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Flyger J, Larsen CVL, Jensen E, Niclasen B, Nielsen AS. A qualitative study of the implementation and organization of the national Greenlandic addiction treatment service. FRONTIERS IN HEALTH SERVICES 2024; 4:1219787. [PMID: 38510066 PMCID: PMC10950955 DOI: 10.3389/frhs.2024.1219787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
Background Alcohol and cannabis use constitutes the major public health problems in Greenland. Thus, it is important to assess if Allorfik, a new national outpatient addiction treatment service introduced in 2016, was implemented successfully and how it is perceived. Allorfik introduced local treatment centers offering a treatment methodology (motivational interviewing and cognitive therapy) new to addiction treatment in Greenland with limited evidence from Indigenous populations such as the Greenlandic. The present study investigates the implementation of Allorfik from the perspective of those engaged in the process and the field. Methods Data consisted of transcribed interviews with 23 individuals from both Allorfik and organizations collaborating with or supposed to collaborate with Allorfik. The theme of the interviews was their perspectives on the implementation process, enablers, and obstacles in the process and how Allorfik was performing at the time of the interview. The interview guide was informed by implementation theory. The transcribed material was analyzed using a general inductive approach. Results The analysis resulted in three overall and interconnected themes, namely, implementation, collaborations, and challenges. The implementation was overall considered a success by the interviewees as all components were implemented as planned with a few adaptions, e.g., a treatment guideline update. The collaborations are considered challenging but important to all interviewees. Collaborations seem to rely on personal commitment as opposed to well-defined structures, making it unstable and vulnerable to changes in staff. One of the main challenges highlighted by the interviewees is the number of problems other than addiction among people in treatment, which makes addiction treatment and recovery difficult to achieve. Nevertheless, the high levels of other problems being treated in Allorfik highlights the need for easily accessible therapy as many find that Allorfik is the only place to turn to in times of crisis. Conclusion Allorfik seems to have been implemented in accordance with original intentions and plans for addiction treatment service but has also become more than just a service for addiction treatment with easy access in a country with vast distances and limited resources.
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Affiliation(s)
- Julie Flyger
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
| | - Christina Viskum Lytken Larsen
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
- Center for Public Health in Greenland, Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Else Jensen
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
| | - Birgit Niclasen
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Cueva K, Rink E, Lavoie JG, Stoor JPA, Healey Akearok G, Gladun E, Larsen CVL. Diving below the surface: A framework for arctic health research to support thriving communities. Scand J Public Health 2023; 51:1086-1095. [PMID: 33899601 DOI: 10.1177/14034948211007694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Historically, health research in the Arctic has focused on documenting ill-health using a narrow set of deficit-oriented epidemiologic indicators (i.e., prevalence of disease and mortality rates). While useful, this type of research does not adequately capture the breadth and complexities of community health and well-being, and fails to highlight solutions. A community's context, strengths, and continued expressions of well-being need to guide inquiries, inform processes, and contextualize recommendations. In this paper, we present a conceptual framework developed to address the aforementioned concerns and inform community-led health and social research in the Arctic. METHODS The proposed framework is informed by our collective collaborations with circumpolar communities, and syntheses of individual and group research undertaken throughout the Circumpolar North. Our framework encourages investigation into the contextual factors that promote circumpolar communities to thrive. RESULTS Our framework centers on the visual imagery of an iceberg. There is a need to dive deeper than superficial indicators of health to examine individual, family, social, cultural, historical, linguistic, and environmental contexts that support communities in the Circumpolar North to thrive. A participatory community-based approach in conjunction with ongoing epidemiologic research is necessary in order to effectively support health and wellness. Conclusions: The iceberg framework is a way to conceptualize circumpolar health research and encourage investigators to both monitor epidemiologic indicators and also dive below the surface using participatory methodology to investigate contextual factors that support thriving communities.
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Affiliation(s)
- Katie Cueva
- Institute of Social and Economic Research, University of Alaska Anchorage, USA
| | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, USA
| | - Josée G Lavoie
- Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Jon P A Stoor
- Department of Epidemiology and Global Health, Umea University
- Centre for Sámi Health Research, Department of Community Medicine, UiT - the Arctic University of Norway, Norway
| | | | - Elena Gladun
- Professor of Public Administration Department, Tyumen State University, Russia
| | - Christina V L Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark
- Greenland Center for Health Research, University of Greenland, Greenland
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Caught between HIV exceptionalism and health service integration: Making visible the role of public health policy in the scale-up of novel sexual health services. Health Place 2021; 72:102696. [PMID: 34736155 DOI: 10.1016/j.healthplace.2021.102696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022]
Abstract
The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.
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Ingemann C, Kuhn RL, Kvernmo S, Tjørnhøj-Thomsen T, Larsen CVL. An in-depth implementation study of the Greenlandic parenting program MANU's initial stages of implementation. Int J Circumpolar Health 2021; 80:1938443. [PMID: 34294025 PMCID: PMC8317938 DOI: 10.1080/22423982.2021.1938443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Greenland, the universal parenting programme MANU was developed in 2016. After documenting the initial years of MANU’s implementation, this study aimed to identify implementation determinants focusing on i) which context MANU was conceptualised in and how it was developed and ii) how MANU was implemented and initially received in the healthcare system. A qualitative in-depth implementation study was conducted: document analysis, 38 interviews, one focus group discussion, and observations at two trainings for professionals and four parent sessions. Participants included stakeholders from both the health and social sector and from management to practitioner level. MANU was conceptualised based on a political desire to ensure children’s well-being by providing parents with the essential parenting skills, and a desire to create a programme for the Greenlandic context. Professionals welcomed the MANU materials, but anticipated or experienced barriers in implementing MANU. The first years of MANU focused on disseminating material and training professionals. Despite political support and financial security enabling implementation, an assessment of the implementation capacity from the very beginning could have prevented some of the implementation challenges identified. Insights on parents’ perspectives and local implementation are lacking and need to be brought to the forefront of the implementation process.
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Affiliation(s)
- Christine Ingemann
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; Greenland Center for Health Research, Institute of Nursing and Health Research, Ilisimatusarfik - University of Greenland, Nuuk, Greenland
| | | | - Siv Kvernmo
- IKM, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; Greenland Center for Health Research, Institute of Nursing and Health Research, Ilisimatusarfik - University of Greenland, Nuuk, Greenland
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Does quitting intention increase by perceived risk of smoking? The effects of negative outcome expectancy, future orientation and emotional support. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01815-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pineo H, Turnbull ER, Davies M, Rowson M, Hayward AC, Hart G, Johnson AM, Aldridge RW. A new transdisciplinary research model to investigate and improve the health of the public. Health Promot Int 2021; 36:481-492. [PMID: 33450013 PMCID: PMC8049543 DOI: 10.1093/heapro/daaa125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Transdisciplinary research approaches are being applied to today's complex health problems, including the climate crisis and widening inequalities. Diverse forms of disciplinary and experiential knowledge are required to understand these challenges and develop workable solutions. We aimed to create an updated model reflective of the strengths and challenges of current transdisciplinary health research that can be a guide for future studies. We searched Medline using terms related to transdisciplinary, health and research. We coded data deductively and inductively using thematic analysis to develop a preliminary model of transdisciplinary research. The model was tested and improved through: (i) a workshop with 27 participants at an international conference in Xiamen, China and (ii) online questionnaire feedback from included study authors. Our revised model recommends the following approach: (i) co-learning, an ongoing phase that recognizes the distributed nature of knowledge generation and learning across partners; (ii) (pre-)development, activities that occur before and during project initiation to establish a shared mission and ways of working; (iii) reflection and refinement to evaluate and improve processes and results, responding to emergent information and priorities as an ongoing phase; (iv) conceptualization to develop goals and the study approach by combining diverse knowledge; (v) investigation to conduct the research; (vi) implementation to use new knowledge to solve societal problems. The model includes linear and cyclical processes that may cycle back to project development. Our new model will support transdisciplinary research teams and their partners by detailing the necessary ingredients to conduct such research and achieve health impact.
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Affiliation(s)
- Helen Pineo
- Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, Central House, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Eleanor R Turnbull
- Academic Foundation Programme, North Central and East London Foundation School, Health Education England, Stewart House, 32 Russell Square, Bloomsbury, London, UK
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Michael Davies
- Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, Central House, 14 Upper Woburn Place, London WC1H 0NN, UK
| | - Mike Rowson
- Faculty of Population Health Sciences, University College London, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Graham Hart
- Faculty of Population Health Sciences, University College London, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London, WC1E 6JB, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
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Sandager Budtz AE, Lynge AR, Budtz CS, Pedersen ML. Weight among children born 2005-2011 in Nuuk at the time of school entry. Int J Circumpolar Health 2020; 78:1618667. [PMID: 31116095 PMCID: PMC6534250 DOI: 10.1080/22423982.2019.1618667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this study was to explore weight status among children born between 2005–2011 at the time of their school entry in Nuuk, and separately to compare weight status between Nuuk and the rest of Greenland among children born in 2011. Study method was an observational study based on data from the electronic medical records (EMR). All children born between 2005–2011 with an address in Nuuk, and registered weight and height were included. For children born in 2011 two study populations were used: children living in Nuuk, and children living outside Nuuk. Body Mass Index (BMI) was calculated. Atotal of 1,616 children born in 2005–2011, with address in Nuuk between 2011-2017 were identified. 78% were included (N = 1, 280: 676 boys and 604 girls, ranging from 5.4–7.6 years). Prevalence of overweight and obesity were estimated to 12.0% (N = 153) and 5.1% (N = 65)respectively. Among children born in 2011, the prevalence of overweight or obesity was 14.6% in Nuuk, compared to 28.8% in the rest of Greenland (p < 0.001). The prevalence of overweight and obesity was stable for children living in Nuuk. A higher prevalence was observed among children living outside Nuuk. Continued monitoring of weight status is recommended. Abbreviations: BMI: body mass index; EMR: electronic medical records; IOTF: international obesity task force; SD: standard derivation
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Affiliation(s)
| | | | | | - Michael Lynge Pedersen
- a Queen Ingrid Health Care Center , Nuuk , Greenland.,d Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland , Nuuk , Greenland
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