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Online health promoting communities: Design, implementation and formative evaluation of an intervention
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden, obesity among children has not yet reached the epidemic proportions reported from other parts of the world. However, among adolescents, being overweight and self-consciousness regarding body shape, diet and exercise influence social, psychological and physical health. Obese children may be in need of secondary prevention because of adverse effects related to obesity, but it is less obvious exactly what to prevent in the rest of the population. General interventions to prevent overweight and obesity are problematic because of the lack of associations for general application; there is a need for personalized community-based health promotion. Online interventions are especially suitable considering the amount of time adolescents spend online.

This thesis takes a design approach to interventions and describes the design of an online health promoting community as a path to health promotion among adolescents. The first two studies use data from the first 15 years of a 1991 cohort living in Östergötland to determine the predictability of obesity from childhood body mass index and to investigate interventions and available evidence to suggest appropriate interventions. The next two studies use these findings to design and formatively evaluate a health promotion intervention.

In Study I we found reasons for offering population-based interventions systematically from 5 years of age. It would be worthwhile identifying at an early age those relatively few children with substantially increased risk of maintaining obesity in adulthood and offering them interventions; but interventions must be avoided when they are not necessary. The projections in Study II indicate that more specified interventions would benefit adolescents without increasing the costs. In Study III, we found than an online health promoting community can be designed simply at relatively low cost and can be negotiated to satisfy both the needs of the user community and public health goals and service capabilities. In Study IV, a checklist for pre-launch evaluation of online health promoting communities was developed and the most important result was the delicate balance between community autonomy and quality control. Future studies addressing health outcome constructs for use in online health promoting community evaluations are warranted.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1321
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-81730ISBN: 978-91-7519-827-9OAI: oai:DiVA.org:liu-81730DiVA: diva2:555822
Public defence
2012-10-29, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-21 Created: 2012-09-21 Last updated: 2015-06-05Bibliographically approved
List of papers
1. Prediction of obesity from infancy to adolescence
Open this publication in new window or tab >>Prediction of obesity from infancy to adolescence
2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, 1249-1252 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To examine the development of childhood obesity and to determine the earliest age when estimating body mass using only weight and height data is associated with a corresponding estimate at the age of 15. less thanbrgreater than less thanbrgreater thanMethods: Subjects included are all children born in 1991 in Ostergotland County, Sweden. Weight and height data collected during regular check-ups at well-child centres and school health care assessments up to 15 years of age were assembled from health records. Correlations between childhood estimates of body mass and the body mass index (BMI) at 15 years of age were computed pairwise. Correlations with r andgt; 0.5 were defined as reliably strong. less thanbrgreater than less thanbrgreater thanResults: Complete data were available for 3579 children (62%). Fewer girls (2.6%; C.I. 1.9-3.3) than boys (4.6%; C.I. 3.7-5.5) were obese at 15 years of age. Correlations with BMI at 15 years of age were strong (significantly higher than 0.5) from 5 years of age. Only 23% of girls and 8% of boys found to be obese at 5 years of age were of normal weight at the age of 15. less thanbrgreater than less thanbrgreater thanConclusion: From 5 years of age, point estimates of body mass using only weight and height data are strongly associated with BMI at the age of 15. More data sources are needed to predict weight trajectories in younger children.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keyword
Childhood obesity, Obesity prevalence, Predictive correlations
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70319 (URN)10.1111/j.1651-2227.2011.02326.x (DOI)000293942500028 ()
Available from: 2011-09-02 Created: 2011-09-02 Last updated: 2014-01-16Bibliographically approved
2. History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents
Open this publication in new window or tab >>History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents
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2012 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, no 4, 524-528 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. less thanbrgreater than less thanbrgreater thanMETHODS: All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. less thanbrgreater than less thanbrgreater thanRESULTS: Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.

Place, publisher, year, edition, pages
Nature Publishing Group, 2012
Keyword
economics, epidemiology, decision support, cohort
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-77329 (URN)10.1038/ijo.2011.263 (DOI)000302776300008 ()
Note

Funding Agencies|Ostergotland County Council, Sweden||

Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2014-01-16Bibliographically approved
3. Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities
Open this publication in new window or tab >>Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities
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2013 (English)In: BMC Health Services Research, ISSN 1472-6963, Vol. 13, no 258Article in journal (Refereed) Published
Abstract [en]

Background

An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.

Methods

Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.

Results

The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.

Conclusions

OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

Keyword
community-based participatory research, health promotion, adolescents, health service
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-81727 (URN)10.1186/1472-6963-13-258 (DOI)000321580500001 ()
Available from: 2012-09-21 Created: 2012-09-21 Last updated: 2013-09-25
4. Checklist for online health promoting communities
Open this publication in new window or tab >>Checklist for online health promoting communities
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Disease prevention via web-based interventions has matured into a relatively inexpensive health intervention alternative; however, few studies on web-based health promotion have been published. Despite the apparent potential of online health promoting communities (OHPC), not much guidance is available for developers on the basic design features that characterize successful applications. The aim of this study was to develop a checklist for a pre-launch evaluation of OHPCs. The checklist is required to take the perspectives of both the user community and the health services into account.

Methods: The study was based on an action research design. Constructs used in an evaluation for information system success, applicable before the introduction of the OHPC to the end users, were used as the basis for a checklist. Each construct was contextually adapted for the OHPC context and formatively evaluated in the case study project, and then organized into a checklist applicable to both the end-user community and the health care services.

Results: The checklist applicable to OHPC included the following constructs: information quality, service quality, and subjective norms. The contextual adaptation of the information quality construct resulted in items for content area, trust, and format. The contextual adaptation of the service quality construct resulted in items for staff competence, prompt service and empathy. The contextual adaptation of the subject norms construct resulted in items for social facilitation, interconnectivity and communication.

Conclusions: The most important result from the formative evaluation was the delicate balance between community autonomy and quality control in the formulation of the information and service quality constructs. Before the checklist is implemented, a comparison of the infrastructure and processes of the study context and the target context is needed to determine what aspects of the checklist are irrelevant. Future studies addressing health outcome constructs for use in OHPC evaluations are warranted.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-81728 (URN)
Available from: 2012-09-21 Created: 2012-09-21 Last updated: 2013-09-05Bibliographically approved

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