cohorts of children while often reducing outdoor space. This trend raises concerns about the quality of outdoor environments and their impact on physical activity (PA) opportunities. This study aims to explore outdoor total PA and PA levels among children in traditionally and newly designed preschools across varied outdoor play environments. The primary research question was: How does total outdoor PA differ among children attending traditionally designed versus newly designed preschools, and across different types of outdoor play environments? The hypothesis was that children’s total outdoor PA is higher in preschools with higher-quality outdoor play environments, and, among preschools of similar quality, those with traditional designs are associated with higher PA levels than newly designed ones. The secondary research question was: How do outdoor PA levels differ among children attending traditionally designed versus newly designed preschools? The hypothesis was that children attending traditionally designed preschools engage in higher levels of outdoor PA than those attending newly designed preschools.

Methods: This cross-sectional study involved 106 children aged 3-5-year-olds from six (3 traditional and 3 newly designed) strategically selected preschools in Sweden. Data for total PA was collected with accelerometers (ActiGraph GT3X+) among 106 children. Data for PA level (n = 371 observations) was collected through observations. The preschool outdoor play environments were assessed using the Outdoor Play Environment Categories (OPEC). Multiple regression was used to assess how preschool type (traditional/newly designed) and OPEC predicted total PA. Chi-square test was used to explore differences in PA levels.

Results: The result showed that children in newly designed preschools (p = 0.019 for forenoon and p = 0.049 for afternoon) and children in preschools with higher OPEC (p < 0.001 for forenoon and p < 0.001 for afternoon) had higher outdoor total PA than their children peers. In contrast, observations showed that PA levels differed among children in traditional and newly designed preschools (p = 0.005), with those at traditional preschools having higher proportions of moderate movements.

Conclusions: The present study showed that children in newly designed preschools, and children in preschools with higher-quality outdoor play environment, had higher outdoor total PA than their children peers. In addition, that children in traditional preschools had higher proportions of moderate movements compared to newly designed preschools. These results emphasise the importance of balancing environmental design and unstructured PAs to support diverse and engaging outdoor PA opportunities for children. Further studies should explore how social dynamics, spatial organization, and activity flow within newly designed preschools across different outdoor play environments contribute to higher total PA and different PA levels among children.

Introduction: The burden of work-related ill health is increasing in working-life. The employer has the main responsibility for securing a healthy work environment, preventing ill health, andfacilitating employees’ return to work after sickness. In organizations, the responsibility for thesystematic work environmental practice is often shared or divided between a first-line managerand a Human Resource (HR) function. The aim of this study was to describe how the workenvironmental responsibility is shared or divided in large and small organizations, and how thiscould impact the organizations’ implementation and use of a health promoting workplaceintervention.

Method: The Workplace Dialogue is a digital method that guides and supports anorganization’s work environmental practice, to discover, act on and adapt work to work-relatedill health. It includes concrete support in the form of text, films, and discussion materials. Thisstudy is based on a one-year intervention which started in 2022 with the Workplace dialoguebeing implemented in five large (two public and three private) and seven small (three publicand four private) organizations. Data was collected six and twelve months into the interventionand was based on focus-group discussions with eight and three HR functions from large andsmall organizations respectively. Interviews included questions concerning how HR functionsexperienced the implementation process, and how they perceived their mandate to influencethis process. Interviews were transcribed and then analysed using qualitative content analysis.

Results: The preliminary findings indicate that, after the implementation, the practice of theWorkplace Dialogue was more established in organizations where the board of managementwere leading the project. In large organizations where HR functions were not a part of thestrategic board, the implementation was more complicated and dependent on the commitmentof certain individuals. In small companies, a structure for the organization’s systematic workenvironmental practice could be missing, which made the implementation more difficult. AlbeitHR functions overall had positive attitudes towards the Workplace dialogue and were importantresources for managers’ use of it, HR functions’ opinions and actions generally had less impacton securing the method practice in the organizations.

Conclusion: To facilitate the comprehensive implementation of a new health promotingworkplace method, such as the Workplace dialogue, it is crucial for organizations to involve HRfunctions in the strategic management board. Further, to secure the practice of such method,organizations’ management board needs to be involved in and support the implementation anduse of it. However, small companies may have less organizational resources to realise thepractice of a new health promoting workplace method.

Objective: This study aimed to investigate and explore Occupational Health and Safety (OHS) management, office ergonomics, and musculoskeletal symptoms in a group of office workers relocating from cell offices to activity-based flex offices (AFOs).

Methods: The analysis was based on qualitative interview data with 77 employees and longitudinal questionnaire data from 152 employees.

Results: Results indicate that there was a need to clarify roles and processes related to the management of OHS. Self-rated sit comfort, working posture, and availability of daylight deteriorated and symptoms in neck and shoulders increased after the relocation and seemed to be influenced by many factors, such as difficulties adjusting the workstations, the availability of suitable workplaces, and age, sex, and individual needs.

Conclusion: Research on the long-term effects of physical work environments and management of (OHS) issues after implementing activity-based flex offices is sparse. This study demonstrates the importance of planning and organising OHS issue management when implementing an AFO, and to carefully implement office ergonomics among office workers.

Background: Stress-induced exhaustion disorder (SED) is the most common reason for long-term sick leave in Sweden and the recovery process may be long and troublesome. This study explores the symptoms of burnout, depression and anxiety among patients with SED 10 years after termination of a multimodal rehabilitation program. Another aim of the study was to investigate work situation, work functioning, and any remaining exhaustion and sleeping disorders among those who were gainfully employed at the 10-year follow-up.

Methods: This longitudinal study included 107 patients (91 women and 16 men), who had been diagnosed with SED 10 years prior to the study. After establishing the diagnosis they all underwent and completed an multimodal rehabilitation program. Data on symptoms of burnout, anxiety and depression were collected before and after the multimodal rehabilitation program, and at follow-ups after additional 1 year and an additional 10 years. At the 10-year follow-up, work situation, work functioning, and symptoms of exhaustion and sleep disorders were assessed in those who were gainfully employed (89 patients).

Results: Symptoms of burnout, anxiety, and depression remained stable from the 1- to the 10-year follow-up after completed rehabilitation. Among participants who were gainfully employed, 73% had changed workplaces, and 31.5% had reduced their working hours. Common reasons for these changes were lack of energy or because they had chosen to prioritise their lives differently. Work functioning was rated as moderate, one third self-reported SED to some extent, and one fifth reported moderate-to-severe insomnia.

Conclusion: A relatively large proportion of former patients with SED have residual health problems 10 years after rehabilitation and some have not been able to return to full-time work. Preventive and early rehabilitative interventions with adjustments and measures at the organisational level are probably needed to achieve a more sustainable working life.

Background: Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important.

Objective: The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder.

Method: A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison.

Results: The analysis of the data was developed into the core category ‘trying to integrate physical activity into daily life in a sustainable way’, and three categories: ‘acceptance of being good enough’, ‘learning physical activity by doing’ and ‘advocation for physical activity in rehabilitation’. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was ‘good enough’ in terms of dose and intensity of physical activity, and how to listen to the body’s signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested.

Conclusion: Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.

Stress-related exhaustion is associated with cognitive deficits, measured subjectively using questionnaires targeting everyday slips and failures or more objectively as performance on cognitive tests. Yet, only weak associations between subjective and objective cognitive measures in this group has been presented, theorized to reflect recruitment of compensational resources during cognitive testing. This explorative study investigated how subjectively reported symptoms of cognitive functioning and burnout levels relate to performance as well as neural activation during a response inhibition task. To this end, 56 patients diagnosed with stress-related exhaustion disorder (ED; ICD-10 code F43.8A) completed functional magnetic resonance imaging (fMRI) using a Flanker paradigm. In order to investigate associations between neural activity and subjective cognitive complaints (SCCs) and burnout, respectively, scores on the Prospective and retrospective memory questionnaire (PRMQ) and the Shirom-Melamed burnout questionnaire (SMBQ) were added as covariates of interest to a general linear model at the whole-brain level. In agreement with previous research, the results showed that SCCs and burnout levels were largely unrelated to task performance. Moreover, we did not see any correlations between these self-report measures and altered neural activity in frontal brain regions. Instead, we observed an association between the PRMQ and increased neural activity in an occipitally situated cluster. We propose that this finding may reflect compensational processes at the level of basic visual attention which may go unnoticed in cognitive testing but are reflected in the experience of deficits in everyday cognitive functioning.

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.

Background: Stress-induced exhaustion disorder is a major challenge in Swedish working life. Despite its increase in prevalence, there is still limited knowledge about the effectiveness of different rehabilitation methods. In this study, we aim to describe the healthcare utilisation for patients with stress-induced exhaustion disorder before, during and after a multi-modal rehabilitation (MMR) programme, as well as the health-related quality of life, work ability, sick leave level and psychological measures, and their possible relations.

Methods: In this longitudinal observational study, 53 patients who were part of an MMR programme at the Stress Rehabilitation Clinic participated with survey data, and among them 43 also contributed with healthcare data. Data were collected from one year before start of MMR to one year after the end of it. The patients also answered a questionnaire at the start of, end of and at a one-year follow-up of the MMR, which included questions about health-related quality of life, work ability, clinical burnout, sick leave level, anxiety and depression.

Results: There was a statistically significant increase in healthcare consumption during MMR, if including visits to the Stress Rehabilitation Clinic, while it decreased if excluding such visits, when comparing with before and after MMR. During the follow-up period there was a non-statistically significant (p=0.11), but still rather large difference (15.4 compared with 12.0 visits per patient), in healthcare consumption in comparison with the period before MMR, when excluding follow-up visits at the Stress Rehabilitation Clinic. Health-related quality of life was rated as poor before MMR (mean 0.59). There was a statistically significant improvement, but values were still below normal at the end of follow-up (mean 0.70). In addition, the level of sick leave, the work ability and signs of clinical burnout improved statistically significantly after MMR, but were not fully normalised at the end of follow-up. Individual healthcare consumption was related to residual health problems.

Conclusions: Patients with stress-induced exhaustion disorder have not reduced their healthcare consumption notably after MMR, and residual health problems remain for some patients. More studies are needed for a deeper understanding of the individual effectiveness of MMR, and also of its cost-effectiveness.