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  • 1.
    Aagaard, Hanne
    et al.
    Lovisenberg Diaconal University College, Oslo, Norway.
    Hall, ElisabethO.C.
    Health, Aarhus University, Aarhus, Denmark; Faculty of Health Sciences and Nursing University of Faroe Islands, Torshavn, Faroe Islands.
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ludvigsen, Mette S.
    Department of Clinical Medicine - Randers Regional Hospital, Aarhus University, Aarhus, Denmark; Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Westergren, Thomas
    Department of Public Health, University of Stavanger, Norway; Department of Nursing Science, University of Agder, Norway.
    Fegran, Liv
    Department of Nursing Science, University of Agder, Norway.
    Parents’ experiences of transitioning to home with a very-low-birthweight infant: a meta-ethnography2023Ingår i: Journal of Neonatal Nursing, ISSN 1355-1841, E-ISSN 1878-089X, Vol. 29, nr 3, s. 444-452Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Medical-technological advances and neurodevelopmental care have improved the survival of extremely- and very-low-birthweight infants born before 32 weeks' gestation. After months in neonatal care, the infants are discharged, and parents exited but full of anxiety. This review is designed as a meta-ethnography, addressing parents' discharge experiences to comprehend the synthesised research, which includes 12 eligible studies. From the analysis, we constructed three themes: ‘approaching discharge with both uncertainty and confidence’; ‘discharge as a longed-for though disordering turning point’; and ‘facing joys, worries and multiple challenges when at home’. The overarching interpretation was ‘discharge as double-edged sword’. We conclude that bringing home very-low-birthweight infants is a joyful event, yet parents also experience discharge as never-endingly worrying, as a time filled with challenges to which parents must adapt and as necessitating continuous support from knowledgeable providers.

  • 2.
    Audulv, Åsa
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    The over time development of chronic illness self-management patterns: a longitudinal qualitative study2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikel-id 452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.

    Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.

    Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.

    Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern.

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  • 3.
    Audulv, Åsa
    et al.
    Department of Health Sciences, Mid Sweden University, Sweden.
    Asplund, Kenneth
    Norbergh, Karl-Gustav
    Who's in charge?: The role of responsibility attribution in self-management among people with chronic illness2010Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 81, nr 1, s. 94-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore how responsibility attribution influences self-management regimens among people with chronic illness.

    Methods: This qualitative content analysis included 26 interviews with people living with chronic illness.

    Results: The participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to “conventional” self-management such as taking medication, managing symptoms and lifestyle changes.

    Conclusion: How responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility.

    Practice implications: Health-care providers should acknowledge and support individuals’ wishes about various levels of responsibility as well as different kinds of patient–provider relationships.

  • 4.
    Audulv, Åsa
    et al.
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    Ghahari, Setareh
    Kephart, George
    Warner, Grace
    Packer, Tanya L.
    The Taxonomy of Everyday Self-management Strategies (TEDSS): A framework derived from the literature and refined using empirical data2019Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, nr 2, s. 367-375Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To extend our understanding of self-management by using original data and a recent concept analysis to propose a unifying framework for self-management strategies.

    METHODS: Longitudinal interview data with 117 people with neurological conditions were used to test a preliminary framework derived from the literature. Statements from the interviews were sorted according to the predefined categories of the preliminary framework to investigate the fit between the framework and the qualitative data. Data on frequencies of strategies complemented the qualitative analysis.

    RESULTS: The Taxonomy of Every Day Self-management Strategies (TEDSS) Framework includes five Goal-oriented Domains (Internal, Social Interaction, Activities, Health Behaviour and Disease Controlling), and two additional Support-oriented Domains (Process and Resource). The Support-oriented Domain strategies (such as information seeking and health navigation) are not, in and of themselves, goal focused. Instead, they underlie and support the Goal-oriented Domain strategies. Together, the seven domains create a comprehensive and unified framework for understanding how people with neurological conditions self-manage all aspects of everyday life.

    CONCLUSIONS: The resulting TEDSS Framework provides a taxonomy that has potential to resolve conceptual confusion within the field of self-management science.

    PRACTICE IMPLICATIONS: The TEDSS Framework may help to guide health service delivery and research.

  • 5.
    Audulv, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hall, Elisabeth O. C.
    Faculty of Health, Aarhus University, Aarhus, Denmark; Faculty of Health Sciences, University of Faroe Islands, Faroe Islands, Thorshavn, Denmark.
    Kneck, Åsa
    Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Westergren, Thomas
    Department of Health and Nursing Science, University of Agder, Kristiansand, Norway; Department of Public Health, University of Stavanger, Stavanger, Norway.
    Fegran, Liv
    Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.
    Pedersen, Mona Kyndi
    Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
    Aagaard, Hanne
    Lovisenberg Diaconale Univeristy of College, Oslo, Norway.
    Dam, Kristianna Lund
    Faculty of Health Sciences, University of Faroe Islands, Faroe Islands, Thorshavn, Denmark.
    Ludvigsen, Mette Spliid
    Department of Clinical Medicine-Randers Regional Hospital, Aarhus University, Aarhus, Denmark; Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Qualitative longitudinal research in health research: a method study2022Ingår i: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 22, nr 1, artikel-id 255Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). A method study can provide an insightful understanding of the use, trends and variations within this approach. The aim of this study was to map how QLR articles within the existing health research literature are designed to capture aspects of time and/or change.

    Methods: This method study used an adapted scoping review design. Articles were eligible if they were written in English, published between 2017 and 2019, and reported results from qualitative data collected at different time points/time waves with the same sample or in the same setting. Articles were identified using EBSCOhost. Two independent reviewers performed the screening, selection and charting.

    Results: A total of 299 articles were included. There was great variation among the articles in the use of methodological traditions, type of data, length of data collection, and components of longitudinal data collection. However, the majority of articles represented large studies and were based on individual interview data. Approximately half of the articles self-identified as QLR studies or as following a QLR design, although slightly less than 20% of them included QLR method literature in their method sections.

    Conclusions: QLR is often used in large complex studies. Some articles were thoroughly designed to capture time/change throughout the methodology, aim and data collection, while other articles included few elements of QLR. Longitudinal data collection includes several components, such as what entities are followed across time, the tempo of data collection, and to what extent the data collection is preplanned or adapted across time. Therefore, there are several practices and possibilities researchers should consider before starting a QLR project.

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  • 6.
    Audulv, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Nursing Science, Mid Sweden University, Sweden.
    Hutchinson, Susan
    Warner, Grace
    Kephart, George
    Versnel, Joan
    Packeref, Tanya L.
    Managing everyday life: Self-management strategies people use to live well with neurological conditions2021Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 104, nr 2, s. 413-421Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This paper uses the Taxonomy of Everyday Self-management Strategies (TEDSS) to provideinsight and understanding into the complex and interdependent self-management strategies peoplewith neurological conditions use to manage everyday life.

    Methods: As part of a national Canadian study, structured telephone interviews were conducted monthlyfor eleven months, with 117 people living with one or more neurological conditions. Answers to fiveopen-ended questions were analyzed using qualitative content analysis. A total of 7236 statements wereanalyzed.

    Results: Findings are presented in two overarching patterns: 1) self-management pervades all aspects oflife, and 2) self-management is a chain of decisions and behaviours. Participants emphasizedmanagement of daily activities and social relationships as important to maintaining meaning in theirlives.

    Conclusion: Managing everyday life with a neurological condition includes a wide range of diversestrategies that often interact and complement each other. Some people need to intentionally manageevery aspect of everyday life.

    Practice implications: For people living with neurological conditions, there is a need for health providersand systems to go beyond standard advice for self-management. Self-management support is besttailored to each individual, their life context and the realities of their illness trajectory.

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  • 7.
    Audulv, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norbergh, Karl-Gustaf
    Asplund, Kenneth
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    An ongoing process of inner negotiation: a grounded theory study of self-management among people living with chronic illness2009Ingår i: Journal of nursing and healthcare of chronic illness, Vol. 1, nr 4, s. 283-293Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.

    Background. One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.

    Method. The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.

    Results. Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual's considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.

    Conclusions. The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.

    Relevance to clinical practice. This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.

  • 8.
    Audulv, Åsa
    et al.
    Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
    Packer, Tanya
    Hutchinson, Susan
    Roger, Kerstin S.
    Kephart, George
    Coping, adapting or self-managing - what is the difference? A concept review based on the neurological literature2016Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 11, s. 2629-2643Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to report: (1) an analysis of the concepts of coping, adaptation and self-management in the context of managing a neurological condition; and (2) the overlap between the concepts.

    BACKGROUND: The three concepts are often confused or used interchangeably. Understanding similarities and differences between concepts will avoid misunderstandings in care. The varied and often unpredictable symptoms and degenerative nature of neurological conditions make this an ideal population in which to examine the concepts.

    DESIGN: Concept analysis.

    DATA SOURCES: Articles were extracted from a large literature review about living with a neurological condition. The original searches were conducted using SCOPUS, EMBASE, CINAHL and Psych INFO. Seventy-seven articles met the inclusion criteria of: (1) original article concerning coping, adaptation or self-management of a neurological condition; (2) written in English; and (3) published between 1999-2011.

    METHODS: The concepts were examined according to Morse's concept analysis method; structural elements were then compared.

    RESULTS: Coping and adaptation to a neurological condition showed statistically significant overlap with a common focus on internal management. In contrast, self-management appears to focus on disease-controlling and health-related management strategies. Coping appears to be the most mature concept, whereas self-management is least coherent in definition and application.

    CONCLUSION: All three concepts are relevant for people with neurological conditions. Healthcare teams need to be cautious when using these terms to avoid miscommunication and to ensure clients have access to all needed interventions. Viewing the three concepts as a complex whole may be more aligned with client experience.

  • 9.
    Audulv, Åsa
    et al.
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden; School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Packer, Tanya
    Versnel, Joan
    Identifying gaps in knowledge: A map of the qualitative literature concerning life with a neurological condition2014Ingår i: Chronic Illness, ISSN 1742-3953, E-ISSN 1745-9206, Vol. 10, nr 3, s. 192-243Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe patterns in the qualitative literature regarding the everyday experience of living with a neurological condition; to identify areas of depth as well as gaps in the existing knowledge base.

    METHODS: An extensive search of the literature yielded 474 articles meeting the inclusion criteria. Data extraction, based on scrutiny of both abstract and full text article included country of origin, diagnosis, stated aim, methodological framework/design, participants, and data collection method(s). Studies were categorized into 27 topics within four broad foci.

    RESULTS: Four broad foci describe the field: impact and management, daily activities and occupations, impact on family, and the healthcare experience. Overall the research is unevenly distributed by diagnosis; some are well represented while others are the subject of little research. Even diagnoses well represented in quantity can be limited in breadth.

    DISCUSSION: Possible explanations for the patterns of emphasis include: a focus on issues and problems, highlighted points of contact between patients and healthcare providers, and ability of participants to voice their views. The literature is also characterized by limited across diagnoses research or that comparing the experience of people with different diagnoses. There is a need for more research in particular diagnoses; more varied data collection methods and acknowledgement of ethnicity, gender, discrimination, and social inequalities.

  • 10.
    Audulv, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Westergren, Thomas
    Department of Health and Nursing Science, University of Agder, Kristiansand, Norway; Department of Public Health, University of Stavanger, Stavanger, Norway.
    Ludvigsen, Mette Spliid
    Department of Clinical Medicine, Randers Regional Hospital, Aarhus University, Aarhus, Denmark; Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
    Pedersen, Mona Kyndi
    Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
    Fegran, Liv
    Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.
    Hall, Elisabeth O. C.
    Faculty of Health, Aarhus University, Aarhus, Denmark; Faculty of Health Sciences and Nursing, University of Faroe Islands, Torshavn, Faroe Islands.
    Aagaard, Hanne
    Lovisenberg Diaconal University College, Oslo, Norway.
    Robstad, Nastasja
    Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.
    Kneck, Åsa
    Department of Health Care Sciences, Marie Cederschöld University, Stockholm, Sweden.
    Time and change: a typology for presenting research findings in qualitative longitudinal research2023Ingår i: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 23, nr 1, artikel-id 284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Qualitative longitudinal research (QLR) is an emerging methodology used in health research. The method literature states that the change in a phenomenon through time should be the focus of any QLR study, but in empirical studies, the analysis of changes through time is often poorly described, and the emphasis on time/change in the findings varies greatly. This inconsistency might depend on limitations in the existing method literature in terms of describing how QLR studies can present findings. The aim of this study was to develop and describe a typology of alternative approaches for integrating time and/or change in QLR findings.

    Methods: In this method study, we used an adapted scoping review design. Articles were identified using EBSCOhost. In total, methods and results sections from 299 QLR articles in the field of health research were analyzed with inspiration from content analysis.

    Results: We constructed a typology of three types and seven subtypes. The types were based on the underlying structural principles of how time/change was presented: Type A) Findings have a low utilization of longitudinal data, Type B) Findings are structured according to chronological time, and Type C) Findings focus on changes through time. These types differed in 1) the way the main focus was on time, change or neither; 2) the level of interpretation in the findings; and 3) how theoretical understandings of time/change were articulated in the articles. Each type encompassed two or three subtypes that represented distinct approaches to the aim and results presentation of QLR findings.

    Conclusions: This method study is the first to describe a coherent and comprehensive typology of alternative approaches for integrating time/change into QLR findings in health research. By providing examples of various subtypes that can be used for results presentations, it can help researchers make informed decisions suitable to their research intent.

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  • 11.
    Glans, Anton
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för diagnostik och intervention. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Wilén, Jonna
    Umeå universitet, Medicinska fakulteten, Institutionen för diagnostik och intervention. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Hansson, B.
    Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden.
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindgren, Lenita
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Managing acoustic noise within MRI: a qualitative interview study among Swedish radiographers2024Ingår i: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 30, nr 3, s. 889-895Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Acoustic noise from magnetic resonance imaging (MRI) can cause hearing loss and needs to be mitigated to ensure the safety of patients and personnel. Capturing MR personnel's insights is crucial for guiding the development and future applications of noise-reduction technology. This study aimed to explore how MR radiographers manage acoustic noise in clinical MR settings.

    Methods: Using a qualitative design, we conducted semi-structured individual interviews with fifteen MR radiographers from fifteen hospitals around Sweden. We focused on the clinical implications of participants’ noise management, using an interpretive description approach. We also identified sociotechnical interactions between People, Environment, Tools, and Tasks (PETT) by adopting a Human Factors/Ergonomics framework. Interview data were analyzed inductively with thematic analysis (Braun and Clarke).

    Results: The analysis generated three main themes regarding MR radiographers’ noise management: (I) Navigating Occupational Noise: Risk Management and Adaptation; (II) Protecting the Patient and Serving the Exam, and (III) Establishing a Safe Healthcare Environment with Organizational Support.

    Conclusion: This study offers insights into radiographers’ experiences of managing acoustic noise within MRI, and the associated challenges. Radiographers have adopted multiple strategies to protect patients and themselves from adverse noise-related effects. However, they require tools and support to manage this effectively, suggesting a need for organizations to adopt more proactive, holistic approaches to safety initiatives.

    Implications for practice: The radiographers stressed the importance of a soundproofed work environment to minimize occupational adverse health effects and preserve work performance. They acknowledge noise as a common contributor to patient distress and discomfort. Providing options like earplugs, headphones, mold putty, software-optimized “quiet” sequences, and patient information were important tools. Fostering a safety culture requires proactive safety efforts and support from colleagues and management.

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  • 12. Keddy, America Cristina
    et al.
    Packer, Tanya Leigh
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sutherland, Lindsay
    Sampalli, Tara
    Edwards, Lynn
    Kephart, George
    The Team Assessment of Self-Management Support (TASMS): A new approach to uncovering how teams support people with chronic conditions. Healthcare Management Forum2021Ingår i: Healthcare Management Forum, ISSN 0840-4704, Vol. 34, nr 1, s. 43-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Canadian and other healthcare systems are adopting primary care models founded on multidisciplinary, team-based care. This paper describes the development and use of a new tool, the Team Assessment of Self-Management Support (TASMS), designed to understand and improve the self-management support teams provide to patients with chronic conditions. Team Assessment of Self-Management Support captures the time providers spend supporting seven different types of self-management support (process strategies, resources strategies, disease controlling strategies, activities strategies, internal strategies, social interactions strategies, and healthy behaviours strategies), their referral patterns and perceived gaps in care. Four unique features make TASMS user-friendly: it is patient-centred, it uses provider-level data to create a team profile, it has the ability to be tailored to needs (diagnosis and visit type), and visual presentation of results are quickly and intuitively understood by both providers and planners. Currently being used by providers and planners in Nova Scotia, scaling up will allow more widespread use

  • 13.
    Kephart, George
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, NS, Halifax, Canada; School of Health Administration, Dalhousie University, Halifax, Canada.
    Packer, Tanya
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Health Administration, Dalhousie University, Halifax, Canada; School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Chen, Yu-Ting
    School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Robinson, Alysia
    Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, NS, Halifax, Canada.
    Olsson, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Warner, Grace
    School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Item selection, scaling and construct validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) measurement tool in adults2022Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 31, nr 9, s. 2867-2880Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To select and scale items for the seven domains of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) and assess its construct validity.

    Methods: Using an online survey, data on 100 potential items, and other variables for assessing construct validity, were collected from 1055 adults with one or more chronic health conditions. Based on a validated conceptual model, confirmatory factor analysis (CFA) and item response models (IRT) were used to select and scale potential items and assess the internal consistency and structural validity of the PRISM-CC. To further assess construct validity, hypothesis testing of known relationships was conducted using structural equation models.

    Results: Of 100 potential items, 36 (4–8 per domain) were selected, providing excellent fit to our hypothesized correlated factors model and demonstrating internal consistency and structural validity of the PRISM-CC. Hypothesized associations between PRISM-CC domains and other measures and variables were confirmed, providing further evidence of construct validity.

    Conclusion: The PRISM-CC overcomes limitations of assessment tools currently available to measure patient self-management of chronic health conditions. This study provides strong evidence for the internal consistency and construct validity of the PRISM-CC as an instrument to assess patient-reported difficulty in self-managing different aspects of daily life with one or more chronic conditions. Further research is needed to assess its measurement equivalence across patient attributes, ability to measure clinically important change, and utility to inform self-management support.

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  • 14. Kephart, George
    et al.
    Packer, Tanya L.
    Audulv, Åsa
    Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
    Warner, Grace
    The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions2019Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, nr 2, s. 545-556Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Self-management ability is commonly assessed in chronic disease research and clinical practice. The purpose of this study was to assess the structural and convergent validity of three commonly used self-management outcome measures in a sample of persons with neurological conditions.

    METHODS: We used data from a Canadian survey of persons with neurological conditions, which included three commonly used self-management measures: the Partners in Health Scale (PIH), the Patient Activation Measure (PAM), and the Self-Efficacy for Managing a Chronic Disease Scale (SEMCD). Confirmatory factor analysis was used to assess the structural and convergent validity of the three measures.

    RESULTS: When treated as single-factor constructs, none of the measurement models provided a good fit to the data. A four-domain version of the PIH was the best fitting model. Confirmatory factor analysis suggests that the three tools measure different, but correlated constructs.

    CONCLUSIONS: While the PAM, PIH and SEMCD scales are all used as measures of patient self-management, our study indicates that they measure different, but correlated latent variables. None, when treated as single, uni-dimensional construct, provides an acceptable fit to our data. This is probably because self-management is multi-dimensional, as is consistently shown by qualitative evidence. While these measures may provide reliable summative measures, multi-dimensional scales are needed for clinical use and more detailed research on self-management.

  • 15. Kneck, Åsa
    et al.
    Audulv, Åsa
    Department of Nursing Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden.
    Analyzing variations in changes over time: development of the Pattern‐Oriented Longitudinal Analysis approach2019Ingår i: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 26, nr 3, artikel-id e12288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Longitudinal qualitative research in nursing is rare but becoming more common. Data collection and analysis over time provide some intriguing possibilities to better understand processes, development, and change in illness experience, healthcare organizations, and self-management. This paper aims to present a process for analyzing qualitative longitudinal data material, namely the Pattern-Oriented Longitudinal Analysis approach (POLA). We developed this approach after synthesizing experiences from two longitudinal qualitative projects and comparing our procedures and reflections with the relevant literature. Using the POLA approach, researchers can describe complexity and variation in changes over time. During the analysis process, emphasis is put on visualizing and identifying change at both an individual and a group level. Ontological and epistemological assumptions for the approach are also described. The benefit of this approach is the possibility to describe complexity and diversity in processes over time, which is important for the development of nursing knowledge. The analysis approach can be further used and developed by researchers seeking to understand variance or contextual features in processes and changes over time.

  • 16.
    Nyberg, Andre
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundell, Sara
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Pesola, Ulla-Maija
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Evaluation of a Digital COPD Education Program for Healthcare Professionals in Long-Term Care: A Mixed Methods Study2022Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 17, s. 905-918Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Lack of routines and competence among healthcare professionals have been reported as barriers to COPD management in long-term care. Online education could be used as a strategy to make COPD education more accessible.

    Purpose: The aim of this study was to evaluate a digital COPD education program for healthcare professionals in long-term care regarding feasibility, knowledge and working procedures.

    Methods: A randomized controlled feasibility trial with a convergent mixed methods design was conducted. Two municipalities in Sweden were randomized to intervention (n=20) or control (n=17). The intervention was a digital COPD education program accessible for three months. Data was collected through questionnaires on COPD-specific knowledge, conceptual knowledge, feasibility and usage of the COPD Web platform. Repeated individual interviews using a semi-structured interview guide was also performed. Quantitative and qualitative findings were merged using a mixed methods design.

    Results: The digital COPD education program appears feasible based on the expressed satisfaction of the healthcare workers and their reports that it supported them in their work. Across questionnaires, objective COPD-specific knowledge increased by 14 to 16 percentage points in the intervention group compared to 0 to 6 percentage points in the control group (p=0.001). The objective increase in COPD-specific knowledge was also captured in the interviews, where a perceived increase in knowledge led to increased security and focus on COPD management. Few changes in working procedures were expressed, but participants felt that attention was raised regarding COPD and the importance of preventive healthcare services. In addition, increased knowledge of healthcare services provided by other involved professions was emphasized, leading to discussions with other professions in relation to COPD management. 

    Conclusion: A digital COPD education program is feasible and can increase the COPD-specific knowledge of healthcare professionals in long-term care, leading to increased focus on COPD-related issues. More comprehensive measures, including organizational changes, might be needed to change working procedures.

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  • 17. Olsson, Helen
    et al.
    Audulv, Åsa
    Mid Sweden University.
    Strand, Susanne
    Kristiansen, Lisbeth
    Reducing or Increasing Violence in Forensic Care: A Qualitative Study of Inpatient Experiences2015Ingår i: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 29, nr 6, s. 393-400Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Semi-structured interviews with 13 forensic psychiatric inpatients that had decreased their assessed risk of violence were analyzed using interpretive description. The main contribution from this study is a detailed description of patients' own strategies to avoid violence. Participants described having an ongoing inner dialog in which they encouraged themselves, thereby increasing their self-esteem and trying to accept their current situation. An unsafe and overcrowded ward with uninterested and nonchalant staff increased the risk of aggressive behavior. In the process of decreasing violence, the patients and the forensic psychiatric nursing staff interacted to create and maintain a safe environment.

  • 18. Packer, Tanya
    et al.
    Kephart, George
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Keddy, America
    Warner, Grace
    Peacock, Kylie
    Sampalli, Tara
    Protocol for development, calibration and validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC)2020Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 9, artikel-id e036776Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Assessing and measuring patients’ chronic condition self-management needs are critical to quality health care and to related research. One in three adults around the world live with multiple chronic conditions. While many patient-reported measures of self-management have been developed, none has emerged as the gold standard, and all have one or more of the following limitations: (1) they fail to measure the different domains of self-management important to patients, (2) they lack sufficient specificity to support patient-centred care or identify the specific components of self-management interventions that work and/or (3) they lack suitability for patients with multiple chronic conditions.

    Methods and analysis: The Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is being developed to overcome these shortcomings. It will measure respondents’ perceived success (or difficulty) in self-managing seven domains important to patients. The protocol has three phases. Phase 1 is conceptual model development and item generation. Phase 2 is assessment of the relevance and understanding of items by people with chronic conditions. Phase 3 is item analysis, dimensionality assessment, scaling and preliminary validation of the PRISM-CC using an online survey of people with chronic conditions (n~750). The expected completion date is early 2021.

    Ethics and dissemination: This study will adhere to the Canadian Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. Ethics approval for all phases has been obtained from the Nova Scotia Health Authority Research Ethics Board. Once completed, the PRISM-CC will be made available for research and healthcare at minimal to no cost.

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  • 19. Packer, Tanya L.
    et al.
    Fracini, America
    Audulv, Åsa
    Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
    Alizadeh, Neda
    van Gaal, Betsie G.I.
    Warner, Grace
    Kephart, George
    What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review.2018Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, nr 4, s. 579-595Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific).

    METHODS: A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures.

    RESULTS: Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains.

    CONCLUSIONS: Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care.

    PRACTICE IMPLICATIONS: In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.

  • 20. Packer, Tanya L.
    et al.
    Kephart, George
    Ghahari, Setareh
    Audulv, Åsa
    School of Occupational Therapy, Dalhousie University, Halifax, Canada; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Versnel, Joan
    Warner, Grace
    The Patient Activation Measure: a validation study in a neurological population2015Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 24, nr 7, s. 1587-1596Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To assess the validity of the Patient Activation Measure (PAM13) of patient activation in persons with neurological conditions.

    METHODS: "The Everyday Experience of Living with and Managing a Neurological Condition" (The LINC study) surveyed 948 adults with neurological conditions residing in Canada in 2011 and 2012. Using data for 722 respondents who met coding requirements for the PAM-13, we examined the properties of the measure using principle components analysis, inter-item correlations and Cronbach's alpha to assess unidimensionality and internal consistency. Rasch modeling was used to assess item performance and scaling. Construct validity was assessed by calculating associations between the PAM and known correlates.

    RESULTS: PAM-13 provides a suitably reliable and valid instrument for research in patients with neurological conditions, but scaling problems may yield measurement error and biases for those with low levels of activation. This is of particular importance when used in clinical settings or for individual client care. Our study also suggests that measurement of activation may benefit from tailoring items and scaling to specific diagnostic groups such as people with neurological conditions, thus allowing the PAM-13 to recognize unique attributes and management challenges in those conditions.

    CONCLUSIONS: The PAM-13 is an internally reliable and valid tool for research purposes. The use of categorical activation "level" in clinical settings should be done with caution.

  • 21. Rising Holmström, Malin
    et al.
    Häggström, Marie
    Audulv, Åsa
    Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
    Junehag, Lena
    Coyne, Imelda
    Söderberg, Siv
    To integrate and manage diabetes in school: Youth's experiences of living with Type 1 diabetes in relation to school – a qualitative study2017Ingår i: International Diabetes Nursing, ISSN 2057-3316, E-ISSN 2057-3324, Vol. 14, nr 2-3, s. 46-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In Sweden, each year approximately 700 children develop Type 1 diabetes. Living with the illness is a challenge for youth and requires adjustments to lifestyle, and to manage school. The aim was to describe youths’ experiences of living with Type 1 diabetes in relation to school. A qualitative research design was used and interviews were performed with eight girls and five boys with Type 1 diabetes. The interviews were subjected to qualitative content analysis. Three themes were identified: to be friends with the diabetes, striving for normality and receiving support from others. Results showed a need to increase the understanding of T1D and diabetic competence within the Swedish school system and knowledge of youths’ own experiences is vital in this work. Living with T1D was a struggle for normality, independency and the youth needed to be friends with diabetes to handle everyday self-management. Although there are demanding life and school circumstances, it eventually becomes possible for the youth to handle the illness and to integrate and manage diabetes in school.

  • 22. Rönngren, Ylva
    et al.
    Björk, Annette
    Audulv, Åsa
    Department of Nursing Sciences, Mid Sweden University.
    Enmarker, Ingela
    Kristiansen, Lisbeth
    Haage, David
    Educational nurse-led lifestyle intervention for persons with mental illness2018Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, nr 3, s. 1022-1031Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although persons with severe mental illness face an increased risk of mortality and of developing negative health outcomes, research has shown that lifestyle interventions can sufficiently support their health. In response, this study examined a nurse-led lifestyle intervention developed in cooperation with members of municipal and county councils to gauge its impact on the quality of life, cognitive performance, walking capacity, and body composition of persons with severe mental illness. Lasting 26 weeks and involving 38 persons with severe mental illness, the intervention prioritised two components: the interpersonal relationships of persons with severe mental illness, staff, and group leaders and group education about physical and mental health. Pre-post intervention measurements of quality of life collected with the Manchester Short Assessment of Quality of Life, cognitive performance with the Frontal Systems Behaviour Scale, walking capacity with a 6-min walk test, and body composition in terms of waist circumference and body mass index were analysed using a nonparametric test Wilcoxon signed-rank test. Results suggest that the intervention afforded significant improvements in the health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference for persons with severe mental illness. However, long-term studies with control groups and that examine parameters related to cardiovascular risk factors are essential to ensure the sustained impact of the intervention.

  • 23. Rönngren, Ylva
    et al.
    Björk, Annette
    Haage, David
    Audulv, Åsa
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    Kristiansen, Lisbeth
    Perspectives of a tailored lifestyle program for people with severe mental illness receiving housing support2018Ingår i: Perspectives in psychiatric care, ISSN 0031-5990, E-ISSN 1744-6163, Vol. 54, nr 2, s. 309-316Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose of the present study was to describe the acceptability of the lifestyle program PHYS/CAT and to get information about the tools used for assessment of functional exercise capacity, cognitive performance, and self-health-related quality of life.

    DESIGN AND METHODS: The findings are based on focus groups and the researchers' experiences of conducting the program as well as using the assessment tools.

    FINDINGS: The acceptability of the program and the assessment tools was mainly satisfactory.

    PRACTICE IMPLICATIONS: The program with relational, educational, and supportive dimensions may be a promising tool to be integrated into daily nursing care.

  • 24. Rönngren, Ylva
    et al.
    Björk, Annette
    Kristiansen, Lisbeth
    Haage, David
    Enmarker, Ingela
    Audulv, Åsa
    Departments of Nursing Sciences, Mid Sweden University, Sundsvall.
    Meeting the needs?: Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting2018Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, nr 1, s. 390-399Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle-related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse-led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16-25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse-led programme provides health information-management strategies that could easily be integrated in a primary health-care setting.

  • 25. Warner, Grace
    et al.
    Packer, Tanya L.
    Kervin, Emily
    Sibbald, Kaitlin
    Audulv, Åsa
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies2019Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, nr 12, s. 2162-2182Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To identify whether community-based Self-Management Programs (SMPs) actively engaged, or taught, individuals patient-oriented strategies; and whether having these attributes led to significant differences in outcomes.

    METHODS: This systematic review included randomized controlled trials (RCTs)and cluster RCTs reporting on community-based SMPs with a group component for older adults with chronic conditions. The ways SMPS actively engaged participants and whether they taught patient-oriented strategies were analyzed. All study outcomes were reported.

    RESULTS: The 31 included studies demonstrated community-based SMP programs actively engaged participants and provided strategies to improve health behaviour or care of their condition. Few included strategies to help manage the impact of conditions on their everyday lives. Seventy-nine percent of studies reported significant differences; variations in sample sizes and outcomes made it difficult to conclude whether having these attributes led to significant differences.

    CONCLUSION: SMPs are not supporting older adults to use strategies to address the impact of conditions on their everyday lives, addressing the needs of older adults with multiple conditions, nor assessing outcomes that align with the strategies taught.

    PRACTICE IMPLICATIONS: Health-care providers delivering SMPs to older adults need to tailor programs to the needs of older adults and assess whether participants are using strategies being proposed.

  • 26. Warner, Grace
    et al.
    Packer, Tanya
    Villeneuve, Michelle
    Audulv, Åsa
    School of Occupational Therapy, Dalhousie University, Nova Scotia, Canada; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Versnel, Joan
    A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors2015Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, nr 23, s. 2141-2163Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: A systematic review of stroke self-management programs was conducted to: (i) identify how many and what self-management support strategies were included in stroke self-management interventions and (ii) describe whether self-management programs effectively improved outcomes, focusing specifically on function and participation outcomes. Methods: Twelve databases were searched for the years 1986–2012 to identify self-management programs for stroke survivors. Pre-post, quasi-experimental and randomized controlled trial study designs were included. Descriptive information about the intervention was scrutinized to identify what self-management support strategies were present in the intervention and comparisons were made between programs using a group versus a one-to-one format. All outcomes were included and categorized. Results: The most prominent strategies identified in our review were goal setting and follow-up, and an individualized approach using structured information and professional support. There are indications that self-management programs can significantly increase participation and functional ability. However, the high level of clinical heterogeneity in program delivery, outcomes and level of stroke severity made it impossible to conduct a meta-analysis. Further examination of individual self-management support strategies, such as linking rehabilitation goal setting to post-acute self-management programs, the inclusion of family members and the contribution of peer-support is warranted.

  • 27. Westergren, Thomas
    et al.
    Ludvigsen, Mette Spliid
    Audulv, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aagaard, Hanne
    Hall, Elisabeth O. C.
    Pedersen, Mona Kyndi
    Fegran, Liv
    Physical activity experiences of children and adolescents with asthma: a qualitative systematic review protocol2020Ingår i: JBI Evidence Synthesis, E-ISSN 2689-8381, Vol. 18, nr 11, s. 2390-2395Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective: The objective of the review is to synthesize existing knowledge about experiences of children and adolescents with asthma related to participation in, or limitation of, physical activity.

    Introduction: Limitations of physical activity, expressed as a barrier of bodily movement, may relate to physiological restraints, as well as emotional and social delimitation, in children and adolescents with asthma. Participation in physical activity is related to management of asthma and is also important for social inclusion. Through childhood and adolescence, physical activity enhances physical, cognitive, and social development, and a dose-response relationship between physical activity and several indicators of improved health is established. Knowledge is needed about experiences of physical activity in children and adolescents with asthma to inform tailored care and implementation of exercise and physical activity supporting interventions into clinical practice.

    Inclusion criteria: This review will consider qualitative studies that include subjective experiences related to participation in, or limitation of, physical activity in children and adolescents with asthma through childhood and adolescence (six to 18 years), in English-language studies from all countries.

    Methods: MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, SocINDEX, and Social Science Citation Index List will be searched for relevant studies. Study selection, assessment of methodological quality, data extraction, synthesis, and assessment of certainty of findings will be conducted using the JBI meta-aggregation approach.

    Systematic review registration number: The systematic review is registered in PROSPERO (CRD42020164797).

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