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The Health Dialogue concept: School children's Self-Reported-Health in a Swedish Context
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Hälsosamtalet: Skolbarns självrapporterade hälsa i ett svenskt kontext. (Swedish)
Abstract [en]

The overall aim of this thesis was to explore and describe schoolchildren's selfreported-health based on the Health Dialogue concept as well as to identify healthindicators and their possible associations in the perspective of 6 to 16 year-olds,and to provide an analysis of school nurses´ experiences of using the HealthDialogue concept, in the County of Västernorrland. The thesis was based on fourstudies (I-IV). Study I was qualitative using a descriptive design, based onindividual interviews with school nurses who had working experience of using theHealth Dialogue concept. Studies II-IV were quantitative with cross sectional andlongitudinal design based on statistical data from the Health Dialogue concept, apopulation survey among schoolchildren. The data were analyzed usingqualitative content analysis (I) and regression analyses (II-IV).Study I showed that the school nurses had developed their own commonapproach, a health promotion model derived from experiences of working with theHealth Dialogue concept. Study II showed that the most important health variablesinfluencing pre-schoolchildren´s positive self-reported-health were experience ofcomfort in preschool, good sleep, absence of headaches, being physicalactive/playing daily, and not being a victim for bullying. Both boys and girlsneeded to experience comfort, being physical active, and not being bullied. Forgirls, positive self-reported-health seemed to be more dependent on comfort, beingphysical active/playing, and not being bullied, whereas boy’s health was moredependent on eating school lunch daily and not experiencing headaches.Study III revealed that in 10-year-old children´s positive self-reported-health,comfort in school, normal iso- body mass index and absence of headaches wereshown to be significantly important health indicators. Normal iso- body massindex (girls) and absence of headaches (boys) were shown to have a potentiallycausal effect on 10-year-old children's positive self-reported-health. Study IVrevealed several significantly important health indicators in schoolchildren´shealth during three school transitions in the Swedish Education system (betweenthe ages of 6-10, 10-13 and 13-16); not experiencing being sad/depressed,afraid/worried, experiencing the school environment positively (schoolyard andivrestrooms), not being bullied, having good sleep, daily physical activity/play andability to concentrate. Gender and age differences were also identified. The HealthDialogue concept, contributes increased knowledge and a new cross sectional andlongitudinal perspective to individual, school, community and organization’sperception of schoolchildren´s self-reported-health. Furthermore, these resultsdemonstrate the importance and validity of children´s experiences in the context ofhealth and should contribute to future health promotion activities and schoolbasedinterventions.Key words: Health promotion, health dialogue, longitudinal design, school nurses,schoolchildren, self-reported-health.

Abstract [sv]

Det övergripande syftet med avhandlingen var att undersöka och beskrivaskolbarns självrapporterade hälsa baserat på Hälsosamtals konceptet, attidentifiera hälsoindikatorer och deras möjliga samband för skolbarn självskattadehälsa i ett 6 till 16- års perspektiv, och att analysera skolsköterskornas erfarenheterav att använda Hälsosamtals konceptet i Västernorrlands län. Avhandlingenbygger på fyra studier (I-IV). Studie I var kvalitativ med en deskriptiv design,baserad på individuella intervjuer med skolsköterskor med arbetserfarenhet frånHälsosamtals konceptet. Studie II-IV var kvantitativ med tvärsnitt ochlongitudinell design baserat på statistisk data på länsnivå från Hälsosamtalskonceptet bland skolbarn i ålder 6-16 år. Data analyserades med kvalitativinnehållsanalys (I) och regressions analys (II-IV). Studie 1 visade attskolsköterskorna i länet hade utvecklat en egen gemensam strategi och modell förhälsofrämjande arbete. Studie II visade att de viktigaste hälso- indikatorer för barni förskoleklass avseende positivt självrapporterade hälsa var trivsel, god sömn,frånvaro av svår huvudvärk, vara fysiskt aktiv/leka varje dag, samt att inte varautsatt för mobbning. Både pojkar och flickor behövde trivas, vara fysisktaktiva/leka, och inte vara utsatta för mobbning. Flickorna visade sig vara merberoende av trivsel, vara fysiskt aktiva/leka, och inte vara utsatta för mobbning föratt rapportera sin hälsa positivt medan pojkarnas positivt självrapporterande hälsavisade sig bero på daglig skollunch och att inte ha huvudvärk. Studie III visade attför 10-åriga barns positivt självrapporterade hälsa var, trivsel i skolan, normalt iso-BMI och frånvaro av huvudvärk viktiga hälsoindikatorer. Normal iso-BMI visadeett potentiellt kausalt samband för 10-åriga flickors, och frånvaro av huvudvärkvisade ett potentiellt kausalt samband för 10-åriga pojkars positivtsjälvrapporterad hälsa. Studie IV visade flera signifikant viktiga hälsoindikatorer iskolbarns (6-16 år) positivt självrapporterade hälsa, under tre skolövergångar i detsvenska utbildningssystemet (6-10, 10-13, 13-16 år). Att inte känna sigledsen/deprimerad, rädd/orolig, uppleva skolmiljön positivt (skolgården ochtoaletter), inte vara mobbad, sova gott, vara dagligt fysiskt aktiv/leka och att kunnakoncentrera sig visade sig vara viktiga hälsoindikatorer. Dessa hälsoindikatorerviskilde sig avseende på ålder och kön. Denna avhandling bidrar med ökad kunskapom skolbarns självrapporterade hälsa grundat på Hälsosamtals konceptet.Hälsosamtals konceptet tillför nya perspektiv avseende barns hälsa på individ,skola, samhälls/organisations nivå i ett tvärsnitts och longitudinellt perspektiv.Hälsofrämjande arbete i skolan och samhället bör ta barns upplevelser,erfarenheter och synpunkter i beaktande och som giltiga. Resultatet i dennaavhandling hoppas kunna bidra till framtida hälsofrämjande arbete och insatser iskolan.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University , 2013. , 162 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 172
Keyword [en]
Health promotion, health dialogue, longitudinal design, school nurses, schoolchildren, self-reported-health.
Keyword [sv]
Hälsofrämjande arbete, Hälsosamtal, longitudinell design, självrapporterad hälsa, skolbarn, skolsköterskor.
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-20073ISBN: 978-91-87557-18-7 (print)OAI: oai:DiVA.org:miun-20073DiVA: diva2:659998
Public defence
2013-11-28, Lubbesalen M108, M Huset, Holmgatan 10 , 851 70, Sundsvall, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2013-11-04 Created: 2013-10-28 Last updated: 2014-02-03Bibliographically approved
List of papers
1. Promoting a relationship-based health practice: A challenge for school nurses
Open this publication in new window or tab >>Promoting a relationship-based health practice: A challenge for school nurses
2013 (English)In: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827, Vol. 8, no 1, 30-38 p.Article in journal (Refereed) Published
Abstract [en]

Background:

School nurses have a unique opportunity to promote health when they meet school children during the Health Dialogue. The Health Dialogue concept is used by all the school nurses in a county in Mid Sweden.

Aim:

To describe school nurses' experiences of the Health Dialogue concept.

Methods:

A qualitative descriptive study with latent content analysis of interviews performed during February–April 2012, where 16 school nurses participated.

Findings:

The school nurses experienced the Health Dialogue concept as a useful tool to work with school children's health in a relationship-based, child focused, structured, and systematic way, which was reflected in one overarching theme: 'To be in a relationship-based, health-promoting practice.' However, school nurses also experienced loneliness and frustration from the many difficult situations with school children, and they indicated needs for further collaboration.

Conclusions:

The Health Dialogue concept is child-focused, systematic and structured, but it requires further development and continuing work on statistical feedback. School nurses indicated a need for collaboration with teachers, parents, and other health professionals, as well as professional-reflective supervision.

Keyword
Health dialogue, School children, School nurses, Sweden
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-20118 (URN)
Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2017-12-06Bibliographically approved
2. Health among 6-year-old children in a Swedish county: Based on the Health dialogue
Open this publication in new window or tab >>Health among 6-year-old children in a Swedish county: Based on the Health dialogue
2011 (English)Conference paper, Published paper (Refereed)
Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Series
Acta Paediatrica Volum 100 December 2011 Suppl 463
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-15500 (URN)000297503200214 ()
Conference
First PNAE Congress on Peadiatric Nursing
Available from: 2011-12-20 Created: 2011-12-20 Last updated: 2013-11-04Bibliographically approved
3. Exploring the development of school children´s health
Open this publication in new window or tab >>Exploring the development of school children´s health
2012 (English)In: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827, Vol. 7, no 4, 189-197 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the association between positive self-reported health(SRH) in pre-school and 4th grade SRH in a long–term prospectivepopulation-based study in Sweden.Methods: Data originated from the Health Dialogue (HD) a structuredinstrument used by school nurses. 1084 children participated. Oddsratios were analyzed.Results: In 10-year-old children’s SRH, comfort in school, normal BMIand absence of headaches were shown to be significantly importanthealth indicators. Normal BMI showed to have a potentially causaleffect on 10-year-old girls and absence of headaches showed apotentially causal effect among 10-year-old boys.Conclusion: Schools should be designed to meet the children’s needsso that they are perceived as comfortable, safe and secure places.Schools should advocate physical activity and play, serve healthynutritious food in order to motivate, support and promote a healthylifestyle. Schools are a unique arena for health promotion as they reachpractically all school-age children.

Place, publisher, year, edition, pages
London: Pensord Press Ltd., 2012
Keyword
health promotion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-17415 (URN)
Available from: 2012-11-22 Created: 2012-11-22 Last updated: 2017-12-07Bibliographically approved
4. Transitions in the Swedish school system and the impact on student's positive self-reported-health
Open this publication in new window or tab >>Transitions in the Swedish school system and the impact on student's positive self-reported-health
2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, Art. no. 1045- p.Article in journal (Refereed) Published
Abstract [en]

Background: To explore three school based transitions and their impact on positive self-reported-health (SRH), pre-school to elementary school (6-10 y), elementary school to junior high school (10-13y), and junior high school to upper secondary school/high school (13-16y), in a long-term longitudinal population based study. Methods: The study followed three cohorts through one school transition each. A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007-2012 with school children age 6-16 years old. Results: Several significant factors were identified with an impact for a positive self-reported-health among children age 6-16y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age. Conclusion: The study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

Keyword
Health dialogue, Health promotion, Longitudinal, School nurse
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-20117 (URN)10.1186/1471-2458-14-1045 (DOI)000343285600001 ()2-s2.0-84940566397 (Scopus ID)
Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2017-12-06Bibliographically approved

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