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Andersson, E. M., Liv, P., Nordin, S., Näslund, U. & Lindvall, K. (2024). Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?. Social Science and Medicine, 341, Article ID 116530.
Open this publication in new window or tab >>Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?
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2024 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 341, article id 116530Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown.

Purpose: To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity.

Method: The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants’ (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0–10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group.

Results: After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32–0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43–0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status.

Conclusion: Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Atherosclerosis, Cardiovascular disease, Pictorial communication, Prevention, Response efficacy, Risk perception, Self efficacy, Vascular age
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-218586 (URN)10.1016/j.socscimed.2023.116530 (DOI)38169179 (PubMedID)2-s2.0-85181833982 (Scopus ID)
Funder
Region Västerbotten, ALFVLL-298001Region Västerbotten, AALFVLL- 643391Swedish Research Council, 521-2013-2708Swedish Research Council, 2016–01891Swedish Research Council, 2017–02246Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481Swedish Society of MedicineThe Swedish Stroke AssociationSwedish Insurance SocietyVisare NorrThe Swedish Heart and Lung Association
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2024-01-22
Nordin, S., Norberg, M., Braf, I., Johansson, H., Lindahl, B., Lindvall, K., . . . Näslund, U. (2023). Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age. Psychology and Health
Open this publication in new window or tab >>Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age
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2023 (English)In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults.

Methods and measures: Cross-sectional data were obtained from participants aged 40–60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations.

Results: Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 − 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 − 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT.

Conclusion: The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.

Place, publisher, year, edition, pages
Routledge, 2023
Keywords
Cardiovascular disease, cardiovascular risk score, carotid artery plaque, carotid vascular ultrasound, social support
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-217344 (URN)10.1080/08870446.2023.2286296 (DOI)37994844 (PubMedID)2-s2.0-85177567916 (Scopus ID)
Available from: 2023-12-01 Created: 2023-12-01 Last updated: 2023-12-01
Andersson, E. M., Johansson, H., Nordin, S. & Lindvall, K. (2023). Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis: a qualitative study within the VIPVIZA trial. Scandinavian Journal of Primary Health Care, 41(1), 69-80
Open this publication in new window or tab >>Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis: a qualitative study within the VIPVIZA trial
2023 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 1, p. 69-80Article in journal (Refereed) Published
Abstract [en]

Objectives, setting and subjects: Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. Design: In-depth interviews with 14 individuals were analysed with qualitative content analysis. Results: Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants’ descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. Conclusions: The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Cardiovascular disease, decision making, health behaviour, prevention, qualitative content analysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-205734 (URN)10.1080/02813432.2023.2178850 (DOI)000942309100001 ()36855328 (PubMedID)2-s2.0-85149358906 (Scopus ID)
Funder
Region Västerbotten, ALFVLL-298001Region Västerbotten, ALFVLL-643391Swedish Research Council, 521-2013-2708Swedish Research Council, 2016-0189Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481Swedish Society of MedicineThe Swedish Stroke AssociationVisare Norr
Available from: 2023-03-17 Created: 2023-03-17 Last updated: 2023-06-20Bibliographically approved
Tong, T. Y. N., Clarke, R., Schmidt, J. A., Huybrechts, I., Noor, U., Forouhi, N. G., . . . Key, T. J. (2023). Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries. European Journal of Nutrition
Open this publication in new window or tab >>Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries
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2023 (English)In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: Previously reported associations of protein-rich foods with stroke subtypes have prompted interest in the assessment of individual amino acids. We examined the associations of dietary amino acids with risks of ischaemic and haemorrhagic stroke in the EPIC study.

Methods: We analysed data from 356,142 participants from seven European countries. Dietary intakes of 19 individual amino acids were assessed using validated country-specific dietary questionnaires, calibrated using additional 24-h dietary recalls. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of ischaemic and haemorrhagic stroke in relation to the intake of each amino acid. The role of blood pressure as a potential mechanism was assessed in 267,642 (75%) participants.

Results: After a median follow-up of 12.9 years, 4295 participants had an ischaemic stroke and 1375 participants had a haemorrhagic stroke. After correction for multiple testing, a higher intake of proline (as a percent of total protein) was associated with a 12% lower risk of ischaemic stroke (HR per 1 SD higher intake 0.88; 95% CI 0.82, 0.94). The association persisted after mutual adjustment for all other amino acids, systolic and diastolic blood pressure. The inverse associations of isoleucine, leucine, valine, phenylalanine, threonine, tryptophan, glutamic acid, serine and tyrosine with ischaemic stroke were each attenuated with adjustment for proline intake. For haemorrhagic stroke, no statistically significant associations were observed in the continuous analyses after correcting for multiple testing.

Conclusion: Higher proline intake may be associated with a lower risk of ischaemic stroke, independent of other dietary amino acids and blood pressure.

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Amino acids, Dietary protein, Haemorrhagic stroke, Ischaemic stroke, Nutritional epidemiology, Prospective cohort
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-215965 (URN)10.1007/s00394-023-03251-4 (DOI)37804448 (PubMedID)2-s2.0-85173723528 (Scopus ID)
Funder
Region Skåne, C8221/A29017EU, FP7, Seventh Framework Programme, HEALTH-F2-2012-279233Wellcome trust, 205212/Z/16/ZEU Sixth Framework Programme for Research, LSHM_CT_2006_037197Swedish Cancer SocietySwedish Research Council
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2023-10-30
Andersson, E. M., Lindvall, K., Wennberg, P., Johansson, H. & Nordin, S. (2023). From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification. BMC Psychology, 12(1), Article ID 47.
Open this publication in new window or tab >>From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification
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2023 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 12, no 1, article id 47Article in journal (Refereed) Published
Abstract [en]

Background: Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients’ reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. 

Methods: In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants’ evaluation of the risk communication was assessed in the intervention group (n=1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n=714-857).

Results: The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification.

Conclusions: The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Atherosclerosis, Lifestyle, Health behaviour, Prevention, Health promotion, Decision making, Cognition, Emotion 
National Category
Psychology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218585 (URN)10.1186/s40359-023-01467-x (DOI)001148313000002 ()38268015 (PubMedID)2-s2.0-85182977469 (Scopus ID)
Funder
Region Västerbotten, Central ALFRegion Västerbotten, ALFVLL-298001Region Västerbotten, ALFVLL- 643391Swedish Research Council, 521–2013-2708Swedish Research Council, 2016- 01891Swedish Research Council, 2017–02246Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481The Swedish Stroke AssociationSwedish Insurance SocietyVisare Norr
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2024-02-07Bibliographically approved
Lindvall, K., Vaezghasemi, M., Feldman, I., Ivarsson, A., Stevens, K. J. & Petersen, S. (2021). Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden. Health and Quality of Life Outcomes, 19(1), Article ID 193.
Open this publication in new window or tab >>Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden
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2021 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 19, no 1, article id 193Article in journal (Refereed) Published
Abstract [en]

Background: This study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.

Methods: In total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity.

Results: The CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin).

Conclusions: This study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Adolescent, Child, CHU9D, Health related quality of life, HRQoL, Psychometrics, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-186637 (URN)10.1186/s12955-021-01830-9 (DOI)000683730500003 ()34344386 (PubMedID)2-s2.0-85112016482 (Scopus ID)
Available from: 2021-08-30 Created: 2021-08-30 Last updated: 2023-03-24Bibliographically approved
Usher-Smith, J. A., Häggström, C., Wennberg, P., Lindvall, K., Strelitz, J., Sharp, S. J. & Griffin, S. J. (2021). Impact of achievement and change in achievement of lifestyle recommendations in middle-age on risk of the most common potentially preventable cancers. Preventive Medicine, 153, Article ID 106712.
Open this publication in new window or tab >>Impact of achievement and change in achievement of lifestyle recommendations in middle-age on risk of the most common potentially preventable cancers
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2021 (English)In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 153, article id 106712Article in journal (Refereed) Published
Abstract [en]

This study aimed to assess the association between achievement, and within-person change in achievement, of lifestyle recommendations in middle-age and incidence of the most common potentially preventable cancers. We used data from 44,572 participants from the Swedish Västerbotten Intervention Programme who had attended at least two health checks 9-11 years apart. We assessed the association between the mean number of healthy lifestyle recommendations achieved (lifestyle score), and change in lifestyle score between the health checks, and risk of one or more of the eight most common potentially preventable cancers using Cox regression. Participants were followed-up for 11.0 (SD 4.9) years. A higher mean lifestyle score was associated with a lower hazard of cancer in men (HR 0.81 (95%CI 0.74-0.90) per unit increase) and women (HR 0.90 (0.84-0.96)). There was no evidence of a linear association between change in lifestyle score and risk (HR 0.93 (0.85-1.03) and HR 1.004 (0.94-1.07) per unit change for men and women respectively). When comparing those with an increase in lifestyle score of ≥2 with those who improved less or declined in achievement the HR was 0.74 (0.54-1.00) and 1.02 (0.84-1.24) for men and women respectively. These findings support the inclusion of lifestyle recommendations in cancer prevention guidelines. They further suggest that interventions to change health behaviours in middle-age may reduce risk of the most common preventable cancers in men, but this association was not observed in women. Strategies to encourage healthy lifestyles earlier in the life course may be more effective.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Cancer prevention, Change, Lifestyle, Västerbotten intervention programme
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-191016 (URN)10.1016/j.ypmed.2021.106712 (DOI)000709483800025 ()34242663 (PubMedID)2-s2.0-85121958253 (Scopus ID)
Available from: 2022-01-05 Created: 2022-01-05 Last updated: 2022-01-05Bibliographically approved
Bengtsson, A., Lindvall, K., Norberg, M. & Fhärm, E. (2021). Increased knowledge makes a difference!–general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial. Scandinavian Journal of Primary Health Care, 39(1), 77-84
Open this publication in new window or tab >>Increased knowledge makes a difference!–general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial
2021 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 1, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Objectives: To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors.

Design, setting and subjects: Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis.

Results: Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result–A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action.

Conclusion and implications: Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures.

Trial registration: https://clinicaltrials.gov/ct2/show/NCT01849575.

KEY POINTS: Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention:

  • Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures
  • GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making
  • GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis.
Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Cardiovascular disease, consultation process, family practice, pictorial information, qualitative research, risk
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-181026 (URN)10.1080/02813432.2021.1882083 (DOI)000617228200001 ()33569981 (PubMedID)2-s2.0-85101040572 (Scopus ID)
Available from: 2021-03-05 Created: 2021-03-05 Last updated: 2022-04-27Bibliographically approved
Ng, N., Eriksson, M., Guerrero, E., Gustafsson, C., Kinsman, J., Lindberg, J., . . . Wennberg, P. (2021). Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme. Frontiers In Public Health, 9, Article ID 593453.
Open this publication in new window or tab >>Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme
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2021 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, article id 593453Article in journal (Refereed) Published
Abstract [en]

Introduction: The Västerbotten Intervention Programme (VIP) in the Region Västerbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD.

Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019–2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated.

Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps.

Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985).

Dissemination: The collaboration between Umeå University and Region Västerbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2021
Keywords
behavioural change, digital coaching, interdisciplinary programme, formative research, evaluation ofintervention, social network, social media, health behaviour trajectories
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-180937 (URN)10.3389/fpubh.2021.593453 (DOI)000628667800001 ()2-s2.0-85102713934 (Scopus ID)
Available from: 2021-03-03 Created: 2021-03-03 Last updated: 2023-09-05Bibliographically approved
Lindvall, K., Koistinen, S., Ivarsson, A., van Dijken, J. & Eurenius, E. (2020). Health counselling in dental care for expectant parents: a qualitative study. International Journal of Dental Hygiene, 18(4), 384-395
Open this publication in new window or tab >>Health counselling in dental care for expectant parents: a qualitative study
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2020 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 18, no 4, p. 384-395Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Interventions during pregnancy and early childhood have been shown to impact dental health. Thus, Antenatal Care and Dental Care collaborated in an intervention called Health Counselling in Dental Care (HCDC). HCDC was offered free of charge to first-time expectant parents and was aimed at reducing the frequency of dental caries in children and their parents. However, the intervention reached less than 50% of the parents. The aim of this study was to explore facilitators of, barriers to, and suggestions for increased participation in HCDC.

METHODS: Data was collected through semi-structured, face-to-face interviews with expectant parents. Participants were purposively sampled based on having been invited to HCDC and to achieve a variation in socio-demographics. Interviews were audio recorded, transcribed verbatim, and analysed using conventional qualitative content analysis.

RESULTS: In total, 16 interviews were conducted (10 women, 6 men). Six categories representing three facilitators and three barriers for participation emerged. The facilitators were the midwife's crucial role for disseminating information about HCDC and motivating participation, that the parents perceived HCDC as valuable for themselves and their offspring, and a desire for new or more knowledge. The barriers included a shortage of information regarding the counselling, a perceived lack of value for the parents and offspring, and the timing of the counselling during pregnancy.

CONCLUSIONS: The midwives were crucial in providing information and motivation for HCDC participation. To increase attendance, sufficient information regarding the benefits of counselling is required, and the timing needs to be flexible and family-centred.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Antenatal care, Dental care, Health Counselling, Interviews, Pregnancy, Prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology Dentistry Pediatrics
Identifiers
urn:nbn:se:umu:diva-174119 (URN)10.1111/idh.12461 (DOI)000564456900001 ()32794308 (PubMedID)2-s2.0-85090060845 (Scopus ID)
Available from: 2020-08-18 Created: 2020-08-18 Last updated: 2024-04-02Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-4942-611x

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