Health promotional interventions informed by community-based participatory research in a socially disadvantaged neighbourhood : development, exploration and evaluation

Sammanfattning: The overall aim of this thesis was to understand the impact of community-based participatory research-informed health promotional initiatives on the health of communities living in socially disadvantaged neighbourhoods in Southern Sweden. The thesis was part of a larger program, Health promotion, Innovation in Collaboration which was a community-based participatory research program aiming to create novel ways to improve health through participatory and collaborative strategies. The thesis embraces one mixed-method study, a quantitative study, a qualitative study and finally a participatory action research study with a qualitative approach. A total of 49 citizens and 10 families with children aged 7-14 years from a disadvantaged neighbourhood in Southern Sweden participated in the different studies. The mixed-method study (Study I) described the development of initial evaluation of a Community-based participatory research(CBPR) informed physical activity intervention, which showed the need for the intervention to be offered cost-free and exclusively for women. In line with the results of the first study, the CBPR physical activity intervention was offered to 35 women in the neighbourhood and the effect of the intervention was assessed over time both quantitatively (Study II) and qualitatively (Study III), including a perspective on the pandemic. The last study (Study IV) focused on diet and oral health among families, particularly mothers and children. In this study, the children were initially engaged in a photovoice interview which was followed by a focus group with parents. The pre-study revealed that children disliked school lunch and did not eat breakfast regularly owing to time constraints and family situations. Furthermore, children also consumed a high amount of sugar. To this, the parents expressed that they were not able to guide their children appropriately and needed help with aspects such as diet focusing on breakfast, lunch and dinner, as well as knowledge on oral hygiene habits. The quantitative part of Study I and Study II were repeated measures data at different time points before and after the intervention. The qualitative data in studies I and III were collected in form of focus group interviews in parallel to the quantitative data. The mode of data collection in Study IV was Multi-staged focus groups where the same families met at different time points and engaged in dialogue and reflection on different topics at each meeting. The results of the first three studies show that a CBPR informed physical activity intervention when offered in groups improved health-related quality of life, physical health, induced behavioural change and potentially builds resilience to withstand the psychosocial and physical effects of the pandemic. The last study shows that a CBPR informed oral health promotion through reflection and dialogue among families together with other stakeholders, influences behavioural change and perceived changes in health among parents and children living in a disadvantaged neighbourhood. In conclusion, this thesis highlights that social support is key to improved perceived health, empowerment, and sustainable behavioural change among citizens in the neighbourhood. Although women are most in need of support, they are also gateways to the families and thereby their communities. And finally, health promoters have had a vital role in engaging communities in health promotional efforts and bringing them closer to other societal actors, strengthening their social bonds and helping build community resilience in the face of adversity.