The INHERIT model: A tool to jointly improve health, environmental sustainability and health equity through behavior and lifestyle change

This is the final version. Available on open access from MDPI via the DOI in this recordThe need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration.European Union Horizon 202

What else should we know about experiencing COPD? A narrative review in search of patients’ psychological burden alleviation

Marta Rzadkiewicz,1 Ola Bråtas,2 Geir Arild Espnes2 1Second Faculty of Medicine with The English Division and The Physiotherapy Division, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland; 2Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway Abstract: The present paper is a narrative review focusing on the psychological impact, identification of protective factors, and interventions minimizing the psychological burdens of chronic obstructive pulmonary disease (COPD). The research reviews studies on neurocognitive functions, personality, emotional problems, and health-related quality of life. This is done with regard to resources as well as activities enabling or enhancing a patient’s adaptation. PubMed and PsychArticles databases were searched for relevant medical (eg, CODP, emphysema), psychopathology (eg, depression), and psychological (eg, personality) keywords, followed by hand search. After application of the inclusion and exclusion criteria, the search resulted in 82 articles and book chapters. The choice was based on evidence accepted by evidence-based medicine, although at different levels of strength. Psychological experiencing of COPD appears to be very unequally represented with scientific research on emotional problems and functioning decrease significantly outnumbering those addressing resources or effective interventions. As our initial literature search called for an urgent need for further exploration, we have carefully pointed out numerous areas where the knowledge on how to protect or restore psychological well-being among COPD patients should be broadened. Keywords: COPD, chronic illness, psychological intervention, personality, mental health, HRQo

Lived experiences of self-care among older physically active urban-living individuals

Kari Sundsli,1,2 Geir Arild Espnes,3 Olle Söderhamn21Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, Norway, 2Centre for Caring Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway, 3Research Centre for Health Promotion and Resources HiST-NTNU, Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, NorwayBackground: Promoting physical activity is a public health priority in most industrial countries, and physical function is an important factor when taking into consideration older people’s self-care and health. Despite the increasing challenges associated with urbanization and the aging population, urban life appears to be positive in many ways for urban dwellers. However, the manner in which older people live in urban settings and how this influences their ability to take care of themselves should be considered important knowledge for health professionals and politicians to acquire. The aim of this study was to describe the lived experiences of self-care and features that may influence health and self-care among older urban home-dwelling individuals who are physically active.Methods: Ten subjects, three women and seven men, who were aged 65–82 years and identified to be physically active, were interviewed. The interviews were recorded, transcribed verbatim, and analyzed according to the descriptive phenomenological method devised by Giorgi.Results: Our findings showed beneficial self-care. The participants lived active everyday lives and were frequently physically active. They were part of a supportive, inclusive, and promoting fellowship, and they had the opportunity to travel. They utilized their competence and experienced making themselves useful. It was a privilege to be part of a family life as a husband, wife, parent, and/or a grandparent. They acknowledged physical and mental limitations, yet they felt they were in good health.Conclusion: Health professionals and politicians should identify places where fellowship and relationships can be built, as well as encourage older people to use their competence by engagement in volunteering. These interventions are important to support older people’s self-care and health. This may also be a way to reduce ageism in Western societies.Keywords: aged, health promotion, perceived health, phenomenolog

Being old and living alone in urban areas: the meaning of self-care and health on the perception of life situation and identity

Kari Sundsli,1,2, Geir Arild Espnes,3 Olle Söderhamn21Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, 2Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 3Research Centre for Health Promotion and Resources, Norwegian University of Science and Technology, Trondheim, NorwayBackground: Living alone in urban areas when getting old is an important and necessary field for research as the growth of the urban population worldwide increases, and due to the fact that people live longer. How older people manage their self-care and health, and how this might influence their identity and life situation may be very important to understand when planning for a new, upcoming older generation. The aim of this study was to elucidate the meaning of self-care and health for the perception of life situation and identity among single-living older individuals in urban areas in southern Norway.Methods: A phenomenological–hermeneutic approach inspired by Ricoeur was applied. Nine single-living older persons in urban areas, 70–82 years of age, and identified to be in good health were interviewed. The interviews were audiotaped, transcribed verbatim, and analyzed using a phenomenological–hermeneutic method.Results: Strength and a time dimension characterized the meaning of self-care and health for the perception of life situation and identity as narrated by the group of single-living older individuals in urban areas in southern Norway. The informants were, as older individuals, caring, autonomous, and robust characters, who had gone through difficult times in life, and in a resilient way moved towards a new future. They valued and were grateful for what they had learned in their lives and could go forward and still experience and explore.Conclusion: Self-care is significant in the perception of life situation and identity among single urban older people in this study, and characterized by strength, temporality, gratitude, autonomy, and natality. Society needs to acknowledge the strengths and capabilities of older people to a greater extent.Keywords: aged, health promotion, phenomenological–hermeneutic method, salutogenesis, tim

Return to work after vocational rehabilitation: does mindfulness matter?

Solveig Vindholmen,1 Rune Høigaard,2 Geir Arild Espnes,3 Stephen Seiler41Department of Psychosocial Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway; 2Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway; 3Research Centre for Health Promotion and Resources, Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway; 4Faculty of Health and Sport Sciences, University of Agder, Kristiansand, NorwayPurpose: Mindfulness has become an important construct in return-to-work (RTW) rehabilitation. The aim of this study was to investigate whether mindfulness is a predictor for RTW, and to examine the indirect effect of mindfulness on RTW and work ability through quality of life (QOL).Methods: A retrospective study was conducted among 80 former participants (71 females and seven males) from age 24 to 66, in a multidisciplinary vocational rehabilitation program (MVRP). Self-report questionnaires were used to measure work status, work ability, QOL, and mindfulness. Demographic data were also collected.Results: In the current sample, 47% of participants reported having returned to ordinary work. The majority of the non-working sub-sample reported being in work-related activity or education. A bias-corrected bootstrapping technique was used to examine indirect effects. Results revealed that mindfulness was indirectly related to both RTW and work ability through QOL. There was no significant total effect of mindfulness on work ability or RTW. Logistic regression analysis was performed to assess the impact of mindfulness on the likelihood that respondents returned to work. None of the independent mindfulness variables (observe, describe, act aware, non-judge, non-react) made a unique statistically significant contribution to the model. The covariates work ability and education level significantly predicted RTW. However, when the data were analyzed after stratification by education level, the "observation" facet of mindfulness made a significant contribution to the model (odds ratio =1.28, confidence interval =1.03–1.59) for "high educated" participants.Conclusion: These data suggest that mindfulness may enhance RTW and work ability through QOL. Furthermore, for "high educated" participants the observation facet of mindfulness significantly predicted RTW.Keywords: work ability, quality of life, multidisciplinary, mindfulness, return to work, vocational rehabilitatio

Nutritional self-care in two older Norwegian males: a case study

Solveig T Tomstad,1,2 Ulrika Söderhamn,2 Geir Arild Espnes,1,3 Olle Söderhamn21Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, 2Centre for Caring Research-Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 3Research Centre for Health Promotion and Resources, Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, NorwayBackground: Knowledge about how to support nutritional self-care in the vulnerable elderly living in their own homes is an important area for health care professionals. The aim of this case study was to evaluate the effects of nutritional intervention by comparing perceived health, sense of coherence, self-care ability, and nutritional risk in two older home-dwelling individuals before, during, and after intervention and to describe their experiences of nutritional self-care before and after intervention.Methods: A study circle was established to support nutritional self-care in two older home-dwelling individuals (≥65 years of age), who participated in three meetings arranged by health professionals over a period of six months. The effects of this study circle were evaluated using the Nutritional Form For the Elderly, the Self-care Ability Scale for the Elderly (SASE), the Appraisal of Self-care Agency scale, the Sense of Coherence (SOC) scale, and responses to a number of health-related questions. Qualitative interviews were performed before and after intervention to interpret the changes that occurred during intervention.Results: A reduced risk of undernutrition was found for both participants. A higher total score on the SASE was obtained for one participant, along with a slightly stronger preference for self-care to maintain sufficient food intake, was evident. For the other participant, total score on the SASE decreased, but the SOC score improved after intervention. Decreased mobility was reported, but this did not influence his food intake. The study circle was an opportunity to express personal views and opinions about food intake and meals.Conclusion: An organized meeting place for dialogue between older home-dwelling individuals and health care professionals can stimulate the older person’s engagement, consciousness, and learning about nutritional self-care, and thereby be of importance in reducing the risk of undernutrition.Keywords: elderly, health promotion, intervention, study circl

Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients - especially in patients with mild or moderate disease

The first objective of the study was to evaluate a 4-week inpatient pulmonary rehabilitation program on exercise capacity, health-related quality of life (HRQL) and psychological distress in patients with COPD. The second objective was to investigate the influence of gender, age, disease severity, co-morbidity, anxiety and depression on improved HRQL after rehabilitation. The study comprised 136 consecutive patients from baseline to follow-up with mild-to-severe COPD. Exercise capacity was measured by the 6-min walking distance test, disease severity by spirometric tests, HRQL by The St. George’s Respiratory Questionnaire and psychological distress by the The Hospital Anxiety and Depression Scale. Variables on socio-demography and co-morbidity were self-reported. Exercise capacity was improved from baseline to follow-up with a score difference of +44 metres (p = 000). Except for the activity score, HRQL was significantly improved: a change of -3.5 for the symptom score (p = 014), —3.1 for the total score (p = 003) and a clinical significant change of — 4.0 for the impact score (p = 002). The anxiety score did not change significantly after rehabilitation (—0.1, p = 545), though there was a significant reduction of the depression score (—0.8, p = 002) and a 10.4% reduction in the prevalence of possible depression cases (p = 017). Patients with forced expiratory volume in 1 second ≥50% predicted were 4.2 times more likely to achieve a clinical significant improved HRQL after rehabilitation than patients with forced expiratory volume in 1 second &lt;50% predicted (95% confidence interval [CI] 1.7—10.3, p = 002). A 4-week inpatient rehabilitation program improves HRQL and exercise capacity and reduces depression in COPD patients. Patients with mild or moderate disease are more likely to achieve an improved HRQL after rehabilitation than patients with severe or very severe disease. </jats:p

Lived experiences of self-care among older, home-dwelling individuals identified to be at risk of undernutrition

Solveig T Tomstad,1,2 Ulrika S&amp;ouml;derhamn,2 Geir Arild Espnes,3 Olle S&amp;ouml;derhamn21Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway; 2Centre for Caring Research &amp;ndash; Southern Norway, University of Agder, Grimstad, Norway; 3Research Centre for Health Promotion and Resources HiST-NTNU, Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, NorwayIntroduction: In a society where most older people live in their own homes, it may be expected of older individuals to exercise their potential to take care of themselves in daily life. Nutrition is a central aspect of self-care, and groups of older, home-dwelling people are at risk of undernutrition.Aim: The aim of this study was to describe the lived experiences of self-care and features that influence health and self-care among older, home-dwelling individuals identified to be at risk of undernutrition.Methods: Qualitative interviews were performed with eleven home-dwelling individuals who had been identified as being at risk of undernutrition. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method.Findings: Self-care as a lived experience among older, home-dwelling individuals identified to be at risk of undernutrition is about being aware of food choices and making decisions about taking healthy steps or not. In the presence of health problems, the appetite often decreases. Being able to take care of oneself in daily life is important, as is receiving help when needing it. Working at being physically and socially active and engaged may stimulate the appetite. Having company at meals is important and missed when living alone. Being present and taking each day by day, as well as considering oneself in the light of past time and previous experiences and looking ahead, is central, even when having fears for the future and the end of life.Conclusion: Health care professionals should be aware of these findings in order to support self-care in older people, and they should pay attention to the social aspects at meals.Keywords: aged, health promotion, phenomenology, qualitative interview

Living alone, receiving help, helplessness, and inactivity are strongly related to risk of undernutrition among older home-dwelling people

Solveig T Tomstad1, Ulrika S&amp;ouml;derhamn2, Geir Arild Espnes3, Olle S&amp;ouml;derhamn21Department of Social Work and Health Science, Faculty of Sciences and Technology Management, NTNU, Trondheim, Norway and Centre for Caring Research &amp;ndash; Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 2Centre for Caring Research &amp;ndash; Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 3Research Centre for Health Promotion and Resources HiST-NTNU, Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, NorwayBackground: Being at risk of undernutrition is a global problem among older people. Undernutrition can be considered inadequate nutritional status, characterized by insufficient food intake and weight loss. There is a lack of Norwegian studies focusing on being at risk of undernutrition and self-care ability, sense of coherence, and health-related issues among older home-dwelling people.Aim: To describe the prevalence of being at risk of undernutrition among a group of older home-dwelling individuals in Norway, and to relate the results to reported self-care ability, sense of coherence, perceived health and other health-related issues.Methods: A cross-sectional design was applied. A questionnaire with instruments for nutritional screening, self-care ability, and sense of coherence, and health-related questions was sent to a randomized sample of 450 persons (aged 65+ years) in southern Norway. The study group included 158 (35.1%) participants. Data were analysed using statistical methods.Results: The results showed that 19% of the participants were at medium risk of undernutrition and 1.3% at high risk. Due to the low response rate it can be expected that the nonparticipants can be at risk of undernutrition. The nutritional at-risk group had lower self-care ability and weaker sense of coherence. Living alone, receiving help regularly to manage daily life, not being active and perceived helplessness emerged as predictors for being at risk of undernutrition. The results indicate difficulties in identifying people at nutritional risk and supporting self-care activities to maintain a good nutritional status.Conclusion: Health care professionals have to be able to identify older home-dwelling people at risk of undernutrition, support self-care activities to enable people at risk to maintain a sufficient nutritional status, and be aware that older people living alone, who receive help, feel helpless, and are inactive are especially vulnerable.Keywords: health, nutrition, self-care, sense of coherenc