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  • 1.
    Awad, Eman
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Cirovic, Stefan
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Shleev, Sergey
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University.
    Developing and evaluating non-invasive healthcare technologies for a group of female participants from a socioeconomically disadvantaged area2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 23896Article in journal (Refereed)
    Abstract [en]

    When compared to the general population, socioeconomically disadvantaged communitiesfrequently experience compromised health. Monitoring the divide is challenging since standardizedbiomedical tests are linguistically and culturally inappropriate. The aim of this study was to developand test a unique mobile biomedical testbed based on non-invasive analysis, as well as to explorethe relationships between the objective health measures and subjective health outcomes, asevaluated with the World Health Organization Quality of Life survey. The testbed was evaluated in asocioeconomically disadvantaged neighborhood in Malmö, which has been listed as one of the twelvemost vulnerable districts in Sweden. The study revealed that compared to conventional protocolsthe less intrusive biomedical approach was highly appreciated by the participants. Surprisingly, thecollected biomedical data illustrated that the apparent health of the participants from the ethnicallydiverse low-income neighborhood was comparable to the general Swedish population. Statisticallysignificant correlations between perceived health and biomedical data were disclosed, even thoughthe dependences found were complex, and recognition of the manifest complexity needs to beincluded in further research. Our results validate the potential of non-invasive technologies incombination with advanced statistical analysis, especially when combined with linguistically andculturally appropriate healthcare methodologies, allowing participants to appreciate the significanceof the different parameters to evaluate and monitor aspects of health.

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  • 2.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Enskär, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Uppsala Universitet.
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Tengland, Per-Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Theodoridis, Kyriakos
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The Need for Parental Support for Migrant Parents in Transition Into Sweden: A Perspective2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 680767Article in journal (Refereed)
    Abstract [en]

    Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents.  

    The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

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  • 3.
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Health promotional interventions informed by community-based participatory research in a socially disadvantaged neighbourhood: development, exploration and evaluation2022Doctoral 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.

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  • 4.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Brogårdh-Roth, Susanne
    Malmö University, Faculty of Odontology (OD).
    Olofsson, Anna Nilvéus
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden.2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 4, article id e035732Article in journal (Refereed)
    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.

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  • 5.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden.2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 997329Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood.

    METHODS: A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach.

    RESULTS: In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge".

    CONCLUSION: The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

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  • 6.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Shleev, Sergey
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces.
    Awad, Eman
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Development and evaluation of a physical activity intervention informed by participatory research: a feasibility study2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, article id 112Article in journal (Refereed)
    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.

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  • 7.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nilsson, Maria
    Arnetz, Bengt
    Wiklund, Ywonne
    Arnetz, Judy
    Taking a Stand: An Untapped Strategy to Reduce Waterpipe Smoking in Adolescents2019In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 54, no 3, p. 514-524Article in journal (Refereed)
    Abstract [en]

    Introduction: Waterpipe use amongst adolescents is on the rise globally. Thus, there is a need to understand adolescents 'attitudes towards and perceptions of waterpipe use in order to develop specific interventions against this form of tobacco use. Methods: Focus group interviews were conducted among 37 Swedish adolescents (14 boys and 23 girls) from grades 10 to 12. Waterpipe users and nonusers were interviewed separately, with two groups each for users and nonusers. Interviews were audiotaped, transcribed, and thematically analyzed using content analysis. Results: Six themes emerged including taking a stand, weighing the risks, Lack of knowledge, Social context, Waterpipe new and unknown, and Family influence. Taking a stand was about being able to stand up for one's owns views rather than giving in to peer pressure to smoke waterpipe. Participants feared harming others via secondhand smoke and expressed criticism of the tobacco industry. Participants considered the health consequences and feared addiction. Lack of knowledge concerning health effects of waterpipe smoking due to the unavailability of credible information was also reported. Waterpipe smoking was considered a social event carried out in the company of friends. Perceived as novel and fun, waterpipe was smoked out of curiosity. Parents' and siblings' smoking behaviors influenced adolescent waterpipe use. Conclusion: Adolescents reported lacking information about the possible health effects of waterpipe smoking and that gaining such knowledge would make it easier for them to take a stand and refuse smoking waterpipe. Prevention strategies should focus on providing adolescents with factual information about the dangers of waterpipe use.

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  • 8.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Shleev, Sergey
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Awad, Eman
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Cirovic, Stefan
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective.2023In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 17972Article in journal (Refereed)
    Abstract [en]

    The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups.

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  • 9.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Psychometric properties of the WHOQOL-BREF in citizens from a disadvantaged neighborhood in Southern Sweden2023In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14Article in journal (Refereed)
    Abstract [en]

    Background: Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden.

    Methods: The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study.

    Results: Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved.

    Conclusion: WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.

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  • 10.
    Rämgård, Margareta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmo Univ, Fac Hlth & Soc, Dept Care Sci, Jan Waldenstroms Gata 25, SE-20506 Malmo, Sweden..
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    'No one size fits all' - community trust-building as a strategy to reduce COVID-19-related health disparities2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 18Article in journal (Refereed)
    Abstract [en]

    Background Citizens with low levels of social capital and social status, and relative poverty, seem to have been disproportionally exposed to COVID-19 and are at greater risk of experiencing poor health. Notably, the incidence of COVID-19 was nearly three times higher among citizens living in socially vulnerable areas. Experiences from the African Ebola epidemic show that in an environment based on trust, community partners can help to improve understanding of disease control without compromising safety. Such an approach is often driven by the civil society and local lay health promoters. However, little is known about the role of lay health promoters during a pandemic with communicable diseases in the European Union. This study had its point of departure in an already established Community Based Participatory Research health promotion programme in a socially disadvantaged area in southern Sweden. The aim of this study was to explore how citizens and local lay health promoters living in vulnerable neighbourhoods responded to the COVID-19 pandemic a year from the start of the pandemic.Method In-depth interviews with the 5 lay health promoters and focus group discussions with 34 citizens from the neighbourhood who were involved in the activities within the programme were conducted in autumn 2020. The interviews and focus group discussions were transcribed verbatim and analysed using qualitative content analysis following an inductive approach.Results Four themes emerged including, 'balancing between different kinds of information', 'balancing between place-based activities and activities on social media', 'bridging between local authorities and the communities and community members', and 'balancing ambivalence through participatory dialogues'.Conclusion The study highlights that a Community Based Participatory Research programme with lay health promoters as community trust builders had a potential to work with communicable diseases during the pandemic. The lay health promoters played a key role in promoting health during the pandemic by deepening the knowledge and understanding of the role that marginalised citizens have in building resilience and sustainability in their community in preparation for future crises. Public health authorities need to take the local context into consideration within their pandemic strategies to reach out to vulnerable groups.

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