Högskolan i Skövde

The anthropometric index that best predicts cardiometabolic risk remains inconclusive. This study therefore assessed the prevalence of obesity using six indices and compared their associations with obesity-related cardiometabolic disorders. We determined obesity prevalence according to body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio (WHtR), body fat percentage and fat mass index (FMI) using data from the Know Your Heart study (n = 4495, 35–69 years). The areas under the receiver operating characteristic curves (AUCs) provided predictive values of each index for detecting the presence of hypertension, hypercholesterolaemia and diabetes. Age-standardised obesity prevalence significantly varied according to anthropometric index: from 17.2% (FMI) to 75.8% (WHtR) among men and from 23.6% (FMI) to 65.0% (WHtR) among women. WHtR had the strongest association with hypertension (AUC = 0.784; p < 0.001) and with a combination of disorders (AUC = 0.779; p < 0.001) in women. In women, WHtR also had the largest AUCs for hypercholesterolaemia, in men–for hypertension, diabetes and a combination of disorders, although not all the differences from other obesity indices were significant. WHtR exhibited the closest association between hypertension and a combination of disorders in women and was non-inferior compared to other indices in men. 

Background

Sense of Coherence (SOC) relates to an individual’s overall life orientation, and stronger SOC is associated with better health, quality of life, and coping strategies. When our research group used the SOC-13 questionnaire for the first time in Nepal, we identified difficulties in response patterns. The findings necessitated further evaluation of the Nepali version of the SOC-13 questionnaire.

Objective

To qualitatively evaluate the SOC-13 questionnaire in Nepali for cross-cultural adaptation.

Method

Nineteen nurses were interviewed. We used the methodological approach of “think aloud” to obtain a deeper understanding of the interferences of the scales. Transcribed materials were analyzed using a deductive approach through qualitative content analysis. The original translated version of the SOC-13 questionnaire in Nepali was modified by replacing words that were easier to understand.

Result

Participants found the questionnaire content general and non-specific but easy to complete. The nurses experienced that the meanings and sentences in some of the items and response alternatives were difficult to understand. However, the overall comprehensiveness of most items and response alternatives was perceived as good. Nurses’ interpretation of the SOC-items in the translated version of the SOC-13 questionnaire in Nepali matched the original English version. Items that were experienced as difficult in the Nepali language were modified to increase their comprehensiveness. Modified items and response alternatives had the same content as before, but some words and meanings were substituted with easier language.

Conclusion

The current revised version of SOC-13 in Nepali is valid and useful to explore individuals’ overall life orientation and their abilities to deal and cope with various life events in the Nepalese context.

Background: Digital interventions are promising tools to reach adolescents for cardiovascular health promotion.

Purpose: We assessed adolescents’ knowledge, attitude and practice (KAP) regarding cardiovascular disease (CVD), explored opportunities for a digital intervention, and developed a serious game prototype.

Methods: In total, 649 adolescents grades 8-10 were surveyed in a semi-urban community of Nepal regarding KAP of CVD and digital pre-requisites. Eight focus group discussions (FGDs) separately among boys and girls (n=76) provided deeper understanding of CVD perceptions.

Findings: Median (IQR) percent scores for KAP were 70.6 (10.59), 78.5 (8.46) and 69.5 (11.59), respectively. Good KAP (median percent scores >75%) was found in 27.7%, 69% and 27.8% adolescents, respectively. Knowledge (p<0.001), attitude (p=0.025) and practice (p<0.001) was higher among adolescents in private than government schools. Girls had better attitude than boys (<0.001). Furthermore, 98% adolescents had smartphone access and 91.6% had internet access.

In preliminary FGD analyses adolescents mentioned physical, nutritional, mental, environmental and hereditary causes for CVD. Financial and work-related burdens, plus psychological and family-related issues were perceived to influence CVD severity. Junk food and physical inactivity were health barriers. Adolescents perceived serious games as beneficial and easy to use. Challenging game and attractive visuals were thought to stimulate game use.

Conclusion: With good attitude and excellent digital prerequisites, we conclude that serious games can help fill the existing gaps in knowledge and practice in Nepal. A prototype of “Happy Heart” is being pilot-tested among adolescents as a promising way for digital cardiovascular health promotion.

Background

Stronger Sense of Coherence (SOC) associates with better health, quality of life, and coping strategies. We translated and applied the SOC-13 questionnaire for the first time in Nepal. In this process we identified difficulties in response patterns. The findings necessitated further evaluation of the Nepali version of the questionnaire.

Purpose of the study

To qualitatively evaluate the SOC-13 questionnaire in Nepali for cross-cultural adaptation.

Methods and Theory

Nineteen registered nurses from Nepal were asked to respond to the SOC-13 questionnaire in Nepalese, in order to receive their thoughts and understanding of SOC-13, inspired by the “think-aloud” method. Transcribed materials were analyzed using a deductive approach through qualitative content analysis.

Findings

Participants described the questionnaire content as general and non-specific but easy to complete. The overall comprehensiveness and response alternatives were perceived as good, even if there were some items and response alternatives that were difficult to understand according to the nurses. Nurses’ interpretation of the SOC items in the translated version of the SOC-13 questionnaire in Nepali matched the original English version. Items that were experienced as difficult in the Nepali language were modified to increase their comprehensiveness by substituting with easier language.

Conclusion

The current revised version of the SOC-13 questionnaire in Nepali is valid and useful to explore individuals’ overall life orientation and their abilities to deal with and cope with various life events in the Nepalese context.

Background

Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to explore and thereby gain a deeper understanding of how nurses in Nepal’s hospitals experience their everyday work, with a focus on promoting and sustaining their work-related health.

Methods

A qualitative design with semi-structured individual interviews were used. Nineteen registered nurses working at hospitals in Kathmandu Valley, Nepal, were individually interviewed between October 6 and December 5, 2018. Transcribed interviews were analyzed through thematic analysis.

Results

Four main themes with belonging eight subthemes were constructed from the analysis: (1) “Sense of meaningfulness and belongingness in work culture” with subthemes; “Open environment” and “Sharing attitude and cooperating for the entire team” (2) “Support and rewards from the management team” with subthemes; “Lacking managerial support” and “Fair evaluation and job promotion opportunities”(3) “Workload and protection against work-related hazards” with subthemes; “Stressful and multitasking in workload” and “Lacking equipment for own health and caring”, and (4) “Motivation through opportunities and activities” with subthemes; “Employment benefits that motivate work”, and “Activities outside of work needed to recover”. These main themes and subthemes described nurses’ facilitators for and barriers to their work environment and health.

Conclusion

Our study highlighted nurses’ experiences with facilitators and barriers to their work-related health. Nurses’ work-related health was positively affected by support from colleagues, managers, and the organization. Conversely, less support from managers, lack of equipment, and unfair judgment were barriers to nurses’ work-related health. This study adds new knowledge about nurses’ work-related health from the context of Nepal. Hospital organizations and nursing managers in similar cultural and healthcare settings can apply the results of our study to develop strategies to promote and sustain nurses’ health and prevent work-related illness.

Background

Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals’ job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes?

Methods

Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression.

Results

Nursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout.

Conclusions

Nursing professionals’ job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

Associations between obesity and socio-demographic and behavioral characteristics varybetween populations. Exploring such differences should throw light on factors related to obesity. Weexamined associations between general obesity (GO, defined by body mass index) and abdominalobesity (AO, defined by waist-to-hip ratio) and sex, age, socio-economic characteristics (education,financial situation, marital status), smoking and alcohol consumption in women and men aged40–69 yearsfrom the Know Your Heart study (KYH, Russia,N= 4121, 2015–2018) and the seventhTromsø Study (Tromsø7, Norway,N= 17,646, 2015–2016). Age-standardized prevalence of GO andAO was higher in KYH compared to Tromsø7 women (36.7 vs. 22.0% and 44.2 vs. 18.4%, respectively)and similar among men (26.0 vs. 25.7% and 74.8 vs. 72.2%, respectively). The positive associationof age with GO and AO was stronger in KYH vs. Tromsø7 women and for AO it was stronger inmen in Tromsø7 vs. KYH. Associations between GO and socio-economic characteristics were similarin KYH and Tromsø7, except for a stronger association with living with spouse/partner in KYHmen. Smoking had a positive association with AO in men in Tromsø7 and in women in both studies.Frequent drinking was negatively associated with GO and AO in Tromsø7 participants and positivelyassociated with GO in KYH men. We found similar obesity prevalence in Russian and Norwegianmen but higher obesity prevalence in Russian compared to Norwegian women. Other results suggestthat the stronger association of obesity with age in Russian women is the major driver of the higherobesity prevalence among them compared to women in Norway.

Games for health is one of the most prominent areas for serious games, i.e. games with a purpose beyond only entertainment. The purpose of a health game may be to inform about health related issues; promote healthy lifestyles and even to drive behavioral change. This paper outlines the initial game design considerations and some future research directions for a game focusing on cardiovascular health. As the overall aim of the project is to promote a healthy lifestyle through diet and physical activity to prevent future cardiovascular disease, we focused on “taking care of your heart” as the basis for the game. Hence we call the game Happy Heart and use a heart symbol as a non-playable character (NPC) that the player needs to take care of. To some extent we are inspired by the electronic Tamagochi toys (Bandai) where players need to take care of a digital pet. The heart symbol is universal and is also an ideograph that expresses the concept of love and as such it transcends language barriers.

The burden of non-communicable diseases (NCD) is rapidly increasing across the world. Today they are the main drivers of morbidity, disability, and mortality in low- and middle income countries (LMICs), and are expected to increase due to unhealthy lifestyles in the wake of ongoing societal changes [1]. Among the major risk factors in many LMICs are poor diet, insufficient physical activity, tobacco and alcohol consumption, and exposure to hazardous substances, e.g. from air pollution. LMICs currently contribute three quarters of the deaths from NCD.

Among the NCD, cardiovascular diseases are the most common cause of hospitalization in Nepal [1]. Digitalization and collaboration with the education sector (e.g. community schools) in health promotion interventions could further improve children’s behavior by targeting factors that affect their lifestyle outside the family environment [4]. Hence, the Digital Game Based Learning approach.

Background

Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal.

Objective

To determine and evaluate women’s SOC before and after a health education intervention.

Method

This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban Jhaukhel-Duwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA.

Result

Women’s total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At follow-up three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001).

Conclusion

Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.