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Björk, Annette
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Björk, A. (2020). Stödjande gemenskap: Utveckling och utvärdering av en intervention för livsstilsförändring bland vuxna med adhd. (Doctoral dissertation). Sundsvall: Mid Sweden University
Open this publication in new window or tab >>Stödjande gemenskap: Utveckling och utvärdering av en intervention för livsstilsförändring bland vuxna med adhd
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The entire project revolves around a lifestyle intervention that has been developed, implemented and evaluated. The intervention included adults with ADHD and comorbid mental illness. ADHD (Attention Deficiency Hyperactive Disorder) is a neuropsychiatric diagnosis/disability characterized by attention problems, impulsivity and hyperactivity and can affect education, working life, social relationships and form the basis for impaired lifestyle habits. Previous research shows shortened life expectancy in adults with ADHD, which related to deteriorating lifestyle habits. In the long run, the disability may be the basis for impaired living conditions and lifestyle habits and contribute to the individual's well-being and quality of life. In the field of health sciences, it is important to alleviate suffering, promote health and prevent ill health. Thus, the overall aim of this dissertation is to analyze living conditions among people with ADHD and mental illness, as well as to develop and evaluate a lifestyle intervention for this group.

The PhD project includes four sub-studies: Study I, a qualitative interview study (n = 20) of adults with ADHD and mental illness, aimed at describing experiences of everyday suffering in this group. The analysis showed experiences of both suffering and well-being in living with ADHD. The focus of the suffering was the experience of loneliness, both regarding relationships in life, relationships in health care, but also to ADHD diagnosis and mental illness. Well-being was experienced when diagnosed with ADHD but also in relation to supportive social relationships. Study II, a quantitative descriptive and comparative study, aimed to gain more knowledge about people withADHD and their health situation. One group of people with ADHD (n = 48)was compared to the normal population without ADHD (n = 42). The results showed poorer health outcomes regarding self-perceived general health and the group with ADHD was less weekly physical active but nevertheless had no decreased aerobic fitness compared to the normal population. Study III, aquantitative descriptive study (n = 25), aimed to examine the degree of acceptance of the intervention and its impact on lifestyle habits, health and well-being, MBI and physical fitness. The tests before and after completing intervention showed small positive effects regarding weekly physical activity, quality of life and general- and mental health. Study IV, a qualitative study(n = 15), with adults with ADHD and comorbid mental illness aimed to investigate the experience of participating in a nurse-led lifestyle intervention. The analysis, based on material from interviews, showed that the participants perceived the intervention as supportive, which is related to the interpersonal relationships that arose in the intervention. Through supportive kindship with the other participants in the intervention, lifestyle habits and health experience were improved.

The conclusion of the thesis is that the lifestyle intervention, based on interpersonal relationships and supported kindship, can be useful for making lifestyle changes in adults with ADHD and mental illness. Such support is important because adults with ADHD and mental illness experience a lack of and a desire for social support and has an increased risk of deteriorating health and unhealthy lifestyles. However, future adjustments to the content of the intervention must be made to improve the lifestyle intervention towards more sustainable lifestyle changes. Above all, the lifestyle intervention ought to be continuous. It is also of great importance for further research that insider perspective is used, that is, investigate the professionals' experiences regarding the intervention.

Abstract [sv]

Hela det avhandlingsprojekt som avrapporteras här rör sig kring en livsstilsintervention som utvecklats, genomförts och utvärderats. I interventionen ingick vuxna personer med adhd och psykisk ohälsa. Adhd (Attention Deficiency Hyperactive Disorder) är en neuropsykiatrisktdiagnos/funktionsnedsättning karaktäriserad av uppmärksamhetsproblem, impulsivitet och hyperaktivitet och kan påverka utbildning, arbetsliv, sociala relationer och den fysiska och psykiska hälsan. Funktionsnedsättningen kan i förlängningen utgöra grund för försämrade livsvillkor och livsstilsvanor och bidra till individens välmående och livskvalitet.

Forskning visar på en förkortad livslängd hos vuxna med adhd som också har med försämrade livsstilsvanor att göra. Inom det hälsovetenskapliga området är det viktigt att lindra lidande, främja hälsa och förebygga ohälsa. Därmed är det övergripande syftet med denna avhandling att analysera levnadsomständigheter bland personer med adhd och psykisk ohälsa samt att utveckla och utvärdera en livsstilsintervention för denna grupp.

Avhandlingsprojektet inkluderar fyra delstudier: Studie I, en kvalitativintervjustudie (n=20) med vuxna personer med adhd och psykisk ohälsa, syftade till att beskriva upplevelser av lidande i vardagen bland vuxna med adhd och psykisk ohälsa. Analysen påvisade upplevelser av både lidande och välbefinnande vad gäller att leva med adhd. Fokus i lidandet var upplevelsen av ensamhet både gällande relationer i livet, stödjande relationer i vården men också till adhd diagnosen och psykisk ohälsa. Välbefinnande upplevdes när deltagarna diagnostiserades med adhd men också i relation till stödjande sociala relationer. Studie II, en kvantitativ beskrivande och jämförande studie, syftade till att få mer kunskap om personer med adhd och deras hälsosituation. En grupp personer med adhd (n=48) jämfördes med normalpopulation utan adhd (n=42). Resultaten visade sämre hälsoresultat gällande självupplevd allmän hälsa och gruppen med adhd var mindre fysisk aktiva per vecka men hade trots det inte sämre kondition jämfört med normalbefolkningen. Studie III, en kvantitativ beskrivande studie (n = 25), där syftet var att undersöka grad av acceptans för interventionen och dess påverkan när det gäller livsstilsvanor, hälsa och välbefinnande, BMI och fysisk kondition. Testerna före och efter avslutad grupputbildning visade på små positiva förändringar gällande veckovis fysisk aktivitet, livskvalitet och allmän och mental hälsa. Studie IV, en kvalitativ studie (n=15), med vuxna personer med adhd och samtidig psykisk ohälsa syftade till att undersöka upplevelsen av att delta i sjuksköterskeledd livsstilsintervention. Analysen, baserad på material från intervjuer, visade att deltagarna upplevde interventionen som stödjande vilket relateras till de interpersonella relationer som uppstod i interventionen. Genom stödjande gemenskap med de andra deltagarna i interventionen förbättrades livsstilsvanor och upplevelsen av hälsa.

Avhandlingens slutsats är att den genomförda livsstilsinterventionen, baserad på interpersonella relationer och kontinuerligt stödjande gemenskap med andra, kan vara användbart för att genomföra livsstilsförändringar hos vuxna personer med adhd och psykisk ohälsa. Sådant stöd är viktigt eftersom vuxna med adhd och psykisk ohälsa upplever avsaknad av och en önskan om socialt stöd samt har ökad risk för ohälsosam livsstil och försämrad hälsa. Framtida justeringar av innehållet behövs för att förbättra livsstilsinterventionen mot mera hållbara livsstilsförändringar, men framförallt att livsstilsinterventionen är kontinuerlig. Det är också av stor vikt för vidare forskning att ett utifrån perspektiv används det vill säga att de professionellas upplevelser angående interventionen undersöks.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2020. p. 98
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 315
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-38302 (URN)978-91-88947-38-3 (ISBN)
Public defence
2020-03-06, C312, Sundsvall, 10:30 (Swedish)
Opponent
Supervisors
Note

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 (inskickat), delarbete 4 (manuskript).

At the time of the doctoral defence the following papers were unpublished: paper 3 (submitted), paper 4 (manuscript).

Available from: 2020-01-29 Created: 2020-01-29 Last updated: 2020-01-30Bibliographically approved
Rönngren, Y., Björk, A., Audulv, Å., Enmarker, I., Kristiansen, L. & Haage, D. (2018). Educational nurse-led lifestyle intervention for persons with mental illness.. International Journal of Mental Health Nursing, 27(3), 1022-1031
Open this publication in new window or tab >>Educational nurse-led lifestyle intervention for persons with mental illness.
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2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 3, p. 1022-1031Article in journal (Refereed) Published
Abstract [en]

Although persons with severe mental illness face an increased risk of mortality and of developing negative health outcomes, research has shown that lifestyle interventions can sufficiently support their health. In response, this study examined a nurse-led lifestyle intervention developed in cooperation with members of municipal and county councils to gauge its impact on the quality of life, cognitive performance, walking capacity, and body composition of persons with severe mental illness. Lasting 26 weeks and involving 38 persons with severe mental illness, the intervention prioritised two components: the interpersonal relationships of persons with severe mental illness, staff, and group leaders and group education about physical and mental health. Pre-post intervention measurements of quality of life collected with the Manchester Short Assessment of Quality of Life, cognitive performance with the Frontal Systems Behaviour Scale, walking capacity with a 6-min walk test, and body composition in terms of waist circumference and body mass index were analysed using a nonparametric test Wilcoxon signed-rank test. Results suggest that the intervention afforded significant improvements in the health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference for persons with severe mental illness. However, long-term studies with control groups and that examine parameters related to cardiovascular risk factors are essential to ensure the sustained impact of the intervention.

Keywords
clinical practice, educational intervention, healthy lifestyle support, interpersonal relationship, severe mental illness
National Category
Clinical Medicine
Identifiers
urn:nbn:se:miun:diva-32479 (URN)10.1111/inm.12410 (DOI)000431999300011 ()29171905 (PubMedID)2-s2.0-85035026741 (Scopus ID)
Available from: 2017-12-05 Created: 2017-12-18 Last updated: 2018-05-31Bibliographically approved
Björk, A., Rönngren, Y., Selander, J., Vinberg, S., Hellzén, O. & Olofsson, N. (2018). Health, lifestyle habits, and physical fitness among adults with ADHD compared with a random sample of a Swedish general population. Society, health and vulnerability, 9(1), Article ID UNSP 1553916.
Open this publication in new window or tab >>Health, lifestyle habits, and physical fitness among adults with ADHD compared with a random sample of a Swedish general population
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2018 (English)In: Society, health and vulnerability, E-ISSN 2002-1518, Vol. 9, no 1, article id UNSP 1553916Article in journal (Refereed) Published
Abstract [en]

Background: Persons with Attention Deficit Hyperactive Disorder (ADHD) represent a high-risk population according to health and lifestyles. In the present study, 48 adults with ADHD were recruited to a forthcoming lifestyle intervention. The ADHD sample was matched to a random sample of 42 persons from a Swedish general population that was selected from LIV (a Lifestyle-Performance-Health project).

Objective: To identify potential differences in health, lifestyle habits, and physical fitness between adults with and without ADHD.

Method: Self-reported questionnaires and physical fitness tests.

Results: The ADHD group show worse health outcomes with higher odds ratios for bad general health (OR;13 CI; (3,4–50)), and poorer lifestyle habits with higher odds ratios for low weekly exercise (OR; 3,8 CI; (1,2–13)). When adjusting for education, employment status, and cash margin, the ADHD sample did not show decreased aerobic fitness (OR; 0,9 CI; (0,8–1,0), but lower odds ratios for doing less sit-ups (OR; 0,6 CI; (0,4–0,9)) compared to the general population group.

Conclusion: It is not possible to prove that the ADHD diagnosis itself cause the worse health and lifestyle. Other lifestyle factors may have negative consequences of adult ADHD, such as lower levels of education, less succeed in working life, and minor financial margins.

Keywords
Adult ADHD, general health, lifestyle habits, mental health, fitness test, Swedish general population
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-35207 (URN)10.1080/20021518.2018.1553916 (DOI)000453874400001 ()
Note

Published online: 18 Dec 2018

Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2020-01-29Bibliographically approved
Rönngren, Y., Björk, A., Kristiansen, L., Haage, D., Enmarker, I. & Audulv, Å. (2018). Meeting the needs? Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting. International Journal of Mental Health Nursing, 27(1), 390-399
Open this publication in new window or tab >>Meeting the needs? Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting
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2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 1, p. 390-399Article in journal (Refereed) Published
Abstract [en]

Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle-related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse-led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16–25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse-led programme provides health information-management strategies that could easily be integrated in a primary health-care setting.

Keywords
health information management, mental illness, primary health care, young adult
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-30608 (URN)10.1111/inm.12333 (DOI)000419717100039 ()28374967 (PubMedID)2-s2.0-85017454831 (Scopus ID)
Available from: 2017-04-19 Created: 2017-04-19 Last updated: 2019-08-06Bibliographically approved
Rönngren, Y., Björk, A., Haage, D., Audulv, Å. & Kristiansen, L. (2018). Perspectives of a tailored lifestyle program for people with severe mental illness receiving housing support. Perspectives in psychiatric care, 54(2), 309-316
Open this publication in new window or tab >>Perspectives of a tailored lifestyle program for people with severe mental illness receiving housing support
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2018 (English)In: Perspectives in psychiatric care, ISSN 0031-5990, E-ISSN 1744-6163, Vol. 54, no 2, p. 309-316Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of the present study was to describe the acceptability of the lifestyle program PHYS/CAT and to get information about the tools used for assessment of functional exercise capacity, cognitive performance, and self-health-related quality of life.

Design and Methods

The findings are based on focus groups and the researchers’ experiences of conducting the program as well as using the assessment tools.

Findings

The acceptability of the program and the assessment tools was mainly satisfactory.

Practice Implications

The program with relational, educational, and supportive dimensions may be a promising tool to be integrated into daily nursing care.

Keywords
cognitive support, interpersonal relationship, nurse-led lifestyle intervention, physical activity, severe mental illness
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-32016 (URN)10.1111/ppc.12239 (DOI)000429719400029 ()28901554 (PubMedID)2-s2.0-85029367484 (Scopus ID)
Available from: 2017-11-07 Created: 2017-11-07 Last updated: 2019-02-18Bibliographically approved
Björk, A., Rönngren, Y., Selander, J., Vinberg, S. & Hellzen, O. (2017). Perspectives on Everyday Suffering among People with Adult Attention Deficit Hyperactivity Disorder and Concurrent Mental Disorders. Open Journal of Nursing, 7, 583-598
Open this publication in new window or tab >>Perspectives on Everyday Suffering among People with Adult Attention Deficit Hyperactivity Disorder and Concurrent Mental Disorders
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2017 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 7, p. 583-598Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe the perceptions of everyday suffering among adults with attention deficit hyperactivity disorder (ADHD) and comorbid mental disease. Directed content analysis guided by Eriksson’s theory on human suffering was performed on data from 20 individual interviews. Expressions of both suffering and well-being were identified; the former centred on loneliness and related to life, illness, and care, which supported Eriksson’s theory, whereas expressions of well-being related to ADHD diagnosis and supportive social relationships. Nevertheless, results indicate the need to expand those expressions in order to better contribute to developing a supportive rehabilitation regimen that can provide more interpersonal care.

Keywords
Adult Attention Deficit Hyperactivity Disorder, Directed Content Analysis, Suffering, Supportive Rehabilitation
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-30783 (URN)10.4236/ojn.2017.75044 (DOI)
Available from: 2017-05-28 Created: 2017-05-28 Last updated: 2020-01-29Bibliographically approved
Rönngren, Y., Björk, A., Haage, D. & Kristiansen, L. (2014). LIFEHOPE.EU – Lifestyle & Healthy Outcome in Physical Education: Development of a lifestyle intervention program for people with severe mental illness: Physical activity, dietary changes, and cognitive adaptation training. Journal of Psychiatric and Mental Health Nursing, 21(10), 924-930
Open this publication in new window or tab >>LIFEHOPE.EU – Lifestyle & Healthy Outcome in Physical Education: Development of a lifestyle intervention program for people with severe mental illness: Physical activity, dietary changes, and cognitive adaptation training
2014 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 21, no 10, p. 924-930Article in journal (Refereed) Published
Abstract [en]

People with severe mental illness (SMIs) are more prone to physicalillnesses, increased mortality and cognitive impairments, all of whichnegatively influence their daily lives. Physical activity (PHYS)programmes have helped alleviate SMI. LIFEHOPE is an ongoing researchproject with the purpose of developing a sustainable lifestyleintervention for physical and mental health. PHYS/cognitive adaptationtraining (CAT) is a newly created lifestyle intervention that providesgroup education and is based on CAT. It provides individualized supportfor PHYS and dietary change in a natural nursing environment. The aim ofthis study was to obtain further knowledge for developing a sustainablelifestyle programme by exploring psychiatric clients' experiences withPHYS and lifestyle habits, which we did by interviewing a localreference group, community mental healthcare users and community mentalhealthcare workers. Then, we developed a lifestyle programme for peoplewith SMI using information obtained from these focus group interviews.Our results suggest that there is a need for support and education, aswell as active interventions, in carrying out PHYS and dietary changesamong people with SMIs, and the PHYS/CAT may be a useful strategy.

Keywords
cognitive adaptive training, cognitive disabilities, lifestyle intervention programme, nursing care, physical activity, severe mental illness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-21181 (URN)10.1111/jpm.12175 (DOI)000345321900010 ()2-s2.0-84911195330 (Scopus ID)
Available from: 2014-01-29 Created: 2014-01-29 Last updated: 2018-04-16Bibliographically approved
Kristiansen, L., Björk, A., Kock, V. B., Nilsson, A., Rönngren, Y., Smedberg, A. & Trillo, Å. (2011). Urinary incontinence and newly invented pad technique: patients', close relatives' and nursing staff's experiences and beliefs. International Journal of Urological Nursing, 5(1), 21-30
Open this publication in new window or tab >>Urinary incontinence and newly invented pad technique: patients', close relatives' and nursing staff's experiences and beliefs
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2011 (English)In: International Journal of Urological Nursing, ISSN 1749-7701, E-ISSN 1749-771X, Vol. 5, no 1, p. 21-30Article in journal (Refereed) Published
Abstract [en]

Urinary incontinence (UI) is a major public health issue and considered to be undertreated, costly and often lead to suffering for patients. Close relatives involved in caring for sufferers describe UI as a complicated problem. For older patients, close relatives and staff, it is important with high absorption UI pads in order to have an undisturbed nightly rest and to prevent bedsores. The aim was twofold: to understand older persons', close relatives' and nursing staff's views and experiences of UI, and their experience of using a particular UI pad system with an alarm. A qualitative design with individual and focus-group interviews was used to describe 6 patients', 14 close relatives' and 22 staff's experience of UI. These were analysed by using qualitative manifest analysis. The findings were divided into four categories. The patients expressed that they, due to UI, regarded themselves as burdens to others. The patients, the relatives and some staff experienced UI as a natural consequence of ageing. The UI pad system appeared to be a functional incontinence aid during the night, but more research is needed to develop the product and to find new fields of applications. From all perspectives, it appears that nursing cannot be replaced by technology, though the UI pad system can be a very useful complement in UI nursing care. Complementary use of the UI pad system might lead to a more economically effective and safe use of the existing nursing resources.

Keywords
Close relative; Diaper technology; Experiences; Nursing staff; Patients; Urinary incontinence
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10510 (URN)10.1111/j.1749-771X.2011.01110.x (DOI)000287486000004 ()2-s2.0-79951753174 (Scopus ID)
Available from: 2009-12-04 Created: 2009-12-04 Last updated: 2017-12-12Bibliographically approved
Björk, A., Rönngren, Y., Vinberg, S., Hellzén, O., Wall, E. & Olofsson, N. A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden.
Open this publication in new window or tab >>A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden
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(English)In: Article in journal (Refereed) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-38300 (URN)
Available from: 2020-01-29 Created: 2020-01-29 Last updated: 2020-01-29Bibliographically approved
Björk, A., Rönngren, Y., Hellzén, O. & Wall, E.Being embraced in a meaningful context - a nurse-led lifestyle intervention for adult persons with ADHD.
Open this publication in new window or tab >>Being embraced in a meaningful context - a nurse-led lifestyle intervention for adult persons with ADHD
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-38298 (URN)
Available from: 2020-01-29 Created: 2020-01-29 Last updated: 2020-01-29Bibliographically approved
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