BACKGROUND: Determinants of ill-health have been studied far more than determinants of good and improving health. Health promotion measures are important even among individuals with chronic diseases. The aim of this study was to find predictors of positive subjective health among disability pensioners (DPs) with musculoskeletal disorders. METHODS: Two questionnaire surveys were performed among 352 DPs with musculoskeletal disorders. Two groups were defined: DPs with positive health and negative health, respectively. In consequence with the health perspective in this study the conception Positive Odds Ratio was defined and used in the logistic regression analyses instead of the commonly used odds ratio. RESULTS: Positive health was associated with age > or = 55 years, not being an immigrant, not having fibromyalgia as the main diagnosis for granting an early retirement, no regular use of analgesics, a high ADL capacity, a positive subjective health preceding the study period, and good quality of life. CONCLUSION: Positive odds ratio is a concept well adapted to theories of health promotion. It can be used in relation to positive outcomes instead of risks. Suggested health promotion and secondary prevention efforts among individuals with musculoskeletal disorders are 1) to avoid a disability pension for individuals <55 years of age; if necessary, to make sure rehabilitation actions continue, 2) to increase efforts to support immigrants to adjust to circumstances connected to ill-health and retirement, 3) to pay special attention to individuals with fibromyalgia and other general pain disorders, and 4) to strengthen ADL activities to support an independent active life among disability pensioners.

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ABSTRACT Widfeldt, M. (2011). Health motivators in the workplace – a study on the manager’s attitude. Public Health Science C: Theory and method with application and examination paper. Faculty of Health and Working Life: University of Gävle. Within the Swedish Post office, health promotion is actively being carried out. In order to reach out with health promotion to all employees, health motivators have an important role. In order to succeed in achieving good results from this work, managers’ attitudes are seen as an important prerequisite. The purpose of this study was to investigate the attitudes to health motivators among managers in the Swedish Post office. The study was based on a qualitative design and involved 16 managers, of whom eight managers worked with health motivators and eight managers did not. The collected interviews were analyzed using a content analysis and the results showed that managers had a positive attitude towards working with health motivators. Managers with health motivators noticed positive effects in the form of healthier employees, reduced absenteeism, and an improved working environment. Managers without health motivators noted time constraints and lack of interest among employees as the main reasons for not working with them. In conclusion, this study has shown that managers have a positive attitude towards working with health motivators, but that the time and the interests among employees are required to work in this way. Key words: health motivator, managers, attitudes, effects

Syfte och frågeställningar  Syftet med uppsatsen är att belysa barns föreställningar om alkohol och dess påverkan.  Frågeställningar:  Vilka tankar har barn om alkohol? Finns det några genomgående teman och trender i barnens föreställningar om alkohol? Hur beskriver barn alkohol och människors beteende i samband med alkohol? Metod  Denna studie har utförts med kvalitativa intervjuer som metod. Femton barn i årskurs två, samtliga åtta år, har intervjuats efter godkännande från målsman, klassföreståndare och rektor.  Urvalet var inriktat på åttaåringar i en klass och gjordes i samarbete med klassföreståndaren samt efter vilka som fick godkännande av målsman. Förutom ålder fanns inga andra kriterier. Intervjuerna var semistrukturerade men de utgick dock från samma frågemall. Intervjuerna transkriberades och analyserades med hjälp av teorier om barns utvecklingspsykologi, av Jean Piaget och Erik H. Erikson.  Resultat  Efter att ha tematiserat resultaten gick det att urskilja trender i barnens föreställningar. Begreppet alkohol var för många barn svårt att beskriva, men det verkade bli mer begripligt då de fick höra exempel på olika alkoholsorter. De hade alla en föreställning om att alkohol är något människor dricker när det är fest och för att det är gott. Barnen beskrev hur människor blev när de druckit alkohol med konsekvenser, hur människor agerar eller utifrån de känslor de fick av att se dem. En person som är berusad beskrev barnen som obehaglig eller konstig. Nästan alla barn kunde tänka sig att dricka när de blev äldre även om de idag inte gillade det, då det kunde vara farligt eller leda till att man blir berusad.  Slutsats  Det går att urskilja vissa trender och mönster i barnens tankar om alkohol. Den övergripande tolkningen är att barnen upplever berusade människor som obehagliga och annorlunda, detta kan kopplas till att beteendet hos människor som druckit förändras. Genom svaren från intervjuerna har vi fått fram de övergripande föreställningar barn har om alkohol och dess påverkan på människor. Vi har även belyst dessa genom att anknyta intervjuerna till tidigare studier och utvecklingsteorier.

Declining response rates are threatening the usefulness of and confidence in survey data. Survey practitioners have therefore studied why nonrespondents refuse to respond and have tried to counter the declining response rates by intensified follow-up methods. Such efforts sometimes yield negative reactions among respondents. This thesis focuses on the respondent’s perspective in self-administered health-related surveys. The aim was to investigate positive and negative aspects that respondents experience when participating in surveys, to study factors that could increase motivation and to study possibilities to increase response rates in a way that promotes data quality as well as positive experiences among respondents. Self-Determination Theory is a motivation theory that was used as a theoretical framework. Paper I is a study regarding two self-administered health questionnaires among patients in 20 intervention groups in 18 Swedish hospitals. Paper II is a qualitative analysis of data from telephone interviews with respondents to a self-administered health-related survey of the population in the county of Östergötland. Paper III is a randomized experiment in a self-administered survey of a random sample of parents in the municipality of Stockholm. Paper IV is an experimental study concerning a self-administered health questionnaire in a random sample of the general adult population in the county of Östergötland. The results from paper I show that questionnaire length and ease of response were not crucial arguments in choosing between two health questionnaires for use in routine health care. Instead, the most common motives for the choice concerned aspects of the questions’ comprehensiveness and ability to describe the health condition. Respondent satisfaction as described by respondents in paper II includes being able to give correct and truthful information as well as reflection and new insights from the questions. Respondent burden includes experiences of being manipulated or controlled by the researcher as well as worry, anxiety or sadness caused by the questions. Experiences of satisfaction and burden differed depending on the respondents’ primary motive for participating in surveys. The findings of paper III illustrate that the use of lottery tickets as incentives to parents may be less valuable or even harmful as a means of increasing response rates. In paper IV a survey design inspired by Self-Determination Theory yielded higher satisfaction among respondents and improved response rates with similar or better data quality compared with a standard design. Focusing on the respondents’ perspective provided important new knowledge. The results show a broad spectrum of positive as well as negative aspects of survey participation. The results support Self-Determination Theory as a useful theoretical framework for studying motivation in survey research and an interesting additional source to provide ideas on how to design surveys with the potential to motivate respondents. The results suggest that it is possible to improve response rates in a way that promotes data quality as well as positive experiences among the respondents.

Tobacco use, mostly smoking, has been a deeply rooted habit for many people for centuries. However, it was not until the second half of last century that the risks with smoking became obvious. Today when the bad consequences of smoking are recognized by almost all people, it is important to discuss why smokers choose to continue smoking. The main aim of this thesis is to try to better explain why some middle aged smokers choose to continue smoking in spite of knowledge of the huge mass of information that is gathered about the serious side effects of smoking. Many of these people cannot by any means stop smoking while others succeed in their attempt to quit. Since 1990 all inhabitants in Västerbotten County are invited to a health survey the year they become 40, 50 and 60 years: the Västerbotten Intervention Programme (VIP). The VIP health survey consists of risk markers for cardiovascular diseases (blood pressure, blood sugar and blood lipids), a questionnaire on socioeconomic, psychosocial and life style factors, supplemented by a health counselling discussion with a district nurse. The thesis is based on five papers. Four of them use VIP data. In Paper I tobacco habits are related to different levels of age, gender and education and are analyzed in a 18 year perspective, based on 112 920 VIP participants. As it has been suggested that women might have more difficulties than men to stop smoking, Paper II elucidates women’s perceptions about smoking, based on interviews with nine smoking and ex-smoking women. Paper III identify metabolic consequences of heavy smoking and relate these to social and life style factors that might accompany smoking behaviour. Paper IV analyzes the individual pattern of changes in tobacco use over a ten year period among 16 492 subjects, while Paper V, a questionnaire study, addresses 513 respondents own assessments of what was especially important for them in their attempts to become smoke-free and what was positive and what was negative when they stopped to smoke. Their knowledge and attitudes about smoking issues were also analyzed. The thesis shows that heavy smokers seem to have a metabolic profile heading towards the metabolic syndrome, and that this pattern could be reinforced by some social and life style factors. Smoking women expressed their concern over weight gain, if quitting. They provided a series of different hinders and barriers against smoking cessation as well as some explanations of why it was reasonable to continue smoking. Feeling of shame and fatalism played a major role but also influence from friends, relatives and media was regarded as important factors. For both men and women the decision to quit smoking was supported from relatives and from a wish for a healthier lifestyle. Support from the health care providers was perceived to be rare. Snus use and nicotine replacement therapy in the attempts to stop smoking were also discussed. In summary the thesis stresses that the use of tobacco products in Västerbotten is slowly decreasing in the middle aged population in general. For people with shorter school education and at somewhat younger age the dual use of tobacco products, cigarettes and snus, are slowly increasing. However, after ten years, half of the smokers in these age cohorts still smoke. It is possible that the more addicted smokers remain, why a major challenge is to find new ways to support these individuals. Health care providers have to do more, but also schools, media, societal organizations and governmental bodies on local, regional and national levels. One proposal is to look upon nicotine dependence, especially smoking, as a chronic condition that needs various multifactorial treatment and long time follow up, and that it is important to organize the support accordingly. Special antitobacco or life style centres outside the established health care organization where focus could be on different healthy life style matters is suggested. The thesis also suggest different ways to handle smoking cessation at the primary health care level.