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SHP-Strategiske høgskoleprogram

Health Promotion - Worthwhile? Reorienting the community health care services

Alternative title: Helsefremming - verdifullt? Reorientering av kommunale helse- og omsorgstjenester.

Awarded: NOK 16.2 mill.

This HPWW-project containing three work packages and six research projects has gained new knowledge about health-promoting interventions among adolescents, adults with chronic conditions, older adults in nursing homes (NHs) as well as health care professionals working in NHs. Accordingly, this HPWW-project contributes with valuable insights for a reorientation of the municipality health services in a health promotion direction. More specifically, PROJECT1 evaluated the implementation of MEST which is a health-promoting intervention among adolescents delivered by school health services. An instrument assessing Positive Mental Health Literacy (PMHL) in adolescents was developed and validated. High PMHL associated with high mental well-being, showing a significant increase among adolescents participating in MEST compared to non-MEST participants. No significant difference was found in mental wellbeing between the MEST and non-MEST participants. However, girls participating in MEST reported higher mental wellbeing compared to non-MEST female participants. No difference was found for boys. PROJECT2 translated and linguistically validated a Swedish questionnaire for parents who have lost a child to cancer, and studied resilience as a predictive factor towards healthy adjustment to grief after the loss of a child to cancer. Resilient factors were significant in predicting whether cancer-bereaved parents indicated that they had come to terms with their grief to a great extent. The study supports the hypotheses that regard resilience as an important contribution in predicting health outcomes in people exposed to adverse life events. PROJECT3 evaluated the expectations, effects of, and experiences with an easily accessible health-promoting self-management intervention in adults with chronic pain. Qualitative data showed that the participants hoped for a better everyday life resulting from their participation in this intervention, which represented a new and untried approach to acquire and reinforce skills. The effect-study showed that the self-management course had no effect on pain after three and 12 months compared to the low-impact physical activity. However, both groups improved in pain experienced in the previous week, self-reported health, and the 30-second Chair to Stand Test. PROJECT4 explored the implementation and impact of user participation at healthy living centers (HLCs) in Norway: how did professionals in HLCs experience user involvement, what were facilitators/barriers for users' involvement, and how contributed involvement to change in health behaviors related to physical activity and healthy eating. Further, the experience of user involvement among HLC users participating in individual health consultations was explored, followed by physical activity groups and/or diet courses. The findings showed that motivational interviewing was an adequate tool for supporting users to achieve lifestyle changes, as well as supporting ownership and personal responsibility among the service users. Feeling respected along with a trustworthy relationship with the professionals were essential for the service users' involvement. Finally, two projects investigating the implementation of joy-of-life NH national strategy were conducted. PROJECT5 focused on the working culture among health care personnel in NHs; firstly, the psychometric properties of the Norwegian version of the work-related sense of coherence (SOC) scale was evaluated, which measures the perceived comprehensibility, manageability, and meaningfulness of an individual's current work situation. The results supported that work-SOC was strongly and positively related to affective organizational commitment, perceived job resources, and job demands. The longitudinal relationship with work engagement suggested that work-SOC is an important factor to consider in workplace health-promotion and management of employee health. Moreover, this study disclosed that the importance of the certification process increased over time; it seemed that the longer the NH had been certified as a joy-of-life NH, the more useful was the actual work process perceived by the health care professionals. PROJECT6 focused on wellbeing and joy-of-life among residents in Norwegian NHs. Firstly, the essence of joy-of-life was explored. In total, 29 in-depth qualitative interviews were conducted, showing that positive relations,sense of belonging,sources of meaning, moments of feeling well, and acceptance constituted the conceptualization of joy-of-life in NHs. A scale assessing joy-of-life was developed and validated, and a brief quality-of-life questionnaire (OPQOL brief) was translated and validated among residents in Norwegian NHs. Symptom severity (pain,fatigue,dyspnoea, constipation) was high while joy-of-life and wellbeing were modest to good in NH residents. The nurse-patient interaction was perceived as crucial to wellbeing, meaning-in-life, and self-transcendence in this population.

*2 PhD-candidates have achieved the PhD degree, 1 candidate submits her PhD-thesis in February 2020, 2 candidates submit their PhD-theses in 2020 *50 papers are published in internationally acknowledged scientific journals;new knowledge about health promotion in the health care services (adolescents, children losing a sibling to cancer, adults with chronic conditions, residents and health care personnel in nursing homes) has been developed and communicated. *International collaboration has been established with universities/researchers in Singapore,Turkey,Belgium,Sweden,Finland,USA,Portugal. *National collaboration are further developed with Western Norway University of Applied Science,Bergen University,OsloMet University,Nord University,University of South-Eastern Norway and University of Agder *New projects are in developing related to the municipality health care, focusing on (1)older adults with cancer, (2)older migrants (55+),(3)Generational platform as health promoting

To successfully deal with the health challenges of the 21th century, a reorienting of the community health care services in a health promoting (HP) direction is requested. Our research group at the Sør-Trøndelag University College is unique in Norway doin g HP research in the health care services. In HP we use a salutogenic approach of what creates health instead of focusing on diseases and disabilities. Though illness, weaknesses and limitations are present, the main focus in salutogenesis is on human str engths, capacities and well-being. However, available evidence guiding the community health care services in a HP direction is scarce. Therefore, our main objective is to reorient the community health care services into a HP direction. In close collaborat ion with Trondheim municipality we will in this SHP project provide evidence and scientific bases for: 1) Implementing health promoting actions in the community health care, in terms of mental health and school health care services; 2) Work ability result ing from participating in an health promotion intervention at Healthy Living Centers (in Norwegian: "Frisklivssentraler"); 3) Positive gains of the Norwegian national nursing home strategy "Joy-of-Life-Nursing-Homes" (in Norwegian: "Livsglede for eldre"). The project constitutes studies focusing on different phases of the life-course, as well as studies among healthy, vulnerable, and ill populations. This project will contribute to innovation in public services which might reduce future health care costs. It will also result in the completion of six new PhD's in nursing, and help our talented associate professors to achieve professor competence.

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SHP-Strategiske høgskoleprogram