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Objective: To analyse the interrelated processes of identity, participation and knowledge in the context of the health educational Lifecalculator computer game. The analysis focuses on if and how this school-based health promotion initiative communicated relevant health knowledge to adolescents. Further development of the concept of health identity was a secondary objective of the study. Setting: Danish public schools. Methods: A qualitative study based on 21 focus group interviews with a total of 103 adolescents and 10 individual interviews with their teachers. Results: The simplified description of health and health choices in Lifecalculator makes it hard for the adolescents to relate the game to their everyday lives. They know that everyday health choices are more complex and they consequently dismiss the information altogether and do not gain much knowledge. The adolescents' identities and the way they interpret themselves and their health in relation to others decide if and how they acquire knowledge. Healthy adolescents, who consider themselves as healthy, find it easier to relate to the health knowledge than the unhealthy adolescents who are aware of their unhealthiness. Lifecalculator seems to confirm that healthy adolescents (who view themselves as healthy) are healthy and unhealthy adolescents (who view themselves as unhealthy) are unhealthy and, as such, this approach does very little in terms of motivating participation and presenting the adolescents with new health knowledge. Conclusions: The study of Lifecalculator and the theoretical advances disclose the multi-layered interrelatedness of health identity, knowledge and participation. This interrelatedness creates multiple perspectives for both practice and research. © 2012 The Author(s).


Grabowski D.,Steno Health Promotion Center
Health Education | Year: 2013

Purpose: The main aim of the paper is to explore whether health theatre as a school-based health promotion initiative communicates relevant health knowledge to children and the interrelated processes of identity development, knowledge acquisition and participation. Development of the definition of "health identity" was a subsidiary objective of the study. Design/methodology/approach: This was a qualitative study based on observation of five health theatre performances, with 20 focus group interviews with a total of 98 children and 22 individual interviews with teachers and parents. Findings: Three themes emerged from the qualitative analysis: children's varying capacities for participation affect knowledge acquisition and identity development; health knowledge acquisition is enhanced when information is made relevant by linking health to everyday life; and acquisition of health information and children's health identities are closely related. Coherent information and environments are conducive to knowledge acquisition, and health promotion efforts must be careful to avoid reinforcing negative health identities and furthering perceived divisions between "healthy" and "unhealthy" children. Originality/value: The paper provides important foundational information for school-based health theatre initiatives. It presents knowledge for practitioners working with knowledge-based health promotion for children and explores the connection between identities, health knowledge acquisition and participation within an alternative theoretical framework. © Emerald Group Publishing Limited.


Hindhede A.L.,Steno Health Promotion Center
Health Care Analysis | Year: 2015

Focusing on the largest and, arguably, the least visible disability group, the hearing impaired, this paper explores present-day views and understandings of hearing impairment and rehabilitation in a Danish context, with particular focus on working-age adults with late onset of hearing impairment. The paper shows how recent changes in perception of the hearing impaired patient relate to the introduction of a new health care reform that turns audiological rehabilitation into a consumer issue. Ethnographic and interview data from hearing clinics provides evidence that the hearing technologies that are on offer stabilise in specific forms through processes of negotiation among a variety of social actors representing the interests of science, industry, government, and hearing-impaired people. The discussion critically considers the emergence of an “informed consumer” in audiological practices. © 2013, Springer Science+Business Media New York.


Willaing I.,Steno Health Promotion Center
Diabetic medicine : a journal of the British Diabetic Association | Year: 2013

The aim of this study was to investigate associations between HbA1c recall by patients with Type 2 diabetes and self-management behaviours, patient activation, perception of care and diabetes distress. In a cross-sectional survey, 993 patients with Type 2 diabetes reported their latest HbA(1c). Validated scales measured self-management behaviours, patient activation, perception of care and diabetes distress. Self-reported HbA(1c) was compared with latest measured HbA(1c). Using logistic regressions, associations between HbA(1c) recall and the variables of interest were investigated. Sixty-four per cent of patients recalled their latest HbA(1c). Poor HbA(1c) recall was significantly associated with unhealthy eating behaviour, low level of exercise, low level of patient activation, poor glycaemic control, not knowing target HbA(1c) level, low educational level and being female. There were no associations between recall of HbA(1c) and diabetes distress or perceived care. Recall of HbA(1c) level may increase patient activation and health-promoting behaviours. However, low educational level may be a barrier for using HbA(1c) as a motivator for health-promoting behaviours. This study indicates a need for studies of causal relationships, as well as mechanisms and challenges in using patient awareness of HbA(1c) as a driver for health-promoting behaviours. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.


Rogvi S.,Steno Health Promotion Center | Almdal T.P.,Steno Diabetes Center | Schiotz M.L.,Steno Health Promotion Center | Willaing I.,Steno Health Promotion Center
Diabetic Medicine | Year: 2012

Aims To investigate the association between glycaemic control and patient socio-demographics, activation level, diabetes-related distress, assessment of care, knowledge of target HbA1c, and self-management behaviours, and to determine to what extent these factors explain the variance in HbA1c in a large Danish population of patients with Type 2 diabetes. Methods Cross-sectional survey and record review of 2045 patients from a specialist diabetes clinic. Validated scales measured patient activation, self-management behaviours, diabetes-related emotional distress, and perceived care. The electronic patient record provided information about HbA1c, medication, body mass index, and duration of diabetes. Data were analysed using multiple linear regression models with stepwise addition of covariates. Results The response rate was 54% (n=1081). Good glycaemic control was significantly associated with older age, higher education, higher patient activation, lower diabetes-related emotional distress, better diet and exercise behaviours, lower body mass index, shorter duration of disease and knowledge of HbA1c targets (P<0.05 for all). Patient socio-demographics, behaviour; perceptions of care and diabetes distress accounted for 14% of the total variance in HbA1c levels (P=0.0134), but the variance explained was higher for respondents treated with medications other than insulin. Conclusions Our study emphasizes the complex relationships between patient activation, distress and behaviour, specific treatment modalities and glycaemic control. Knowledge of treatment goals, achieving patient activation in coping with diabetes, and lowering disease-related emotional stress are important patient education goals. However, the large unexplained component of HbA1c variance highlights the need for more research to understand the mechanisms of glycaemic control. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

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