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Background: In Western Australia, the issue of bushfires (wildfires) poses a persistent health risk to both volunteer and career forestry firefighters, populations that have been historically understudied. Aims: This descriptive qualitative study aimed to examine firefighters' level of understanding concerning hazardous exposures, their Personal Protective Equipment (PPE) protocols and their decontamination practices. Methods: Guided by the socioecological model, 23 semi-structured interviews were conducted with firefighters representing both volunteer and forestry sectors. Key results: Results indicate a gap in knowledge regarding the health risks associated with bushfire-generated smoke and contaminants among volunteer firefighters. Forestry firefighters, conversely, showed a greater awareness of these risks. Social dynamics, such as peer pressure, were identified as historical deterrents to PPE use, although recent trends indicate positive change. Forestry firefighters also highlighted systemic shortcomings, including inadequate provision of respiratory protection and lack of decontamination facilities for cleaning themselves and their PPE. Conclusion: This study underscores the critical need for educational initiatives to address these gaps in understanding, along with organisational reforms to promote a culture encouraging PPE use and to provide essential resources for effective decontamination. Implications: This research emphasises that a multi-level approach is essential for safeguarding the health of firefighters in bushfire-prone environments.

Purpose: Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care. Methods: A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings. Results: Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care. Conclusion: Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collabora

Purpose: Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care. Methods: A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings. Results: Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care. Conclusion: Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collabora

The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10–19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) – in the field of sustainability, health, nutrition and/or education – participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6–7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). ‘Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by ‘food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), ‘social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), ‘autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and ‘food availability' (N = 7; urgency (M = 6

BACKGROUND: Mounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the worlds refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan. METHODS: 32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis. RESULTS: Mean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan - with a shared language, religion, and culture - offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging. CONCLUSIONS: Findings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions

BACKGROUND: The Philippines primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. OBJECTIVE: This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. METHODS: We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. RESULTS: Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. CONCLUSIONS: Examining individual

82 p. -- Bibliogr.: p. 43-51, [EUS] Aisian emakumeek gizonezkoek baino jarduera fisiko (JF) gutxiago egiten dutela jakinda eta emakume etorkinek are gutxiago, ikerketa honen helburua, Lasarte-Oriako emakume latinoamerikarrek aisian jarduera fisikoa egiteko dituzten oztopo eta arrazoiak ezagutzea izan zen, baita haien behar eta interesen inguruko informazio lortzea ere. Honetarako, ikuspegi feministak eta eredu sozioekologikoak oinarri hartuta metodologia kualitatiboa erabili zen. Elkarrizketa teknika bitartez, sakontzeko galdeketak eginez, parte-hartzaileen ahotsak, bizipen eta begirada ezagutzea lortu zen. Hauen ahotsetan JF egiteko oztopoak emakumea eta etorkina izateak dakarrenetik, zaintza ardurak dakarren denbora faltaraino. JF egiteko aukerei dagokienean, berriz, JF egiteko arrazoi nagusia askatasun unerako erabiltzen zutela izan zen. Emakumeek etorkizunera begira egindako proposamenen artean adierazi zuten, emakumeei bideratutako jardueren eskaintza zabalduko balute eta diru-sarrerak kontuan hartuko balituzte lagunduko lukeela euren bizi estiloa aldatzen eta JF egiteko aukerak zabaltzen. Ondorioz, emakume hauek emakume izateagatik dituzten zaintza ardurak eta gorputz irudiaren estereotipoen oztopoez gain, migrazio-politikek, besteen begiradek eta gutxiespenek hesi handiagoa sorrarazten dute, JF egiteko orduan eraginez., [ES] Se ha constatado que en su ocio las mujeres realizan menos actividad física que los hombres y las mujeres inmigrantes menos aún. El objetivo de este trabajo fue conocer los hábitos, obstáculos y razones de la actividad física en el tiempo libre de mujeres latinoamericanas de Lasarte-Oria para así, conocer sus necesidades e intereses. Para ello, mediante el método cualitativo, se ha usado como base la prespectiva feminista y el modelo socioecólogico. Mediante la técnica de entrevista se han logrado las voces, vivencias y la mirada de estas mujeres. En general, han destacado los obstáculos, desde lo que conlleva ser mujer e inmigrante hasta lo que suponen las responsabilidades de cuidado. La razón más importante para practicar actividad física fue tener un momento de desconexión. Las mujeres hicieron hincapié en propuestas de mejora para el futuro como ofrecer más actividades dirigidas a mujeres teniendo en cuenta sus ingresos. En consecuencia, además de las barreras asociadas a los estereotipos de la imagen corporal y de las responsabilidades de cuidado que tienen estas mujeres por el hecho de ser mujeres, las políticas migratorias, las miradas ajenas y los menosprecios han puesto de manifiesto una mayor barrera en la práctica de la actividad física., [EN] Women are less active in leisure than men, and more so in immigrant women. The purpose of this study was to recognize the difficulties and the reasons for doing physical activity of Latin women in leisure, and to obtain information about their needs and interests. A qualitative methodology was used based on feminist views and socioecological models. Through conversational techniques, deepening interrogations, the voices of participants became known for their experience and their gaze. The results underlined the inconvenience of being a woman and an immigrant in their voices as well as the lack of time due to caring responsibilities. The main reason to be physically active was that it was their moment of freedom. They pointed out among their proposals for the future, that if they were to extend the offer of activities aimed at women and take into account their income, it would help change their lifestyle and expand their chances of being physically active. Consequently, besides the obstacles such as stereotypes ans caring responsibilities, and stereotyopes related to the body image of these women for being women, they also answered that migration policies, the looks and the diminution of others create a greater barrier to physical activity.

Despite the many benefits of club-organized sports participation for children, studies have shown that sports participation is lower among children from low-income families than among children from middle- or high-income families. Adopting a socioecological perspective, the main aim of our study was to identify and describe experiences of person-environment (PE) misfits in relation to parental facilitation of children's sports participation. We conducted 24 interviews with parents from low-income families. PE misfits were found in multiple behaviors related to the facilitation of children's sports participation: financing sports participation; planning and investing time; transporting children; acquiring, processing, and providing information; and arranging support. Across these PE misfits, influential attributes were found on the individual level (e.g., skills) as well as within the social, policy, physical, and information environment. In response to PE misfits experienced, parents deployed multiple strategies to reduce these PE misfits, aimed at enhancing either themselves (e.g., increasing financial capacities) or their environments (e.g., arranging social support). These results provide an insight into experienced PE misfits that took the form of multiple specific behaviors which parents found difficult while facilitating their children's sports participation. Furthermore, the results provide insight into the environmental and individual attributes that were involved in these PE misfits, and into how parents modified themselves or their environments in order to make their environments more supportive. The study contributes to future research on individual and environmental influences on parental facilitation of their children's sports participation, as well as on the development of multilevel interventions aimed at increasing sports participation among children from low-income families.

Objective: To analyze different types of barriers and facilitators to healthy eating in people with diabetes that attend Grupos de Ayuda Mutua (self-help groups for people with chronic disease) in Sonora, Mexico, and participated in the Meta Salud Diabetes (MSD) program. Methodology: We conducted 136 observations registered in ethnographic field notes of MSD implementation and four post-intervention focus groups. Results: Regional food culture, publicity and abundance of non-healthy food, and difficult access to healthy food are barriers at the different socioecological levels that hinder healthy food selection and consumption among participants. Limitations: More research expanding on the issues observed and the characteristics and experiences of subgroups among people with diabetes is needed. Conclusions: Interventions like MSD that incorporate the needs and possibilities of participants to bring about eating behavior change through peer education and goal follow-up are needed. To make individual behavior change sustainable, these efforts must be accompanied by other actions promoted by health system institutions and other government and civil society sectors., Objetivo: analizar los diferentes tipos de factores que obstaculizan o facilitan la adopción y mantenimiento de hábitos de alimentación saludable en personas con diabetes que asisten a los Grupos de Ayuda Mutua en el estado de Sonora y que participaron en el programa Meta Salud Diabetes (MSD). Metodología: se realizaron 136 observaciones registradas en diarios de campo etnográficos de la implementación de MSD, así como cuatro grupos focales post intervención. Resultados: se destaca la influencia de la cultura alimentaria, la publicidad, la amplia oferta de productos no saludables y el difícil acceso a alimentos saludables como barreras que se expresan en los diferentes niveles socioecológicos, obstaculizando la selección y consumo de alimentos saludables. Limitaciones: Se destaca la necesidad de futuras investigaciones que profundicen en los temas observados y en las características y experiencias de los subgrupos que conforman la población con diabetes. Conclusiones: se requieren programas como MSD que, tomando en cuenta las necesidades y posibilidades de las personas participantes, instrumentan el cambio de hábitos a través de la formación entre pares y el seguimiento de metas. Este esfuerzo debe ser complementado por acciones desde el sector salud y otros sectores de gobierno y de la sociedad en general para que el cambio sea sostenible.

Migrant health has been identified as one of the most pressing issues of the 21st century. Migration experiences are influenced by gender and gender norms and have important implications for the sexual health of migrant women. This systematic review explored socioecological factors influencing sexual health experiences and health outcomes of migrant Asian women living in “Western” high-income countries. PRISMA guidelines were followed and this study was registered with PROSPERO. Five academic databases were searched for peer-reviewed articles published between 2000 and 2019. Of 2415 studies retrieved, 17 met the selection criteria: 12 qualitative, 4 quantitative, and 1 mixed-methods study. The four levels of Bronfenbrenner’s socioecological model were applied to examine the individual, interpersonal, institutional, and societal factors of influence. Most studies (n = 13) reported individual level factors, focusing on knowledge and use of contraceptives. At a societal level, host country sociocultural factors, including gender and cultural norms, influenced knowledge, ability to access and utilise contraceptives, and access to health services. Findings suggest that the public health policy, practice, and research to improve the sexual health of migrant women requires greater consideration of the intersecting factors of gender, culture, and the migration process.

Bakgrund: Samhälls-och hälsoorienteringen till nyanlända är en av de hälsofrämjande insatserna som bedrivs över hela landet och är även lagstadgad. Trots det etableras det inte på samma sätt eller nivå i varje län och forskning visar för att de nyanlända ska kunna finna möjligheterna att etablera sig bör det finnas ett arbete som förhåller sig till den nivån av behov som krävs. Syfte: Syftet med studien är att undersöka hur aktörer arbetar och upplever samhälls-och hälsoinformation för nyanlända och personer med utomnordiskt påbrå samt vilka förutsättningar finns för att genomföra samhälls-och hälsoinformation på modersmål. Metod: En kvalitativ metod användes för att besvara studiens syfte och frågeställning. Kvalitativa semi-strukturerade intervjuer var studiedesignen som valdes för att smala in data. Urvalet bestod av tio intervjupersoner och alla intervjupersoner är aktörer med olika yrken, som är kopplade till integration och nyanlända. Resultat: Studiens resultat påvisade att befintliga samhälls-och hälsoorienteringen upplevs ge både möjligheter och svårigheter när det gäller aktörerna som arbetar med det och deras upplevelse av nyanlända som deltar. En ständig utveckling, ökade resurser och behovsanpassade insatser krävs för en lyckad samhälls-och hälsoorientering som hjälper till att främja hälsan. Slutsats: Resultatet redogjorde att den befintliga samhälls-och hälsoorienterings insatsen har två olika upplevda perspektiv. Det studerade perspektivet som var aktörerna och det andra var mottagarna av insatsen vilket är de nyanlända. Aktörerna upplevdes ha olika behov, upplevelser och uppfattningar av samhälls-och hälsoorienterings insatsen. Studiens fynd redovisade att samhälls-och hälsoorientering på modersmål kommer att gynna och påverka samhället på ett främjande sätt lika mycket som individen själv, samt att förutsättningarna är positiva trots de olika nivåerna av utmaningar som kan påträffa insatsen., Background: Community and health orientation to immigrants is one of the health promotion efforts conducted across the country and is also statutory. Despite this, they do not hold the same quality in each county, which is required to give immigrants the same opportunities to integrate themselves in the new contest. Aim: The purpose of the study is to examine how sectors experience social and health information for immigrants and people with non-Nordic ancestry and the conditions for implementation of social and health information in the native language. Method: A qualitative method was used to answer the questions of the study. Qualitative semi-structured interviews were used. The sample consisted of ten interviewees and all respondents are sectors with different professions, that work with immigrant integration. Results: The results of the study show that existing social and health orientation is perceived to provide both opportunities and difficulties in terms of both perspectives, the actors working with it and immigrants participating. Continuous development, increased resources and needs-based efforts are needed for a successful community and health orientation that helps to promote health. Conclusion: The existing social and health orientation has two different perceived perspectives. The studied perspective was the sectors working with the orientation. Each perspective has different needs, experiences, and perceptions of the orientation. The study's findings showed that orientation in the native language will benefit and influence society as much as the individual, and that the conditions are positive despite the different levels of challenges that may be encountered.

Bakgrund: Samhälls-och hälsoorienteringen till nyanlända är en av de hälsofrämjande insatserna som bedrivs över hela landet och är även lagstadgad. Trots det etableras det inte på samma sätt eller nivå i varje län och forskning visar för att de nyanlända ska kunna finna möjligheterna att etablera sig bör det finnas ett arbete som förhåller sig till den nivån av behov som krävs. Syfte: Syftet med studien är att undersöka hur aktörer arbetar och upplever samhälls-och hälsoinformation för nyanlända och personer med utomnordiskt påbrå samt vilka förutsättningar finns för att genomföra samhälls-och hälsoinformation på modersmål. Metod: En kvalitativ metod användes för att besvara studiens syfte och frågeställning. Kvalitativa semi-strukturerade intervjuer var studiedesignen som valdes för att smala in data. Urvalet bestod av tio intervjupersoner och alla intervjupersoner är aktörer med olika yrken, som är kopplade till integration och nyanlända. Resultat: Studiens resultat påvisade att befintliga samhälls-och hälsoorienteringen upplevs ge både möjligheter och svårigheter när det gäller aktörerna som arbetar med det och deras upplevelse av nyanlända som deltar. En ständig utveckling, ökade resurser och behovsanpassade insatser krävs för en lyckad samhälls-och hälsoorientering som hjälper till att främja hälsan. Slutsats: Resultatet redogjorde att den befintliga samhälls-och hälsoorienterings insatsen har två olika upplevda perspektiv. Det studerade perspektivet som var aktörerna och det andra var mottagarna av insatsen vilket är de nyanlända. Aktörerna upplevdes ha olika behov, upplevelser och uppfattningar av samhälls-och hälsoorienterings insatsen. Studiens fynd redovisade att samhälls-och hälsoorientering på modersmål kommer att gynna och påverka samhället på ett främjande sätt lika mycket som individen själv, samt att förutsättningarna är positiva trots de olika nivåerna av utmaningar som kan påträffa insatsen., Background: Community and health orientation to immigrants is one of the health promotion efforts conducted across the country and is also statutory. Despite this, they do not hold the same quality in each county, which is required to give immigrants the same opportunities to integrate themselves in the new contest. Aim: The purpose of the study is to examine how sectors experience social and health information for immigrants and people with non-Nordic ancestry and the conditions for implementation of social and health information in the native language. Method: A qualitative method was used to answer the questions of the study. Qualitative semi-structured interviews were used. The sample consisted of ten interviewees and all respondents are sectors with different professions, that work with immigrant integration. Results: The results of the study show that existing social and health orientation is perceived to provide both opportunities and difficulties in terms of both perspectives, the actors working with it and immigrants participating. Continuous development, increased resources and needs-based efforts are needed for a successful community and health orientation that helps to promote health. Conclusion: The existing social and health orientation has two different perceived perspectives. The studied perspective was the sectors working with the orientation. Each perspective has different needs, experiences, and perceptions of the orientation. The study's findings showed that orientation in the native language will benefit and influence society as much as the individual, and that the conditions are positive despite the different levels of challenges that may be encountered.

Worldwide, the overwhelming majority of parents initiate chest/breastfeeding at birth. Human milk is regarded as optimal nutrition for infants and the perfect version of milk for the first years of life; lactation also prevents disease in chest/breastfeeders. Most birth parents want to chest/breastfeed and it is seen as central to motherhood. Chest/breastfeeding is often challenging, resulting in early cessation. Exclusive pumping—that is, only expressing/pumping milk rather than nursing directly at the breast/chest—provides an alternative for those who cannot or do not want to nurse, while retaining most chest/breastfeeding benefits. Existing literature on EPing predominantly focuses on neonatal intensive care unit settings, milk composition, and quantitative data, such as secondary analyses of nationwide surveys. Despite the growing numbers of exclusive pumpers, there is little-to-no data concerning the lived experiences of exclusive pumpers, particularly pertaining to support needs and information provision. Through a retrospective, cross-sectional survey of over 2,000 exclusive pumpers and longitudinal follow-up with over 300 participants, the Breastfeeding Without Nursing study collected qualitative and quantitative data to explore their lived experiences, including: why some chest/breastfeeding exclusively pump; how they feel about it; and what information and support they need and where they find it. Themes within four domains—the circumstances surrounding exclusive pumping, affective experiences, information, and support—were identified through inductive thematic analysis. The findings of this analysis, combined with descriptive and statistical analysis of quantitative data, demonstrate that exclusive pumpers, in general, wanted to nurse at the breast, but as a result of a variety of socioecological influences, were unable to. This led to feelings of loss, grief, and anger, but also determination and pride. Participants needed earlier and better information

The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviors related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area. This focus group study will be implemented across seven geographically diverse United States research centers using a semi-structured focus group guide informed by a conceptual framework based on the socioecological model. The study was approved in July 2017. A total of 44 focus groups composed of 6-8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions and urinary symptom experience. Up to 10 of these focus groups will be conducted in Spanish. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes. This foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women. This study has the potential to provide new insights and understanding into adolescent and adult women's lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course. This article is protected by copyright. All rights reserved.

BACKGROUND: Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. METHODS: A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. RESULTS: Thirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2-9.5) and scored high on the depression scales (95 % confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1-31.2). CONCLUSION: The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, includ

BACKGROUND: Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. METHODS: A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. RESULTS: Thirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2-9.5) and scored high on the depression scales (95 % confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1-31.2). CONCLUSION: The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, includ

BACKGROUND: Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. METHODS: A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. RESULTS: Thirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2-9.5) and scored high on the depression scales (95 % confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1-31.2). CONCLUSION: The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, includ

Introduction The beggars are one the most vulnerable and stigmatized groups in the European society and are determined to live in substandard conditions, characterized by lack of sanitation and overcrowdings, and bare the harsh weather conditions to earn their living. Often, they have limited access to healthcare and their lifestyle has a great impact upon their health. However, little is known about their own perceptions of their health and their strategies to keep it. Aim The aim was to explore the Romanian beggars’ perceptions of their health prior to and during begging, the perceived consequences of begging on their health, and their coping strategies to maintain health while begging in Uppsala, Sweden. Method Data was collected from 8 semi-structured interviews in Uppsala, Sweden during March 2015. The collected data was then analysed using manifest qualitative content analysis. Findings The Romanian beggars in Uppsala perceived their health status to be affected through their activity. Physical consequences involved developing new illnesses and conditions, but also aggravating previous health conditions, and mental consequences included degrading and marginalizing effects of begging, but also harassment from passersby. Access to healthcare in Sweden was limited and determined the beggars to develop alternative strategies for health management or to return to Romania for treatment. Conclusion The health status was found to be both negatively and positively affected through complex interactions between the individual and the surrounding levels: social network, community, institutions and society. More attention should be given to this group from all levels to improve their health status.

Introduction The beggars are one the most vulnerable and stigmatized groups in the European society and are determined to live in substandard conditions, characterized by lack of sanitation and overcrowdings, and bare the harsh weather conditions to earn their living. Often, they have limited access to healthcare and their lifestyle has a great impact upon their health. However, little is known about their own perceptions of their health and their strategies to keep it. Aim The aim was to explore the Romanian beggars’ perceptions of their health prior to and during begging, the perceived consequences of begging on their health, and their coping strategies to maintain health while begging in Uppsala, Sweden. Method Data was collected from 8 semi-structured interviews in Uppsala, Sweden during March 2015. The collected data was then analysed using manifest qualitative content analysis. Findings The Romanian beggars in Uppsala perceived their health status to be affected through their activity. Physical consequences involved developing new illnesses and conditions, but also aggravating previous health conditions, and mental consequences included degrading and marginalizing effects of begging, but also harassment from passersby. Access to healthcare in Sweden was limited and determined the beggars to develop alternative strategies for health management or to return to Romania for treatment. Conclusion The health status was found to be both negatively and positively affected through complex interactions between the individual and the surrounding levels: social network, community, institutions and society. More attention should be given to this group from all levels to improve their health status.

BACKGROUND: Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. METHODS: A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. RESULTS: Thirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2-9.5) and scored high on the depression scales (95 % confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1-31.2). CONCLUSION: The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, includ

BACKGROUND: Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. METHODS: A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. RESULTS: Thirty-three percent reported ever having smoked waterpipe (ever use), with 30 % having done so during the last 30 days (current use). Among waterpipe ever users, 60 % had ever smoked cigarettes in comparison to 32 % of non-waterpipe smokers (95 % confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95 % confidence interval 1.2-9.5) and scored high on the depression scales (95 % confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95 % confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95 % confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95 % confidence interval 2.1-31.2). CONCLUSION: The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, includ

El propósito de este artículo es dar cuenta de un modelo socioecológico de inclusión social dirigido a personas en situación de discapacidad, sus cuidadores y la comunidad de la vereda La Balsa del Municipio de Chía, el cual fue construido a través de una experiencia de investigación acción participativa. En la primera fase del proyecto se identificaron los significados que han construido las personas, sus familias y las redes de apoyo alrededor de la discapacidad, los cuales están relacionados con los problemas que deben afrontar en su cotidianidad y revelan que esta condición les permite reconocer su valía y potencialidades. En la segunda fase participaron 42 personas en situación de discapacidad, sus cuidadores, líderes comunitarios y un equipo conformado por profesionales de enfermería, psicología y pedagogía, la cual estuvo dirigida a construir participativamente el modelo a través de foros comunitarios y el uso de estrategias como las metáforas del árbol y del sol que tienen un carácter evaluativo y motivacional, a partir de las cuales se identificaron los núcleos de desarrollo del modelo: personal, familiar, comunitario, de comunicación y de bienestar, los cuales se pondrán en marcha en la tercera fase del proyecto., The purpose of this article is to give an account of the socio-ecological model of inclusion addressed to people who were in a condition of disability, their caregivers and the community of La Balsa district in the town of Chia. During the first phase of the study, the meanings given by the patients, their families and the support networks to the word "disability" were identified and it was found that these meanings were related to the difficulties that disabled people and their families must face in their day-to-day lives and how this condition might allow them to recognize their sheer value and potential. During the second phase, 42 people, among which were disabled individuals, caregivers, community leaders and a team formed by professionals in nursing, psychology and education participated in the process of construction of this model. The recollection of information related to the personal, family, social and community resources was done through a series of community forums and the use of strategies like the tree and sun metaphor, which have an evaluative and motivational character. These resources were central to identifying the nucleus of development at the personal, family, community, communication and well-being levels, which constituted the central elements of the project.

El propósito de este artículo es dar cuenta de un modelo socioecológico de inclusión social dirigido a personas en situación de discapacidad, sus cuidadores y la comunidad de la vereda La Balsa del Municipio de Chía, el cual fue construido a través de una experiencia de investigación acción participativa. En la primera fase del proyecto se identificaron los significados que han construido las personas, sus familias y las redes de apoyo alrededor de la discapacidad, los cuales están relacionados con los problemas que deben afrontar en su cotidianidad y revelan que esta condición les permite reconocer su valía y potencialidades. En la segunda fase participaron 42 personas en situación de discapacidad, sus cuidadores, líderes comunitarios y un equipo conformado por profesionales de enfermería, psicología y pedagogía, la cual estuvo dirigida a construir participativamente el modelo a través de foros comunitarios y el uso de estrategias como las metáforas del árbol y del sol que tienen un carácter evaluativo y motivacional, a partir de las cuales se identificaron los núcleos de desarrollo del modelo: personal, familiar, comunitario, de comunicación y de bienestar, los cuales se pondrán en marcha en la tercera fase del proyecto., The purpose of this article is to give an account of the socio-ecological model of inclusion addressed to people who were in a condition of disability, their caregivers and the community of La Balsa district in the town of Chia. During the first phase of the study, the meanings given by the patients, their families and the support networks to the word "disability" were identified and it was found that these meanings were related to the difficulties that disabled people and their families must face in their day-to-day lives and how this condition might allow them to recognize their sheer value and potential. During the second phase, 42 people, among which were disabled individuals, caregivers, community leaders and a team formed by professionals in nursing, psychology and education participated in the process of construction of this model. The recollection of information related to the personal, family, social and community resources was done through a series of community forums and the use of strategies like the tree and sun metaphor, which have an evaluative and motivational character. These resources were central to identifying the nucleus of development at the personal, family, community, communication and well-being levels, which constituted the central elements of the project.

El propósito de este artículo es dar cuenta de un modelo socioecológico de inclusión social dirigido a personas en situación de discapacidad, sus cuidadores y la comunidad de la vereda La Balsa del Municipio de Chía, el cual fue construido a través de una experiencia de investigación acción participativa. En la primera fase del proyecto se identificaron los significados que han construido las personas, sus familias y las redes de apoyo alrededor de la discapacidad, los cuales están relacionados con los problemas que deben afrontar en su cotidianidad y revelan que esta condición les permite reconocer su valía y potencialidades. En la segunda fase participaron 42 personas en situación de discapacidad, sus cuidadores, líderes comunitarios y un equipo conformado por profesionales de enfermería, psicología y pedagogía, la cual estuvo dirigida a construir participativamente el modelo a través de foros comunitarios y el uso de estrategias como las metáforas del árbol y del sol que tienen un carácter evaluativo y motivacional, a partir de las cuales se identificaron los núcleos de desarrollo del modelo: personal, familiar, comunitario, de comunicación y de bienestar, los cuales se pondrán en marcha en la tercera fase del proyecto., The purpose of this article is to give an account of the socio-ecological model of inclusion addressed to people who were in a condition of disability, their caregivers and the community of La Balsa district in the town of Chia. During the first phase of the study, the meanings given by the patients, their families and the support networks to the word "disability" were identified and it was found that these meanings were related to the difficulties that disabled people and their families must face in their day-to-day lives and how this condition might allow them to recognize their sheer value and potential. During the second phase, 42 people, among which were disabled individuals, caregivers, community leaders and a team formed by professionals in nursing, psychology and education participated in the process of construction of this model. The recollection of information related to the personal, family, social and community resources was done through a series of community forums and the use of strategies like the tree and sun metaphor, which have an evaluative and motivational character. These resources were central to identifying the nucleus of development at the personal, family, community, communication and well-being levels, which constituted the central elements of the project.

El propósito de este artículo es dar cuenta de un modelo socioecológico de inclusión social dirigido a personas en situación de discapacidad, sus cuidadores y la comunidad de la vereda La Balsa del Municipio de Chía, el cual fue construido a través de una experiencia de investigación acción participativa. En la primera fase del proyecto se identificaron los significados que han construido las personas, sus familias y las redes de apoyo alrededor de la discapacidad, los cuales están relacionados con los problemas que deben afrontar en su cotidianidad y revelan que esta condición les permite reconocer su valía y potencialidades. En la segunda fase participaron 42 personas en situación de discapacidad, sus cuidadores, líderes comunitarios y un equipo conformado por profesionales de enfermería, psicología y pedagogía, la cual estuvo dirigida a construir participativamente el modelo a través de foros comunitarios y el uso de estrategias como las metáforas del árbol y del sol que tienen un carácter evaluativo y motivacional, a partir de las cuales se identificaron los núcleos de desarrollo del modelo: personal, familiar, comunitario, de comunicación y de bienestar, los cuales se pondrán en marcha en la tercera fase del proyecto., The purpose of this article is to give an account of the socio-ecological model of inclusion addressed to people who were in a condition of disability, their caregivers and the community of La Balsa district in the town of Chia. During the first phase of the study, the meanings given by the patients, their families and the support networks to the word "disability" were identified and it was found that these meanings were related to the difficulties that disabled people and their families must face in their day-to-day lives and how this condition might allow them to recognize their sheer value and potential. During the second phase, 42 people, among which were disabled individuals, caregivers, community leaders and a team formed by professionals in nursing, psychology and education participated in the process of construction of this model. The recollection of information related to the personal, family, social and community resources was done through a series of community forums and the use of strategies like the tree and sun metaphor, which have an evaluative and motivational character. These resources were central to identifying the nucleus of development at the personal, family, community, communication and well-being levels, which constituted the central elements of the project.

El propósito de este artículo es dar cuenta de un modelo socioecológico de inclusión social dirigido a personas en situación de discapacidad, sus cuidadores y la comunidad de la vereda La Balsa del Municipio de Chía, el cual fue construido a través de una experiencia de investigación acción participativa. En la primera fase del proyecto se identificaron los significados que han construido las personas, sus familias y las redes de apoyo alrededor de la discapacidad, los cuales están relacionados con los problemas que deben afrontar en su cotidianidad y revelan que esta condición les permite reconocer su valía y potencialidades. En la segunda fase participaron 42 personas en situación de discapacidad, sus cuidadores, líderes comunitarios y un equipo conformado por profesionales de enfermería, psicología y pedagogía, la cual estuvo dirigida a construir participativamente el modelo a través de foros comunitarios y el uso de estrategias como las metáforas del árbol y del sol que tienen un carácter evaluativo y motivacional, a partir de las cuales se identificaron los núcleos de desarrollo del modelo: personal, familiar, comunitario, de comunicación y de bienestar, los cuales se pondrán en marcha en la tercera fase del proyecto., The purpose of this article is to give an account of the socio-ecological model of inclusion addressed to people who were in a condition of disability, their caregivers and the community of La Balsa district in the town of Chia. During the first phase of the study, the meanings given by the patients, their families and the support networks to the word "disability" were identified and it was found that these meanings were related to the difficulties that disabled people and their families must face in their day-to-day lives and how this condition might allow them to recognize their sheer value and potential. During the second phase, 42 people, among which were disabled individuals, caregivers, community leaders and a team formed by professionals in nursing, psychology and education participated in the process of construction of this model. The recollection of information related to the personal, family, social and community resources was done through a series of community forums and the use of strategies like the tree and sun metaphor, which have an evaluative and motivational character. These resources were central to identifying the nucleus of development at the personal, family, community, communication and well-being levels, which constituted the central elements of the project.

El propósito de este artículo es dar cuenta de un modelo socioecológico de inclusión social dirigido a personas en situación de discapacidad, sus cuidadores y la comunidad de la vereda La Balsa del Municipio de Chía, el cual fue construido a través de una experiencia de investigación acción participativa. En la primera fase del proyecto se identificaron los significados que han construido las personas, sus familias y las redes de apoyo alrededor de la discapacidad, los cuales están relacionados con los problemas que deben afrontar en su cotidianidad y revelan que esta condición les permite reconocer su valía y potencialidades. En la segunda fase participaron 42 personas en situación de discapacidad, sus cuidadores, líderes comunitarios y un equipo conformado por profesionales de enfermería, psicología y pedagogía, la cual estuvo dirigida a construir participativamente el modelo a través de foros comunitarios y el uso de estrategias como las metáforas del árbol y del sol que tienen un carácter evaluativo y motivacional, a partir de las cuales se identificaron los núcleos de desarrollo del modelo: personal, familiar, comunitario, de comunicación y de bienestar, los cuales se pondrán en marcha en la tercera fase del proyecto., The purpose of this article is to give an account of the socio-ecological model of inclusion addressed to people who were in a condition of disability, their caregivers and the community of La Balsa district in the town of Chia. During the first phase of the study, the meanings given by the patients, their families and the support networks to the word "disability" were identified and it was found that these meanings were related to the difficulties that disabled people and their families must face in their day-to-day lives and how this condition might allow them to recognize their sheer value and potential. During the second phase, 42 people, among which were disabled individuals, caregivers, community leaders and a team formed by professionals in nursing, psychology and education participated in the process of construction of this model. The recollection of information related to the personal, family, social and community resources was done through a series of community forums and the use of strategies like the tree and sun metaphor, which have an evaluative and motivational character. These resources were central to identifying the nucleus of development at the personal, family, community, communication and well-being levels, which constituted the central elements of the project.