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Health promotional interventions informed by community-based participatory research in a socially disadvantaged neighbourhood: development, exploration and evaluation
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). (ProHeq)ORCID iD: 0000-0003-4603-9974
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to understand the impact of community-based participatory research-informed health promotional initiatives on the health of communities living in socially disadvantaged neighbourhoods in Southern Sweden. The thesis was part of a larger program, Health promotion, Innovation in Collaboration which was a community-based participatory research program aiming to create novel ways to improve health through participatory and collaborative strategies. The thesis embraces one mixed-method study, a quantitative study, a qualitative study and finally a participatory action research study with a qualitative approach. A total of 49 citizens and 10 families with children aged 7-14 years from a disadvantaged neighbourhood in Southern Sweden participated in the different studies. The mixed-method study (Study I) described the development of initial evaluation of a Community-based participatory research(CBPR) informed physical activity intervention, which showed the need for the intervention to be offered cost-free and exclusively for women. In line with the results of the first study, the CBPR physical activity intervention was offered to 35 women in the neighbourhood and the effect of the intervention was assessed over time both quantitatively (Study II) and qualitatively (Study III), including a perspective on the pandemic. The last study (Study IV) focused on diet and oral health among families, particularly mothers and children. In this study, the children were initially engaged in a photovoice interview which was followed by a focus group with parents. The pre-study revealed that children disliked school lunch and did not eat breakfast regularly owing to time constraints and family situations. Furthermore, children also consumed a high amount of sugar. To this, the parents expressed that they were not able to guide their children appropriately and needed help with aspects such as diet focusing on breakfast, lunch and dinner, as well as knowledge on oral hygiene habits. The quantitative part of Study I and Study II were repeated measures data at different time points before and after the intervention. The qualitative data in studies I and III were collected in form of focus group interviews in parallel to the quantitative data. The mode of data collection in Study IV was Multi-staged focus groups where the same families met at different time points and engaged in dialogue and reflection on different topics at each meeting. The results of the first three studies show that a CBPR informed physical activity intervention when offered in groups improved health-related quality of life, physical health, induced behavioural change and potentially builds resilience to withstand the psychosocial and physical effects of the pandemic. The last study shows that a CBPR informed oral health promotion through reflection and dialogue among families together with other stakeholders, influences behavioural change and perceived changes in health among parents and children living in a disadvantaged neighbourhood. In conclusion, this thesis highlights that social support is key to improved perceived health, empowerment, and sustainable behavioural change among citizens in the neighbourhood. Although women are most in need of support, they are also gateways to the families and thereby their communities. And finally, health promoters have had a vital role in engaging communities in health promotional efforts and bringing them closer to other societal actors, strengthening their social bonds and helping build community resilience in the face of adversity.

Place, publisher, year, edition, pages
Malmö universitet, 2022. , p. 153
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 2022:2
Keywords [en]
Participatory Action Research, Quality of Life, Physical Activity, Oral Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Care science
Identifiers
URN: urn:nbn:se:mau:diva-50234DOI: 10.24834/isbn.9789178772438ISBN: 978-91-7877-242-1 (print)ISBN: 978-91-7877-243-8 (electronic)OAI: oai:DiVA.org:mau-50234DiVA, id: diva2:1638017
Public defence
2022-02-25, AULA, Jan Waldenströms gata 25, Malmo, 14:00 (English)
Opponent
Supervisors
Part of project
Health promotion in Collaboration, VinnovaAvailable from: 2022-02-15 Created: 2022-02-15 Last updated: 2022-08-16Bibliographically approved
List of papers
1. Development and evaluation of a physical activity intervention informed by participatory research: a feasibility study
Open this publication in new window or tab >>Development and evaluation of a physical activity intervention informed by participatory research: a feasibility study
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2020 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, article id 112Article in journal (Refereed) Published
Abstract [en]

Background: Despite numerous interventions aiming to improve physical activity in socially disadvantagedpopulations, physical inactivity remains to be a rising challenge to public health globally, as well as, in Sweden. Inan effort to address this challenge, a community-based participatory intervention was developed through activecommunity engagement and implemented in a socially disadvantaged neighborhood in Sweden. The current studyaims to present the development and initial evaluation of a participatory research driven physical activityintervention.Methods: Fifteen participants (11 females and 4 males) aged 17–59 years volunteered to participate in the physicalactivity intervention program. The intervention program was evaluated using a longitudinal mixed methods designmeasuring health impact changes over time through focus group discussions and quality of life surveys. Furtheradditional biomedical health parameters such as levels of glycosylated hemoglobin, blood pressure, levels ofoxygen saturation and body mass index were monitored before and after the intervention. Focus group data wereanalyzed using content analysis with an inductive approach. The pre-and post-test scores from the survey-basedquality of life domains, as well as the health parameters were compared using non-parametric and parametricstatistics.Results: Four themes emerged from the analysis of the focus group discussions including sense of fellowship,striving for inclusion and equity, changing the learner perspective and health beyond illness. The scores for thedomains Physical Health, Psychological Health, Social Relationships and Health Satisfaction where significantlyhigher after participation in the physical activity intervention program compared to the pre-test scores (p < .05)s.There were however, no significant changes in the scores for the environmental domain and overall quality of lifeafter intervention compared to that prior to intervention start. Overall, the biomedical health parameters remainedstable within the normal ranges during intervention.Conclusion: The focus group discussions and results from the surveys and biomedical measures reveal importantfindings to understand and further develop the intervention program to promote health equity among citizens indisadvantaged areas. Evaluating the feasibility of such an intervention using multiple approaches contributes toeffective implementation of it for larger communities in need.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Action research, Community-based participatory research, Health equity, Health promotion, Socially disadvantaged
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-13774 (URN)10.1186/s12889-020-8202-2 (DOI)000513881300011 ()31992285 (PubMedID)2-s2.0-85078659365 (Scopus ID)
Available from: 2020-03-12 Created: 2020-03-12 Last updated: 2024-02-05Bibliographically approved
2. Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden.
Open this publication in new window or tab >>Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden.
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2020 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 4, article id e035732Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.

SETTING: The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.

PARTICIPANTS: Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.

RESULTS: Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.

CONCLUSIONS: The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
community child health, public health, qualitative research, social medicine
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-17142 (URN)10.1136/bmjopen-2019-035732 (DOI)000538150800098 ()32265249 (PubMedID)
Available from: 2020-04-30 Created: 2020-04-30 Last updated: 2024-06-17Bibliographically approved

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Ramji, Rathi

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