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  • 1.
    Avery, Helen
    et al.
    Center for Middle Eastern studies, Lund University, Lund, Sweden.
    Sjögren Forss, Katarina
    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).
    Empowering communities with health promotion labs: result from a CBPR programme in Malmö, Sweden2022In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, no 1, p. 1-15, article id daab069Article in journal (Refereed)
    Abstract [en]

    Health promotion is thus not only a participatory practice, but a practice forempowerment and social justice. The study describes findings from a community-basedparticipatory and challenge-driven research program. that aimed to improve health through healthpromotion platform in an ethnically diverse low-income neighbourhood of Malmö, Sweden. Localresidents together with lay health promoters living in the area were actively involved in theplanning phase and decided on the structure and content of the program. Academic, public sectorand commercial actors were involved, as well as NGOs and residents. Empowerment was usedas a lens to analyse focus group interviews with participants (n=322) in six co-creative healthpromotinglabs on three occasions in the period 2017-2019. The CBP R interview guide focusedon the dimensions of participation, collaboration and experience of the activities. The CBP Rapproach driven by community member contributed to empowerment processes within the healthpromotion labs: Health promotors building trust in social places for integration, Participantsmotivate each other by social support and Participants acting for community health in widercircle. CBP R Health promotion program should be followed up longitudielly with communityparticipants to be able to see the processes of change and empowerment on the community level.

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  • 2.
    Borglin, Gunilla
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hew Thach, Emelie
    Jeppsson, Maria
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered nurse's experiences of continence care for older people: A qualitative descriptive study2020In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 15, no 1, article id e12275Article in journal (Refereed)
    Abstract [en]

    Aim: This study aimed to illuminate nurses’ experience of continence care for older people receiving home care, either in their own home or in an assisted living facility. Background: Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor. Methods: Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis. Result The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence‐based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care. Conclusion: The provision of continence care that is based on key nursing standards, such as evidence‐based and person‐centred care, as well as individualised continence care that is based on evidenced‐based guidelines, would ensure an improvement in the continence care that is presently on offer to older people.

  • 3.
    Borglin, Gunilla
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Räthel, Kristina
    Helene, Paulsson
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered nurse’s working at elderly care centers experience of depressive symptoms among older people: a qualitative descriptive study2019In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 18, article id 43Article in journal (Refereed)
    Abstract [en]

    Background: Depressive symptoms and/or depression are commonly experienced by older people. Both are underdiagnosed, undertreated and regularly overlooked by healthcare professionals. Healthcare facilities for people aged ≥ 75 years have been in place in Sweden since 2015. The aim of these care centres, which are managed by registered nurses (RNs), is to offer care adjusted to cater to the complex needs and health problems of older people. Although the mental health of older people is prioritised in these centres, research into the experience of RNs of depressive symptoms and/or depression in older people in this setting is limited. Therefore, this study aimed to illuminate RNs, working at care centres for older people, experience of identifying and intervening in cases of depressive symptoms. Methods: The data for this qualitative descriptive study were collected through interviews (n = 10) with RNs working at 10 care centres for older people in southern Sweden. The transcribed texts were analysed using inductive content analysis. Results: The participants’ experiences could be understood from four predominant themes: (1) challenging to identify, (2) described interventions, (3) prerequisites for identification, and (4) contextual influences. Key findings were that it was difficult to identify depression as it often manifested as physical symptoms; evidence-based nursing interventions were generally not the first-line treatment used; trust, continuity and the ability of RNs to think laterally; and the context influenced the ability of RNs to manage older people’s depressive symptoms and/or depression. Conclusions: The process of identifying depressive symptoms and performing an appropriate intervention was found to be complex, especially as older people were reluctant to present at the centres and provided obscure reasons for doing so. A nurse-patient relationship that was built on trust and was characterised by continuity of care was identified as a necessary prerequisite. Appropriate nursing interventions—afforded the same status as pharmacological treatment—are warranted as the first-line treatment of depression. Further research is also needed into efficacious nursing interventions targeting depressive symptoms and/or depression.

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  • 4.
    Borglin, Gunilla
    et al.
    Department of Bachelor’s in Nursing, Lovisenberg Diaconal University College, Oslo, Norway.
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    New year, new circumstances, new goals2022In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 42, no 1, p. 1-2Article in journal (Other academic)
  • 5.
    Karlsson, E
    et al.
    Karolinska Institute.
    Sjögren Forss, Katarina
    Blekinge Institute of Technology.
    Jorgréus, C
    Blekinge Institute of Technology.
    Stjernberg, Louise
    Blekinge Institute of Technology.
    Exercise and factors associated with active commuting2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no S2, p. 312-Article in journal (Other academic)
  • 6.
    Lindsjö, Cecilia
    et al.
    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).
    Kumlien, Christine
    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).
    Migrant women's engagement in health-promotive activities through a women's health collaboration2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1106972Article in journal (Refereed)
    Abstract [en]

    Introduction: Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

    Aim: The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

    Materials and methods: This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

    Result: Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

    Conclusion: The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

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  • 7.
    Lindsjö, Cecilia
    et al.
    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).
    Kumlien, Christine
    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).
    Health promotion focusing on migrant women through a community based participatory research approach2021In: BMC Women's Health, E-ISSN 1472-6874, Vol. 21, article id 365Article in journal (Refereed)
    Abstract [en]

    Background Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women's health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach. Methods A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmo, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis. Results Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion. Conclusions The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women's health.

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  • 8.
    Ljungbeck, Birgitta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmö.
    Carlson, Elisabeth
    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).
    Swedish stakeholders' views of the preparatory workneeded before introducing the nurse practitioner role inmunicipal healthcare–A focus group study2023In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    Background: The nurse practitioner role has become important globally in handlingthe growing healthcare needs of older adults with chronic diseases. Nevertheless,research shows that introducing the role is a complex process, and more studies areneeded to prepare for its introduction into different healthcare contexts, such as municipalhealthcare.Aim: The aim is to investigate what Swedish stakeholders identify as the preparatorywork needed before introducing the nurse practitioner role into municipalhealthcare.Methods: Data were collected through four focus group interviews conducted virtuallyon the TEAMS digital platform, with three to six participants in each groupand 18 participants total. The transcribed interviews were analysed using a six-stepthematic approach: familiarisation with the data, coding the data, generating initialthemes, reviewing themes, defining and naming the themes and producing thereport.Findings: The findings are divided into two main themes, each with two sub-themes.In the first, clarifying why the nurse practitioner role is needed, participants stressedthe importance of having a clear intention for introducing the role. The second, ensurea national framework to bolster the introduction at the local level, demonstratesthe need for collaboration among national actors to clarify the role's mandate andauthority before its introduction.Conclusions: Adding the nurse practitioner role to municipal healthcare can helpincrease the supply of nursing competence and the quality of patient care, but preparationfor introducing the role requires extensive work. The development of thenurse practitioner role requires decision-makers and leaders to take primary responsibilityfor its introduction. This study can support countries in the early phase ofdeveloping the nurse practitioner role by identifying both best practices and pitfalls.

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  • 9. Ljungbeck, Birgitta
    et al.
    Sjögren Forss, Katarina
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Advanced nurse practitioners in municipal healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative interview study with managers, doctors and specialist nurses2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16Article in journal (Refereed)
    Abstract [en]

    Background: The number of frail elderly people with complex nursing and medical care needs is increasing, and consequently, the healthcare burden. The implementation of Advanced Nurse Practitioners globally has been shown to make healthcare more effective and increase patient safety, continuity of care and access to care. In Sweden, research about Advanced Nurse Practitioners is limited. Thus, this study aimed to investigate the opinions of managers, doctors and nurses in primary care and municipal healthcare about the role of ANPs in municipal healthcare as a way to meet the increasing healthcare needs of the frail elderly. Methods: Managers, doctors and specialist nurses in primary care and municipal healthcare adopted a qualitative, descriptive design through 12 semi-structured interviews. The data were analysed using content analysis. Results: The participants expressed both opportunities as well as challenges with Advanced Nurse Practitioners in municipal healthcare. This role considered to satisfy frail elderly people’s healthcare needs and making the Healthcare more effective as the doctors would have more time for other patients. The challenges mainly consist of doubts from the managers whether the nurses would be motivated to pursue further education to become an Advanced Nurse Practitioner if the role becomes a reality. The doctors were unsure if the nurses would consider taking the responsibility the role would imply. Conclusions: Advanced Nurse Practitioner is considered to be a valuable resource not only for the frail elderly but also for the nurses in the municipal healthcare and for the doctors in primary care as they probably would make Healthcare more effective. They might be a way to meet the increasing healthcare needs of frail elderly, however there are also challenges to overcome before they can become a reality in a Swedish healthcare context. Consequently, this role deserves further investigation.

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  • 10.
    Ljungbeck, Birgitta
    et al.
    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).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nurse practitioner in Swedish municipal elderly care: A Delphi study of challenges and opportunities2023In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 1, p. 216-228Article in journal (Refereed)
    Abstract [en]

    Introduction Worldwide, countries are struggling with strained healthcare systems, especially due to the growing number of frail elderly. Developing the role of nurse practitioner in the care of the frail elderly is therefore of interest to make the care chain more efficient. In Sweden, the role is in an early development phase, but more research is needed. Aim The aim was to investigate how stakeholders at the national level express the challenges and opportunities of the evolving nurse practitioner role in Swedish municipal elderly care. Method A Delphi survey technique with three rounds of electronic questionnaires was used. Twenty-seven experts responded to the first questionnaire, containing two open questions; what opportunities respectively challenges do you see in developing and implementing the nurse practitioner role in municipal elderly care? The following questionnaires consisted of statements to rate using a four-grade Likert scale, and 20 and 17 responded to the second and third, respectively. The first round was analysed using content analysis, and the other two with descriptive statistics. Results Thirty-four statements about challenges and opportunities related to the nurse practitioner role in municipal elderly care were identified and rated as important. Conclusion The findings provide knowledge that can contribute to discussions and decisions to refine the nurse practitioner role in Swedish municipal elderly care. The nurse practitioner role may contribute with much-needed competence to the elderly care. However, it is important to consider the challenges that need to be overcome before the development of the role. To solve this, it is necessary to have clear national guidelines concerning issues of education, title protection and the mandate and authority of the NP role.

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  • 11.
    Ljungbeck, Birgitta
    et al.
    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).
    Finnbogadottir, Hafrún
    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).
    Content in nurse practitioner education - A scoping review.2021In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 98, article id 104650Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Globally, the role of nurse practitioner is evolving to meet increased healthcare demands. Nevertheless, there are factors hindering the development of this role, one of which involves differences in nurse practitioner education worldwide. Therefore, the objective of the present study is to identify what is known in the research field on the content of nurse practitioner educational programmes.

    DESIGN AND DATA SOURCES: The literature scoping review follows a six-stage methodological framework including: i) formulate research questions, ii) identify relevant studies, iii) select studies, iv) chart data, v) collate, summarize and report the results, vi) consultations. Data bases searched included CINAHL, PubMed and ERIC and were followed by manual searching of reference list in the included papers. Of the 1553 papers identified, 16 met the aim of this study.

    REVIEW METHODS: To answer the research questions 'what is the content of curricula in nurse practitioner education?' a deductive content analysis was used.

    RESULTS: Two main categories emerged. The first was related to the professional nurse practitioner role and includes research and nursing theories, leadership and collaboration, and organizational, political, economic, regulatory and legislative issues. The second is related to becoming an autonomous practitioner and includes health promotion and disease prevention, and other medically oriented content.

    CONCLUSIONS: The content identified is consistent with the core competencies that nurse practitioners are expected to have after graduation, which have been described by the International Council of Nurses and by other researchers. Given the lack of recent research in nurse practitioner education, the results of the present study advance knowledge in this research field. Additionally, this study may be of practical value in developing new nurse practitioner educational programmes.

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  • 12.
    Ljungbeck, Birgitta
    et al.
    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).
    Finnbogadóttir, Hafrún
    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).
    Curricula and learning objectives in nurse practitioner programmes: a scoping review protocol2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 7, article id e028699Article in journal (Refereed)
    Abstract [en]

    Introduction: Globally, nurse practitioner (NP) has become an important nursing role in the pursuit of a more efficient healthcare, possessing the necessary expert skills to work as autonomous practitioners. Nevertheless, there are barriers in the implementation of this role. One barrier concerns the different levels of education required for NPs. Previous studies demonstrate the importance of acting for a uniform international education. The aim of the scoping review was to compile research about education to become an NP, focusing on the content of curricula and learning objectives.

    Methods and analysis: The six-stage methodological framework by Arksey and O'Malley will guide the scoping review through the following stages: identifying the research questions; identifying relevant studies; study selection; charting the data; collating, summarising and reporting the results; and consultation. The research questions are as follows: What is the content of curricula in NP programmes? What are the learning objectives in NP programmes? The literature searches will be conducted between March and June 2019 in the following databases: PubMed, CINAHL and ERIC, followed by hand searching reference lists of key studies. Grey literature will be searched in Google Scholar, Libsearch, existing networks and relevant organisations. Two researchers will screen titles and abstracts. Included full-text articles will be screened by three researchers and assessed for their methodological quality by the use of the Critical Appraisal Skills Programme. The PreferredReporting Items for Systematic Reviews and Meta-Analyses flow diagram will be used to demonstrate included and excluded articles. The findings will be presented through a numerical summary of the included articles, followed by a thematic analysis.

    Ethics and dissemination: Research ethics approval is not required for a scoping review. The scoping review will be submitted to a peer-reviewed journal. Additionally, the findings will be disseminated to stakeholders representing political, educational, professional and union organisations through a Delphi study as part of the consultation stage of the Arksey and O'Malleys framework.

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  • 13.
    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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  • 14.
    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).
    Maneesh, Paul-Satyaseela
    Acharya Inst Technol, R&D Directorate, Bengaluru, India..
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Antimicrobial Resistance & Migrants in Sweden: Poor Living Conditions Enforced by Migration Control Policies as a Risk Factor for Optimal Public Health Management2021In: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, article id 642983Article in journal (Refereed)
    Abstract [en]

    Infectious diseases exacerbated by Antimicrobial Resistance (AMR) are of increasing concern in Sweden, with multi-drug resistant strains associated with new resistance mechanisms that are emerging and spreading worldwide. Existing research has identified that sub-optimal living conditions and poor access to healthcare are significant factors in the spread and incubation of AMR strains. The article considers this linkage and the effort to control the spread of AMR in relation to migrants, highlighting deficiencies in public policy where such individuals are often increasingly exposed to those conditions that exacerbate AMR. In many of the richest countries, those conditions are not accidental, but often direct goals of policies designed with the goal of deterring migrants from staying within host countries. Without engaging with the politics around migration control, the article points to urgent need for more holistic assessment of all public policies that may, however unintentionally, undermine AMR control through worsening living conditions for vulnerable groups. The consequences of prioritizing policies meant to deliberately worsen the living conditions of migrants over avoiding those conditions that accelerate AMR spread, are today made ever apparent where new AMR strains have the potential to dwarf the societal effects of the current Covid-19 pandemic.

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  • 15.
    Mangrio, Elisabeth
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Sjögren Forss, Katarina
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Refugees’ experiences of healthcare in the host country: a scoping review2017In: BMC Health Services Research, E-ISSN 1472-6963, no 17:814, p. 1-16Article, review/survey (Refereed)
    Abstract [en]

    Background: During the last years, Europe experienced an increase in immigration due to a variety of worldwide wars and conflicts, which in turn resulted in a greater number of physical and mental health issues present among the refugees. These factors place high demands not only on the refugees, but also on healthcare professionals who meet the refugees in different situations. Information about the refugees’ experiences of the healthcare systems in their host countries is urgently needed to improve the quality of healthcare delivered, as well as to provide opportunities for better access. The aim of this scoping review is to compile research about the experiences that the refugees have with the healthcare systems in their host countries. Methods: This study was conducted as a scoping review and the methodology is derived from Levac et al. and with inspiration from the framework of Arksey & O’Malley. A systematic article search was done in Medline, Cinahl and Psychinfo. A total of 619 articles were found in the search and finally 26 articles met the inclusion criteria and were included. Results: The results show that communication between healthcare professionals and refugees is important, however, insufficient language knowledge acts as an effective communication barrier. There is a need for more information to be given to the refugees about the reception country’s healthcare system in both oral and written formats, as well as the right to healthcare. Support from healthcare professionals is also important for refugees to have a positive experience with healthcare. In some of the studies included, refugees experienced discrimination due to low proficiency in the language of the host country, and/or because of their race or accent, which shows that culturally appropriate healthcare is needed for them. Conclusions: Since refugees are suffering from poor mental and physical health and could therefore be at a greater risk of morbidity and mortality in comparison to the rest of the population of the host country, there is an urgent need for improvements in communication, interpretation, support, and deliverance of culturally appropriate healthcare.

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  • 16.
    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).
    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).
    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).
    The Association Between Self-perceived Health and Sleep-Quality and Anxiety Among Newly Arrived Refugees in Sweden: A Quantitative Study.2020In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 22, p. 82-86Article in journal (Refereed)
    Abstract [en]

    Previous research findings suggest that insomnia could be related to decreased health status and that it could also be affected by traumatic life experiences, such as war. Good health is important for newly arrived refugees for an effective integration process. The aim of the present study is, therefore, to investigate the association between self-perceived health and sleep quality among newly arrived refugees in Sweden. The results are based on 681 migrants who participated in a survey between 2015 and 2016. There was a significant odds ratio (OR) after adjustment for confounders for newly arrived refugees that were experiencing bad self-perceived health to also experience bad sleep: OR 8.07 (4.34-15.00). Furthermore, the OR remained significant but lower after adjustments for confounders for newly arrived refugees that had bad self-perceived health to be suffering from anxiety during sleep, with OR 3.83 (2.11-6.94).

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  • 17.
    Olofsson, Jonas
    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).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bramhagen, Ann-Cathrine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Older migrants' experience of existential loneliness2021In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 28, no 7-8, p. 1183-1193, article id 969733021994167Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age.

    AIM: This study explored older migrants' experience of existential loneliness.

    RESEARCH DESIGN: Qualitative study.

    PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through interviews (n = 15) with older (>65) migrants' in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data.

    ETHICAL CONSIDERATIONS: The study was conducted in accordance with the principles of research ethics.

    FINDINGS: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country.

    DISCUSSION: Ethical reflection and knowledge about how older migrants' life story can lead to experiencing existential loneliness, could be of use in care for older migrants'.

    CONCLUSION: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.

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  • 18.
    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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  • 19.
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The importance of addressing ageism in Swedish healthcare2020In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 40, no 3Article in journal (Refereed)
    Abstract [en]

    Ageism is discrimination against individuals or groups based on their age. In the Swedish healthcare context, the term isuncommon, despite the fact that older people are a significant class of users. One of every five individuals in Sweden is 65 yearsof age or older, and the proportion of older people in the population is rising. Therefore, ageism in healthcare warrants moreawareness and focus. In three recent articles that we have published relating to nutritional, depression and continence care forolder people, we found indications of ageism even though we did not aim to study it. There is a need to identifythe manifestations of ageism and label them, and to become alert to both the visible and invisible expressions of ageism.This will help in the development of interventions and policies to eliminate ageism in healthcare. With health inequalitiesgrowing and seemingly becoming the norm rather than the exception in Sweden and other European countries, it has becomeimperative to address and eliminate health inequalities through a range of initiatives and mechanisms. Fighting ageism in differentsettings must be a part of this larger goal.

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  • 20.
    Sjögren Forss, Katarina
    et al.
    Faculty of Medicine, Department of Clinical Sciences in Malmö, General Practice, Lund University; School of Health Science, Blekinge Institute of Technology.
    Ekvall Hansson, Eva
    Faculty of Medicine, Department of Clinical Sciences in Malmö, General Practice, Lund University.
    Troein, Margareta
    Faculty of Medicine, Department of Clinical Sciences in Malmö, General Practice, Lund University.
    Stjernberg, Louise
    School of Health Science, Blekinge Institute of Technology.
    Patterns of physical activity among women and men before and during pregnancy2014In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 128, no 9, p. 814-816Article in journal (Refereed)
    Abstract [en]

    Objectives: Follow changing physical activity (PA) patterns among women and men during pregnancy compared to before pregnancy. Study design: Longitudinal study. Methods: The study involved 280 individuals, 145 women and 135 men (who were partners to the women), from the municipality of Karlskrona, Sweden. Data were collected during 2008–2009. We measured the self-reported amount of PA performed outdoors and indoors during the 12 months before pregnancy and throughout the entire pregnancy. Results: Among both women and men, we found changes in PA patterns during pregnancy compared to before pregnancy. Women and men were more physically active before pregnancy than during pregnancy. Similar patterns were found among women and men with regard to the type of activity, with both groups taking more exercise and pursuing aquatic sports, indoor PA and non-strenuous activities before pregnancy and more strolling/walking during pregnancy. Conclusions: Our findings contribute new knowledge about changes in men’s PA patterns from pre-pregnancy to pregnancy that is an unexplored field. Changes in the women’s activity patterns during pregnancy also affect the men. Women seem to adjust their activity patterns during the pregnancy. The changes in activity patterns among the men are more tentative but follow the pattern for the women, which could be explained by the couples sharing their everyday lives. Midwives should consider providing information to men about the importance of being physically active during pregnancy and informing them about their role in encouraging women to be physically active.

  • 21.
    Sjögren Forss, Katarina
    et al.
    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).
    Collaborating in a penta-helix structure within a community based participatory research programme: 'Wrestling with hierarchies and getting caught in isolated downpipes'2021In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 79, no 1, article id 27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the light of the existence of social inequalities in health, a CBPR (Community Based Participatory Research) programme for health promotion started in Malmö, Sweden, in 2017. The programme was based on a penta-helix structure and involved a strategic steering group with representatives from academia, voluntary organisations, the business sector, the public sector, and citizens from the community where the programme took place. The aim of this study was to explore how the penta-helix collaboration worked from the perspectives of all partners, including the citizens.

    METHODS: Individual interviews, that were based on a guide for self-reflection and evaluation of CBPR partnerships, were conducted with the representatives (N = 13) on three occasions, during the period 2017-2019. A qualitative content analysis was used to analyse the interviews.

    RESULTS: Six themes emerged from the analysis, including Challenges for the partners in the penta-helix collaboration; Challenges for the professionals at the local level; Citizen-driven processes are important for the penta-helix collaboration; Health promoters are essential to build trust between different sectors of society; Shift of power; and System changes take time. The analysis shows that the penta-helix collaboration worked well at the local level in a governance-related model for penta-helix cooperation. In the overall cooperation it was the citizen-driven processes that made the programme work. However, the findings also indicated an inflexibility in organisations with hierarchical structures that created barriers for citizen involvement in the penta-helix collaboration.

    CONCLUSION: The main issue uncovered in this study is the problem of vertically organised institutions where discovery and innovation processes flow down from the top, thereby eliminating the essential input of the people and community that they are supposed to serve. The success of the programme was based on an interprofessional cooperation at a local level, where local professions worked together with voluntary organisations, social workers, CBPR researchers from the university, citizens and local health promoters.

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  • 22.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    A scoping review of refugees' experiences of healthcare2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl 1, p. 142-143Article in journal (Other academic)
    Abstract [en]

    Background: During recent years, Europe has faced increased immigration. The growing number of refugees presents huge challenges to the healthcare systems of host countries. However, healthcare professionals are generally unprepared to understand and address the health and care needs of refugees. More information about refugees’ experiences of the healthcare system is urgently needed to improve the quality of healthcare delivered and provide opportunities for better access. The aim of this study was to learn more about refugees’ experience of the healthcare system in their host country. Methods: The study was conducted as a scoping review. A systematic search of articles was done in Medline, Cinahl and Psychinfo. 619 articles were found in the searches. Twenty-six articles were included in the study. Results: The results showed that the communication between the health professionals and the refugees was important but poor language skills were perceived as a barrier for good communication. There was a need for both increased oral and written information about the health care system and the right to health care in the host countries. Supportive health professionals were of great importance for a good interaction between the refugee and the health care system. In some of the studies included, some refugees had felt discrimination due to their low proficiency in the national language, or because of race or accent. There was a perceived need for more culturally appropriate health care for the refugees. Conclusions: Since refugees may be at greater risk of poor mental and physical health compared to the rest of the population, there is an urgent need for improvement in communication, interpretation, support and delivery of a culturally appropriate care.

  • 23.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hellström, Lisa
    Malmö University, Faculty of Education and Society (LS), Department of School Development and Leadership (SOL).
    Interprofessional Teamwork to Promote Health: First-Time Parents' Experiences of a Combined Home Visit by Midwife and Child Health Care Nurse2022In: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 10, article id 717916Article in journal (Refereed)
    Abstract [en]

    Background: To achieve the requisites for a child’s healthy development and to reducehealth inequalities, it is important to promote health initiatives at an early stage in a child’slife and to include the parents. Home visits by healthcare professionals have been foundto have positive health effects for both the baby and the parents. From an extended homevisit programme in Sweden, our aim was to illuminate first-time parents’ experience of ahome visit conducted by a midwife and a child health care nurse 1–2 weeks postnatal.Methods: Data was collected by interviews (n = 13) with first-time parents. Thetranscribed texts were analyzed using inductive content analysis.Results: The participants’ experiences could be understood from the two themes, Atrust in the professionals and Feeling safe as a new parent. The participants experiencedthat the midwives and the child health care nurses complemented each other andappreciated to get knowledge and information from both professions. In their own home,they felt secured and relaxed, and the professionals could help them provide a safe homeenvironment for the child.Conclusion: By meeting both professionals at the same time and in their own home,the participants experienced that the needs of the baby and their needs and concernsas new parents were included and supported.

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    Interprofessional Teamwork to Promote Health: First-Time Parents' Experiences of a Combined Home Visit by Midwife and Child Health Care Nurse
  • 24.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    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).
    Leijon, M.
    Grahn, M.
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Physical activity in relation to wellbeing among newly arrived refugees in Sweden2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no s5, article id ckaa166.727Article in journal (Other academic)
    Abstract [en]

    BackgroundIn the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden. 

    MethodsThe study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%). 

    ResultsWe found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.

    ConclusionsNewly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

    Key messages There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.

  • 25.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    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).
    Leijon, Matti
    Department of Medical and Health Sciences, Linköping University.
    Grahn, Mathias
    Unit for Statistics and Data, Municipality of Malmö.
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Physical Activity in Relation to Wellbeing Among Newly Arrived Refugees in Sweden: A Quantitative Study2021In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 532883Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about physical activity among newly arrived refugees and what impact physical activity might have on their health, as measured by mental wellbeing, vitality, stress and sleep quality. Thus, this study sought to investigate the relationship between physical activity and wellbeing among refugees who were newly arrived in Sweden. Methods: The present study was based on the results from a survey, conducted in 2015-2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39.5%). Results: We found a significant association between physical activity and mental wellbeing, vitality, stress and sleep quality among newly arrived refugees. Conclusions: Newly arrived refugees need to be informed about the importance of prioritizing physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

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  • 26.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nilsson, Jane
    Borglin, Gunilla
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Registered nurses’ and older people’s experiences of participation in nutritional care in nursing homes: a descriptive qualitative study2018In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 17, article id 19Article in journal (Refereed)
    Abstract [en]

    Background The evaluation and treatment of older people’s nutritional care is generally viewed as a low priority by nurses. However, given that eating and drinking are fundamental human activities, the support and enhancement of an optimal nutritional status should be regarded as a vital part of nursing. Registered nurses must therefore be viewed as having an important role in assessing and evaluating the nutritional needs of older people as well as the ability to intervene in cases of malnutrition. This study aimed to illuminate the experience of participating in nutritional care from the perspectives of older people and registered nurses. A further aim is to illuminate the latter’s experience of nutritional care per se. Methods A qualitative, descriptive design was adopted. Data were collected through semi-structured interviews (n = 12) with eight registered nurses and four older persons (mean age 85.7 years) in a city in the southern part of Sweden. The subsequent analysis was conducted by content analysis. Result The analysis reflected three themes: ‘participation in nutritional care equals information’, ‘nutritional care out of remit and competence’ and ‘nutritional care more than just choosing a flavour’. They were interpreted to illuminate the experience of participation in nutritional care from the perspective of older people and RNs, and the latter’s experience of nutritional care in particular per se. Conclusions Our findings indicate that a paternalistic attitude in care as well as asymmetry in the nurse-patient relationship are still common characteristics of modern clinical nursing practice for older people. Considering that participation should be central to nursing care, and despite the RN’s awareness of the importance of involving the older persons in their nutritional care this was not reflected in reality. Strategies to involve older persons in their nutritional care in a nursing home context need to take into account that for this population participation might not always be experienced as an important part of nursing care.

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  • 27.
    Sjögren Forss, Katarina
    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).
    Persson, Karin
    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).
    Borglin, Gunilla
    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).
    Nursing students' experiences of caring for ethnically and culturally diverse patients: A scoping review2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 37, p. 97-104Article, review/survey (Refereed)
    Abstract [en]

    Little is known about nursing students' experiences of caring for patients from diverse cultures, which is an important factor in educational settings when it comes to understanding whether the teaching strategies applied are successful. Thus, the aim of this study was to conduct a scoping review of the literature, thereby synthesising existing studies to explore nursing students' experiences of caring for patients with different cultural backgrounds from theirs. A systematic article search was done in PubMed, CINAHL and ERIC. A total of 996 studies were found in the searches and finally seven studies met the inclusion criteria and were included. The analysis of the seven included studies was interpreted to represent two overarching themes, namely the challenge of communication and non-mutual language and the challenge of culture and culturally influenced behaviour, representing nursing students' experiences of caring for patients with a different cultural background from theirs. A major challenge for nursing educators appears to be creating pedagogical interventions that cultivate a humble, solicitous and caring curiosity among students, such that they do not perceive only challenges in caring for culturally diverse patients.

  • 28.
    Sjögren Forss, Katarina
    et al.
    Department of Health, Blekinge Institute of Technology; Jönkoping University .
    Stjernberg, Louise
    Department of Health, Blekinge Institute of Technology; Jönkoping University .
    Differences in physical activity patterns among women and men with and without children2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no suppl. 2, p. 133-133Article in journal (Refereed)
    Abstract [en]

    Background Due to health effects from participating in physical activity (PA) it is from a public health perspective important to study how participation PA may change over a lifetime and how different life events impact on the participation. Although studies in the field are sparse, parenthood has been found to be a life event associated with decreased PA, especially among women. We studied physical activities performed among women and men with and without children. Methods This study includes data for from parents-to-be, 224 women and 208 men, from Karlskrona municipality, situated in the south eastern part of Sweden. Data collection was carried out during 2008–2009. When contacting the antenatal clinics in the municipality all expectant parents were asked by the midwife about participation in the study. Respondents completed a questionnaire about age, socioeconomic status, level of education, previous children, smoking and alcohol habits, Body Mass Index, self estimated health, and participation in different kinds of outdoor and indoor recreational PA. We measured the self-reported amount of outdoor recreational PA undertaken during the last year. Results Both women and men without children performed more outdoor and indoor PA compared to those who had children. Women walked significantly more (p = 0.017) than men irrespective of whether or not they had children. Women with children participated in significantly more gardening (p = 0.009) and winter sports (p = 0.013) than women without children, and women without children participated in significantly more PA indoors (p = 0.001) than women with children. Men with children participated in significantly more gardening (p = 0.001) than men without children, and men without children participated in significantly more PA indoors (p = 0.006). Conclusions Becoming a parent is a life event that affects participation in PA, both concerning duration and the kind of activities performed. To gain deeper understanding and more insight about reasons for these changed patterns of PA as well as the effects on the outcome of the parents health in a short- and long term would be important to follow prospectively.

  • 29.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Stjernberg, Louise
    Department of Health Sciences, The Swedish Red Cross University College.
    Physical activity among parents during pregnancy and 8 months postpartum compared to pre-pregnancy2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no s5, p. V849-V849, article id ckaa166.858Article in journal (Other academic)
    Abstract [en]

    BackgroundAs there is incontrovertible evidence of the essential prerequisite of regular physical activity it is also important to understand how different life change events may impact individual's participation in physical activity. Pregnancy and the transition to parenthood have been found to be life change events associated with decreased physical activity among women however, the examination of changes of physical activity in the male parent during this major life change event has been largely neglected in scientific literature and a significant research gap can be found. In the light of this, this longitudinal study aimed to follow changing physical activity patterns among women and med during pregnancy and eight months postpartum compared to pre-pregnancy.

    MethodsThe study involved 123 women and 112 men (partners of the women) from the municipality of Karlskrona, Sweden. We measured the self-reported amount of physical activity performed outdoors and indoors before pregnancy (calculated from one month before pregnancy), throughout the entire pregnancy, and eight months postpartum. 

    ResultsWe found similar trends among both women and men in decreasing frequency of physical activity during pregnancy and eight months postpartum as compared to pre-pregnancy, however, overall physical activity levels did not change.

    ConclusionsOur findings contribute new knowledge about changes in men's physical activity patterns from pre-pregnancy to pregnancy and postpartum and is an important contribution in research, as the area is very limited. As couples seem to change activity patterns similarly, it is important to promote family-based physical activity initiatives and encourage couples to be active together during pregnancy and postpartum. 

    Key messages Couples seem to change physical activity patterns similarly during pregnancy and postpartum. as compared to pre-pregnancy.It is important to promote family-based physical activity initiatives and encourage couples to be active together during pregnancy and postpartum.

  • 30.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Stjernberg, Louise
    Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.
    Physical Activity Patterns Among Women and Men During Pregnancy and 8 Months Postpartum Compared to Pre-pregnancy: A Longitudinal Study2019In: Frontiers In Public Health, ISSN 2296-2565, Vol. 7, article id 294Article in journal (Refereed)
    Abstract [en]

    Background: Realizing the essential prerequisite of regular physical activity (PA) it is essential to have knowledge about how different life change events may influence individual's participation. Many studies have documented that pregnancy and the transition to parenthood are life change events associated with decreased PA among women however, the examination of changes of PA in the male parent during this major life change event has been largely neglected in scientific literature and a significant research gap can be found. In the light of this, this longitudinal study aimed to follow changing PA patterns among women and men during pregnancy and 8 months postpartum compared to pre-pregnancy. Methods: In this study, 123 women and 112 men (partners of the women) that lived in the municipality of Karlskrona, Sweden, were included. Data were collected between 2008 and 2010. The self-reported amount of PA performed outdoors and indoors before pregnancy throughout the entire pregnancy, and 8 months postpartum, were measured. Results: We found similar changes in PA patterns among both women and men during pregnancy and 8 months postpartum when compared to pre-pregnancy. In almost all the activities studied except for walking/strolling, a significant decline was found. Conclusions: Our findings contribute new knowledge about changes in men's PA patterns from pre-pregnancy to pregnancy and postpartum. As couples seem to change activity patterns similarly, it is important to promote family-based PA initiatives and encourage couples to be active together during pregnancy and postpartum.

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  • 31.
    Sjögren Forss, Katarina
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Stjernberg, Louise
    The Swedish Red Cross University College, Stockholm,Sweden.
    Ekvall Hansson, Eva
    Department of Clinical Sciences, Lund University, Sweden.
    Osteoarthritis and fear of physical activity—The effect of patient education2017In: Cogent Medicine, ISSN 2331-205X, Vol. 4, no 1328820, article id 1328820Article in journal (Refereed)
    Abstract [en]

    Abstract: Purpose: The aim of the current study was twofold. The first aim was to investigate, from the aspects of gender, age and Body Mass Index, the prevalence of fear among individuals with osteoarthritis that their joints would be harmed if they performed physical activity. The second aim was to determine if a patient education programme might lessen this fear. Method: A total of 100 participants were enrolled in a randomised controlled study and completed measures on two occasions over the course of six months. The participants were randomised to either an intervention group or to a control group. Results: More than a quarter of the participants feared that their joints would be harmed if they performed physical activity. This was reported by significantly more men than women. Age and Body Mass Index did not seem to have any significant impact on the fear. The patient education programme for osteoarthritis reduced fear significantly (p = 0.010). Conclusions: A patient education programme appear to be one way of reducing the fear among individuals with osteoarthritis, that the joints would be harmed by physical activity.

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  • 32.
    Sjögren, Katarina
    et al.
    School of Health Science, Blekinge Institute of Technology; Lund University.
    Hansson, Eva Ekvall
    Lund University.
    Stjernberg, Louise
    School of Health Science, Blekinge Institute of Technology.
    Outdoor recreational physical activity and parenthood in a gender perspective-a study from south eastern part of Sweden2010In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 20, no Suppl. 1, p. 182-182Article in journal (Refereed)
  • 33.
    Sjögren, Katarina
    et al.
    Faculty of Medicine, Department of Clinical Sciences in Malmö, General Practice, Lund University, CRC entrance 72:28:11, Malmö University Hospital, 205 02, Malmö, Sweden; School of Health Science, Blekinge Institute of Technology, 371 79, Karlskrona, Sweden.
    Hansson, Eva Ekvall
    Faculty of Medicine, Department of Clinical Sciences in Malmö, General Practice, Lund University, CRC entrance 72:28:11, Malmö University Hospital, 205 02, Malmö, Sweden.
    Stjernberg, Louise
    School of Health Science, Blekinge Institute of Technology, 371 79, Karlskrona, Sweden.
    Parenthood and factors that influence outdoor recreational physical activity from a gender perspective2011In: BMC Public Health, E-ISSN 1471-2458, Vol. 11, no 93Article in journal (Refereed)
    Abstract [en]

    Background: A physically active life promotes both physical and mental health, increasing well-being and quality of life. Physical activity (PA) performed outdoors has been found to be particularly good for promoting well-being. However, participation in PA can change during the course of a lifetime. Parenthood has been found to be a life event associated with decreased PA, especially among women, although studies in the field are sparse. The aim of this study was to investigate participation in outdoor recreational PA, and factors influencing participation among parents-to-be, with and without previous children, from a gender perspective. Methods: This study included baseline data from parents-to-be, 224 women and 208 men, from the municipality of Karlskrona in south-east Sweden. Data collection was carried out during 2008-2009. We measured the self-reported amount of outdoor recreational PA undertaken during the last year and analysed the probability of participating in this PA using 25 variables covering individual and socioeconomic factors. Results: Seventy-six per cent of the women and 65% of the men had participated in outdoor recreational PA, varying from several times per month to every day, over a 12-month period prior to one month before pregnancy. Participation in PA indoors and owning a dog or a horse emerged as the most important factors associated with the probability of participation in outdoor recreational PA. Men were affected by a greater number of factors than women, for example men who had a family situation that permitted outdoor recreational PA participated in activities to a greater extent than men without such a family situation. The physical aspect, i.e. improved physical condition, staying power and vigour, also played a significant role with regard to participation among men. Conclusions: Becoming a parent is a life-changing event that affects participation in PA. By offering family-oriented PA choices that involve both parents and children, midwives and health promoters can encourage parents to be active and to support each other. The promotion of outdoor recreational PA, which also has restorative effects on well-being, needs to focus on activities which are attractive and affordable for the majority of both women and men.

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  • 34.
    Sjögren, Katarina
    et al.
    Faculty of Medicine, Department of Clinical Sciences in Malmö, General Practice Lund University, Sweden; School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.
    Stjernberg, Louise
    A gender perspective on factors that influence outdoor recreational physical activity among the elderly2010In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 10:34Article in journal (Refereed)
    Abstract [en]

    Background Physical activity (PA) is part of a healthy lifestyle and prevents many chronic health problems, in addition to promoting mental health. PA performed outdoors has been found particularly good for promoting one's well-being. The aim of this study was to investigate the extent to which outdoor recreational PA was carried out during 1 year, and the factors influencing such activities from a gender perspective among persons ≥ 60 years of age. Methods This study included 999 individuals 60-96 years of age living in the south eastern part of Sweden. Data collection was carried out during the years of 2001-2003. We measured the amount of regular light and/or intense outdoor recreational PA performed during the last year and determined the probability of performing PA as a function of 10 variables covering individual and socioeconomic factors. Results Our results suggest that being independent physically and healthy enough to manage one's personal hygiene and having access to areas for country walks were the most important factors associated with the probability of engaging in outdoor recreational PA for both men and women. Despite the level of performance being almost equal for the sexes as two-thirds of both had performed outdoor recreational PA during the preceding year more factors, i.e., living alone, being unable to cover an unexpected cost, fear of being violated, and fear of falling, were associated with the possibilities of engaging in outdoor recreational PA among women. Also increasing age seems to affect activities among women negatively to a higher extent than men. Conclusion Men and women seem to have different opportunities and needs with respect to performing PA. These considerations do not seem to be sufficiently taken into account today and improvements could be made concerning e.g., health-promoting activities suggested to the elderly by healthcare personnel and spatial planning within society. Promoting outdoor recreational PA that has restorative effects on well-being needs to focus on activities which are attractive and affordable for the majority of both men and women.

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  • 35.
    Sjögren, Katarina
    et al.
    BTH.
    Stjernberg, Louise
    BTH.
    Factors influencing outdoor recreation physical activity among elderly in the south eastern part of Sweden2009Conference paper (Refereed)
    Abstract [en]

    Background The elderly population in the world are increasing. Health promoting activities aiming at a long healthy life among the elderly is a central public health issue. Regular outdoor recreation physical activity is associated with physical and mental health benefits, also if starting late in life. We studied outdoor recreation physical activities and factors influencing such activities, among persons aged >60 years. Methods The study was performed within the longitudinal Swedish National Study on Aging and Care. Baseline data were collected between 2001 and 2003. Respondents completed a questionnaire about sex, age, outdoor physical activities during the last year, access to recreational areas, socioeconomic status, social network, anxiety of falling or being assaulted outdoors and capability to have a shower by themselves. A binary logistic regression was used to determine differences in variables constituting on factors enhancing the probability on performing outdoor recreation physical activities. Results In total, 999/1402 (71 %) respondents aged 60-96 years answered all the questions in the questionnaire. Of those, 659/999 (66 %) had performed outdoor recreation physical activities several times/week during the last year. The probability on performing activities was significantly higher among women when compared to men. The activities decreased significantly when becoming >80 years, especially among women. Also, being a woman with poor economy decreased the probability significantly compared to men in the same situation. Other factors which significantly increased the performance were; access to a recreational area, if respondents were not anxious of falling and if respondents were capable to have a shower by themselves. Conclusions To facilitate outdoor physical activities among elderly, extra support seems important for men <80 years and for both sexes when becoming >80 years. Also, those anxious of falling and women with a poor economy need support. Access to recreational areas is of importance.

  • 36.
    Svensson, Annsofie
    et al.
    Kunskapscentrum demenssjukdomar VE minnessjukdomar Skånes University Hospital Malmö, Sweden.
    Granvik, Eva
    Kunskapscentrum demenssjukdomar VE minnessjukdomar Skånes University Hospital Malmö, Sweden.
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Performance of the Eight-item Informant Interview to Differentiate Aging and Dementia within a context similar to the Swedish primary healthcare sector: a systematic review of diagnostic test accuracy studies2020In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 4, p. 454-463Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Dementia is a common but underdiagnosed health problem. Instruments developed for initial screening exist internationally but are not available within the Swedish primary healthcare sector. This systematic review aimed to evaluate the diagnostic test accuracy of the Eight-item Informant Interview to Differentiate Aging and Dementia in identifying symptomatic dementia within a context similar to the Swedish primary healthcare sector.

    DESIGN: reference lists up to November 2019. Eligibility criteria were the reporting of Diagnostic test accuracy outcomes for the Eight-item Informant Interview to Differentiate Aging and Dementia's ability to identify dementia according to internationally approved criteria. The population of interest was selected within the community or primary care. QUADAS-2 was used for quality assessment, and data were analysed with a narrative approach.

    RESULTS: Five studies with a total of 13,345 participants were included. With sensitivity (88-100%), specificity (67-91%), positive and negative predictive values (28-63%; 96-100%) respectively, the results show that the Eight-item Informant Interview to Differentiate Aging and Dementia has good ability to identify true positives, false negatives and predict low-risk dementia. That is, the Eight-item Informant Interview to Differentiate Aging and Dementia has a greater ability to predict people who are at risk of not having dementia than to correctly identify those at risk of having dementia within the target population.

    CONCLUSION: The results show that the Eight-item Informant Interview to Differentiate Aging and Dementia has the ability to identify persons with symptomatic dementia within the target population. Thus, an evaluation of its potential benefits should be considered and evaluated within the Swedish primary healthcare context. KEY POINTS Dementia is a common but underdiagnosed health problem. Instruments developed for initial screening exist but are not available within the Swedish primary healthcare sector. We found that the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8), has the ability to identify individuals with symptomatic dementia within the target population. The Eight-item Informant Interview to Differentiate Aging and Dementia (AD8), has the potential to increase the possibility for timely detection of individuals with symptomatic dementia.

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  • 37. Thern, Emelie
    et al.
    Sjögren Forss, Katarina
    Blekinge Tekniska Högskola, Institutionen för hälsa.
    Jogreus, Claes
    Blekinge Tekniska Högskola, Institutionen för matematik och naturvetenskap.
    Stjernberg, Louise
    Blekinge Tekniska Högskola, Institutionen för hälsa.
    Exercise and factors associated with active commuting2014Conference paper (Refereed)
    Abstract [en]

    Background: In order to increase the current levels of physical activity new strategies have been suggested where it is incorporated into daily routines, such as commuting to and from school/work. Active commuting i.e. cycling or walking to and from school/work is an excellent strategy to increase the overall activity levels. Even though the health benefits of active commuting are well documented, non-active modes of transportation (i.e. cars, bus, train) remain the main mode of transportation. The purpose of the present study is to examine the prevalence and what factors are influencing participation in active commuting in the municipality of Karlskrona, Sweden. Method: A cross-sectional study, including base-line data from parents-to- be was carried out, including 432 participants. Questionnaires were filled in and data collection was conducted during a year in 2008 and 2009. The results were calculated using multivariate logistic regression with odds ratios (OR) and 95% confidence interval (CI). Results: The main mode of commuting was motorised vehicle (63.0%), whilst active commuters were a minority (8.3%). The regression model demonstrated a negative association between being Swedish and AC; as such immigrants were more likely to be active commuters (CI 0.08-0.80). The variable mostly associated with AC was the type of residential area. Participants living in an urban area had 5.4 times higher odds of AC compared to participants living in a rural area (CI 1.51-18.54). Being surrounded by a green-space environment decreased the probability of engaging in AC compared to being surrounded by buildings the majority of time (CI 0.07-0.60). Another important variable was outdoor recreational PA, were engaging resulted in 3.9 times higher odds of AC compared to those not engaging in outdoor recreational PA (CI 1.31-11.71). Although the variable pet-ownership remained in the last step of the model non-significant, it explains some of the variance in the model (0.10-1.24). Conclusions: The number of people being active are modest and are instead using other modes of transportation. This study found several factors both facilitating and impeding active commuting, signifying the importance of applying a broad health promotional approach to active commuting.

  • 38. Thern, Emelie
    et al.
    Sjögren Forss, Katarina
    Blekinge Tekniska Högskola, Institutionen för hälsa.
    Jogreus, Claes
    Blekinge Tekniska Högskola, Institutionen för matematik och naturvetenskap.
    Stjernberg, Louise
    Blekinge Tekniska Högskola, Institutionen för hälsa.
    Factors associated with active commuting among parents-to-be in Karlskrona, Sweden2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 1, p. 59-65Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of the present study is to examine the prevalence of active commuting and factors associated with participation in active commuting in the municipality of Karlskrona, Sweden. Active commuting is defined here as walking or cycling to and from school/work for at least 15 min one-way. Method: A cross-sectional study was carried out, which included baseline data from parents-to-be. Pregnant females and their partners were invited to participate in the study when they contacted either of the municipality’s two antenatal clinics. Data collection ran from March 2008 to February 2009. When completing the questionnaire, the participants were asked to reflect on their situation one month before the female became pregnant. The final sample consisted of 432 participants (response rate 51.9% for females and 85.0% for males). Results: The main mode of commuting was motor vehicle (63.0%), with active commuters forming a minority (8.3%). The main facilitating factor for active commuting was living in an urban as opposed to a rural area. Regular participation in outdoor recreational physical activity was significantly positively associated with active commuting. Being Swedish and being surrounded by a green space environment were significantly negatively associated with active commuting. Conclusions: This study found that the number of people who are active commuters is modest and other modes of transportation are preferred. Several facilitating and impeding factors associated with active commuting were also found, indicating the importance of applying a broad health-promoting approach to encouraging active commuting.

  • 39. Wong, Arnold Y L
    et al.
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Jakobsson, Jenny
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Schoeb, Veronika
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Borglin, Gunilla
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Older adult's experience of chronic low back pain and its implications on their daily life: Study protocol of a systematic review of qualitative research2018In: Systematic Reviews, E-ISSN 2046-4053, Vol. 7, no 1, article id 81Article, review/survey (Refereed)
    Abstract [en]

    Background: Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults’ experiences of living with chronic LBP and the implications on their daily lives. Methods/design: Candidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases). Discussion: This systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals. Systematic review registration: PROSPERO 2018: CRD42018091292

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