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Adaptation and validation of a positive health scale for adolescents
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.ORCID iD: 0000-0003-2239-5683
Mid Sweden University, Faculty of Human Sciences, Department of Education.ORCID iD: 0000-0002-8731-8040
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.ORCID iD: 0000-0003-2148-8044
2014 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 119, no 2, 1079-1093 p.Article in journal (Refereed) Published
Abstract [en]

There is a demonstrated need to develop alternative approaches to measuring health from a positive health perspective in order to support systematic planning and evaluation of health promotion in schools. The Salutogenic Health Indicator Scale (SHIS) aims to measure health from a positive perspective, However, it has not been developed, or previously been tested, for use with adolescents between the ages of 12 and 16, at which age youth often exhibit a need for extra support in order to be successful in school and life. Inspired by the SHIS, we generated a Positive Health Scale (PHS) appropriate for 12-16-year-olds and determined its validity and reliability using principal component analysis (PCA). In the study, the scale was tested in a sample of 1,527 Grade 6-9 students, using PCA. The findings indicated the need to reduce the scale to nine items, which was then shown to be valid and reliable for use with both adolescent boys and adolescent girls. We conclude that the PHS can be used in systematic health promotion planning and evaluation. Communities and schools can use this scale to examine and improve health determinants in different adolescent settings.

Place, publisher, year, edition, pages
2014. Vol. 119, no 2, 1079-1093 p.
Keyword [en]
adolescents; health promotion; measuring; positive health; principal component analysis (PCA)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-20148DOI: 10.1007/s11205-013-0516-3ISI: 000343223100031Scopus ID: 2-s2.0-84887598906OAI: oai:DiVA.org:miun-20148DiVA: diva2:662135
Note

Published online 20 Nov 2013.

Erratum published online 30 Nov 2013.

Erratum published DOI 10.1107/s11205-013-0517-2

Available from: 2013-11-06 Created: 2013-11-06 Last updated: 2016-09-26Bibliographically approved
In thesis
1. Där eleverna är: Ett arenaperspektiv på skolan som en stödjande miljö för hälsa
Open this publication in new window or tab >>Där eleverna är: Ett arenaperspektiv på skolan som en stödjande miljö för hälsa
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Hälsa skapas inte i ett vakuum utan i relation mellan individer och omgivning. Skolan är därför en viktig arena för barn och ungdomar eftersom de tillbringar större delen av sin vakna tid där. Tidigare forskning har framförallt riktats mot riskfaktorer relaterade till barn och ungas psykiska ohälsa, mindre mot vad som främjar och stärker möjligheterna till deras positiva hälsa. Genom ett salutogent perspektiv kan kunskap erhållas om faktorer som bidrar till en stödjande miljö för hälsa. För att få förståelse för nya generationers behov och värderingar behöver elever göras delaktiga i studier och utveckling av sin egen vardagsmiljö.

Avhandlingens syfte var att studera skolan som en stödjande miljö för hälsa genom att involvera elever och att finna metoder för att studera de positiva aspekterna av hälsa. Artiklarnas syften inkluderade utmaningar och möjligheter att använda en metod för ökad delaktighet, fördjupa förståelsen om aspekter som främjar hälsa och lärande, med särskilt fokus på delaktighet och stöd samt hur positiv hälsa kan mätas.

Elever på en gymnasieskola valdes som deltagare i två kvalitativa studier. Metoden photovoice studerades genom ljudinspelning av elevernas dialog under arbetet med photovoice och deras och lärarnas synpunkter under fokusgruppsintervjuerna. Data analyserades med innehållsanalys (I). Grundad teori användes för att studera elevernas syn på vad som var viktigt för hälsa och lärande (II). En enkät användes för att ta fram en positiv hälsoskala och för att studera faktorer associerade till hälsa bland elever årskurs 6-9. Enkäten besvarades av 1527 elever (52,3% flickor, 47,7% pojkar) i årskurs 6-9 i skolorna i Östersunds kommun. Svarsfrekvensen var 80%. En principalkomponentanalys användes anpassa och validera en positiv hälsoskala till åldersgruppen 12-16 år (III). För att studera associationen mellan faktorer som kunde vara associerade till positiv hälsa valdes multipel logistisk regressionsanalys (IV).

Resultatet visade att photovoice fungerade som en metod i gymnasieskolan för ökad delaktighet i frågor relaterade till hälsa och lärande. Metoden behövde dock anpassas till elevgruppen. Photovoice upplevdes som stimulerande men också utmanade av både lärare och elever. Kritiska aspekter för metodens användbarhet var knutna till lärarrollen och den demokratiska organisationen (I). Elevernas syn på vad som främjade hälsa och lärande var relaterat till bemötande, personligt och pedagogiskt stöd samt möjligheter till återhämtning. Resultatet visade också att eleverna upplevde att skolan bidrog till att skapa skillnad mellan dem som upplevde sig vara låg- respektive högpresterande (II). Den positiva hälsoskalan (PHS) visade sig vara valid för elever 12-16 år och skalan bör kunna användas i ett sytematiskt hälsofrämjande arbetet där utgångspunkten är ett salutogent perspektiv (III). Faktorer associerade till positiv hälsa bland flickor och pojkar, 12-16 år, var: upplevd delaktighet i klassrummet, stöd från lärare och kamrater samt stöd från båda föräldrarna. Socioekonomisk status, mätt som att ha pengar som kompisar, visade sig vara oberoende associerat till positiv hälsa (IV).

Slutsatsen var att betydelsefulla faktorer för en stödjande miljö för hälsa i skolan är; elevers upplevelse av och möjlighet till delaktighet i klassrummet och i skolans arbetsmiljö, personligt stöd från lärare såväl som stöd i undervisningen, stöd från kamrater och förutsättningar för återhämtning under och efter skoldagen. Samtidigt visade resultatet att det finns skillnader mellan olika grupper av elever relaterat till hälsa och stöd.

För att utveckla en stödjande miljö för hälsa i skolan kan photovoice användas för att involvera eleverna och upptäcka unika aspekter på den enskilda skolan. Med hjälp av den positiva hälsoskalan (PHS) kan främjande faktorer kartläggas, vilket ökar möjligheterna till ett systematiskt hälsofrämjande arbete med ett salutogent perspektiv.

Abstract [en]

Health is not created in a vacuum but in the relationship between individuals and their surroundings. School is therefore an important arena for children and youth since they spend the majority of their waking hours there. Earlier research has been particularly focused on risk factors related to mental illness in children and youth, rather than what promotes and strengthens their possibilities for positive health. Through a salutogenic approach, one can obtain knowledge about factors that contribute to a supportive environment for health. In order to gain understanding of the needs and values of new generations, students need to be made a part of their studies and the development of their own everyday environment.

The aim of the dissertation was to study school as a supportive environment for health by involving students and finding methods of studying the positive aspects of health. The aim of the articles included challenges and possibilities for using a method to increase participation, deepen the understanding about aspects that promote health and learning, with a special focus on participation and support and how positive health can be measured.

Students in a high school were chosen to be the participants in two qualitative studies. The method of photovoice was studied through sound recordings of the students’ dialogue during their work with photovoice and their points of view as well as the teachers’ during the focus group interviews. Data was analyzed by using content analysis (Paper I). Grounded theory was used to study the students’ view of what is important to health and learning (Paper II). A survey was used to create a positive health scale and to study factors associated with health among students in grades 6-9. The survey was taken by 1527 students (52,3% girls, 47,7% boys) in grades 6-9 in schools in the municipality of Östersund. The response rate was 80%. A principal component analysis was used to adjust and validate a positive health scale for the age group 12-16 (Paper III). In order to study the association between factors that might be associated with positive health, a multiple logistic regression was chosen (Paper IV).

The results showed that photovoice worked as a method in high school to increase participation in matters related to health and learning. However the method needed to be adjusted to the student group. Photovoice was perceived as stimulating but also challenging by both teachers and students. Critical aspects were tied to the teacher role and the democratic organization (Paper I). The students’ view of what promoted health and learning were related to treatment, personal and pedagogical support and the potential for recovery. The results also showed that students regarded school as something that creates distinction between those who perceived themselves as under or over achievers (Paper II). The positive health scale (PHS) proved to be valid for students 12-16 years old and the scale should be useful for work with systematic health promotion where the starting point is a salutogenic perspective (Paper III). Factors associated with positive health among girls and boys age 12-16 were: a perceived participation in the classroom, support from teachers and friends and support from both parents. Socioeconomic status, measured as having as much money as pupils, was shown to be independently associated with positive health (Paper IV).

The conclusion was that important factors for a supportive environment for health were; students’ perception of and possibility to participate in the classroom and in the school’s work environment, personal support from teachers and support in their education, support from friends and conditions that permit recovery during and after school. At the same time the results showed that there are distinctions between different groups of students in relation to health and support.

In order to develop a supportive environment for health in schools, photovoice can be used to engage students and discover unique aspects of the individual school. With the help of the positive health scale (PHS), promoting factors can be examined, which increases the possibilities for systematic health promoting work with a salutogenic perspective.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet, 2013. 98 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 174
Keyword
adolescents, empowerment, health promotion, participation, positive health, salutogenic, settingsapproach, pupils, support, supportiv environment, students, teenagers, recuperation, youth, arenabaserat, barn, delaktighet, elever, empowerment, hälsofrämjande, positiv hälsa, salutogenes, stödjande miljö, tonåringar, ungdomar, återhämtning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-20149 (URN)978-91-87557-20-0 (ISBN)
Public defence
2013-11-29, F229, Mittuniversitetet, Östersund, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2013-11-06 Created: 2013-11-06 Last updated: 2014-02-03Bibliographically approved

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