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.

Reports indicate a decrease in youth mental health in Sweden but at the same time research suggests that what is interpreted as mental ill-health could be considered everyday challenges by young people themselves. The distribution of mental health and illness among young people is uneven based on inequities related to factors such as race, gender and socioeconomic status. Sweden in particular is a country with large socioeconomic inequities in youth mental health and in school results, compared to other European countries. The aim of this study was to explore young people's experiences of the role of race, gender and socioeconomic status in relation to everyday challenges. Sixty-five young people aged 13–15 years old were recruited by student health services and participated in focus group discussions at schools in the southernmost part of Sweden. Data were analysed by secondary analysis with deductive qualitative content analysis using Ecosocial theory of disease distribution as theoretical framework. The analysis resulted in one main theme; Navigating inequities to gain and keep social status, with three underlying themes; Guided by social norms, Negative impact in everyday life and Importance of family influence. Participants were aware and critical of norms and expectations related to race, gender and socioeconomic status. Experiences of prejudice and unfairness was both own lived experiences by the participants as well as observed through friends and classmates. Young people spontaneously identify everyday challenges related to race, gender and socioeconomic status, even when not asked directly about these issues. Conforming to sexist, racist and classist, expectations is a way to lose and gain status in a school setting. Many of the inequities discussed related to socioeconomic status and the direct consequences of having or not having money. Young people's everyday experience of inequities is important to consider in youth mental health promotion aiming to tackle health inequities. Further research is needed on those experiences and how this affects mental health.

Childhood obesity is a global public health threat correlated with several comorbidities and increased mortality in adult life. Heredity and physical development concomitant with environment culture and lifestyle habits are contributing key factors for the onset of overweight. Non-genetic components related to unhealthy dietary and activity patterns shared in families, are environmental factors that are possible to prevent before habits are set. Research indicates that there are several barriers against the proper management of this often long-term condition, where preschool children are an understudied group. This thesis aims to investigate how the Child Health Care (CHC) nurses pursue the preventive work on childhood overweight and obesity in CHC and further, to explore parental risk factors in relation to overweight and obesity in children.  

In the first study (Paper I), 18 nurses at 17 CHC centers in the southern part of Sweden were interviewed using semi-structured interviews with a phenomenographic approach. This study aimed to elucidate the conceptions of childhood overweight, including obesity, among nurses working in CHC. The analysis yielded 11 different conceptions from which emerged  four categories of description; “Perception of childhood overweight changes”, “Overweight in younger children, a neglected concern”, “Overweight, a delicate issue” and “The importance of family lifestyle”. The results show that CHC nurses conceived overweight and primarily obesity in children to be an extensive and serious health problem, mainly due to parent’s lifestyle. Childhood overweight during infancy and their preschool years was conceived as a minor concern and further nurses perceived it as a provoking and sensitive issue that was difficult to define. Despite there being an adaption towards the acceptance of larger children, childhood overweight and obesity were considered to be undesirable by both the CHC and the Swedish society in general. Both nurses and parents were more concerned about the children’s appearance and the risk of their being bullied than about the children’s health. Nurses conceived that it was important to protect the parent-nurse relationship. Therefore in order not to jeopardize this relationship; the subject of childhood obesity was avoided.  

The second study (Paper II) aimed to elucidate the CHC nurses conceptions of their preventive work with childhood overweight and obesity in CHC. Study II was conducted at 17 CHC units using semi-structured interviews with 18 CHC nurses in the southern part of Sweden. The interviews had a phenomenographic approach which elucidated seven conceptions, from which emerged two categories of description; “internal obstacles to nurses’ work with overweight in children” and “external obstacles to the management of overweight in children”. The results show that the CHC nurses work was conceived to be complicated and constrained by several obstacles. Nurses’ preventive work was affected by factors linked to personal traits, lack of sufficient knowledge and lack of several resources affecting their ability to conduct preventive work.  

The third and the fourth study (Paper III and IV), were based on a crosssectional survey with a questionnaire administered to a stratified and randomized selection of parents to preschool children registered at CHCs in the southern part of Sweden. In total, 598 parents participated in the study, divided into 255 fathers and 343mothers to 372 children, i.e. 372 families. 

The third study (Paper III), examined socio- and demographic parental risk factors for overweight and obesity in children and the frequency of overweight and obesity in the context of child health care.  

Descriptive analyses were used to present the frequency of parental and childhood overweight and obesity, and logistic regression was used to estimate the relation between parental socio- and biodemographic factors and children’s risk for overweight or obesity. Our results show that the frequency of overweight and obesity was 14.5 % in children, 56.0 % in fathers and 36.5 % in mothers. A distressed financial situation in fathers (OR 2.85, CI 1.06-7.69) was associated with increased risk for overweight and obesity in children. After adjusting for potential confounders in mutually adjusted models, the aggregated results for both parents showed that mothers and fathers born outside of Sweden (OR 4.50, CI 1.55-13.12 and OR 4.94, CI 1.72-14.20) was the strongest risk factor for overweight and obesity in children.

The fourth and final study (Paper IV) aimed to investigate parental lifestyle habits as risk factors for overweight and obesity in children. The relation between parental lifestyle habits and children’s risk for overweight and obesity was analyzed using logistic regression. Our results show that there might be a trend indicating an increased risk for children to develop overweight and obesity if the father is a daily smoker (OR 4.11, CI 1.45-11.68) and the mother is physically inactive (OR 2.33, CI 1.11-4.90). 

This thesis comprises four studies of both qualitative and quantitative character, with focus on nurses’ preventive work with childhood overweight and obesity in CHC and parental risk factors. Our findings identify multiple levels of barriers to the prevention work on childhood overweight. Nurses’ lack of sufficient knowledge, nurses’ negative conceptions of families with overweight problems, parents’ lack of awareness and the sensitive nature of the issue are circumstances that complicate nurses’ work. Additionally, society’s adaption to the increased proportion of children with overweight has led to an acceptance of excess weight in children. Further, parental risk factors were also identified. Parents being born outside Sweden was associated with increased risk of childhood overweight and obesity, as well as financial distress within the family. Further, the findings show a trend that indicates that paternal smoking and maternal physical inactivity might be factors associated with enhanced risk of overweight and obesity in younger children. 

We conclude that there exists a need to supplement the existing nurse education in child health care by putting the accent on intensifying education related to childhood overweight and weight assessment, with emphasis on the younger child. Further, this thesis implies that there is a need to better prepare specialist nurse student’s clinical skills related to their encounters with families and children at risk for overweight and obesity, through raising their awareness of their own perceptions of overweight in young children. Childhood overweight should be recognized and prioritized in CHC, further, the implementation of research results needs to be prioritized in the clinical work.  The identification of risk factors may help health care personnel to identify and target children in risky family environments.  

Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach. Two categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses' work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses' personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation. Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.

Abstract Background: Registered Sick Children’s Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. Method: A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Results: Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent’s lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. Conclusion: CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse’s conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse’s, as well as the parent’s efforts to influence the children’s weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight. Keywords: Child, Conceptions, Nurses, Overweight, Perceptions, Primary health care, Qualitative research

Introduction: According to the Convention on the Rights of the Child, all children have the right to health. Since good health is a decisive factor for children's future, investing in children's health is important, especially children from vulnerable areas. The purpose of this study was to investigate the perceptions of health among school-aged children from socially vulnerable areas.

Methods: The study has an explorative mixed-method design with a participatory and inductive approach based on focus group interviews with children and youth leaders, respectively, at Multi-activity Centers in three of the vulnerable areas in Malmö Municipality, as well as results from the Multi-activity Centers' own questionnaire. The data has been analyzed with inductive and deductive content analysis.

Results: The children and the youth leaders described health in terms of well-being, participation, and activity. Well-being included feeling good and safe, having a healthy body, and having fun by doing things together with friends and leaders. Participating in activities was described as having a feeling of involvement, being able to have an influence on the organization of the activities and participating on one's own terms.

Discussion: The result of this study shows that participating in activities increases the child's sense of well-being.

The nursing program is intended to prepare students for future occupational life. One role for nurses in thenursing occupation includes being prepared to communicate well in various patient situations. The aim of thisstudy was to describe variations in nursing students’ conceptions of a drama workshop to practically illustratecommunication in nurses’ work. This qualitative study was conducted at a university in southern Sweden. Interviewswith 15 nursing students were conducted and the data were analyzed using a phenomenographicapproach. Four descriptive categories were identified through the analysis: ‘Conceptions in relation to thedevelopment of empathy’, ‘Conceptions in relation to “my” learning’, ‘Conceptions in relation to personaldevelopment of professional identity’ and ‘Conceptions in relation to the understanding of applying pedagogythrough drama as a method’. This study illustrates that the use of drama in nursing education can increasenursing students’ understanding of professional communication relating to the care of patients. To use drama asan educational method provides opportunities to develop nurses’ professional identity and professional role.Moreover, drama can act as a teaching strategy that increases the understanding of theory through practical exercises.

INTRODUCTION: Research suggests that participating in after-school leisure activities has been related to promoting health, well-being and safety among children living in disadvantaged neighbourhoods. The United Nations Child Rights Convention emphasises the inclusion of children in decisions that concern them. However, children seldom are involved in designing implementing and evaluating health promotional environments. The aim of this programme is through a participatory process with children, parents/guardians, and peer-activity leaders explore, measure and evaluate the impact on children's overall well-being related to the social context in an already established health promotion environments in Southern Sweden.

METHODS AND ANALYSIS: The project is based on a previously implemented unique community-based participatory research (CBPR) model for equal health in three socially disadvantaged areas in Malmö. All activity house (AAH) is a meeting place for children established in schools but after school time by the culture department of the Malmö municipality. In AAH migrant children participate in need-driven after school activities that they themselves create and develop. To increase participation of the children and ensure that these environments are based on their needs, 30 children (10-12 years), parents/guardians (30), peer-activity leaders (15), and researchers create CBPR teams in the areas and engage in a participatory process. The children reflect, analyse and write about their well-being; identify and discuss key factors in an iterative process, which also includes a strategic group of stakeholders. The children then develop and validate (with 100 other children from AAH) the Socioculturally Aligned Survey Instrument for Children survey inspired by the KIDSSCREEN V.27. The survey tool so developed will further be used to evaluate AAH and will be distributed to all children participating in their activities.

ETHICS AND DISSEMINATION: This programme has been approved by the Swedish Ethical Review Authority. The results from this programme will be published as reports and scientific publication.