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Ungdomstiden er en tid med mange raske utviklinger, blant annet kroppslige, psykologiske og sosiale endringer. Studier har vist at selvfølelse i ungdomstiden kan ha betydning for ulike helsemål både på kort sikt og på lang sikt, og det kan derfor være relevant å vite hva som påvirker selvfølelsen i denne perioden. Fysisk aktivitet har som kjent flere positive innvirkninger på den fysiske helsen, og det er studier som indikerer at det kan være positivt for selvfølelsen også. Men sammenhengene er ofte svake, og resultatene varierer mellom studier, noe som motiverer for mer forskning på temaet. Denne masteroppgaven ser derfor på sammenhengen mellom fysisk aktivitet og selvfølelse hos ungdom. Den består av to separate, men sammenknyttede artikler: en teoretisk artikkel, som ser på den eksisterende litteraturen på feltet, og en empirisk artikkel som undersøker sammenhengen i et utvalg av norske ungdommer. For å forstå sammenhengen mellom fysisk aktivitet og selvfølelse hos ungdom er det viktig å ha kunnskap om begrepene som er involvert, samt om selve ungdomstiden. Den teoretiske artikkelen ser derfor nærmere på dette, i tillegg til å undersøke den teoretiske og empiriske litteraturen på denne sammenhengen. Metoden er litteratursøk, og det er gjennomført søk etter teoretisk og empirisk litteratur på både engelsk og norsk. Et gjentagende funn er at gutter har høyere selvfølelse enn jenter, og at selvfølelsen i ungdomstiden viser seg å være relativ stabil. Noen studier har også funnet at gutter er mer fysisk aktive enn jenter, mens andre ikke har funnet en forskjell mellom kjønnene. Et annet gjentagende funn er at aktivitetsnivået, både trening og hverdagsaktivitet, går ned i løpet av ungdomstiden. Tidligere studier har også funnet en positiv sammenheng mellom fysisk aktivitet og selvfølelse hos ungdom. Samtidig er mange av disse sammenhengene små, studier har kort varighet, i tillegg til at det også er studier som ikke har funnet slike sammenhenger. Ved å bygge på den teoretiske artikkel, så gjennomfører den empiriske artikkelen en kvantitativ undersøkelse med statistiske analyser ved hjelp av data fra tverssnittundersøkelsen «Oppvekst i bygder» som ble gjennomført blant et utvalg norske ungdommer i alderen 13-19 år, høsten 2016. Dens mål er å undersøke kjønnsforskjeller i forbindelse med selvfølelse, stress og fysisk aktivitet, samt sammenhengen mellom fysisk aktivitet, stress og utfallsmålet selvfølelse, kontrollert for sosioøkonomisk status, alder og kjønn. Det blir funnet at gutter scorer signifikant høyere på selvfølelse enn jenter, jenter opplever signifikant mer stress, mens det ikke blir funnet noen kjønnsforskjell i forbindelse med fysisk aktivitet. Stress viser seg å ha en negativ sammenheng med ungdoms selvfølelse, mens det er en signifikant positiv sammenheng mellom fysisk aktivitet og selvfølelse blant ungdom, kontrollert for alle andre faktorer. Som en helhet kan funnene i denne masteroppgaven bidra med videre innsikt i faktorer som har betydning for ungdoms selvfølelse, og kan derav være av relevans for helsefremmende og forebyggende arbeid blant ungdom. The adolescent period is a time with many rapid developments, including bodily-, psychological- and social changes. Studies have shown that self-esteem in adolescence may influence different health outcomes both in the short term and in the long term, and it can therefore be relevant to have knowledge about what influences self-esteem in this period. Physical activity is known to have many positive effects on the physical health, and there are studies indicating that it may have positive effects on self-esteem as well. However, the found associations are often weak, and results vary between studies, motivating further research on this topic. This master’s thesis therefore looks at the association between physical activity and self-esteem in adolescents. It consists of two separate, but interconnected articles: one theoretical article, which looks at the existing literature in the field, and an empirical article looking at the association in a sample of Norwegian adolescents. To understand the association between physical activity and self-esteem in adolescents, it is important to have knowledge about the concepts involved, as well as the adolescent period itself. The theoretical article therefore looks at this more closely, in addition to investigating the theoretical and empirical literature on the association. The method is a literature search, and searches have been conducted for theoretical and empirical literature in both English and Norwegian. A recurring finding is that boys have higher self-esteem than girls, and that self-esteem in adolescence seems to be relatively stable. Moreover, some studies have found that boys are more physical active than girls, while other studies have not found such a difference between genders. Another recurring finding is that physical activity, both exercising and everyday activity, decreases during adolescence. Previous studies have also found a positive association between physical activity and self-esteem in adolescents. At the same time, there are studies who have not found an association, and of those who find an association many of the found associations are weak, and many studies have short duration. Building upon the theoretical article, the empirical article carries out a quantitative investigation with statistical analyses; using data from the cross-sectional survey “Oppvekst I Bygder” which was conducted in autumn 2016 amongst adolescents aged 13-19 in Norway. Its aim is to investigate gender differences on self-esteem, stress and physical activity, and the association between physical activity, stress and the outcome self-esteem, controlled for socioeconomic status, age and gender. It is found that boys score significantly higher on self-esteem than girls, girls experience significantly more stress, while no gender difference is found in relation to physical activity. It is also shown that stress has a negative association with adolescents’ self-esteem, while there is a significant positive association between physical activity and self-esteem in adolescents, controlled for all other factors. As a whole, the findings in this master’s thesis may contribute further insight into factors that are important for adolescents’ self-esteem, and may therefore be of relevance to health promotion and preventive work among adolescents.

Sammendrag Denne oppgaven har som mål å øke forståelsen av familiesentrert omsorg, se på hvilke utfordringer som hindrer implementering i nyfødt intensive avdelinger, samt å se hvilke faktorer som øker foreldres tilstedeværelse og deltakelse i den daglige pleien av barnet sitt. På 1800-tallet ble spedbarn født hjemme og pleid av sine foreldre. Økt medisinsk og teknologisk utvikling gjorde at flere premature og svake nyfødte overlevde og omsorgen for disse barna ble flyttet fra hjemmet til spesialiserte avdelinger på sykehus. Dette førte dette til at barnet ble skilt fra foreldrene og sykepleieren tok over omsorgen for barnet. Flere studier viste til viktigheten av foreldre-barn nærhet, noe som gradvis bidro til at foreldre fikk delta i pleien av barnet på sykehuset. Familiesentrert omsorg ble for første gang kjent av Blake på 1950-tallet med økt oppmerksomheten på betydningen av foreldre-barn nærhet for barnets helse. Flere aspekter knyttet til familiesentrert omsorg I dag som foreldres deltakelse i omsorg, individuell støtte og informasjon og individualisert pleie var komponenter i hennes omsorgsfilosofi. I løpet at de siste 40-50 årene har ulike intervensjoner økt foreldrenes tilstedeværelse og deltakelse i pleien for barnet sitt som amming, kengurupleie og individuell utviklingstilpasset omsorg for barnet. Familiesentrert omsorg har utviklet seg over tid. Først støttet sykepleierne foreldrene i å delta i omsorgen, deretter beskrev de et partnerskap med foreldre for deretter å støtte familien som en enhet. Flere studier har vist at familiesentrert omsorg er knyttet til bedre utfall på både barn og foreldre. Til tross for mye forskning som viser ulike fordeler med å praktisere familiesentrert omsorg på nyfødt intensive avdelinger, er det utfordringer med å implementere modellen. To store barrierer finnes i litteraturen, mangel på sykepleie kunnskaper og ferdigheter i å støtte familien, og barrierer ved avdelingen som utforming, mangel på tid, høyt medisinsk fokus og mangel på støtte fra ledelse. Omsorgskulturen i avdelingen påvirker hvordan hver enkelt sykepleier er villig til å praktisere familiesentrert omsorg. For å bidra til økt foreldre-barn nærhet må sykepleiere ønske foreldre velkommen til å delta i pleien og omsorgen, samt gi veiledning på hvordan de kan lese sitt barns atferd. Sykepleierrollen endrer seg fra å “være den som utfører” og “overvåker” til å bli en som tilrettelegger for at foreldrene kan ha omsorgen for barnet sitt. I November 2016 startet Nyfødt Intensiv på St. Olav´s Hospital implementeringen av den familiesentrerte intervensjonen “Close Collaboration with Parents Training Program”. Close Collaboration with Parents Training Program er utviklet for å bedre helsepersonells ferdigheter i å kommunisere og samarbeide med foreldre I en nyfødt intensive avdelinger. Det er et strukturert treningsprogram som inkluderer alle I helseteamet som jobber med barn og foreldre. Programmet er basert på utviklingsteorier om tidlig nærhet mellom foreldre og barn, og tidlig foreldrerolle. Programmet inneholder fire faser som bygger på hverandre. Læring skjer gjennom teori, erfaring og refleksjon. Effektiviteten av den familiesentrerte intervensjonen Close Collaboration with Parents Training Program ble evaluert gjennom en prospektiv studies om sammenliknet resultater fra før og etter implementeringen. Studien ble gjennomført over 3 måneders perioder med SMS spørsmål til foreldre og WEB spørsmål til sykepleiere om ulike aspekter av familiesentrert omsorg. Resultatene viste at bade mødre, fedre og sykepleiere opplevde kvaliteten på den familiesentrerte omsorgen som bedre etter implementeringen noes om kan indikere at implementering av den familiesentrerte intervensjonen Close Collaboration with Parents Training Program har vært en suksess.

Summary Background: Mental health is an integral component of people’s health and wellbeing, and over the last years, adolescent mental health has received considerable attention as an important public health issue. Mental health literacy (MHL) is considered a significant determinant of mental health, with the potential to benefit both individual and public mental health. Research and practice have generally focused on mental ill-health; however, growing evidence shows the long-term benefits of promoting positive mental health. Positive MHL refers to people’s understanding of how to obtain and maintain good mental health. Health is created within the settings of adolescents’ everyday life; thus, schools represent an important arena for promoting adolescent mental health, and school health services are considered central in Norwegian municipalities' public health work. MEST 1 is a universal work and teaching strategy for school health services that aims to promote mental health by improving adolescents’ positive MHL and mental wellbeing. The aims of this thesis were to develop a measure assessing positive MHL among adolescents, investigate the relationship between positive MHL and mental wellbeing, and finally, begin the process of evaluating MEST. Methods: The participants were Norwegian upper secondary school students aged 15-21 years. The data were mainly collected by survey questionnaires, in addition to five focus group discussions (n=29) for the scale development. A pilot study (n=479) was conducted prior to the quantitative data collection at time one, i.e., fall 2016 (T1 n=1888), and the quantitative data collection at time two, i.e., spring 2017 (T2 n=1054), and a cohort (n=357) was followed from T1 to T2. Factor analysis was used for item reduction and assessment of the psychometric properties of the new measure. A linear regression model was used to investigate the relationship between positive MHL and mental wellbeing. Linear treatment effect modeling was used to estimate the average treatment effect of MEST and describe the observed statistical relationship between MEST participation and the levels of positive MHL and mental wellbeing between the MEST and non-MEST participants. Results: The confirmatory factor analysis yielded a satisfactory fit for a 10-item onefactor model referred to as the mental health-promoting knowledge measure, i.e., MHPK-10. Positive MHL was associated with mental well-being in the study population and found to be a significant explanatory variable of mental well-being (p ≤.01). Positive MHL was significantly increased among the MEST participants compared to that among the non-MEST participants (p = .02). No significant difference was found in mental wellbeing between the MEST and non-MEST participants (p = .98). According to the average treatment effect analyses, MEST resulted in a significant 2.7 % (p = .03) average increase in positive MHL in both genders and a 9.7 % (p = .03) average increase in mental wellbeing among the females. No significant treatment effect of MEST was found in mental wellbeing overall (p = .12) or among males (p = .99). Conclusions: The MHPK-10 measure of positive MHL is an important contribution to the literature on measuring MHL. Positive MHL has been identified as an important concept in mental health promotion work by school health services where a positive association was established between positive MHL and adolescents’ perceived mental health. The results supports positive MHL to be included as an integral part of school health services mental health promotion work. These results further support investments in evaluations of MEST as a potential evidence-based working strategy for school health services' mental health promotion work in Norwegian upper secondary schools. Sammendrag Bakgrunn: Psykiske helse hos ungdom har fått stor oppmerksomhet de siste årene som en folkehelseutfordring som bør adresseres. Psykisk helsekunnskap eller mental health literacy (MHL) anses å være en avgjørende faktor for psykisk helse, både på individnivå og i folkehelsearbeid. Forskning og praksis har tradisjonelt fokusert på psykisk uhelse, mens forskningslitteraturen peker på langsiktige fordeler med å fremme god psykisk helse. Positiv MHL eller psykisk helsefremmende kompetanse er en del av MHL som til nå har fått lite oppmerksomhet. Psykisk helsefremmende kompetanse angår folks forståelse av og kunnskap om hvordan man bygger og opprettholder god psykisk helse. Helse og da også psykisk helse skapes der ungdommene lever sine liv, dermed blir skolen en viktig arena for å fremme ungdoms psykisk helse. Skolehelsetjenesten er en lavterskel og lovpålagt helsetjeneste som er samlokalisert med skolen, og regnes som en sentral aktør i norske kommuners folkehelsearbeid. MEST2 er en universell arbeids- og undervisningsstrategi for skolehelsetjenesten, som tar sikte på å fremme psykisk helse med målsetning om å påvirke ungdommens psykisk helsefremmende kompetanse, samt opplevd mentalt velvære. Formålet med denne doktorgraden var å utvikle et instrument som måler psykisk helsefremmende kompetanse blant ungdommer; å undersøke forholdet mellom psykisk helsefremmende kompetanse og opplevd mentalt velvære, og til slutt å starte prosessen med å evaluere MEST som arbeidsstrategi for skolehelsetjenesten i videregående skole. Metoder: Deltakerne i studiet var ungdom i alderen 15-21 år fra fem videregående skoler i Trondheim kommune. Data ble samlet inn ved hjelp av spørreskjema i tillegg til fem fokusgruppediskusjoner (n=29) som ble brukt i utvikling av måleinstrumentet. En pilotstudie (n = 479) ble utført før kvantitativ datasamling høsten 2016 (T1 n = 1888). Datainnsamling to (T2 n = 1054) ble utført våren 2017. En utvalg av ungdommer (n = 357) ble fulgt fra T1 til T2. I skalautvikling ble faktoranalyse brukt til reduksjon av antall spørsmål og vurdering av skalaens psykometriske egenskaper. Multippel lineær regresjon ble brukt for å undersøke forholdet mellom psykisk helsefremmende kompetanse og mentalt velvære. Lineær behandlingseffektmodellering ble brukt til å estimere gjennomsnittlig behandlingseffekt av MEST; det observerte statistiske forholdet mellom to grupper elever der en gruppe har deltatt i MEST og en gruppe ikke har deltatt i MEST når det gjelder skårer på psykisk helsefremmende kompetanse og mentalt velvære. Resultater: Faktoranalysen ga støtte for et valid og reliabelt endimensjonalt instrument for måling av psykisk helsefremmende kompetanse blant ungdom; MHPK-10. Psykisk helsefremmende kompetanse ble funnet å være en signifikant forklarende variabel av opplevd mentalt velvære blant ungdommene (p = ≤.01). Psykisk helsefremmende kompetanse økte signifikant mer over et skoleår blant MEST-deltakere sammenlignet med ikke-MEST-deltakere (p = .02). Ingen signifikant endring ble funnet i opplevd mentalt velvære mellom MEST og ikke MEST-deltakere (p = .98). Ifølge gjennomsnittlige behandlingseffektanalyser ga MEST en gjennomsnittlig økning på 2,7 % (p = .03) i psykisk helsefremmende kompetanse for begge kjønn, og en gjennomsnittlig økning i mental velvære blant jenter på 9,7% (p = .03). Ingen signifikant behandlingseffekt av MEST ble funnet i mental velvære totalt (p = .12) eller blant gutter (p = .99). Konklusjon: Måleinstrumentet MHPK-10 for psykisk helsefremmende kompetanse er et viktig bidrag i litteraturen om måling av MHL. Psykisk helsefremmende kompetanse har blitt identifisert som viktig i skolehelsetjenestens arbeid, og avhandlingen støtter psykisk helsefremmende kompetanse som en integrert del av skolehelsetjenestens psykisk helsefremmende arbeid. Psykisk helsefremmende kompetanse har vist seg å ha en sammenheng med opplevd psykisk helse hos ungdom og resultatene støtter ytterlige investeringer i videre evalueringer av MEST som en kunnskapsbasert arbeids- og undervisningsstrategi for skolehelsetjenesten i videregående skole. digital fulltext not avialable

Bakgrunn: Forskning viser at til tross for at flesteparten av dagens ungdom er fornøyde med tilværelsen sliter fortsatt en høy andel av ungdomsgenerasjonen daglig med psykiske helseproblemer i større eller mindre grad. Psykiske lidelser har en høy forekomst, både nasjonalt og globalt, og medfører betydelige negative konsekvenser både helsemessig, sosialt og økonomisk. Psykiske problemer og lidelser har ikke bare store konsekvenser for enkeltindividet, men også familier, venner og samfunnet som helhet blir påvirket i ulik grad. Økt kunnskapsnivå omkring psykisk helse, og ikke minst å sikre riktig kompetanse om hvordan man skaffer til veie, oppfatter og benytter seg av helseinformasjon vil kunne virke positivt i det helsefremmende arbeidet. Om man styrker enkeltindividets og samfunnets kunnskap om hvilke determinanter som virker positivt inn på den psykiske helsen vil man kunne bedre evnen til å ta helsefremmende valg. Vi vet i dag en hel del om hvilke faktorer som påvirker psykisk helse både i positiv og negativ retning, men det har vært utført lite forskning på befolkningens kunnskap omkring hvordan man skaffer til veie helseinformasjon, hvordan det leses og forstås, og ikke minst i hvilken grad man er i stand til å nyttiggjøre seg av kunnskapen. Metode: Denne kvalitative studien baserer seg på et semistrukturert fokusgruppeintervju med norsk ungdom fra videregående skole. Utvalget bestod av totalt ni informanter, fordelt på seks jenter og tre gutter i aldersgruppen 16 til 20 år. Forskningsspørsmål som har blitt stilt i denne studien handler om hvorvidt mental health literacy skala måler ungdoms psykisk helsefremmende kompetanse. Studien har til hensikt å finne ut om skalaens utsagn er relevante for å fremme egen og andres psykiske helse. Resultat og konklusjon: Målet med undersøkelsen var å finne ut om mental health literacy skala er utviklet på en slik måte at den måler kunnskap om determinanter for positiv psykisk helse. Undersøkelsen hadde også som mål å finne ut om noen av spørsmålene burde vært formulert på en annen måte, om noen var overflødige og burde vært strøket, og om skalaen manglet spørsmål som ungdom selv mente var relevant med tanke på å ta vare på sin egen psykiske helse. Studien er liten og med et lite utvalg, og funnene kan ikke dermed direkte generaliseres til hele populasjonen. Studien indikerer likevel at mental health literacy skala er et valid og reliabelt vurderingsverktøy for å måle kunnskap om positiv psykisk helse. Background: Research shows that despite the fact that most of today's youth are happy with their lives, a high proportion of the youth generation still struggles to a greater or lesser extent with daily mental health problems. Mental disorders have a high incidence, both nationally and globally, and cause significant negative consequences both health, social and economic. Psychological problems and disorders have not only major consequences for the individual, but also families, friends and society as a whole are affected to different degrees. An increased level of knowledge about mental health, and not least to ensure proper competence in how to obtain, perceive and use health information may be beneficial in the health promotion work. Strengthening the individuals and societies knowledge of the determinants that have a positive impact on mental health will improve the ability to take health-promoting choices. Today, we know a lot about the factors that affect mental health both positively and negatively, but little research has been done on the populations knowledge about how to provide health information, how it is read and understood, and not least the degree to which you are able to utilize the knowledge. Methods: This qualitative study is based on semi-structured focus group interviews with Norwegian youth from high school. The committee consisted of a total of nine informants, divided between six girls and three boys in the age 16- 20 years. Research questions that have been asked in this study are about whether the mental health literacy scale measures adolescence mental health promotion skills. The purpose of the study is to determine whether the scales statements are relevant to promoting the mental health. Results and conclusion: The aim of the study was to determine if the mental health literacy scale has been developed in such a way that it measures knowledge of determinants of positive mental health. The survey also aimed to determine if any of the questions should have been formulated differently, if any were superfluous and should have been deleted, and if the scale lacked questions that the youth considered relevant with regard to taking care of their own mental health. The study is small, with a small selection, and the findings can`t therefore be directly generalized to the entire population. The study nevertheless indicates that the mental health literacy scale is a valid and reliable assessment tool for measuring knowledge about determinants of positive mental health.

This master’s thesis investigated the theoretical and empirical background on stress, self-efficacy and mental health in adolescence, and a quantitative investigation of the role of stress and self-efficacy in association with mental health outcomes in adolescence was conducted. The thesis contains a description of the adolescent period and mental health, as well as conceptualizations and definitions of stress and self-efficacy. Further, it contains a review of the empirical findings regarding the relationship between the constructs. Empirical evidence suggests that there are relationships between stress, self-efficacy and mental health, and that they influence one another. Results from the quantitative analyses showed significant sex differences. Girls reported higher levels of stress and lower levels of general self-efficacy than boys, and lower levels of mental well-being and higher levels of symptoms of depression than boys. A significant positive association was found between self-efficacy and mental well-being, and between stress and symptoms of depression. A significant negative association was found between self-efficacy and symptoms of depression, and between stress and mental well-being. Self-efficacy was especially important to explaining the variance in mental well-being, whereas stress was especially important to explaining the variance in symptoms of depression. Denne mastergradsoppgaven undersøkte den teoretiske og empiriske litteraturen om stress, mestringstro og psykisk helse i ungdomstiden, og en kvantitativ undersøkelse av betydningen av stress og mestringstro i forhold til psykisk helse i ungdomstiden ble utført. Oppgaven inneholder en beskrivelse av ungdomstid og psykisk helse, og konseptualiseringer og definisjoner av stress og mestringstro, i tillegg til en gjennomgang av empiriske funn på forholdet mellom konstruktene. Empiriske funn antyder at det er assosiasjoner mellom stress, mestringstro og psykisk helse, og at de påvirker hverandre. Resultatene av de kvantitative analysene viste signifikante kjønnsforskjeller. Jenter rapporterte høyere nivåer av stress og lavere nivåer av mestringstro enn gutter, og lavere nivåer av psykisk velvære og høyere nivåer av symptomer på depresjon enn gutter. Det ble funnet en signifikant, positiv assosiasjon mellom mestringstro og psykisk velvære og mellom stress og symptomer på depresjon. Det ble funnet en signifikant, negativ assosiasjon mellom mestringstro og symptomer på depresjon og mellom stress og psykisk velvære. Mestringstro forklarte mest av variansen i psykisk velvære, mens stress forklarte mest av variansen i symptomer på depresjon.

The present master’s thesis consists of investigations on the relation between self-esteem and sense of coherence, and the outcome of self-rated health and subjective health complaints in adolescents. Adolescence is a life phase filled with rapid changes and challenges, but also positive development and great potential for health. Self-esteem and sense of coherence are both shown to vary during adolescence and impact individuals’ health. Research indicate that sense of coherence can be viewed as a moderator for subjective health complaints and self-rated health in adolescents, and that the level of self-esteem impacts the strength of sense of coherence. Further, the strength of self-esteem and sense of coherence is seen to vary during adolescence and differ between sexes. The results showed relation between low self-esteem and higher symptom levels of subjective health complaints, weak sense of coherence and higher symptom levels of subjective health complaints, and strong sense of coherence and positive evaluation of self-rated health. Adolescent girls reported higher symptom levels of subjective health complaints, lower self-esteem and weaker sense of coherence than adolescent boys, but girls interestingly had a more positive evaluation of self-rated health. The results also showed that the older adolescents had a more negative evaluation of self-rated health. When separating subjective health complaints into emotional and physical complaints, the results showed that self-esteem and sense of coherence only had significant relations to emotional subjective health complaints. No conclusions can be drawn on causality from this cross-sectional study, but it can be viewed as a basis for future research. Masteroppgaven omfatter en undersøkelse av forholdet mellom selvfølelse og opplevelse av sammenhengen, og utfallet av selvvurdert helse og subjektive helseplager hos ungdommer. Ungdomstiden er fylt med raske endringer og utfordringer, men også positiv utvikling og stort potensial for utvikling og etablering av helse. Både selvfølelse og opplevelse av sammenheng er vist å variere i løpet av ungdomstiden, og begge har en innvirkning på individers helse. Forskning indikerer at opplevelse av sammenheng kan anses som en moderator for subjektive helseplager og selvvurdert helse hos ungdommer. Det indikeres også at selvfølelsesnivået har en innvirkning på styrken av opplevelse av sammenheng. Videre vises det at styrken av selvfølelse og opplevelse av sammenheng varierer gjennom ungdomstiden og mellom kjønnene. Resultatene viste relasjon mellom lav selvfølelse og høyere symptomnivå av subjektive helseplager, og svak opplevelse av sammenheng og høyere symptomnivå av subjektive helseplager. De kvinnelige ungdommene rapporterte høyere symptomnivå av subjektive helseplager, lavere selvfølelse og svakere opplevelse av sammenheng enn gutter, men jenter hadde en mer positiv evaluering av selvvurdert helse. Resultatene viste også at de eldre ungdommene hadde en mer negativ evaluering av selvvurdert helse. Ved å dele subjektive helseplager inn i emosjonelle og fysiske plager viste resultatene at selvfølelse og opplevelse av sammenheng kun hadde signifikant relasjon til emosjonelle subjektive helseplager. Det kan ikke bli trukket noen konklusjon med tanke på kausalitet fra denne tverrsnittstudien, men den kan ses på som et grunnlag for fremtidig forskning.

Objective: The purpose of this study is to review the literature on factors influencing life satisfaction for adults after a moderate or severe traumatic brain injury. Methods: Pubmed, PsycInfo, SweMed+ and Scopus were queried for studies pertaining to life satisfaction for adults after a moderate or severe TBI. Additional studies were identified through searching bibliographies of related publications. Results: Titles were read for all matches in the searches, and abstracts were read for all matches exploring satisfaction with life. 42 articles were chosen for discussion in this review. The results show that life satisfaction is negatively influenced by cognitive functioning and depression, and positively influenced by productivity, participation in leisure activities, social integration, higher age and personality. Two important findings are that work status after TBI influences life satisfaction while work status prior to TBI does not, and that motor functioning does not influence life satisfaction directly in the longer term. Conclusion: Life satisfaction is a heterogenous concept involving numerous factors. When planning interventions after TBI, rehabilitation professionals should acknowledge the importance of an individual approach exploring meaningful activities and targeting social participation to influence life satisfaction. Denne masteroppgaven vil bli tilgjengelig 31.5.2019

Population ageing is a global trend. For example, in the EU-27 population the share of the older population (65 and above) increased from 13.9 % in 1991 to 17.5 % in 2011. It is expected that by 2060 the share of those 65 years and overwill account for 29.5 % of the EU-27 population (Eurostat, 2013). The ageing of the population results from decreasing fertility rates, but also from increasing life-expectancy rates and the progressive ageing of the ageing population itself.These latter trends are partially attributable to improved quality of nutrition, and advances in medicine, especially knowledge about diseases and their control, and to developments such as early detection of colorectal and breast cancer in screening programmes which increase the chances of survival. Improvements in housing, nutrition, and sanitation standards have also contributed to improved life expectancy (Staehelin, 2005).In developed countries, years added to life are generally lived in good health. However, because more people live into old age and because chronic diseases more frequently occur in the older population, the burden of disease will alsoincrease. The ageing of the population will have an impact on healthcare, housing and community facilities, consumption patterns, and also on social security costs. In response, health professionals, researchers, and policymakers are increasingly concerned with healthy ageing, where ageingin-place is used as a key concept. In this chapter, we first discuss the meaning of the concept of healthy ageing, and how Sense of Coherence contributes to this process. Next, we discuss the characteristics of the community in whicholder people live their lives and how the community can provide resources (GRR and SRR) to strengthen Sense of Coherence and hence perceived well-being and quality of life.

Bakgrunn: Etablering av helsefremmende tiltak er viktig for at befolkningen skal forbedre sin helse. Vi trenger derfor kunnskap om hvilke tiltak og for hvem tiltakene er effektive for. Ungdom har mye fritid i løpet av en dag, studien skal derfor se på om det er kjønns- og aldersforskjeller samt hvilken betydning aktiviteter på fritiden (AF) har for ungdoms helse. Metode: I studien har det blitt brukt litteratursøk og den inkluderer 12 vitenskapelige artikler fra 2012 og frem til i dag. Resultat: Deltakelse i AF er knyttet til subjektiv helse og tilfredshet med livet. Det er kjønns -og aldersforskjeller i hvilke aktiviteter ungdom deltar i og hvilke effekt det har på helsen. Fysisk aktivitet har bedre helseeffekt på gutter, mens kulturelle og passive aktiviteter på jenter. Psykologiske mekanismer og opplevelse av sammenheng (OAS) ser ut til å kunne bidra til å forklare sammenhengen mellom AF og helsevariablene. Konklusjon: For å bidra til å fremme ungdoms helse vil det være viktig å legge til rette for ulike fritidstilbud i nærmiljøet hvor alle kan oppleve å få dekket noen av sine behov og på denne måten oppleve god helse og tilfredshet med livet.

Background: The reorientation of the health services in a health promotion direction has been requested since 1986 when the Ottawa charter (WHO) was launched. A theoretical framework based on salutogenesis is recommended for health promotion development. This study emanated from a mental health hospital, where it was relevant to know how people with mental disorders perceive positive mental health and mental health promotion. Service user involvement in health research has been argued to hold the potential to make research more relevant to clinical practice, and further that it might result in effective improvements in the healthcare services. Aims: The purpose of the study ‘Positive mental health – from what to how’ was to contribute to the knowledge base of health promotion by exploring experiences of persons with mental health disorders. The present study evolved into two parts. The first aim was to explore how mental health and mental health promotion are experienced by adults affected by severe mental disorders. The next aim was to explore former inpatients’ experiences of mental health promotion in a mental healthcare hospital setting. In the second part of the study, the aim was to explore the applied process of involving mental healthcare service users in the entire research process of the study, in our case as part of an advisory team. Thereafter, how service user involvement may contribute to the development of the methodology Interpretative Phenomenological Analysis (IPA), and in turn enhance the research quality, was examined. Methodology: In the first part of the study, IPA was used to explore lived experiences of twelve participants. These former inpatients with mental disorders were interviewed in-depth. Analysis of the data was case focussed and then cross case focussed. As part of the study design service user involvement was applied in all stages of the research process. In the second part of the study, a case study design was used to explore the process of collaboration between five members of the advisory team and the researcher. Research data was collected from documentation, by multi-stage focus group interviews, and participant observations.Important concepts, insights and common opinions were identified by the advisory team and the researcher in analytical discussions, and further developed into understandings formulated in texts and illustrations that helped display and present our findings. Findings: The first of four papers included in this thesis shows how mental health is perceived as a dynamic phenomenon and an ever-present aspect of life. Mental health is perceived as a process, a constantly ongoing movement, like walking up or down a staircase and expressed through body language and everyday spoken language. The movement is nourished by experiences in the emotional, physical, social and spiritual domains of life, and accompanied by a sense of energy. The second paper focuses on the prominent finding of an appetite for learning. The participants perceive the learning processes that occur in the healthcare settings as health promoting. They are craving knowledge in order to cope with the mental disorder and to increase their mental health and wellbeing in daily life. The third paper discusses the applied service user involvement process. The level of involvement was dynamic and six features facilitated contributions from service users; role clarification, a predictable meeting structure, a safe and supportive setting through leadership, focus on possibilities, being a team member and being seen and treated as a whole person. These features helped the service users see themselves as valuable and competent. The fourth paper argues that the multiple perspectives of service users and researchers gave more insightful interpretations of nuances, complexity, richness and ambiguity in the participants' accounts. The power of multiple perspectives in service user involvement reinforced the IPA methodology and vice versa. Conclusions: This thesis shows that lived experiences by persons with severe mental disorders, constitute a rich and important source of knowledge to the field of health promotion. According to the participants, mental health is a dynamic, ever present aspect of life, with improvement or deterioration in their condition being likened to moving up or downa staircase. The learning processes that occurred in the hospital, including both salutogenic and pathogenic knowledge, were perceived as mental health promoting. The participants support the development of educational activities to complement the curative focus in mental healthcare hospitals. When it comes to service user involvement in the present study, the levels of involvement were dynamic and varied throughout the research process. The research advisors experienced certain features of the collaboration process as essential to facilitating their contributions to the research and to seeing themselves as competent. The power of multiple perspectives came across in the collaboration process and this gave us more insightful interpretations of nuances, complexity, richness or ambiguity in the interviewed participants’ accounts. The advisory team became ‘the researcher’s helping hand’.

Article I: Experiencing conflicts and financial difficulties during childhood, and the relation to subjective well-being. Improving health for the upcoming generations across the world requires evidence based knowledge, increased insight, financial commitment and available resources to invest in actions aiming to improve these areas of health. Actions aiming to improve children’s health has the potential to save society and the individual for major expenses compared with actions towards adults. Granting value and respect to peoples own evaluation of life has shown to be a good indicator of the persons’ health status, and such an assessment is called subjective wellbeing. The review has gathered previous research aiming to confirm or reject the following hypothesis: “Experiencing conflicts and economical challenges during childhood is related to reduced subjective wellbeing”. Based on previous research the hypothesis was confirmed. Experiencing economic challenges can increase levels of stress, concerns and conflicts at home. This can further have a negative impact on ways of parenting, with the possible cost of the child developing behavior problems like depression, school problems and antisocial behavior, and further lower levels of SWB. One can therefore argue that conflicts at home decreases parts of the social support the individual needs. Looking at the hypothesis in a broader perspective, social support and income were the two factors with greatest influence on SWB. Lower levels of income and social support were negatively related to SWB in contrast to high levels of income and social support. Social support is critical for well-being, which highlights the importance of social engagement in children and adolescence. Political actions aiming to support parents handling parenthood, and reducing social inequalities, can therefore be preventive for negative development of children’s SWB. Since disadvantage in early life makes an important contribution to poor health in adulthood, these actions can both have an immediate and a long-lasting effect. Actions aiming to improve SWB has the potential to improve human health, social relations, participation in working life, coping with crises at national level, healthier reactions to stress and many other beneficial outcomes. In future research one can look at the relation between conflicts and economic challenges during childhood and SWB later as adult, a link which is barely looked at in research so far. Article II: Experiencing severe financial difficulties and serious conflict in the household during childhood, and the relation to subjective well-being later as adults. Background: Disadvantage from early life makes an important contribution to poor health in adulthood. From previous research one can see that conflicts or economic challenges might lead to a more unfortunate way of parenting, with the possible cost of the child developing behavior problems like depression, school problems and antisocial behavior. Behavioral problems are associated with lower levels of SWB. Previous research has barley explored the relation between conflicts and economic challenges during childhood and SWB later as adult. Objective: The purpose of this study was to investigate whether experiencing severe financial difficulties and serious conflict during childhood, were related to lower levels of SWB later as adults. The European Social Survey (ESS) round 7, counts happiness and life satisfaction as the two subjective parts of well-being. This has led to the following hypothesis “Experiencing serious conflicts or severe financial difficulties most of the time during childhood, increases occurrence of reporting unhappiness and dissatisfaction later as adult”. Method: In this quantitative study, data from the European Social Survey round 7 were analyzed using binary logistic regression. 40.185 informants from 21 countries across Europe participated. Subjective well-being was measured through the questions: “All things considered, how satisfied are you with your life as a whole nowadays?” and “Taking all things together, how happy would you say you are?”. Childhood circumstances was measured through the questions: “Using this card, please tell me how often there was serious conflict between the people living in your household when you were growing up?”, and “Using the same card, please tell me how often you and your family experienced severe financial difficulties when you were growing up?” . For the purposes of analyses, responses to questions regarding happiness and life satisfaction were dichotomized to indicate poor scores as approximately

Purpose: The overall purpose of this project was to explore the transition into long-term care placement for older residents from different perspectives in order to maintain and enhance health and well-being, and inform practice and improve care. Methods: An ethnographic design used three sources of data, periodic participating observations, individual semi-structured interviews, and reading of relevant documents. The project comprises three studies. The aim of study I was to describe and explore the experiences of next of kin during the older residents’ transition into long term care placement. I interviewed ten next of kin to eight newly admitted residents. The next of kin talked about their experiences during the preparation period, the arrival day, and the first week after placement. The aim of study II was to explore and describe the staff’s actions during the initial transition process for the older residents into long-term care facility. In study III, the aims were to explore and describe the staff’s interactions during the older residents’ transition into long-term care facility, and explore how the staff interactions may influence their assistance and care of the older residents. In studies II and III, I followed through periodic participating observations, the staff who assisted ten new residents during the preparation period, arrival day, and the first week after placement. Moreover, I interviewed sixteen staff and the leader of the institutional services, and read relevant documents. Thematic analyses were used to analyze the data in studies I and III and content analysis inspired the analysis of study II. Main findings: What happened prior to the long-term care placement as well as what happened in the initial period in the nursing home influenced the experiences of the next of kin and relationships within the family (I). Moreover, it influenced staff’s actions and interactions, which ultimately influenced the older residents’ transition processes (II, III). The next of kin strove to handle the new situation. They kept on feeling responsible for their older family member, and provided continuity with their past life. Structural arrangements, such as the older family member having to share a private room with a co-resident and being moved about in the nursing home frustrated the next of kin. They did not expect much for themselves, apart from staff notice them and approach them during visits. This seldom happened, and they experienced little support from the staff (I). The next of kin and the staff were distant to each other and members from both groups expected the other to approach them. They appeared shy towards each other in this rural community where they knew of each other. In study II, staff’s actions varied from involvement with the new resident to ignorance. Some powerful influential forces on their actions were the management of the facility, individual staff’s formal position, traits, and enthusiasm, resident and staff mix, and local transparency. Both licensed and unlicensed staff were susceptible of performing poor assistance towards the new residents, which may contribute to directing the new resident towards vulnerability and risk. In study III, the staff interactions influenced the new residents’ transition process in complex ways. This study captures some descriptions and connections between micro and macro levels, and some power mechanism at play among the participants that may contribute to enhancing or inhibiting a smooth transition for the older residents and their next of kin. Organizational structures, staff’s formal position, and informal staff alliances were complex and paradoxical. Some powerful influential forces on the staff’s interactions were the previous health care setting, the management of the facility, the strong oral culture, individual staff’s formal position, personality and authority, resident and staff mix, the physician’s round, local transparency, and the taken-for-granted. The findings demonstrate the significance of every agent in the organization, and how each one may influence the staff’s work in unpredictable ways. When happening, the spontaneous staff interactions were “pockets of excellence” and contributed to maintaining the evolving needs of the new residents in the initial period. These interactions depended on dedicated permanent staff who involved everybody present for the best of the new residents, and on the mix of staff at any given time. During holidays with many supply staff, the involved permanent staff were unable to perform their work according to their own standards. Especially the part-time unlicensed supply staff seemed prone at disturbing the work of most permanent staff. Conclusion: Main areas of concern regarding both the next of kin and the staff were that they needed support and information, and clarify roles between them. Moreover, to maintain the health and well-being of the older residents and their next of kin during the transition involve focus on the playing out of power in staff actions and interactions. In this respect, this project shows some connections and dialectics between macro- and micro levels, which may influence on this: inter organizational level, organizational level, inter professional level, professional level and personal level, as well as contexts and circumstances at any given time. The findings show the importance of involving everybody to the best for the new resident and their next of kin. Combining complexity science with transition theory in nursing provide valuable insights for grass root-, management-, education-, research-, and policy levels how to improve the assistance of the older residents and their next of kin during transitions into longterm care placement. Digital fulltext not available

Introduction: Over the next decades the generation of older adults is expected to increase significantly worldwide. As elderly are often suffering from multimorbid an increasing number will be in need of nursing home care. Hope is found to be needed by all persons throughout the life cycle including the end of life, and is viewed as a resource to provide strength when experiencing illness and losses. In this thesis hope is defined as a multidimensional dynamic life force characterized by a confident, yet uncertain expectation of achieving a future that, to the hoping person, is realistically possible and personally significant. Therefore, the overall aim of this study is to explore and elaborate the concept of hope for cognitively intact nursing home patients in Norway in relationship to symptom burden and quality of life. Method: In Paper 1 a qualitative method was used performed by a systematic literature search. With a phenomenological approach data was categorized and thereafter analyzed. In paper 2 a quantitative approach was applied. Here data was collected by a descriptive cross-sectional design, and analyzed by descriptive, correlation and regression statistics. Results: Hope is found to be an essential coping resource among older adults, and to provide strength in times with suffering (Paper 1). Nursing home patients are found to be hopeful, at the same level as other patient’ groups. Findings indicate that physical and emotional symptoms have a significant relationship to hope, as well as to quality of life. Multiple regression analysis showed a positive relationship between hope and quality of life, and insomnia was found to have a slightly negative impact on hope (Paper 2). Conclusion: Based on the findings hope is a multidimensional dynamic life force with an expectation of achieving good, and a vital resource for nursing home patients experiencing multimorbid and losses. Emotional symptoms seem to have a positive relationship to hope, and physical symptoms such as fatigue, nausea/vomiting, dyspnea and insomnia are shown to have a negative relationship to hope. Furthermore, increased insomnia is also found to have a direct negative impact on hope in nursing home patients, while quality of life has a positive effect on hope.

In highly organised societies, understanding how organisations influence employees’ health, customers’ health and population health is crucial for health promotion. As the immediate influence on employee health is particularly strong, the chapter focuses on this aspect. Based on a review of ongoing changes of the economy, of organising work and of the roles of employees, we argue that agency for organisational health lies and needs to be strengthened within the organisation. Consequently, we define Organisational Health Development (OHD) as both the ongoing reproduction and the targeted improvement of health in organisations as social systems, based on the interaction (process dimensions) of individual and organisational capacities (structural dimensions).

The term salutogenesis is associated with a variety of meanings that Aaron Antonovsky introduced in his 1979 book Health, Stress and Coping and expounded in many subsequent works. In its most thoroughly explicated meaning, salutogenesis refers to a model described in detail in Health, Stress and Coping, which posits that life experiences help shape one’s sense of coherence (a global orientation); life is understood as more or less comprehensible, meaningful and manageable. A strong sense of coherence helps one mobilise resources to cope with stressors and manage tension successfully. Through this mechanism, the sense of coherence helps determine one’s movement on the health Ease/Dis-ease continuum. In its most particular meaning, salutogenesis is almost equivalent to the sense of coherence. In its more general meaning, salutogenesis refers to a scholarly orientation focusing attention on the study of the origins of health, contra the origins of disease. Salutogenesis—model, sense of coherence and orientation—is in harmony with developments across the social sciences that seek better understanding of positive aspects of human experience. For instance, the key concepts of salutogenesis, of positive psychology and of positive organisational behaviour are consonant even if the terminologies are not uniform. It is therefore quite easy to label research and practice in these arenas as having a salutogenic orientation, and use the salutogenesis umbrella metaphor to embrace the cornucopia of scholarly ideas. Among these is the quite specific idea of the sense of coherence, and this meaning of salutogenesis is dominant, at least in the health promotion literature. This is so much so that some equate salutogenesis with the sense of coherence and refer to the sense of coherence as a model or theory (rather than as part of the salutogenic model). This book is about salutogenesis in all these meanings, which are briefly characterised in this chapter, to set the stage for the chapters that follow. We also briefly discuss salutogenesis in relation to other concepts within and beyond the health arena, with which salutogenesis has important kinship.

Objectives and intentions of the study: The aim of the study is to examine public health nurses’ experiences with the implementation of health promotion and preventive mental health work (MEST) in upper secondary schools. More specifically, barriers and facilitators for implementation have been considered, as well as strategies that are considered suitable to focus on. Method: Six puclic health nurses, have shared their experiences from the implementation of MEST through individual interviews. Key findings: Public health nurses have a mandate to conduct health-promoting work at the system level at schools, but whether this is possible depends on many factors. Among other things, it places great demands on continuity, proactive work, establishing good relationships with several management levels, dialogues with students, and let alone the opportunity to create a network to collaborate on the implementation. If attaining a network, this type of working method can also provide both increased competence and work satisfaction. Professional networking, in addition to seeing that MEST contributes to changes, are important factors for sustainability. To provide health promotion initiatives in the school's plans, clarification of expectations through agreements, continuous promotion, and an even closer dialogue with the students for further development of MEST are the strategies that appear to be beneficial to focus on in the future. Conclusion: As in previous research, it is seen that there are complex processes and systems when implementation of universal approaches are to be launched in the school context. A conceptual framework concisting of implementation outcomes; acceptability, appropriateness, program integrity, feasibility , coverage and sustainability is a way to understand how the various barriers and facilitiators affect implementation. At the same time it is important to highlight the strategies that should be focused on to successfully manage the most advantageous implementation.

This in-depth survey of salutogenesis shows the breadth and strengths of this innovative perspective on health promotion, health care, and wellness. Background and historical chapters trace the development of the salutogenic model of health, and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence, that differentiate it from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts, from positive psychology to geriatrics, from small towns to corrections facilities, and from school and workplace to professional training. Perspectives from scholars publishing in languages other than English show the global relevance of the field.Among the topics in the Handbook: Emerging ideas relevant to the salutogenic model of health Specific resistance resources in the salutogenic model of health The sense of coherence and its measurement The application of salutogenesis in communities and neighborhoods The application of salutogenesis to health development in youth with chronic conditions The application of salutogenesis in mental health care settings The Handbook of Salutogenesis summarizes an increasingly salient field for graduate and professional students of public health, nursing, psychology, and medicine, and for their instructors. It will also appeal to health-related academicians and professionals who wish to have a thorough grounding in the topic.

There are to date no Danish research environments that stand out in relation to a focus on salutogenesis. A few Danish researchers have conducted studies using a salutogenic perspective, but the research effort appears sparse and uncoordinated and the Danish language literature on salutogenesis is limited with a scarcity of quantitative studies. The majority of Danish publications use salutogenesis as a theoretical framework from which various professions can work.

Work is both detrimental and health promoting. Antonovsky accentuated the distinction between eliminating stressors and developing health-enhancing job characteristics. He elaborated on job characteristics that potentially relate to a sense of coherence, offering a dense description of a workplace where individuals experience meaningfulness, manageability, and comprehensibility. This chapter presents models, measures, and intervention approaches that relate to the double nature of work and to both its pathogenic and its salutogenic qualities. Hereby, the view of Antonovsky is enhanced, insofar that health-promoting, salutogenic job characteristics are not solely understood as buffering the pathogenic effects of stressors at work, but have a direct effect on positive health outcomes. Antonovsky’s original model is first specified and simplified for the context of work. Then, Antonovsky’s line of thinking is related to frameworks researching job resources and demands. After a review of the prevalence of salutogenic measures in worksite health promotion, the point of making salutogenesis more visible in work-related research and practice is elaborated upon. This is illustrated with a practical example of a survey-feedback process promoting salutogenic work. Finally, the implications and challenges for practice and future research on salutogenic work are discussed.

As an occupational therapist, I have always found the interaction between humans, their environment and their activities interesting, and how the environment can influence what we do and our occupational patterns is something that fascinates me. As my interest for urban health and healthy cities has grown during this master program, I have chosen to use the experience and knowledge I have from my field of expertise and put it in the context of healthy urban planning. This master’s thesis therefore consists of two articles focusing on urban health and healthy urban planning. The first article is a review of how the environment can influence health and well-being of urban dwellers. The second article is based on the results from the first article, and is a qualitative study focusing on what creates health in the urban environment, and how this is related to the actual urban design. Article Ι: Today a great amount of the world population lives in urban areas. As health essentially is created outside the health sector, the urban environment becomes an important determinant of health. Thus, it becomes important not only to understand how to develop healthy urban environments, but also to understand what this entails. This review article therefore aims to explore how the built environment can influence the health and well-being of urban dwellers, and what this means for health promoting measures in the urban environment. The built environment appears to affect health and well-being of urban dwellers on both the individual and community level. However, in the process of developing healthy urban environments or health promoting measures in the urban environment, it is important to understand the different environmental dimensions. Article ΙΙ: With the rapid urbanization around the world, it is argued that the urban environment is an important arena for health promotion. The main aim in this study is to identify what creates health in an urban environment and how this is related to the actual urban design. This is a phenomenological study that includes in-depth interviews with three men and five women aged 23-65. Systematic text condensation was used to analyze the material and three categories were identified as health promoting factors of urban life: (1) Accessibility, (2) Variation and (3) Flexible social arenas. The study shows how the three categories are related to the actual urban design and how they can affect health and well-being of urban dwellers. It is also argued that these three categories are connected to each other and as a whole might facilitate healthy urban environments, and thus healthy urban dwellers.

As a nurse one of my main tasks is to communicate and provide patients with health information. During this master's program I have become further interested in health literacy, and its potential in health promotion. Furthermore, my interest for mental health and how the foundation of mental health is created, led me into the theme of this project. Given this background, the aim of this thesis is to raise awareness and enhance knowledge about what creates positive mental health in adolescence. This Master's thesis consists of two parts. The first section presents a literature review exploring factors influencing adolescents’ mental health positively. The second part is a qualitative empirical study exploring Norwegian adolescents experience with positive mental health, where positive mental health factors are examined and placed within a scale measuring knowledge about mental health promotion. Article I: The purpose of this review is to explore the factors promoting mental health in adolescence. This review provides a brief introduction to health promotion and mental health literacy, and connects this to the three basic psychological needs within Self-Determination Theory (SDT), which will function as the theoretical framework for this article. There appears to be a various of factors promoting mental health in adolescence within an ecological context, where social support appears evident at every level. The three psychological needs appear to coincide with the findings, where SDT offers an explanation to why these factors are of importance. In addition, the need for adding a health promoting component to mental health literacy is highlighted. Article II: The study’s primary object is to explore which elements of positive mental health adolescents are aware of, and believe are important in promoting their mental health. The adolescents will discuss a scale meant to measure youths’ knowledge of mental health promotion. This phenomenological study includes focus group interviews with 21 Norwegian adolescents, aged 16 to 19 years old. To analyse the material of this study Systematic Text Condensation was used. The findings of this study revealed ‘mental health’ to be difficult to define, where mostly negative associations were mentioned. Social support from family and friends, and a sense of self-worth were essential determinants for the youths’ mental health. Regarding the scale, the adolescents’ perceptions of important factors for mental well-being seem to concur with the basic psychological need for: competence, autonomy and relatedness. This study combines Health Promoting aspects and a theory within Positive Psychology. By bringing these disciplines together, a broader understanding of mental health in adolescence might be fostered.

This master’s thesis consists of two articles where the first article is theoretical and the second is the empirical study. Article I The purpose with this paper is to explore and illuminate how smart home and smart home technology can contribute to enhance health and Quality of Life in elderly citizens and allow them to live longer in their home. The paper provides a brief introduction to health promotion and highlights the thesis theoretical framework and foundation of Aaron Antonovsky’s theory of Salutogenesis. In light of a growing elderly population worldwide, many nations are eager to search for new ways to meet this challenge. One of several possible solutions to this is smart homes and smart home technology. The papers concluding remarks is that even though there exists little empirical data in relation to achieved health benefits the literature shows that smart homes and smart home technology might contribute to enhance QoL in elderly citizens. Furthermore the paper is providing a proposal to a health promotional (salutogenic) framework and an example on how salutogenesis can be used in a practical and new way of thinking in relation to future development of smart homes and smart home technology. Article II The study’s primary objective is to examine in which ways smart homes and smart home technology can contribute to enhance health and Quality of Life (QoL) in elderly citizens and allow them to live longer in their homes. In addition to this it aims to explore if such technology increases safety, independence and enhances social activity. Six in-depth interviews with elderly citizens living in a smart home make the basis of the result. The interview protocol included questions regarding QoL, smart homes and smart home technology, safety and security and independence. The interviews were recorded and the recordings were transcribed. To analyze the data material a content analysis andsystematical text condensation were used as inspiration. The results showed that there wasn’t a single factor that could contribute to an enhancement in QoL, but the totality of several. The study concludes that smart homes and smart home technology can contribute to enhance health and QoL in elderly citizens and master to live longer in their homes, but further investigation is needed in order to draw a final conclusion. Denne masteroppgaven er skrevet i artikkelform og består av en teoretisk og en empirisk artikkel. Artikkel I Hensikten artikkelen er å utforske og belyse hvordan smarthus og smarthusteknologi kan være med på å forbedre helse og livskvalitet hos eldre mennesker. I tillegg til dette undersøkes det om denne teknologien kan bidra til å øke eldre menneskers muligheter for å bo lengre i sine egne hjem. Artikkelen gir en kort innføring i helsefremming, og belyser masteroppgavens teoretiske rammeverk og fundament i Aaron Antonovsky’s teori om Salutogenese. I lyset av en raskt voksende aldrende befolkning verden over, er mange nasjoner ivrige etter å søke nye metoder for å møte denne utfordringen. En av flere mulige løsninger til dette er smarthus og smarthusteknologi. Artikkelens avsluttende bemerkninger er at selv om det finnes lite empirisk data på dette feltet, viser litteraturen at smarthus og smarthusteknologi kan være med å bidra til en økning i livskvalitet hos eldre mennesker, dette gjennom en økt følelse selvstendighet, trygghet, sikkerhet og trivsel. Videre blir det foreslått et mulig helsefremmende salutogent rammeverk, og gitt et eksempel på hvordan salutogenese kan brukes i praksis og som kan være med på å bidra i utviklingen av fremtidige helsefremmende smarthus. Artikkel II Studien tar sikte på å undersøke på hvilken måte smarthus og smarthusteknologi bidrar til å forbedre helse og livskvalitet hos eldre mennesker og om denne teknologien bidrar til å øke deres muligheter til å bo lengre i sine hjem. Det undersøkes også om denne teknologien bidrar til økt sikkerhet, uavhengighet og sosial aktivitet blant eldre. Det ble gjennomført seks dybdeintervjuer med eldre beboere i et smarthus som danner det empiriske grunnlaget i studien. Intervjuguiden består av spørsmål som tar for seg livskvalitet (QoL), smarthus og smarthusteknologi, sikkerhet og uavhengighet. For å analysere datamaterialet har en innholdsanalyse og systematisk tekstkondensering vært en inspirasjon. Resultatene viser at det ikke var en enkelt faktor som bidro til å øke deres livskvalitet, men det totale av det Kampen Omsorg+ (KO+) tilbød. Smarthus og smarthusteknologi kan bidra til å øke helse og livskvaliteten og i tillegg bidra til at eldre mennesker kan leve lengre i sine hjem, men det er et behov for videre undersøkelser for å kunne trekke en avsluttende konklusjon.

This thesis is the main product of a Masters degree in Health Science, written by a student at the Department of Social Work and Health Science at Norwegian University of Science and Technology. The thesis discusses sickness presenteeism in general and sickness presenteeism among nurses in particular. Nursing is one of the occupations that are more exposed to sickness presenteeism. Despite this, very little research has yet been done on this correlation – in Norway, almost none. The thesis consists of two articles. The first article presents the concept of sickness presenteeism along with existing theories and research in general and concerning nurses. This is a theoretical article, in which the purpose is to identify why sickness presenteeism is not an ideal situation for nurses and which work-related factors that influence sickness presenteeism among nurses. The research question for this article is “What work-environmental factors have an influence on nurses sickness presenteeisem?” The second article is an empirical article and is done in connection with a survey of nurses’ sickness presenteeism within a Norwegian hospital. The survey examines the connection between sickness presenteeism and the use of substitutes, different working time arrangements and the influence of teamwork. The purpose of this article is to assess how the three work-environmental factors influences nurses’ sickness presenteeism, conducted with the help of three hypotheses. These are: H1: Working-time arrangements have an influence on sickness presenteeismH2: Low extent of using substitutes is related to higher level of sickness presenteeismH3: Good working relationship between co-workers is related to higher level of sickness presenteeism The empirical work for this master’s thesis has been conducted using a quantitative method. This method was chosen based on a desire to investigate the extent, distribution and differences within sickness presenteeism among nurses. A quantitative method gives an opportunity to investigate a larger group of nurses, and obtain results that can also be valid for other nurses. If a qualitative method were to be used, it would not have been possible to collect information from the same number of nurses and the results would most likely not represent nurses in general because of assumed differences between nurses. By using a qualitative method I was also able to compare the results with results from similar studies done in other countries. Still, the quantitative method has little room for a flexible approach to theory, and does not provide information about what might cause the sickness presenteeism. I still found this method to be the most suitable for what I wanted to achieve in this master’s thesis. A survey based on questions used by other researchers with an interest in the same field, was used to collect data. Using questions that others had already used made the results easier to compare, and also acted as some kind of quality control to the questions I first developed. The choices made concerning the survey, items and analysis is further described in chapter 2.0 Method of my empirical article. The strength and limitations of the method is discussed in chapter 4.1 Strengths and limitations of that same article.

Denne masteroppgaven undersøker opplevelsen av lykke, daglig stress og resilience blandt ungdommer, og hvordan disse faktorene er relatert til hverandre. Oppgaven består av to tilhørende artikler, en teoretisk og en empirisk. I artikkel I blir opplevelsen av lykke, daglig stress og resilience definert og beskrevet, i tillegg til en gjennomgang av det karakteristiske ved ungdomsperioden. Forholdet mellom lykke, stress i dagliglivet og resilience hos ungdom blir videre diskutert. Artikkel II er en empirisk artikkel basert på teori og empiri i artikkel I. Resultatene i artikkel II viste at en høyere grad av daglig stress var negativt assosiert med hvor lykkelige ungdommene var. Resilience var positivt assosiert med opplevelsen av lykke, og negativt assosiert med graden av daglig stress. Resilience ble ansett som en potensiell moderator for forholdet mellom daglig stress og resilience, men resultatene i denne oppgaven viste ingen statistiske funn for det. Ungdommene rapporterte generelt relativ høy grad av lykke og resilience, og en moderat level av stress i dagliglivet. Jenter og eldre ungdommer opplevde høyere grad av stress, mens gutter og yngre ungdommer rapporterte høyere grad av resilience. Guttene var også generelt mer lykkelig sammenlignet med jentene.

artikkel 1 Subjective well-being (SWB) is an upcoming concept that has caught the attention of the scientific community and society in general. Although much has been learned about the nature of “happiness” both the definition and measurements are still a work in progress. The current paper aimed to examine how global subjective well-being best can be measured based in the current theoretical understanding of the definition and assessment methods. SWB is by Diener (2009) considered to have three main components: positive affect, negative affect and life satisfaction. The concept is complex with many interconnecting dimensions and correlates. The choice of SWB measurement method or instrument should be based on an understanding of the nature of SWB in addition to the study’s design and purpose. Self-report measures are the most utilized and generally shows good psychometric properties. This paper primarily recommends using the Satisfaction With Life Scale (SWLS; Diener, Emmons, Larsen & Griffin 1985) combined with Scale of Positive And Negative Experience (SPANE; Diener et al. 2009) to measure SWB. Abstract artikkel 2 The interest and knowledge of subjective well-being (SWB) and its applicability has the latest decades grown both socially and scientifically. Assessment instruments validated for different languages and cultures can assist in the further development of the SWB concept as well as provide a base for monitoring communities’ fluctuations in SWB levels and operate as a social indicator index. Objective: The following study aimed at translating and validating four acknowledged SWB instruments on a Norwegian sample. Participants: Self-completion questionnaires were administered to convenience samples of senior citizens and university students in Trondheim, Norway. n = 254, 154 females, age 19-96. Design: Psychometric properties such as internal consistency, normative data, factorial structure and convergence validity were examined using independent sample t-tests and principal component factor analyses. Results and conclusions: The findings were overall consistent with previous findings. Overall no major divergences from the scales established psychometric standards were found which suggests that the questionnaires are fit for use on Norwegian samples. Furthermore, the study supports the scales as having good psychometric properties. &nbsp

Et samfunnsvitenskaplig perspektiv i oppgaven er å ha fokus på samspill mellom samfunn, kultur og individ. Samfunnet behøver å legge til rette for helsefremmende adferd slik at dette blir et naturlig valg. Masteroppgaven er knyttet opp mot et prosjekt som ledes fra Senter for Helsefremmende forskning. Hovedprosjektets tema er ” Kulturdeltakelse og Helse”. Formålet med litteraturartikkelen er å se på fysisk aktivitet i et perspektiv fra folkehelsearbeid og helsefremmende teori, som et teoretisk rammeverk for den empiriske oppgaven. Befolkningsintervensjoner for å fremme fysisk aktivitet er et nytt og spennende tema, og det meste av litteraturen eksisterer fra 2000 og frem til i dag. Fokus i den empiriske artikkelen er å evaluere aktivitet i tilknytning til Den Kulturelle Spaserstokken [DKSS] i Trondheim kommune, hvor en ser på sammenhengen mellom kulturaktivitet og helse. Målgruppen for DKSS er seniorer i aldersgruppen 55 år eller eldre, og generelt sier en at både forskning og tilbud i mindre grad omfatter denne aldersgruppen. Den Kulturelle Spaserstokken kan betegnes som et annerledes og mindre tradisjonelt tilbud for å fremme aktivitet og helse, og fysisk aktivitet er en del av dette. En velger fysisk aktivitet som tema i forbindelse med litteraturartikkelen, fordi det er gjennomført lite forskning som har beskrevet kultur- og fritidsaktiviteter som helsefremmende virkemiddel. The main purpose of this article is to identify literature concerning community intervention, specifically to identify publications which explain how to promote physical activity in the healthy elderly. It is an attempt to extend the perspective of involvement in leisure time physical activity. The main question is if physical activity improves quality of life in the elderly? Literature search was accomplished by a computer or by a manual search (tracking citations), and following key words were used: Physical activity, health promotion, aging/elderly, supporting environment, community interv ention, Quality of life, psychological wellbeing and review. The first part of this article will focus on conceptualization of health promotion and quality of life. The second part will focus on physical activity in public health and the community. The third part focuses on community interventions, physical activity and environmental factors, and their definitions. Physical activity is important to health. The health care system understands how to use drugs to reduce pain and the risk for serious events caused by sedentary lifestyle, but methods to promote physical activity are less well understood. Studies in public health interventions suggest that environmental factors are essential to promote physical activity, and the literature research shows that daily activity improves a overall term of quality of life in the healthy elderly. There is some evidence for a strategy in community interventions to focus on environmental factors to promote more physical activity or positive health behaviours. Interventions for promoting physical activity have mainly focused on physical activity and disease prevention, and strategies have not focused, or have not succeeded in increasing the activity level in the general public. New implementation strategies of physical activity are needed. An ecological approach is one suggestion and a possibltheoretical model for this kind of intervention. In addition the conceptualisation of health promotion also includes a broader perspective of activity and public health. A population-wide approach and health promotion need more attention and further improvements in future research. The health promotion perspective, a focus on health and resources, and an ecological theoretical model have been proposed as a paradigm for the present study. Cultural participation has been used both in governmental health policies and as medical therapy. This is based on the assumpti n that cultural participation will improve health and Quality of Life [QoL]. Adapting this framework the present study evaluates cultural activity participation in a group of healthy elderly. Few studies have included leisure-time physical activity in the concept of culture. The aim of this study is to analyze the relation between cultural activity and health. Data on cultural activities both receptive and creative, and quality of life were collected using a questionnaire. The questions were based on a comprehensive questionnaire from The Nord Trøndelag Health Study (2006 - 2008) and SF-36. The municip lity of Trondheim offers a broad range of varied cultural activities for their seniors. Our study sample was 110 healthy elderly people participating in creative cultural activities on a weekly basis in Trondheim. The response rate in the study was 55 %. The multiple regression analyses show that participation in receptive and creative cultural activities was not significantly associated with quality of life after adjustment for relevant cofactors. Nevertheless both error bars in the independent t-test and scatter plot in the regression analyses show that more activities are associated with increased QoL. QoL is measured as an overall term of physical health (SF-36). The population was homogenous and the effect size is small and therefore the power in the study is too week to detect changes. Compared with a normal population the sample was a group of healthy elderly, and they are overall more active in various cultural activities. An increasing number of cultural activities are also associated with more regular physical activity. Physical activity shows a more significant prediction for QoL than cu tural activities. These results do not support the hypotheses on the effect of cultural activities. The conclusions that can be drawn so far about cultural activity and QoL are limited. A population based study among healthy elderly requires a larger sample. Further research is needed: Epidemiological studies analyzing association: Sufficient statistical power is needed. Longitudinal studies and experimental studies analyzing the question on causality. Qualitative studies for analyzing a deeper understanding. Experimental studies for cultural activities or leisure acitivities.

Unhealthy eating during adolescence has shown to have multiple negative consequences. The aim of this paper is to acquire knowledge of dietary habits in adolescence and consider how this behaviour varies across different groups of adolescents. Correlations between dietary habits, age and gender have several times been found, in terms of girls eating healthier than boys, and the intake of healthy food decreasing with age. Additionally, adolescents of low socioeconomic position are at higher risk for having unhealthy dietary habits, while adolescents who are physically active seem to eat healthier. Further, it has been shown that low self-esteem in adolescence is associated with eating disorders, representing both restrained eating, but also binge eating. The mentioned correlations can be understood and explained using individual psychological models of health behaviour, like the KAP model and social cognitive theory.