A digital decision aid for cancer screening can gather balanced information in one place and give individuals the opportunity to elucidate their knowledge, values and engage in shared decision-making. Research shows that ethnic minorities and individuals with various functional limitations participate in cancer screening to a lower extent, hence our ambition to make the decision aid as available and applicable as possible, regardless of end-users' traits. The aim was to describe the design and alpha phases of the development of a digital decision aid for CRC screening and tentative end-users' perceptions. Based on a scientific framework for development of decision aids, participants were recruited through multiple channels. The decision aid was evaluated in two steps, a paper version (design phase) and a website prototype (alpha phase), using the think-aloud approach. Data were rich with detailed suggestions for improvements of the decision aid and how it was perceived. A positive outlook on the decision aid was common. Certain words, wordings or visual features were considered difficult and worry or anxiety, related to the content, were expressed. The variation in the findings illustrates the challenges of decision aid development. Still, our findings emphasise the importance of designing a decision aid in co-creation with its end-users. Developing a digital decision aid is complex, why a well-established framework is essential. With the goal of an equal healthcare system, the inclusion of individuals with diverse backgrounds and functional limitations should not only be a fundamental aspect of all research, but a prerequisite.

Background: The COVID-19 pandemic had a significant impact on the public health and the economy of the Swedish population, with disproportionate effects on communities living in socioeconomically diverse neighborhoods. To mitigate these impacts and enhance outreach, COVID-19 diagnostic and prevention services supported by digital health tools were introduced for early diagnosis and prevention. Assessing the perceptions related to utilization of these efforts is essential to ensure they are benefiting the particular populations living in socioeconomically disadvantaged neighborhoods. Therefore, the aim of this study was to demonstrate available COVID-19 diagnostic tools and explore the implementation of COVID-19 diagnostics and the digital support services from the experiences of lay health promoters (LHPs) in a socioeconomically disadvantaged neighborhood in Malmö. Method: Five LHPs participated in an online focus group via Zoom, in May 2021. The session began with an online presentation of testing procedures, followed by discussion to gather user perspectives. The data was analyzed using the Rapid Identification of Themes from Audio recordings method. Results: Health promoters reported a lack of trust in existing COVID self-test procedures due to validity issues and frequent false-negative results. Polymerase chain reaction testing procedures were deemed inadequate because of delays in receiving results. Additionally, the neighborhood faced barriers to vaccination access, including challenges in using digital technology to book test and vaccination, distance to vaccination centers, and unavailability of slots. Conclusion: This study highlights the need for affordable and easy-to-use COVID-19 test alternatives in these neighborhoods. The implementation of digital healthcare solutions during the pandemic faced significant challenges, limiting access to care and support in socioeconomically disadvantaged neighborhoods. Therefore, implementing digital healthcare initiatives for disease diagnosis and prevention at the national level requires strategic planning that considers the needs and capabilities of residents in socioeconomically disadvantaged areas. Furthermore, the importance of increasing targeted vaccination centers and educating community representatives, such as health promoters, to better support their communities during crises, was emphasized.

BACKGROUND AND PURPOSE:  Measuring patient satisfaction after total hip (THA) and total knee arthroplasty (TKA) is important. We aimed to cross-culturally adapt and examine the psychometric properties of the self-reported Goodman Satisfaction Score (GSS) in a sample of Norwegian patients following primary THA and TKA.

METHODS:  The GSS was translated and adapted into Norwegian (GSS-NO) following standard guidelines. 800 patients from the Norwegian Arthroplasty Register who had undergone surgery 6-11 months prior were invited to complete GSS-NO and questions on sociodemographic factors, pain, and function in a cross-sectional study. We examined validity in relation to internal structure, response processes, and precision using Rasch analysis, relationships between the GSS-NO and pain and function using Pearson's correlation coefficients, and test-retest reliability using linear weighted kappa statistics.

RESULTS:  The GSS-NO was adapted with few challenges. 404 patients (49% THA, 51% TKA) returned complete answers. The GSS-NO met all criteria regarding the rating scale functioning. Local independence among items and unidimensionality was supported and there was acceptable goodness-of-fit. The internal consistency was 0.94. We found no systematic differential item functioning by age, sex, work status, education, cohabitation status, or hip or knee surgery. The correlation coefficients between GSS-NO and pain and function outcomes were 0.79 (95% confidence interval [CI] 0.76-0.82) and 0.79 (CI 0.76-0.82), respectively. Test-retest reliability with weighted kappa ranged from 0.43-0.55 for THA and 0.54-0.81 for TKA.

CONCLUSION:  The cross-cultural adaptation of GSS-NO proved to be a valid and reliable measure for use in Norwegian-speaking patients following primary THA and TKA.

The Paediatric Evaluation of Disability Inventory (PEDI), has been revised as a computer adaptive test; the PEDI-CAT. Many items have been added making it relevant for children and youth from birth to 20 years of age. The PEDI-CAT measures performance in the Functional Skills domains of Daily Activities, Mobility and Social/Cognitive. The PEDI-CAT's Responsibility domain measures the extent to which the caregiver or child takes responsibility for managing complex, multi-step life tasks. In this exploratory study the normative scores of children with typical development of Switzerland (n = 51) and Germany (n = 61) were compared with the American normative sample to investigate its applicability. The mean age of the children was 5.78 years with a standard deviation of 1.39 years and a range of 4.10 years. Statistically significant differences in comparison with the mean normative scores with moderate to strong effect were found in all domains. Still, 95% or more of all scores from the participants were within a 2 standard deviation range from the mean normative scores. The results indicate that the normative scores should right now be applied to the German version of the PEDI-CAT with caution. Further studies are needed to further investigate applicability of the normative values.

Purpose: To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S).

Materials and methods: Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022.

Results: The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis.

Conclusions: Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

Disadvantaged residential areas (DAs), often affected by territorial stigmatization, influence the health and quality of life in older adults. Nevertheless, older adults may prefer to stay in these areas due to emotional bonds. With the Person-Place Fit Measure for Older Adults (PPFM-OA), older adults self-assess how their home and community environments suit their needs. The aim of the study was to explore associations between person-place fit and quality of life among older adults living in different types of DAs. Survey data were collected from 459 older adults living in urban areas with low socioeconomic status and depopulated rural areas in Sweden. Person-place fit was measured using the Swedish 19-item version of the PPFM-OA and quality of life was assessed with WHOQOL-BREF. Mean age was 76 years (SD 7), with 51% being women and 13% were not born in Sweden. Linear regression models demonstrated significant associations between person-place fit and all aspects of quality of life (overall QoL, overall health, physical health, psychological health, social relationships, and environment) even after adjusting for sex, gender and ADL performance. No differences were found between residents of urban and rural DAs. The study shows that older adults’ perceptions of how well their home and community environments meet their needs are associated with their quality of life. Furthermore, the results suggest that residential areas that, from an outsider perspective are considered non-age-friendly, may not be perceived as such by older the older residents.

Background and Purpose: Possibilities to age in place are increasingly important with the demographic shift toward aging populations. With the Person-Place Fit Measure for Older Adults (PPFM-OA), older adults self-assess how their home and community environments suit their needs. The aim of the study was to evaluate the psychometric properties of the Swedish version of PPFM-OA. Methods: Four hundred sixty community-living adults aged 65 and older answered the PPFM-OA. Rasch model was used for analyses. Results: A reduced 19-item version of PPFM-OA showed sufficient evidence of validity in response processes, internal structure, fairness in testing, and reliability/precision. Conclusions: The reduced version is recommended to use in Sweden to capture person-place fit, an aspect to consider when communities, healthcare, and elder care aim to facilitate aging in place.

Introduction: Participation is one of the core elements of health promotion, which means that approaches and methods should focus on involvement. The process of involving women with a migration background in health promotion needs to be further explored. Thus, the aim of this study was to explore the development process of a type 2 diabetes health-promotive community-based participatory research intervention among Middle Eastern women with a migration background, living in Sweden. Materials and methods: This study was performed within the context of a community-based participatory research program in Sweden. The design of this study followed the development process of a community-based participatory research conceptual model, including three of the original four dimensions, that is, the context, the partnership process, and the intervention and research dimension. Appropriate methods for data collection were used in the various dimensions. Participants from the community, active in the program, conducted dialogue cafés, together with the core partners of the program, to inventory existing needs as well as what actions were needed for promoting health and thereby prevent type 2 diabetes. Results: The two dialogue cafes resulted in one long term and three short term goals. The third short-term goal—create health circles around food and nutrition was decided to be in focus for this study together with cooperation with the local health care center. The partnership process made it possible to involve relevant collaborators, which resulted in a jointly developed nurse-led educational intervention. Participants and stakeholders were also involved in the process of modifying and elaborating evaluation tools appropriate for the intervention. Discussion/conclusions: The community-based participatory research approach enables the acknowledgement and use of the various kinds of knowledge of all stakeholders, including the community members. In this study, the community members’ knowledge was obtained through participation and dialogue, aimed at balancing power between stakeholders. This approach, that is, developing a community-based participatory research intervention, offers a possibility for the primary health care to engage with the community members and for other stakeholders to work in a health-promotive way.

Background: Resilience is defined as the ability to adapt to adversity, most widely assessed with the self-reported questionnaire Connor-Davidson resilience scale (CD-RISC). While previous studies have demonstrated CD-RISC psychometrically sound, it has not yet been validated in a young Swedish population. Therefore, the aim was to evaluate validity evidence based on test content, response processes and internal structure of the Swedish CD-RISC-25 and the 10-item combination among adolescents and young adults. Methods: This study is divided into two phases. To ensure validity based on test content eight think-aloud interviews were conducted in phase 1. The results guided refinements prior to phase 2. In phase 2, 1500 16–30-year-old individuals, randomly sampled from the general population to participate by completing an online questionnaire. A Rasch rating scale model analysis was performed. Results: Think-aloud interviews identified difficult wordings in two items, clarified in the survey before phase 2. The Rasch analysis (n = 325) indicated that the response categories were well-functioning, and local independence was demonstrated among all items. Six items in CD-RISC-25 and one item in CD-RISC (10 items) displayed misfit to the chosen model. The iterative process resulted in shortened 19- and 9-item versions. Person-response validity and unidimensionality were acceptable for the shortened CD-RISC (9 items). No floor or ceiling effects were detected. Person-separation index showed that both versions could differentiate between three different levels of resilience in the sample. Differential item functioning (DIF) was observed in one item related to gender in CD-RISC (9 items). In shortened CD-RISC-25 DIF was found in five items related to gender and in two items related to age. Conclusions: When used in a young Swedish population, validity evidence based on test content of CD-RISC is lacking due to difficult wordings and may benefit from additional clarification regarding two items. Shortened versions of CD-RISC (19- and 9-item combinations) demonstrated generally acceptable validity evidence based on response processes and internal structure, but only CD-RISC in the 10-item combination exhibited unidimensionality and met set criteria for person-response validity. For assessing resilience in a young Swedish population, CD-RISC in the 10-item combination appears to be more suitable.

Background: The relationship between doing and belonging is rooted in individuals' engagement in meaningful occupations, which contributes to their sense of connectedness. The meaningfulness of occupation relates closely to the context in which it is performed. However, despite its importance, context is often overlooked and underexplored.

Aim: To explore how older adults living in depopulated rural areas depict positive and negative features of their neighbourhoods and how belonging was connected to doing and participation.

Methods: We utilised data from photo-elicited interviews with 7 men and 10 women, aged 68 to 88 years, from depopulated rural areas in southern Sweden. Data were analysed using Rowles' place attachment framework with a thematic analysis.

Results: The participants expressed how belonging was connected to doing by depicting resources in the area, how community was created through interaction, the importance of past actions for present belonging, how they acted on pride and feelings of obligation, as well as how they experienced challenges for doing and belonging.

Discussion: Our study revealed a reciprocal relationship of doing and belonging. Specifically, doing strengthened participants' belonging, while feelings of belonging resulted in loyalty and motivated supportive community actions. Importantly, participants' actions were more driven by a collective interest in community welfare than personal gain.

Conclusions: This study contributes to occupational science by knowing how doing supports belonging and vice versa. Furthermore, our study showed that belonging can serve as a catalyst for older adults to engage in their community, which likely reduces the risk of social exclusion.