The goal of Swedish public health policy is to create conditions that enable good and equitable health and eliminate avoidable health inequities. Although previous research emphasizes the importance of considering inequities in mental health promotion and policy, and although researchers and policy makers emphasize the importance of a system-approach to mental health, there seems to be an ambiguity in how the concept of equity is understood. Therefore, the aim of this study was to critically examine equity and inequity discourses in Swedish regional action plans for mental health. A critical discourse analysis based on Foucault’s discourse theory was used to reveal discursive practices of inequity. Twenty-two regional action plans for mental health were analyzed. The analysis identified three discourse strands: the vague language of equity, the inequitable people, and education as a pathway to equity, all of which are entangled through the individualization of equity. Overall, the equity discourse was interpreted as representing a naturalistic and liberal view on equity. This could be understood as contributing to upholding the system of inequities rather than dismantling it. There is a need for clarification about the considered causes of mental health inequities as well as possible solutions.

Background: Everyday challenges and stress negatively affect young people's mental health. Socioeconomic status (SES) is associated with different stressors and different stress-coping mechanisms. Many interventions target youth mental health, but few consider socioeconomic differences in the planning, implementation, or evaluation. In a Swedish context socioeconomic status is related with migration experience. The aim of the study was to explore proposals for tackling everyday challenges among young people from different socioeconomic neighborhoods.

Methods: Eight focus groups, with participants between 13 and 15 years old from eight schools, were conducted in the south of Sweden. The participants discussed proposals for tackling everyday challenges. Using comparative thematic analysis, the focus group transcripts were divided into two groups, based on the socioeconomic status of the school's neighborhood, and analyzed comparatively. Most of the participants in low SES neighborhoods had foreign background and most of the participants in high SES neighborhoods were Swedish born.

Results: The analysis resulted in four shared themes between the two SES groups: society is responsible, school is responsible, parents are responsible, and I am responsible. The differences and similarities between the two groups are presented in sub-themes. Many of the proposals were similar between the two SES groups, but with different underlying issues and examples.

Conclusion: Both groups proposed that adults must listen more to young people in order to improve the everyday challenges young people face. However, the low SES group in general expressed both more frustration and more agency, compared to the high SES group. This could be important to consider when planning school-based mental health promotion in different socioeconomic neighborhoods.

Recent research indicates that there is uncertainty among children as well as among adults of where to draw the line between everyday stressors and mental health problems that could indicate a need for a common terminology and language regarding mental health (Wickström & Lindholm, 2020; Hellström & Beckman, 2021). The increased prevalence rates of self-reported mental health problems such as bad mood, difficulty sleeping, headaches or stomachache among youth shows a worrying trend in Sweden as well as internationally (Hagquist et al., 2019; Potrebny et al., 2017). At the same time, mild symptoms of mental health problems can be relatively common and be an expression of everyday challenges (Hellström & Beckman, 2021; Wickström & Lindholm, 2020). This contradictory trend is confirmed in the largescale cross-national survey Health Behavior in School-Aged Children, showing reports of very good health and quality of life among young people in Sweden as well as an increase in self-reported mental health problems (Public Health Agency of Sweden, 2018).

Adolescence is a period that involve many changes in different areas such as increasing academic demands and academic competition, a decrease in teacher-student relationship closeness or school safety, rearrangement of relationships with parents and peers including an increase in social comparison, identity issues, as well as thoughts about the future (Bremberg, 2015; Brown, 2009; Tetzner et al., 2017). In addition, the increased emphasis on high-stakes testing, assessment and grading due to recent school reforms in Sweden have shown potentially negative effects on Swedish pupil’s health (Högberg et al., 2021). There is a need to identify what causes stress in the everyday life of adolescents as they could potentially develop into mental health problems (ref). Studies show that when adolescents and young adults put it into their own words, the most pronounced everyday stressors include academic failures, relationship problems, negative self-evaluations through social comparisons, and other performance-oriented tasks (Gustafsson et al., 2010; Hellström & Beckman, 2021).

To be able to design interventions to decrease mental health problems and increase mental wellbeing for youth a common language is needed. The International Classification of Functioning, Disability and Health (ICF) provides a conceptual framework and terminology for describing health and functioning in everyday life and can serve as a common framework for developing comparable concepts (WHO, 2001). According to ICF, participation is defined as involvement in life situations promoting health and wellbeing (WHO, 2001). The ICF defines components of health included as domains described from the perspectives of the body, the individual and society. Developing a common language will make it easier to interact, discuss and plan health interventions based on young people’s perceptions (Adolfsson et al., 2018; Augustine et al., 2021; Klang Ibragimova et al., 2011; WHO, 2007). The current study investigates how youth explain stressors in their everyday life that could be conceptualized as everyday challenges and possibly symptoms of mental health problems.  Hence, the aim of this study is to conceptualize adolescents’ experiences of everyday stressors, using the ICF as an analytic tool.MethodThis study is a part of a wider project aiming to test and evaluate an intervention to enhance mental wellbeing among school students using an experience-based co-design. The sample includes 65 adolescents (45 girls and 20 boys) in grades 7–9 at seven schools in southern Sweden. Data collection took place during the autumn of 2020. The youth were identified through a purposive sampling procedure, by a gatekeeper assigned by the principal at each school, with the intention of obtaining a wide distribution of experiences to gain transferability of the results. At each school, eight to twelve participants were included. The participants were told to discuss perceived everyday stressors in pairs/smaller groups and documented words from the discussion on post-it notes. The documented words constitute the empirical data in this study. A data analysis with both manifest and latent elements, inspired by a deductive reasoning approach has been adopted. We have aimed to stay close to the text, describe what the adolescents actually say and describe the visible and obvious in the text. To make the manifest linking processes systematic and consistent, the process of coding the documented words/concepts to ICF codes (e.g., “Handling stress and other psychological demands”, “Global psychological functions” and “Emotional functions”) followed established linking rules based on the ICF (Cieza et al., 2005). To ensure that the latent interpretation could lean on a multidisciplinary background knowledge about child functioning, all three authors with different professional backgrounds conducted individual coding (Fayed et al., 2012). In cases were the authors’ linking processes resulted in different ICF codes, a latent procedure with interpretation of the underlying meaning of the content on the post-it notes were conducted by two of the authors (LH and MS). The meaning of the content on each post-it note were thoroughly discussed until consensus was achieved. 39 number of linkages were discussed jointly by the two researchers in relation to the coding scheme. When consensus was obtained, the exact agreement was 94 percentage inter-coder agreement on the 2nd ICF-level. The study was approved by the Swedish Ethical Review Authority (reg.no. 2019-06430 / 2020-04-07).Expected OutcomesThe findings raise awareness about the concept of everyday stressors among adolescents. The aspects of everyday life that adolescents find challenging and stressful can be conceptualized and guide conversations with and about young people and guide supportive actions. The adolescence in this study expressed high psychological demands in combination with a lack of support, mainly from parents, and a lack of resources, mainly time restraints as great challenges. These demands can most often be related to performing well in school or in social contexts. Demands and their effect on wellbeing are essential aspects in the lives of young people when it comes to everyday stressors that needs to be considered in everyday conversations. For parents, school personnel or other adults this could mean talking to adolescents and young people about overwhelming demands and help them sort out what demands they can influence and what demands are hard for them to tackle alone. Here, the relation between demand and control may be a useful theoretical framework and efforts to strengthen a sense of coherence could be a useful coping strategy providing adolescents and young people with a greater sense of control. In addition to demands, how they are perceived by others and how they compare to others are other sources of stress among the adolescents. Social comparisons can function as tools for self-evaluation and self-enhancement in young people’s identity development. However, when these comparisons become stressful and potentially harmful, parents, school personnel or other adults can talk to young people about alternative strategies for identity development. Based on the results in this study in combination with previous research showing a lack of knowledge surrounding mental health, examples of relevant theoretical frameworks to enhance adults’ and young people’s mental health literacy could be demand/control model, sense of coherence and social comparison theory.References 

Adolfsson, M., Sjöman, M., & Björck-Åkesson, E. (2018). ICF-CY as a framework for understanding child engagement in preschool. Frontiers in Education, 3, 36. Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., Ustun, B., & Stucki, G. (2005). ICF linking rules: an update based on lessons learned. J rehabil med, 37(4), 212-218. Fayed, N., Cieza, A., & Bickenbach, J. (2012). Illustrating child-specific linking issues using the Child Health Questionnaire. American Journal of Physical Medicine & Rehabilitation, 91(13), S189-S198. Gustafsson, J.-E., Allodi Westling, M., Alin Åkerman, B., Eriksson, C., Eriksson, L., Fischbein, S., Granlund, M., Gustafsson, P., Ljungdahl, S., & Ogden, T. (2010). School, learning and mental health: A systematic review. Stockholm: Kungl. Vetenskapsakademien. Hagquist, C., Due, P., Torsheim, T., & Välimaa, R. (2019). Cross-country comparisons of trends in adolescent psychosomatic symptoms–a Rasch analysis of HBSC data from four Nordic countries. Health and quality of life outcomes, 17(1), 1-13. Hellström, L., & Beckman, L. (2021). Life Challenges and Barriers to Help Seeking: Adolescents’ and Young Adults’ Voices of Mental Health. International journal of environmental research and public health, 18(24), 13101. Högberg, B., Lindgren, J., Johansson, K., Strandh, M., & Petersen, S. (2021). Consequences of school grading systems on adolescent health: evidence from a Swedish school reform. Journal of education policy, 36(1), 84-106. Klang Ibragimova, N., Pless, M., Adolfsson, M., Granlund, M., & Björck-Åkesson, E. (2011). Using content analysis to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health-version for Children and Youth (ICF-CY). Journal of Rehabilitation Medicine, 43(8), 728-733. Potrebny, T., Wiium, N., & Lundegård, M. M.-I. (2017). Temporal trends in adolescents’ self-reported psychosomatic health complaints from 1980-2016: A systematic review and meta-analysis. PLOS one, 12(11), e0188374. Public Health Agency of Sweden, (2018). Skolbarns hälsovanor i Sverige 2017/18 [The Public Health Agency. Health Behaviour in School-aged Children, Swedish report 2017/18]. Tetzner, J., Becker, M., & Maaz, K. (2017). Development in multiple areas of life in adolescence: Interrelations between academic achievement, perceived peer acceptance, and self-esteem. International journal of behavioral development, 41(6), 704-713. WHO. (2001). International Classification of Functioning, DIsability and Health. W. H. Organization. WHO. (2007). International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). W. H. Organization. Wickström, A., & Lindholm, S. K. (2020). Young people’s perspectives on the symptoms asked for in the Health Behavior in School-Aged Children survey. Childhood, 27(4), 450-467.

Purpose: The purpose of the study was to investigate certified registered nurse anesthetists’ attitude towards and utilization of evidence-based practice, and factors influencing such practice.

Design: The study had a descriptive, cross-sectional, and web-based survey design.

Methods: This study, conducted in September and October 2020, involved certified registered nurse anesthetists (n = 278) employed within 12 operation theater departments in southern Sweden. Data were collected by means of web-based questionnaires including a modified version of “Nurses’ attitudes towards research and development within nursing” (ATRAD-N, version II) with complementary questions. Descriptive statistics and manifest content analysis were used to analyze data.

Findings: A high mean value in ATRAD-N, indicating positive attitudes towards research and improvement, was reported. However, there was a low level of applying research and working with improvement activities. Factors influencing the utilization were attitude and educational level and according to the qualitative data, certified registered nurse anesthetists were limited regarding their participation due to organizational factors, such as lack of time, hierarchical structures, or lack of support from leaders.

Conclusions: Certified registered nurse anesthetists are expected to work in accordance with evidence-based practice to further develop nursing care. The main finding in the present study was that certified registered nurse anesthetists, although having a positive attitude towards research and improvement, are limited regarding their participation in evidence-based practice due to organizational factors. The findings clarify the value of continuous education for staff, and the importance of overcoming negative factors to better support certified registered nurse anesthetists in improving their ability to use evidence-based practice and increase their opportunities for integrating it into practice.

AbstractIn Sweden as well as internationally the teaching and research nexus has been described as the defining charac-teristics of higher education promoting generic skills such as information analysis and critical reflection. Vertically Integrated Projects has been proposed as one educational strategy where research and teaching are linked by in-viting students to take active part in actual research projects. The strategy is well aligned to Scholarship of teaching and learning enabling the transition from a teacher-centred accepted knowledge to a student-centred perspective where students are invited as producers of knowledge. The aim of the current study was to explore students’ experiences of participation in a research-based learning activity with academia and industrial partners, designed as a qualitative explorative study using focus group interviews. Findings describe not only factors students find motivating for learning, but also their experience of being part of professional life with its benefits and challenges.

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.

Aim To explore child health professionals' experiences of the early implementation of the rotavirus vaccination in the two regions that first introduced this vaccination in Sweden. Methods A descriptive and repeated cross-sectional study based on a digital study-specific questionnaire with a baseline in 2014 and with a 2-year follow-up in 2016. The study population consisted of nurses and doctors working in child health centres in the health care regions of Stockholm and Jonkoping. Results In Stockholm, a larger proportion of the respondents (n = 355) had concerns in 2014, in comparison with the respondents in Jonkoping (n = 101), mostly about the vaccination being a new and time-consuming task (60% versus 23%). In 2016, the overall attitude to vaccination was more positive in both regions and the levels of concern about increased workload were reduced (Stockholm, n = 519, 39%, versus Jonkoping, n = 96, 10%). Challenges before and after the introduction in both regions were particularly related to how to give information about the vaccine's potential increased risk of intussusception. Conclusion The gap between respondents' knowledge, attitudes and concerns pre- and post-vaccination introduction was larger in Stockholm compared to Jonkoping. In both regions, overall, the implementation of the rotavirus vaccination was perceived as being easier than expected.

PURPOSE: This study was carried out in order to evaluate children's experiences after taking part in the pilot clinical intervention "See Me" aimed at supporting children as relatives.

METHOD: A qualitative explorative design with interviews was chosen, with analyses using an inductive approach. Interviews were conducted with 19 children (9 aged 7-12 years and 10 aged 13-18 years). The younger children were asked to draw a picture of a person in hospital, using the Child Drawing: hospital (CD:H) instrument to measure the child's level of anxiety. The older children completed the Caring Professional Scale (CPS) as a measure of the caring approach in their encounter with the nurse.

RESULTS: The interviews with the children show that: they felt expected and welcomed at the hospital; they needed knowledge about their parent's situation; they needed information and participation based on their individual situation; and they needed the nurse to offer them information and support. The results from the pictures showed that one child had above-average levels of anxiety. The older children reported that the nurses were Competent Practitioners, but to a lesser degree that they were Compassionate Healers.

CONCLUSIONS: The results of this pilot study indicate that the structure of "See Me" could be used as a starting point to ensure that children as relatives receive information, advice, and support. Further the results indicate that both CD:H and CPS could be used to evaluated children's experiences of support when a parent has a long-term illness.

PURPOSE: The experience of cancer could lead to positive psychological changes following the struggle with diagnosis and treatment. Understanding post-traumatic growth and its influencing factors in women affected by gynecological cancer is essential to enhance their possibility of achieving positive changes. The purpose of this study was to describe the post-traumatic growth level and explore the influencing factors of post-traumatic growth in Chinese women diagnosed with gynecological cancer.

METHOD: A cross-sectional survey with a convenience sampling method was employed to collect data using the Post-traumatic Growth Inventory (PTGI), Distress Disclosure Index (DDI), Medical Coping Modes Questionnaire (MCMQ), and Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaires were administered to 344 participants recruited from two hospitals in Hefei City, the capital of Anhui Province in China, between March 2018 and March 2019. All statistical analyses were performed using nonparametric tests. The Mann-Whitney U Test was used to distinguish the intergroup differences. Correlations were evaluated with Spearman rank correlation coefficients.

RESULTS: Total score for PTGI was 56.5 (range 48.0-68.0). The subscale with the highest centesimal score in the PTGI was appreciation of life and the lowest was spiritual change. The top five items with the highest scores of PTGI belonged to appreciating life, personal strength, and relating to others. Self-disclosure, confrontation, avoidance, acceptance-resignation, perceived social support, education level, cancer type and the place they lived had significant influence on post-traumatic growth.

CONCLUSIONS: The findings indicate that women who have high levels of perceived social support, confrontation, avoidance, self-disclosure and education level tend to experience more post-traumatic growth, while, conversely, high levels of acceptance-resignation have a negative influence on promoting post-traumatic growth. These meaningful findings propose new perspectives for promoting post-traumatic growth in Chinese women diagnosed with gynecological cancer.

BACKGROUND: Children are more vulnerable than adults to environmental risks. Also, children have little control over their environment. Unlike adults, they may be both unaware of risks and unable to make choices to protect their health. Children living in especially vulnerable areas might be even more at risk due to socioeconomic factors, immigration, and high crime rates. Therefore, the aim of this study was to describe the perceptions that schoolchildren from a socially vulnerable area have of safe environments.

METHODS: 52 nine-year-old schoolchildren from a socially vulnerable area participated in this study. The data collection consisted of an environmental walk with photovoicing, followed by rating of the photos, and a focus-group discussion elaborating on the photos and ratings. Six focus groups, with 6-8 children in each group, were conducted and analyzed using an inductive content analysis.

RESULTS: The results show that, according to the children, places that they think are bright and beautiful, where they can do fun things with others and do not risk being exposed to danger, create safety. To increase safety, the children suggested cleaning up, making the environment beautiful with grass and flowers, and painting it in nice colours. Furthermore, they suggested that building features that increase the opportunities to play and engage in activities together with others, would improve safety and enhance protection and surveillance.

CONCLUSIONS: All children have the right to protection and safety. Therefore, it is important to create safe environments for all children by listening to children's own voices.