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Background: Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process.

Objective: The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention.

Methods: The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops.

Results: Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed.

Conclusions: The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention.

Reablement has a health promotive perspective. The goal is to enhance or maintain health and functional ability and, thereby, the ability of older adults to live in their own homes. The intervention described in this study was introduced so the older person would remain at home and be given the opportunity to regain or maintain functional ability physically, mentally, and socially to live independently and have optimal health and well-being. This paper aims to report the measured effects of reablement among the older adults in terms of bio-psycho-social health that emerged in the randomized controlled trial (RCT).MethodsA sample of older adults (65+) was studied, consisting of those who applied for homecare in the municipal home service (n = 237), those who received intensive home reablement (IHR) carried out by an interprofessional team, and a control group who received home-based care as usual. Data were collected at three different occasions with validated instruments: at inclusion, after completion of IHR, and 3 months after completed intervention.ResultsBoth groups improved significantly at the post-measurement, and this improvement was maintained at the 3-month follow-up regarding: global quality of life (HACT); general health (EQ-5D-5 L); the self-estimates for mobility, hygiene, daily activities, pain/discomfort, anxiety/depression (EQ-5D-5 L); subjective well-being (GP-CORE); self-assessed capacity to perform physical activities as well as satisfaction with performance (COPM); measures of physical activity capacity regarding lower extremities (SPPB); upper extremities (hand dynamometer test). No between group differences were statistically significant. At the 3-month follow-up, the average number of homecare hours was slightly lower in the group that underwent IHR than in the group receiving usual homecare and rehabilitation interventions, but the difference was not statistically certain.ConclusionsIn this RCT with a relatively short follow-up period, IHR was equivalent to traditional homecare regarding older people's self-reported health, physical activity ability and number of homecare hours.Trial registrationClinicalTrials.gov (https://clinicaltrials.gov/study/NCT03565614?intr=Reablement&rank=4) Registration number: NCT03565614. Registered on 1 January 2016.

Background: Sedentary behavior is highly prevalent in older adults transitioning to retirement. Sedentary time is all of the time spent in sedentary behavior, and prolonged sedentary time is associated with an increased risk of noncommunicable diseases. The aim of this study was to explore perceptions among older adults transitioning from working life to retirement regarding selfmanagement strategies for reducing sedentary time and adhering to the reduced sedentary time. Methods: Twenty-eight older adults, age 60-75 years, participated in one of four focus group interviews. Qualitative content analysis was used to analyze the data. Results: The analysis resulted in the theme " It has to be my way," and the three categories " Activities scattered with joyfulness," " Support for changes in everyday life," and " Health affects willingness and ability, and is affected by adherence." Conclusions: Interpreted from the perspective of self-determination theory, self-management strategies for reducing sedentary time should be adaptable as every individual is unique, indicating a need for autonomy. Sedentary time was said to be reduced by activities that evoked joyfulness, and joyfulness was considered to increase adherence. Support for changes to one's everyday life was considered necessary. The support that was mentioned primarily involved targeting cognitive determinants such as self-efficacy and attitudes. This new knowledge can be included when designing self-management interventions; however, more research is needed in order to evaluate whether self-management strategies targeting autonomous motivation and affective determinants, such as affective judgment and cognitive determinants, can reduce sedentary time in those who are in the transition to retirement.

Background/Objectives: Swedish schools are mandated to counteract gender norms that restrict students' life opportunities. School personnel also bear the responsibility of fostering students' democratic responsibilities and healthy behaviors, which is crucial not only for their mental wellbeing but also for their academic performance, as stressed by the European Commission. Aim: The purpose of the present study is to explore adolescents' performativity of gender when discussing social barriers to mental and emotional wellbeing. Methods: Fifty adolescents were interviewed in small gender-divided groups, and the transcribed text was analyzed using thematic analysis. Theoretically, interactionist perspective and gender analytic discourses are applied. Results: Emotional barriers to mental wellbeing were identified based on too cogent gender norms. Boys describe challenging each other and the environment by using a social facade that includes "stoneface" and harsh language, seldom showing sadness, even among close friends. The girls' facade includes maintaining a "happy face" and trying to be attractive. Both genders underline the need for belonging, and most of them fear social exclusion from peers. According to the interviewees, it is socially acceptable for girls to display most feelings, even mental difficulties such as anxiety or phobia, but among boys, gender norms still hinder them from showing emotional vulnerabilities such as sadness and risking exclusion. Conclusions: Young people's emotional wellbeing needs to be further developed and included in the curriculum. It is time for adults to focus on boys' sadness and depressive emotions, as well as girls' aggressiveness and frankness rather than their appearance, to push the river of equality forward.

Purpose: Increased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment. Methods: Eleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior. Results: The overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image. Conclusions: Sedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.

Background: Understanding young people's subjective well-being, such as how they experience equality, safety, and supportive environments, is particularly important for identifying possible preventive interventions in the school context. Aim: The aim of this study was to investigate similarities and differences between 15-year-old girls’ and boys’ subjective well-being, and its associations with psychosocial factors. Methods: The study was explorative and cross-sectional. A total of 195 adolescent girls and 116 boys in Grade 9 from four Swedish junior high schools completed a questionnaire on subjective well-being; emotional support opportunities; gender equality; experience of emotional, physical, and sexual violence in close relationships; insecurity due to harassment in the school environment or on social media; and pornography consumption. Results: Compared to boys, girls indicated worse subjective well-being and more harassment in school and on social media, and reported that boys received benefits based on gender. Boys reported higher pornography consumption compared with girls. Girls reporting decreased subjective well-being experienced more harassment on social media and in school, and more recent sexual violence. Among boys, with decreased subjective well-being, more psychological risks such as self-harm and suicidal thoughts was reported. Both girls and boys with decreased subjective well-being reported less availability of attachment and insecure close relations. Conclusion: The absence of a safe and supportive environment, such as feeling secure at school, and lack of close and trusting relationships are associated with 15-year-olds’ subjective well-being for the worse, regardless of gender. It is suggested that school personnel extend the relational possibilities in the school context. 

Study design: Triangulated mixed-methods validation study.

Objectives: To validate the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ).

Setting: Community in Denmark.

Methods: Participants were invited via a patient organization and its specialized hospital. Eligibility criteria were having a spinal cord injury (SCI), being 18 years or older, and able to understand and respond in Danish. Quantitative data were collected to determine internal consistency and criterion validity of the three subscales of SCL-CSQ, i.e., acceptance, fighting spirit, and social reliance. The Three-Step Test-Interview approach was employed to determine whether items measured what they were intended to measure (i.e., construct validity based on response processes).

Results: The quantitative sample consisted of 107 participants, and the interview sample comprised 11 participants. The acceptance and fighting spirit subscales showed adequate internal consistency (Cronbach's alpha of 0.72 and 0.76 respectively) and satisfactory criterion validity (expected correlations with quality of life and depression). The social reliance subscale showed inadequate internal consistency (Cronbach's alpha of 0.58) and criterion validity. All fighting spirit items and all but one acceptance items were interpreted congruently by most participants. Conversely, two social reliance items were only interpreted congruently by 9 and 27%.

Conclusion: The acceptance and fighting spirit subscales of the Danish version of the SCL-CSQ showed good psychometric properties, while the social reliance subscale showed serious issues and should be revised. Researchers and clinicians are urged to reflect on these findings when revising the SCL-CSQ or adapting it to other languages, cultural contexts, and rehabilitation settings.

Chronic heart failure is a common and a serious condition. Research has shown that chronic heart failure has been associated with detrimental effects on wellbeing. Coping effectiveness training (CET) has been applied for patients with heart failure to improve stress appraisal and stress management skills. The aim of this study was to explore the experience of participating in CET for patients with heart failure one year after completion. Eleven patients were interviewed. The study adheres to the SRQR guidelines. A thematic analysis generated three themes: rewarding but challenging to meet other people with heart failure; improved conditions to cope with stress; and not relevant to me. Implications for further development of the intervention were to include existential aspects, recognize comorbidities, test follow-up sessions and apply a codesign.

Introduction: The Swedish version of the patient-reported Clinical Outcomes in Routine Evaluation Outcome Measures (CORE-OM) has demonstrated high reliability and acceptable convergent validity in explanatory factor analyses. However, the fundamental scale properties have not yet been validated according to item response theory. The aim of this study was to analyze the measurement properties of the Swedish CORE-OM in a cohort of psychiatric out-patients with depression and anxiety in a multicultural area and to explore combinations of items based on shorter versions of the scale (CORE-10, CORE-6D) to improve measurement properties.

Methods: Data from CORE-OM assessments of 337 patients were analyzed using Rasch analysis. The patients had a mean age of 30 +/- 14 years, the majority were women (72%). Requirements for measurement properties were checked: overall model fit, item fit residuals, targeting, internal consistency, differential item functioning and thresholds. Sensitivity to change was also analyzed.

Results: The CORE-OM showed high internal consistency (person separation index = 0.947) and adequate targeting, but there was overall model misfit (item trait interaction chi(2) = 917.53, p < 0.001), indication of local dependency, and differential item functioning in 9 items. The risk items showed problems with disordered thresholds. The emotional component of the shorter CORE-6D showed the best fit for our sample. Adding 3 items to include depressive and trauma-related content resulted in a unidimensional 8-item set with acceptable reliability, model fit, targeting and sensitivity to change.

Conclusion: For out-patients with diagnosed depression or anxiety in a multicultural area, the Swedish CORE-OM showed high internal consistency, but also validity problems. Based on the shorter CORE-6D version, a unidimensional 8-item set could be an alternative brief measure of psychological distress for this population, but further validity studies are required. Qualitative studies exploring the CORE-OM items in non-native speakers are also warranted.

BACKGROUND: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years).

METHODS: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time.

RESULTS: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE).

CONCLUSIONS: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.