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Stödjande gemenskap: Utveckling och utvärdering av en intervention för livsstilsförändring bland vuxna med adhd
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
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: urn:nbn:se:miun:diva-38302ISBN: 978-91-88947-38-3 (print)OAI: oai:DiVA.org:miun-38302DiVA, id: diva2:1389334
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
List of papers
1. Perspectives on Everyday Suffering among People with Adult Attention Deficit Hyperactivity Disorder and Concurrent Mental Disorders
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
2. Health, lifestyle habits, and physical fitness among adults with ADHD compared with a random sample of a Swedish general population
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
3. 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
4. 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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