Research on collaborative work for health in children and youth, Norrbottens Municipalities
I) How do professionals, children and young people experience the health dialogue, and what are their thoughts on how to promote health literacy and contribute to health equity?
II) How can learning and health be described and understood from a health education perspective and an educational practice?
III) How can a common agenda to promote children s and young people s health be outlined from the perspectives of professionals, children and young people?
IV) How does participating actors create and perceive health promotion approaches and health promoting organizations in order to collaborate on children's and young people's health issues?
Background to the flexit research project
The title of the Flexit research project was initially ”Samverkande hälsoarbete för barn och unga i Norrbotten”, however after a few months the project was named “Hälsoskolan i Norrbotten” - “School of Health in Norrbotten” in English. The theories of health promotion were the point of departure with focus on empowerment and participatory, appreciative action research. The aim of the research project was to describe and understand the participating actors' experiences of health promotion approaches to promote children's and young people's health, as well as a common agenda to increase health literacy and contribute to health equity in Norrbotten. The participants in the research project came from Norrbotten and were students in grades 4, 7 and 9 and grade 1 in high school, young people outside the school and the labor market, school leaders, teachers, student health personnel and other actors such as representatives from the police, municipal and regional politicians, social services, health care providers and from civil society for example from a support organisation for young women (Tjejjouren), patient organizations, the The Church of Sweden and the Norrbotten Sports Association (Norrbottens Idrottsförbund). Quantitative and qualitative methods such as surveys, focus groups, individual interviews and workshops were used to answer the following research questions:
I) How do professionals, children and young people experience the health dialogue, and what are their thoughts on how to promote health literacy and contribute to health equity?
II) How can learning and health be described and understood from a health education perspective and an educational practice?
III) How can a common agenda to promote children's and young people's health be outlined from the perspectives of professionals, children and young people?
IV) How does participating actors create and perceive health promotion approaches and health promoting organizations in order to collaborate on children’s and young people’s health issues?
Publications
The Flexit project resulted in 35 publications. These 35 publications include 10 articles in scientific peer reviewed journals, 3 book chapters, 20 conference proceedings which 15 were presented at international scientific conferences (peer reviewed abstracts) and 5 at other conferences, and 2 popular science texts.
Abstract summary of articles in peer scientific peer reviewed journals
As described above quantitative and qualitative methods such as surveys, focus groups, individual interviews and workshops were used to answer the research questions. Here is an abstract summary of articles in peer scientific peer reviewed journals to describe the findings. The links to the articles can be found in the list of publications below. Additional answers to the research questions can also be found in other forms of publications listed at the end.
School Nurses’ Experiences with health dialogues: A Swedish case
The aim of this study was to describe school nurses’ experiences with health dialogues and elicit their thoughts about how schools can reach the full potential in promoting students’ health literacy and learning. The phenomenological analysis resulted in four themes: (i) A golden opportunity . . . or not, (ii) Like a double-edged sword, (iii) Able or unable organizations, and (iv) Visions of good conditions for health and learning. School nurses’ experiences revealed that health dialogues are beneficial and can be valuable tools in promoting health and learning when (1) the health dialogues are an important part of the educational assignment, (2) school nurses are valued for fulfilling the educational assignment, and their work conditions are reasonable, (3) the results from the health dialogues and health questionnaires are used systematically to promote health and learning, (4) a
“whole-school approach” is used to build enabling relationships among all school staff and students.
Open letters about health dialogues reveal school staff and students’ expectations of school health promotion leadership
The study explores to what extent health promotion policy in practice and leadership engagement is reflected in school actors’ experiences of health dialogues (HDs) and their ideas about promoting health and learning in schools. The 93 participants consisted of 44 school nurses, 37 students in grades 4, 7 or the first year of high school and 12 teachers, who shared their experiences with HDs by writing open letters. The qualitative content analysis resulted in four themes: Putting health on the agenda, Finding a common goal, Walking side by side and Pointing out a healthy direction. The participants’ expectations of school health promotion leadership are revealed in suggestions on how the HDs can fulfil both the educational assignment and promote student health. Based on the findings, we argue that for successful school health promotion leaders need to acknowledge the field of tension where leadership has to take place, anchor health promotion policy and administer “a Sandwich approach” – a top-down and bottom-up leadership simultaneously that facilitates school-based health promotion. When different school actors (school nurses, teachers and students) are given a voice, a collective picture of HDs can emerge and help develop health promotion practices.
Främja psykisk hälsa – elevers erfarenheter och förslag visar vägen för skolan
The aim was to increase the understanding for students’ experiences of mental health and their suggestions on how mental health can be promoted in school. A secondary analysis was performed of data from four previous studies with a total of 76 students, 36 boys 40 girls, 10-21 years. The ana¬lysis resulted in three themes; School feels open minded, We have invigorating relationships and I feel safe and acknowledged. The students described a school with a salutogenic perspective in which mental ill-health is acknowledged and accepted. They emphasized the importance of adults taking responsibility for health-promoting relationships. The students wished to feel good enough and appreciate predictable structures and positive expectations from adults. Participatory processes at the organizational, group and individual levels are discussed and practical implications are suggested.
Room for interpersonal relationships in online educational spaces – a philosophical discussion
To explore interpersonal relationships within online educational spaces and to connect the discussion to health and well-being among students and teachers. We apply different perspectives to analyse the complexity of interpersonal relationships in online educational spaces, based on the philosophies of Nel Nodding, Maurice Merleau-Ponty, and Alfred Schutz. We use a qualitative methodological combination—philosophical explorations, literature review, and text analysis—to offer significant insights that will substantially inform contemporary theories in research addressing interpersonal relationships in online education. We illuminate and theorize about interpersonal relationships in terms of being cared for, confirmed by, and connected to others as dimensions of significance for health and wellbeing in educational spaces in the form of flexible online courses at the university level. We argue that all education should strive to provide caring relationships and educate for both self-understanding and group understanding, and contribute to school as a place where happiness and joy for genuine learning and knowledge are promoted. To achieve this, it is of significance to also be connected to and confirmed by others, teachers as well as students, and also to exist in a (class)room that provides room for interpersonal relationships: in real life or online.
“When I feel well all over, I study and learn better” - experiences of good conditions for health and learning in schools in the Arctic region of Sweden
A challenge facing the Arctic region is the disengagement of both education and work among its youth. Only by supporting young people who are struggling with mental and physical health challenges can we begin to address this societal challenge. Education, mental health and social inclusion are prominent factors for future employment, income and independent living for young people. The aim of this study was to describe and understand the experiences of good conditions for health and learning in schools in the Arctic region. The 5-D appreciative inquiry method was used to explore 47 students’ and professionals’ experiences and future visions of their school. A phenomenological analysis resulted in three themes: “Standing as one”, “Having an apple a day”, and “Finding the end of the rainbow”. The findings revealed the necessity of promoting health and learning simultaneously in school and viewing health holistically. Health-promoting relationships permeate the findings of good conditions for health and learning. We argue for considering mandatory health education to increase students’ health literacy and making student participation and staff collaboration a priority in schools in the Arctic region. These findings, their practical implications, and future research directions are discussed.
Young migrants’ experiences of and conditions for health - A photovoice study
Visualization and expression of health-related experiences and conditions by young migrants from five different countries residing in Sweden were examined in this study. Using photovoice, the participants were invited to describe and discuss their experiences in three stages: (a) document and portray their everyday lives by taking pictures, (b) discuss their findings, and (c) present their views on health to the adults who are present in their everyday life and that are important for improving young migrants’ health conditions. The overall findings indicate that temporal, spatial, and social conditions are important for the well-being of these young migrants. Thus, in order for the young migrants to feel well in a new cultural context, a search for meaning and meaningfulness in relation to time, place, and other people was important. These findings are discussed in light of social, mental, and existential health dimensions and in relation to the selected study methods.
Promoting mental health in school - young people from Scotland and Sweden sharing their perspectives The rate of mental ill health has increased among children and youth during the past decade in Scotland and Sweden. School is important in influencing both health and education. The starting point for health promotion in school involves those who are affected, the students. The aim of this study was to describe and understand how mental health can be promoted in school from the perspective of young people. A total of 14 Scottish and Swedish young people aged 15–21, 11 girls and 3 boys from 3 municipalities,
participated in 4 focus groups. The phenomenological analysis resulted in one main
theme: Everyone is being there for each other encompassing three themes without any relative order of precedence: being in a safe, inclusive, and well-informed space; meeting adults who are available, listening, and taking action; and feeling significant and being of significance to others. Based on these findings, we suggest the following aspects to be essential when aiming to promote mental health in schools: (1) value and appreciate young people’s experiences, (2) view everyone in school regardless of age or profession to be an important piece in the mental health promotion puzzle by adopting a “whole school approach,” (3) foster a listening culture that focuses on building enabling relationships, (4) promote health and learning simultaneously to increase health literacy, (5) educate about mental health to minimize stigma and increase confidence in taking appropriate action.
Positive self-reported health might be an important determinant of student's experiences of high school in northern Sweden
There is a need for more knowledge about positive health determinants in the school setting. The overall aim of this study was to analyse if positive self-reported health is associated with experiences of school among high-school students. Data originated from the health dialogue questionnaire answered by students in grade 1 of high school. A total of 5035 students participated from the academic years 2013 to 2016. Logistic regression with positive odds ratio (POR) was used to analyse associations between positive self-reported health and school experiences. There was an association between positive self-reported health and school experiences among students. Positive mental health was the strongest predictor for positive school experiences. To frequently participate in Physical Education, have a positive body image and satisfactory sleep nearly doubled the students’ odds for positive school experiences. The results also revealed gender differences; boys more often reported positive experiences of school and positive health than girls. Positive self-reported health is associated with positive experiences of school, particularly mental health. Moreover, these findings have significant implications for how students experience school and demonstrate the importance of including health-promoting interventions in systemic school improvement, meeting both girls’ and boys’ needs.
“My heart has no hurt” – young immigrants health
The purpose of this paper is to explore health from the perspective of young immigrants in Sweden. A total of 25 newly arrived young immigrants attending Swedish language classes in northern Sweden participated by drawing and writing open letters. They continued the open-ended sentence “Now I’ll draw and describe a day when I was feeling good, that was […].” The phenomenological analysis resulted in three themes: longing to be in control for a better life, searching for power in the good and the bad, and striving for a sense of belonging in the new society. The findings illuminate young immigrants’ perspectives of a health-promoting everyday life consisting of agency, reflection and a sense of community. The findings also highlight the young immigrants’ experiences when health-promoting aspects are lacking, characterized by disillusionment, anxiety and loneliness. The findings are discussed with health promotion, health literacy and young immigrants in mind. According to young immigrants, meeting basic needs such as food, sleep and housing is health promoting but easily taken for granted. Being able to have a say in matters concerning everyday life, social inclusion and finding power in memories – positive and negative – can promote health in young immigrants. The young immigrants were able to communicate via drawings and words to overcome language barriers.
Appreciative student voice model - reflecting on an appreciative inquiry research method for facilitating student voice processes
The aim of this paper is to describe and discuss Appreciative Inquiry (AI) as a research method to facilitate student voice in school research. The paper sets out a model for conducting AI in schools. The research questions identified are: What are the researcher’s reflections when using Appreciative Inquiry in school research? What challenges and opportunities can be found when using Appreciative Inquiry in research processes with students? An application of the model will be presented and problematised. The conclusions indicate the importance of inviting students to participate in the process of defining research topics, and of using multimodal methods for facilitating students’ exploration of school
experiences. It is also vital that adults support students in imagining and articulating visions on how to improve the school, as well as plans designing for enacting visions. Finally, a ‘whole school approach’ is emphasised for contributing to sustainable appreciative student voice work in schools.