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Mattebo M, Gottvall M, Grandahl M. School Nurses' Perceptions and Experiences of Delivering a School-Based Intervention to Improve Primary Prevention of Human Papillomavirus Among Adolescents-A Focus Group Study Following a Randomized Controlled Trial. J Sch Nurs 2024; 40:166-173. [PMID: 34632854 PMCID: PMC10924545 DOI: 10.1177/10598405211046174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present qualitative study is a part of the process evaluation of a complex intervention, the randomized controlled trial, "Prevention of human papillomavirus (HPV) in a school-based setting." We aimed to explore participating school nurses' perceptions and experiences of delivering the educational HPV intervention to adolescents aged 16. Focus group interviews were conducted with school nurses (n = 20) and analyzed with inductive qualitative content analysis. The overall theme Easily adapted into the existing role as a school nurse permeated the participants' views. The nurses were in favor of delivering an intervention that increased the HPV vaccination rates and improved beliefs and awareness about HPV prevention. It suits their work and health-promoting aspect of their role well and can easily be adapted into the current school health consultant curriculum. Having material in different languages to share with adolescents and their parents to promote equal health was deemed important.
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Affiliation(s)
- Magdalena Mattebo
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Gottvall
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Health Sciences, The Red Cross University College, Huddinge, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Gottvall M, Kissiti R, Ainembabazi R, Bergman H, Eldebo A, Isaac R, Yasin S, Jirwe M, Carlsson T. Mental health and societal challenges among forced migrants of diverse sexual orientations, gender identities and gender expressions: health professionals' descriptions and interpretations. Cult Health Sex 2024:1-16. [PMID: 38250794 DOI: 10.1080/13691058.2023.2298479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
The aim of this study was to explore health professionals' descriptions and interpretations of post-migration mental health and societal challenges among forced migrants with diverse sexual orientations, gender identities and gender expressions. Participants representing seven professions were recruited by a combination of convenience, purposive and snowball sampling. Data were collected through focus groups and individual interviews, analysed with systematic text condensation in a collaborative process involving researchers, clinicians and migrants with lived experiences. Participants described a challenging trajectory for migrants, as migrants venture through an uncertain and demanding journey impacting their mental health. Needing to deal with legal requirements, stressful circumstances and normative expectations during the asylum process were highlighted as major challenges, along with exposure to discrimination, violence, abuse and lack of psychosocial safety. Participants described significant psychological distress among migrants, including loneliness and shame. Challenges were also recognised related to exploring, accepting and expressing sexuality and gender. Loneliness and shame are major challenges in need of further attention in research, which could be addressed through the development and evaluation of actions, programmes and interventions to provide peer support.
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Affiliation(s)
- Maria Gottvall
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rogers Kissiti
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Ronah Ainembabazi
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Hannah Bergman
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Anna Eldebo
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Rummage Isaac
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Sumera Yasin
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Maria Jirwe
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Gottvall M, Brunell C, Eldebo A, Kissiti R, Mattsson E, Jirwe M, Carlsson T. Nurse education about forced migrants with diverse sexual orientations, gender identities, and gender expressions: An exploratory focus group study. Nurse Educ Today 2023; 128:105880. [PMID: 37356186 DOI: 10.1016/j.nedt.2023.105880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/27/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND In many countries, forced migrants can seek asylum based on persecution and danger related to self-identifying as having diverse sexual orientations, gender identities, and gender expressions; herein defined as lesbian, gay, bisexual, transgender, queer, or other non-heterosexual orientations, non-cisgender identities, gender expressions and/or reproductive development considered beyond cultural, societal or physiological norms. Nurse education has a significant role in promoting cultural competence among future health professionals. OBJECTIVES To explore the experiences and views regarding education about forced migrants with diverse sexual orientations, gender identities, and gender expressions, among students and lecturers in nurse education. DESIGN Explorative qualitative study with focus group discussions. SETTINGS Swedish nursing programs. PARTICIPANTS Final-year nursing students and lecturers (n = 25 participants) at nursing programs were recruited with convenience and snowball sampling. METHODS Semi-structured digital focus group discussions (n = 9) were audio recorded and transcribed verbatim. Data were analyzed with inductive qualitative content analysis. RESULTS Promoting a broader understanding regarding societal structures and preparing students to provide culturally sensitive care were considered as essential components in nurse education. Challenges and problems involved a need for increased awareness, the associated topics and target populations seldom being addressed, and a need for improvements within clinical placements. Participants suggested the utilization of external resources, presented a range of different specific learning activities that would promote in-depth understanding, and articulated a need for overarching decisions and guidelines regarding mandatory inclusion in nurse education. CONCLUSIONS Students and lecturers describe several challenges and problems that need to be addressed in regard to forced migration, sexual health, and inclusion health. There seems to be a need for utilization of external competence in learning activities as well as establishing clearer guidelines, which may increase the quality of education and better prepare future nurses to support patients with diverse backgrounds and identities.
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Affiliation(s)
- Maria Gottvall
- The Swedish Red Cross University, Huddinge, Sweden; The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Anna Eldebo
- The Swedish Red Cross University, Huddinge, Sweden
| | | | - Elisabet Mattsson
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; The Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Maria Jirwe
- The Swedish Red Cross University, Huddinge, Sweden; The Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Tommy Carlsson
- The Swedish Red Cross University, Huddinge, Sweden; The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Gottvall M, Brunell C, Eldebo A, Johansson Metso F, Jirwe M, Carlsson T. Post-migration psychosocial experiences and challenges amongst LGBTQ+ forced migrants: A meta-synthesis of qualitative reports. J Adv Nurs 2023; 79:358-371. [PMID: 36320151 PMCID: PMC10092230 DOI: 10.1111/jan.15480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022]
Abstract
AIMS Synthesize qualitative research to illuminate the post-migration psychosocial experiences amongst LGBTQ+ forced migrants. DESIGN Meta-synthesis of qualitative reports. DATA SOURCES Systematic searches in seven databases and manual screenings were performed in July 2021 (21,049 entries screened in total). The final sample included 29 English-language reports containing empirical qualitative findings about post-migration experiences and published 10 years prior to the searches, based on migrants as the primary source. REVIEW METHODS Methodological quality was appraised using the CASP and JBI checklists. Through a collaborative process involving nurse-midwife researchers and experienced clinical professionals, reports were analysed with a two-stage qualitative meta-synthesis including an inductive qualitative content analysis. RESULTS The methodological quality was high and the reports included 636 participants in total. Two themes were identified through the meta-synthesis. The first theme illustrates the psychological distress and numerous challenges and stressors forced migrants face after arrival, including challenges encountered as an LGBTQ+ forced migrant, psychological reactions and manifestations, and practical issues related to resettlement and living conditions. The second theme highlights the resilience and strength they find through various internal processes and external resources, including resilience and strengthening resources, identity formation and establishing and maintaining social relationships. CONCLUSION After arrival in the host country, forced migrants identifying as LGBTQ+ face numerous societal and personal challenges whilst being at risk of experiencing significant psychological distress. These migrants utilize a wide range of resources that may strengthen their resilience. Peer support stands out as a highly appreciated and promising resource that needs further attention in experimental research. IMPACT Forced migrants identifying as LGBTQ+ need access to adequate and sufficient support. The findings emphasize several strength-building resources that may inform nurses, midwives, researchers and other professionals when providing psychosocial support for these persons. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Maria Gottvall
- Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Calle Brunell
- Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Anna Eldebo
- Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | | | - Maria Jirwe
- Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Tommy Carlsson
- Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Nilsson H, Gustavsson C, Gottvall M, Saboonchi F. Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden: a cross-sectional study. BMC Psychiatry 2021; 21:452. [PMID: 34530806 PMCID: PMC8444359 DOI: 10.1186/s12888-021-03461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden. METHODS A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture. RESULTS About half of the participants (53.3, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001). CONCLUSIONS Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants' health.
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Affiliation(s)
- Henrik Nilsson
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- The Swedish Red Cross Treatment Center for Persons Affected by War and Torture, PO Box 166, SE-201 21 Malmö, Sweden
| | - Catharina Gustavsson
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Nissers väg 3, SE-791 82 Falun, Sweden
| | - Maria Gottvall
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Clinical Psychology in Health Care, Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Gottvall M, Vaez M, Saboonchi F. Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden. BMC Int Health Hum Rights 2019; 19:28. [PMID: 31488136 PMCID: PMC6727543 DOI: 10.1186/s12914-019-0214-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/29/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender. METHODS Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework. RESULTS Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern. CONCLUSION The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.
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Affiliation(s)
- Maria Gottvall
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Clinical Psychology in Health Care, Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Marjan Vaez
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Kohi TW, von Essen L, Masika GM, Gottvall M, Dol J. Cancer-related concerns and needs among young adults and children on cancer treatment in Tanzania: a qualitative study. BMC Cancer 2019; 19:82. [PMID: 30654794 PMCID: PMC6337797 DOI: 10.1186/s12885-019-5279-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of morbidity and mortality worldwide. Seventy percent of deaths of cancer occur in low or middle-income countries, where the resources to provide cancer treatment and care are minimal. Tanzania currently has very inadequate facilities for cancer treatment as there are only five sites, some with limited services; two are in Dar es Salaam and one each in Mwanza, Kilimanjaro and Mbeya that offer cancer treatment. Despite cancer being a prevalent problem in Tanzania, there is a significant shortage of information on the experiences of young people who receive cancer treatment and care. The aim of this study was to explore cancer-related concerns and needs of care and support among young adults and children who are receiving cancer treatment in Dar es Salaam, Tanzania. METHODS Using an explorative, qualitative design, two focus group discussions (FGDs) with young adults (18 to 25 years) and four FGDs with children (9 to 17 years) were held. Data were transcribed into English and analyzed using content analysis. RESULTS Identified concerns included physical effects, emotional effects, financial impacts, poor early care, and poor treatment. Identified needs included the need for improved care in hospital by the staff, need for community support, financial needs, needs for improved cancer care and treatment in the hospitals, and the need for increased education about cancer. Resilience was identified, particularly around hope or faith, having hope to be healed, and receiving good care from staff. CONCLUSION Young adults and children receiving cancer treatment in Tanzania have many needs and concerns. Improvements with regard to the care provided in hospital by the staff, the cancer care and treatment in the hospital, and population-wide education about cancer are necessary to address the identified needs and concerns. Further studies on specific approaches to address the concerns and needs are also warranted.
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Affiliation(s)
- Thecla W Kohi
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
| | - Golden M Masika
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Maria Gottvall
- Clinical Psychology in Healthcare, Department of Women and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Canada
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Nilsson H, Saboonchi F, Gustavsson C, Malm A, Gottvall M. Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment: a qualitative study based on focus group discussions. Eur J Psychotraumatol 2019; 10:1699327. [PMID: 31853335 PMCID: PMC6913663 DOI: 10.1080/20008198.2019.1699327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Refugees with prolonged and repeated experiences of trauma, often in combination with post-migration living difficulties, are subjected to severe levels of stress and stress-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever. However, the effect of PA and exercise has received scarce attention in the context of PTSD, and particularly in the field of refugees' health. Objective: The objective of this study was to explore the experience of participation in PA and exercise as part of the treatment for trauma-afflicted refugees. Method: An explorative qualitative research design was used. Six focus group discussions were conducted with 33 female and male participants that had experience of group-based PA and exercise treatment. The gathered data was analysed by qualitative content analysis. Results: The analysis resulted in one over-arching theme reflecting the participants overall experience of PA and exercise as a process of building resilience. Participants experienced improvements in both physical and mental health domains. Increased self-awareness and self-confidence were seen as additional important benefits, and the interruption of daily stressors provided a sense of relief and recovery. The treatment group settings were experienced as becoming a vehicle for overcoming social fear and isolation, which also carried an empowering and strength-building impact over to participants' family life and social relationships. Treatment characteristics were experienced as highly supportive and often referred to as the basis of other positive experiences and perceived health benefits. Conclusions: The result of this study outlines a detailed account of trauma-afflicted refugees' experiences and preferences of PA and exercise-based treatment from a broad range of perspectives. These findings provide a starting point for future research in this field and indicate a particular need for both research and intervention development to include the real-life impact of participating in such treatments.
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Affiliation(s)
- Henrik Nilsson
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,The Swedish Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Gustavsson
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Andreas Malm
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,The Swedish Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Maria Gottvall
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Abstract
OBJECTIVE To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys. DESIGN Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis. SETTING 11 strategically chosen municipalities in central Sweden. PARTICIPANTS Parents (n=42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme. RESULTS The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine. CONCLUSIONS A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.
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Affiliation(s)
- Maria Gottvall
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Red Cross University College, Huddinge, Sweden
| | - Christina Stenhammar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Grandahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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10
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Grandahl M, Tydén T, Gottvall M, Westerling R, Oscarsson M. Immigrant women's experiences and views on the prevention of cervical cancer: a qualitative study. Health Expect 2015; 18:344-54. [PMID: 23252449 PMCID: PMC5060783 DOI: 10.1111/hex.12034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer. OBJECTIVE To explore immigrant women's experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use. DESIGN An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework. SETTING AND PARTICIPANTS Eight focus group interviews, 5-8 women in each group (average number 6,5), were conducted with 50 women aged 18-54, who studied Swedish for immigrants. Data were analysed by latent content analysis. RESULTS Four themes emerged: (i) deprioritization of women's health in home countries, (ii) positive attitude towards the availability of women's health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups. CONCLUSION The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women's difficulties concerning cultural norms and pay attention to their experiences.
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Affiliation(s)
- Maria Grandahl
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Tanja Tydén
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Maria Gottvall
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Ragnar Westerling
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Marie Oscarsson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
- School of Health and CaringLinnaeus UniversityKalmarSweden
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11
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Abstract
BACKGROUND From spring of 2012, human papillomavirus (HPV) vaccine against cervical cancer is offered free of charge to all girls aged 10-12 years through a school-based vaccination programme in Sweden. The aim of this study was to explore how parents reason when they accept HPV vaccination for their young daughter and also their views on HPV-related information. METHODS Individual interviews with parents (n = 27) of 11-12-year-old girls. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. RESULTS Three themes emerged through the analysis: Trust versus concern, Responsibility to protect against severe disease, and Information about HPV and HPV vaccination is important. The parents expressed trust in recommendations from authorities and thought it was convenient with school-based vaccination. They believed that cervical cancer was a severe disease and felt a responsibility to protect their daughter from it. Some had certain concerns regarding side effects and vaccine safety, and wished for a dialogue with the school nurse to bridge the information gaps. CONCLUSIONS Trust in the recommendations from authorities and a wish to protect their daughter from a severe disease outweighed concerns about side effects. A school-based vaccination programme is convenient for parents, and the school nurse has an important role in bridging information gaps. The findings from this qualitative study cannot be generalized; however, it can provide a better understanding of how parents might reason when they accept the HPV vaccination for their daughter.
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Affiliation(s)
- Maria Gottvall
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Grandahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna T. Höglund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Margareta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Stenhammar
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Andrae
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Tanja Tydén
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Konecna H, Tyden T, Ekstrand M, Gottvall M, Larsson M, Skoog Svanberg A, De Cock G, Balaban-Kasztelanski O. INVITED SESSION, SESSION 41: PATIENT SESSION - EDUCATION IN FERTILITY AWARENESS: FROM PREVENTION TO ACTION: WHOSE DUTY?, Tuesday 5 July 2011 14:00 - 15:00. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gottvall M, Tydén T, Höglund AT, Larsson M. Knowledge of human papillomavirus among high school students can be increased by an educational intervention. Int J STD AIDS 2011; 21:558-62. [PMID: 20975088 DOI: 10.1258/ijsa.2010.010063] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the effect of an educational intervention concerning human papillomavirus (HPV) directed at Swedish first year high school students. The intervention consisted of a class room lesson, a website and a folder. Outcome variables were knowledge of HPV and attitudes to preventive methods such as HPV vaccination, condom use and Pap smear testing. An intervention group (n = 92) was matched with two comparison groups (n = 184). At baseline, the median score for HPV knowledge was one out of 10 in both groups. At follow-up, the median knowledge score had increased to six in the intervention group, but was still one in the comparison group (P < 0.001). Attitudes to HPV vaccination, condom use and Pap smear testing remained the same (P > 0.05). In conclusion, a short school-based intervention can greatly increase the students' knowledge about HPV, but attitudes and behaviours are less easy to influence.
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Affiliation(s)
- M Gottvall
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Gottvall M, Larsson M, Höglund AT, Tydén T. High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students. EUR J CONTRACEP REPR 2010; 14:399-405. [PMID: 19929642 DOI: 10.3109/13625180903229605] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate knowledge of human papillomavirus (HPV) and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. METHODS Classroom questionnaire filled in by 608 students from a strategic sample of seven upper secondary schools in Sweden. RESULTS Only 13.5% (n = 82) of the students had heard about HPV and 6% (n = 35) were aware of HPV vaccination. As many as 84% (n = 508) would like to be vaccinated against HPV. The high cost of vaccination was the greatest obstacle (total group 37%, n = 227); among girls the second major hindrance was the fear of needles (19%, n = 65). Before considering an HPV vaccination 73% (n = 443) wanted more information and 36% (n = 220) would like to receive such information from the school nurse. The students considered it less likely that they would use a condom when having intercourse with a new partner if they were vaccinated than if they were not (p < 0.001). CONCLUSION Despite intensive marketing directed at potential vaccine consumers, knowledge of HPV and of HPV vaccines was very low among first year upper secondary school students. Their attitude towards vaccination was positive but most of them wanted more information before considering vaccination.
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Affiliation(s)
- Maria Gottvall
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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