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Dance Intervention for Adolescent Girls with Internalizing Problems: Effects and Experiences
Örebro University, School of Health Sciences.ORCID iD: 0000-0001-5585-1783
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Globally, psychological health problems are currently among the most serious public health challenges. Adolescent girls suffer from internalizing problems, such as somatic symptoms and mental health problems, at higher rates than in decades. By age 15, over 50 % of all girls experience multiple health complaints more than once a week and one in five girls reports fair or poor health.

The overall aim of this study was to investigate the effects of and experiences with an after-school dance intervention for adolescent girls with internalizing problems. The intervention comprised dance that focused on resources twice weekly for 8 months. Specifically, this thesis aimed to: I) investigate the effects on self-rated health (SRH), adherence and over-all experience; II) evaluate the effects on somatic symptoms, emotional distress and use of medication; III) explore the experiences of those participating in the intervention; and IV) assess the cost-effectiveness.

A total of 112 girls aged 13 to 18 years were included in a randomized controlled trial. The dance intervention group comprised 59 girls, and the control group 53. In paper I, the dance group showed increased SRH scores compared to the control group (p = .02). Girls in the intervention group showed high adherence and a positive overall experience. In paper II, the dance group exhibited a decrease in somatic symptoms (p = .021), emotional distress (p = .023) and use of medication (p = .020) compared to the control group. In paper III, a strategic sample of 24 girls was interviewed. Qualitative content analysis was performed, and five generic categories emerged. Two were “An Oasis from Stress” and “Supportive Togetherness”, which was shown to represent the fundamental basis and setting of the intervention. The main category, participants’ central experience, was understood as “Finding embodied self-trust that opens new doors”. Paper IV revealed that, due to decreased number of visits to the school nurse and an increase in health related quality of life; the intervention was considered to be cost-effective (combined with the usual school health services). In summary, the results of this thesis show that this dance intervention for adolescent girls with internalizing problems generated positive health effects and proved to be cost-effective. For this target group, a non-judgmental environment and supportive togetherness proved to be of importance for participation. The results of this study may provide practical information for school health care staff and caregivers in designing future interventions.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2016. , 129 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 144
Keyword [en]
Adolescent Health, Body Awareness, Cost Effectiveness, Dance, Enjoyment, Physical Activity, Randomized Controlled Trial, Self-rated Health
National Category
Nursing Other Health Sciences
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-48178ISBN: 978-91-7529-140-6 (print)OAI: oai:DiVA.org:oru-48178DiVA: diva2:902081
Public defence
2016-05-20, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-02-10 Created: 2016-02-10 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Influencing self-rated health among adolescent girls with dance intervention: a randomized controlled trial
Open this publication in new window or tab >>Influencing self-rated health among adolescent girls with dance intervention: a randomized controlled trial
2013 (English)In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 167, no 1, 27-31 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate whether dance intervention influenced self-rated health for adolescent girls with internalizing problems.

Design: Randomized controlled intervention trial with follow-up measures at 8, 12, and 20 months after baseline.

Setting: A Swedish city with a population of 130 000.

Participants: Girls aged 13 to 18 years with internalizing problems, ie, stress and psychosomatic symptoms. A total of 59 girls were randomized to the intervention group and 53 were randomized to the control group.

Intervention: The intervention comprised dance classes twice weekly during 8 months. Each dance class lasted 75 minutes and the focus was on the joy of movement, not on performance.

Main Outcome Measures: Self-rated health was the primary outcome; secondary outcomes were adherence to and experience of the intervention.

Results: The dance intervention group improved their self-rated health more than the control group at all follow-ups. At baseline, the mean score on a 5-point scale was 3.32 for the dance intervention group and 3.75 for the control group. The difference in mean change was 0.30 (95% CI, −0.01 to 0.61) at 8 months, 0.62 (95% CI, 0.25 to 0.99) at 12 months, and 0.40 (95% CI, 0.04 to 0.77) at 20 months. Among the girls in the intervention group, 67% had an attendance rate of 50% to 100%. A total of 91% of the girls rated the dance intervention as a positive experience.

Conclusions: An 8-month dance intervention can improve self-rated health for adolescent girls with internalizing problems. The improvement remained a year after the intervention

Place, publisher, year, edition, pages
Chicago, USA: American Medical Association, 2013
National Category
Other Health Sciences Nursing
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-24206 (URN)10.1001/jamapediatrics.2013.421 (DOI)000316797500007 ()23403597 (PubMedID)2-s2.0-84873503070 (Scopus ID)
Note

Funding Agencies:

Örebro County Council 

municipality of Örebro 

Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
2. Dance Intervention for Adolescent Girls: Effects on Somatic Symptoms, Emotional Distress, and Use of Medication. A Randomized Controlled Trial
Open this publication in new window or tab >>Dance Intervention for Adolescent Girls: Effects on Somatic Symptoms, Emotional Distress, and Use of Medication. A Randomized Controlled Trial
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-50024 (URN)
Available from: 2016-04-29 Created: 2016-04-28 Last updated: 2017-10-17Bibliographically approved
3. “I feel free”: Experiences of a Dance Intervention for Adolescent Girls with Internalizing Problems
Open this publication in new window or tab >>“I feel free”: Experiences of a Dance Intervention for Adolescent Girls with Internalizing Problems
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-50025 (URN)
Available from: 2016-04-29 Created: 2016-04-28 Last updated: 2017-10-17Bibliographically approved
4. Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems
Open this publication in new window or tab >>Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems
2013 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 11, no 1, 4- p.Article in journal (Refereed) Published
Abstract [en]

Background: The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular formof exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of thisstudy was to assess the cost-effectiveness of a dance intervention in addition to usual school health services foradolescent girls with internalizing problems, compared with usual school health services alone.

Methods: A cost-utility analysis from a societal perspective based on a randomized controlled intervention trial wasperformed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13–18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n =59) or control (n = 53) group. The intervention comprised dance twice weekly during eight months in addition to usualschool health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs wereconsidered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measuredwith the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs forthe intervention group compared with the control group. Likelihood of cost-effectiveness was calculated.

Results: At 20 months, quality of life had increased by 0.08 units more in the intervention group than in the controlgroup (P = .04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALYand the likelihood of cost-effectiveness was 95%.

Conclusions: Intervention with dance twice weekly in addition to usual school health services may be consideredcost-effective compared with usual school health services alone, for adolescent girls with internalizing problems.

Keyword
Internalizing problems, Adolescent girls, Physical activity, Dance, Cost-utility analysis
National Category
Business Administration Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Business Studies
Identifiers
urn:nbn:se:oru:diva-38723 (URN)10.1186/1478-7547-11-4 (DOI)23425608 (PubMedID)2-s2.0-84873979104 (Scopus ID)
Note

Trial registration:

Name of the trial registry: “Influencing Adolescent Girls’ With Creative Dance Twice Weekly”

Trial registration number: NCT01523561

Available from: 2014-11-18 Created: 2014-11-18 Last updated: 2017-12-05Bibliographically approved

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