Child obesity is a major global public health challenge. One way to reduce risk is through effective health promotion programs in schools that include parental involvement. However, programs often fail to be scaled up and sustained under real-world conditions. Therefore, it is necessary to study their implementation and study the perspective of decision-makers and school principals. The universal Healthy School Start (HSS) program, designed to promote healthy dietary and physical activity habits in children aged 5–7 years, was implemented in three municipalities in Sweden. This study aimed to identify and understand the success factors and barriers for scale-up and sustainment of the HSS program. This study used a qualitative explorative design. Individual semi-structured interviews were conducted with eight municipality leaders responsible for the school sector and eight school principals during 2023 and 2024. Data were analyzed using reflexive thematic analysis. For a municipality to adopt and sustain the HSS program, dedicated leaders, in terms of health promotion, are crucial. Integrating the program into school routines and into the yearly quality assessment could support its sustainment. Barriers included challenges in prioritization of the HSS at the municipal level, perceived workload for school nurses, and staff and leadership turnover which could potentially reduce commitment to long-term program implementation. Facilitators and champions alleviated organizational challenges such as staff turnover. The feeling of support among staff was a key factor for successful implementation. To effectively promote health and prevent obesity, a multilevel and life-course approach involving several community actors was seen as necessary. Success factors for scale-up and sustainment included the appointment of dedicated leaders in the municipality serving as program facilitators by providing consistent support and follow-up during the first year, while barriers such as lack of program prioritization, high workload and staff turnover posed a challenge to the implementation. Program integration into the yearly quality assessment might be the missing piece of the puzzle needed to achieve sustained implementation at scale. These findings are likely applicable in settings with a decentralized school system similar to Sweden’s.

Schools are a key setting for child health promotion, yet implementing school-based programs, particularly those involving parents, remains challenging. Organizational readiness and early implementation outcomes, acceptability (ACC), appropriateness (APP), and feasibility (FEAS), capture how stakeholders perceive the implementability of new interventions and engage with them. These perceptions may evolve during implementation, but evidence on how they change over time and relate to one another in real-world school settings is limited. This study examined these changes among school staff during the first year of implementing the Healthy School Start program in schools in three Swedish municipalities (M). Validated questionnaires were used to assess readiness, ACC, APP, and FEAS pre- and post-intervention to examine how these implementation variables varied with direct experience of the intervention. Data were collected from 39 school principals, 72 teachers, and 40 school nurses between September 2021 and June 2023. Multilevel linear regression models with random intercepts for school and individual examined pre-post changes and interactions by municipality and professional group. Readiness, ACC, and APP declined significantly from pre- to post-intervention in the total sample (readiness: β = −2.54, p = 0.032; ACC: β = −1.31, p = 0.004; APP: β = −1.12, p = 0.022), while FEAS remained stable (β = −0.30, p = 0.501). M2 schools reported lower baseline scores than M1 schools on ACC, APP, and FEAS. M1 schools showed significant declines across all four outcomes, while M3 schools remained stable. FEAS was the only outcome for which pre-post change differed significantly across municipalities (time × municipality interaction: χ²(2) = 9.56, p = 0.008), driven by a decline in M1. No significant differences were observed between professional groups, although school nurses reported the lowest readiness and feasibility scores. Baseline readiness was strongly correlated with ACC (ρ = 0.66), APP (ρ = 0.67), and FEAS (ρ = 0.73; all p < 0.001). Perceptions of implementability generally declined with feasibility remaining stable overall except for one municipality showing a significant decline. These findings run counter to assumptions that exposure alone improves implementation outcomes, and suggest that perceptions are shaped by organizational context, underscoring the importance of addressing contextual barriers both before and during implementation. Registered prospectively at ClinicalTrials.gov ID: NCT04984421, registered July 30, 2021.

A majority of adolescents do not meet the recommended levels of physical activity, while reported levels of mental health problems are increasing, and socioeconomic disparities in academic performance are widening. Many schools are implementing physical activity in different forms, but there is inconclusive evidence on what types of interventions improve mental health, cognitive functions, and academic performance and how to implement such interventions. There is a critical need for integrated, feasible, and equitable interventions. The objective of this study is to develop an effective multi-component school-based intervention that will target both physical activity and homework support during an extended school day and evaluate its effects on mental health, cognitive function and academic performance. The study is designed as a cluster-randomised controlled trial with 54 schools and approximately 2,700 students in grade 8 (age 14–15). The intervention includes three weekly 60-minute sessions: (1) Different types of physical activities (2), Homework support with short activity breaks, and (3) Walking and listening to audiobooks. This study will evaluate both outcome effects and implementation process. The primary outcome is anxiety, assessed using the Spence Children’s Anxiety Scale (SCAS-S). Secondary outcomes include physical activity, sedentary time and behaviours measured by accelerometry and questionnaire, cognitive functions assessed by a computer-based test battery, mental health and sleep with questionnaires, and academic performance by grades. Process evaluation will include fidelity, dose, feasibility, acceptability and context, using structured documentation, interviews, focus groups, and observations. The effectiveness of outcomes between groups will be assessed using mixed-effects regression analysis, adjusting for relevant covariates. Process data will be analysed using descriptive statistics and content, and thematic analysis. This study addresses key knowledge gaps in school-based health promotion by integrating physical activity and homework support within the school structure. The results will yield insights into both effectiveness and implementation, informing future policy and practice in schools to promote health and facilitate students’ learning. The intervention targets youth in diverse socioeconomic contexts and is expected to contribute to reducing health and education inequalities. The trial was retrospectively registered on April 27, 2021. ISRCTN78666212.

BackgroundThe importance of school nurses' active involvement in health promotion directed to school aged children is widely recognized. Research on school nurses' experiences of health promotion remains limited.AimThe aim of this study was to describe school nurses' health promotion practices and experiences within the Swedish educational context.MethodsNational cross-sectional data from school nurses (n = 596) were collected through a web-based survey. Narrative data from an open-ended question (n = 354) were analyzed using qualitative content analysis.ResultsFindings highlight how adoption of health promotion activities was shaped by variations in collaboration, resources, and organizational support. Many school nurses relied on their own initiative and creativity to work with health promotion, often with limited time and beyond the boundaries of the regular program.ConclusionThere is an urgent need for clearer national guidelines and methods for health promotion, collaborative approaches and organizational support with clear expectations and sufficient time allocation.

Current evidence suggests that even in high-income countries such as Sweden, there are socioeconomic differences in children’s participation in physical activity. While family-based programmes appear promising to encourage physical activity, there is a lack of knowledge on how to engage families in such programmes, particularly in socioeconomically disadvantaged areas. The Open Health-Promoting Activities programme was launched to promote physical activity outdoors and health equity for children and their families in these areas. This study aims to explore parents’ experiences with the Open Health-Promoting Activities programme in socioeconomically disadvantaged areas, focusing on family engagement in physical activity and perceived changes in family dynamics. A qualitative design with an ethnographic approach was employed. In line with an ethnographic approach, the research team conducted 15 participant observations of the programme sessions on Saturdays during Spring 2022. Field notes were compiled during the observations, which provided contextual information for individual interviews with 12 programme participants. These interviews were conducted after the researchers attended the programme. The participants were adults/parents who participated in the programme with one or more of their children. An inductive reflexive thematic analysis was used to analyse the field notes and interviews. The analysis identified three main themes: (1) prioritising children’s equal engagement in physical activity, (2) helping parents promote children’s healthy lifestyles, and (3) improving family dynamics through engagement in physical activity. Each theme captures an aspect of the programme that parents perceived as essential to facilitating their family’s engagement in the programme. All the themes are interconnected and form the basis for improving family dynamics. To develop tailored family-based programmes in socioeconomically deprived communities, it is crucial to understand parents’ experiences and perceptions of aspects that facilitate their children’s engagement in physical activity. The findings suggest that emphasising equal opportunities, a safe space approach and participation are essential for increasing family engagement in physical activity. These elements also supported increasing parents’ awareness of their children’s need to be active and have fun together.

Schools are important settings for universal child health promotion. Understanding the experiences of providers of interventions targeting both children and their parents is crucial for designing feasible and sustainable school-based health promotion programs. The aim of this study was to explore school nurses’ perceptions and experiences of delivering a health-promotion program focusing on healthy lifestyle habits in primary schools in Sweden. This study employed an explorative qualitative design with an inductive approach. Interviews were conducted with school nurses using a semi-structured interview guide. The data were audio-recorded, transcribed and analysed using thematic analysis. School nurses had insights regarding the acceptability and appropriateness of the program as well as reflections regarding implementation and perceived impact. School nurses appreciated the evidence-based content and structure of the program and experienced improved collaboration with teachers. Moreover, positive changes were noted in relation to both children and parents such as improved knowledge and relations. Declining interest from school principals over the school year and lack of involvement among some parents were highlighted as implementation challenges. This study sheds light on the complexities faced by school nurses in delivering health-promotion interventions in collaboration with teachers in primary schools. Evidence-based practices, sustained leadership support and culturally sensitive strategies are essential for successful health promotion within schools. Our findings underscore the critical role of school nurses as health advocates, educators, and facilitators.

Background Families residing in disadvantaged communities encounter inequalities that restrict their engagement in physical activity. Family-based interventions and health coordinators have been proposed as promising approaches to encourage physical activity among parents and children. However, there is a paucity of knowledge regarding family experiences of such programmes and the ways health coordinators facilitate continued participation in programmes delivered in disadvantaged communities. The study aimed to explore parents’ perceptions of health coordinators in a family-based physical activity programme, Open Activities, delivered in disadvantaged communities in Sweden. Study design An exploratory design with a qualitative ethnographic approach. Methods Multiple methods, including 12 interviews, 15 observations and field notes, and prolonged researcher engagement between February 2022 and December 2023, were used to obtain complementary insights into parents’ perceptions and experiences in the Open Activities programme. Data was analysed using reflexive thematic analysis. Results A main theme and three sub-themes emerged from the analysis. The sub-themes reflect participants’ perceptions of how health coordinators provide a sense of safety for parents and children, making them feel appreciated and motivated to continue participating in the programme. The sub-themes also reflect the struggles that families encounter with security and social disorders in their neighbourhoods and how these difficulties influence their participation in outdoor activities and trust in outside people, including health coordinators. This required health coordinators to demonstrate a deep commitment to their communities, cultivate trust and fairness, and take a more assertive role in enforcing rules and ensuring respect. Conclusion The involvement of health coordinators, aware of the issues facing disadvantaged communities, could represent a promising avenue for advancing health equity through physical activity. Failure to consider the potential of health coordinators to promote safety can compromise programmes’ sustainability and even exacerbate existing disparities.

Early-life interventions are essential for improving public health since lifestyle behaviours are established already in childhood. Child healthcare (CHC) plays a crucial role in this context. The ‘Saga Stories in health talk’ (SSiHT) material includes a flipchart with colourful illustrations to facilitate CHC nurses’ routine health talks with parents and their children, and a hand-out material kit to support healthy lifestyle behaviours in the families. Our aim was to evaluate the effectiveness of the SSiHT intervention at the 5-year routine visit at CHC on parental self-efficacy (primary outcome) and children’s health-related behaviours (secondary outcomes). Implementation aspects for using the SSiHT material in routine practice for health talks at the 5-year visit were simultaneously evaluated. A hybrid type 1 effectiveness-implementation design was used to evaluate the intervention in six health regions across Sweden. A cluster-randomised controlled trial was conducted to evaluate effectiveness, where 40 CHC centres (98 nurses) were randomised into two arms: use the SSiHT material in routine care (intervention), or standard care (control). Parents (n = 698) of 5-year-olds were recruited. Outcome measures were assessed using digital questionnaires before the health talk (baseline), and two months later (follow-up). Linear mixed-effect models were used to contrast differences in outcomes between groups, in accordance with the study protocol. Acceptability, appropriateness, feasibility, fidelity, and adoption were evaluated using questionnaires and checklists to CHC nurses in the intervention group. No statistically significant intervention effects were found on parental self-efficacy to promote healthy lifestyle behaviours in their children (-0.61 score on a scale 0–160; p = 0.56), nor children’s intake of vegetables, fruits/berries, and sweet drinks or screen time (p > 0.05 for all). However, CHC nurses overall reported that the SSiHT material was feasible and appropriate to use in the health talks with families, and they used it in 83 https://www.clinicaltrials.gov/study/NCT05237362 .

Healthy lifestyle habits, such as performing physical activity and having healthy eating habits, are cornerstones of primary and secondary prevention of noncommunicable diseases, such as type 2 diabetes. Mobile health (mHealth) services may effectively promote healthy lifestyle habits, but more research focusing on users' perspectives of health-promoting mHealth services is needed to adapt them to user’s needs and preferences. This study aimed to explore perceptions of an mHealth service to support physical activity, healthy eating habits, and mental health among adult individuals with type 2 diabetes. In this qualitative study, individual interviews were conducted with 10 people with type 2 diabetes in Sweden who were using an mHealth service providing digital coaching to support physical activity, healthy eating habits, and mental health for four weeks. Qualitative content analysis with an inductive approach was used to analyze the data. Six subcategories and two categories were identified in the data. The participants emphasized the importance of an interactive design, including a user-friendly layout, meaningful and varied functions, and a design promoting motivation and goal setting. Additionally, they highlighted the importance of user-centered content, such as a holistic approach, a setting tailored to the user, and diabetes-specific information. These factors were seen as crucial for optimizing support for healthy lifestyle habits and ensuring that the content of the mHealth service effectively reaches users. Adult individuals with type 2 diabetes highlighted the importance of an interactive design that incorporates user-centered content in mHealth services to facilitate daily usage and promote behavioral change. This study contributes to the understanding of users' perceptions with mHealth services, which have been confirmed to be important when developing person-centered digital interventions.

BACKGROUND:Digital interventions offering behaviour change support are warranted to prevent and treat non-communicable diseases, and have been evaluated rigorously in controlled settings. Effectivenss, factors influencing the uptake of scaled-up interventions-such as reach, received dose, usability and acceptability- and predictors and mediators of efficiency are rarely explored in research. The study described herein aims to evaluate the effectiveness of a personally tailored digital intervention (the app EviBody®), intended to support healthy and sustained lifestyle behaviours among the adult population, on well-being and behaviour change. Further aims are to explore context and uptake factors, predictors and mediators for behaviour change over 24 months. METHODS:This is a real-world study, employing a quasi-experimental design and a process evaluation. EviBody® will be marketed and managed by its owner. A four-armed design will allow for comparison between three levels of intervention (basic, standard and premium) and a control group. Adults who sign up for the app will be invited to the research study including sharing app data and answering questionnaires at 0, 1, 3, 6, 12, 18, and 24 months. Study start is Autumn 2025. Controls (n = 200 to evaluate the primary endpoint well-being at 6 months) will be recruited through advertisements on social media and asked to answer the same questionnaires at 0 and 6 months provided by email. For predicting and mediating analyses the intention is to recruit 1500 app users. Well-being (measured with the WHO-5 Well-Being Index), goal achievement, physical activity, eating habits, mental health, mediators (motivation, self-efficacy, and perceived barriers), and demographics will be self-reported. Uptake will be collected using analytics and ratings of usability and acceptability, and described by demographics. Mixed models for repeated measures and structural equation modelling will be employed for data analysis. DISCUSSION:Besides evaluating the effectivenss of a digital intervention, this study also applies a theory-based evaluation to understand which mediators are effective, for whom they are effective, and the specific conditions under which they are most beneficial. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT05973383 on 8 July 2023.

IntroductionThere is an association between physical activity and both health and academic performance. However, there is still a lack of consensus on how to engage adolescents in physical activity interventions in secondary schools. One approach to better understand the activities and strategies supporting effective implementation is to involve school staff and adolescents in the early stages of planning and preparing for interventions. Therefore, the aim of this study is to explore how multiple stakeholders, including school staff, students, and experts, perceive the barriers and facilitators for implementing a school-based intervention that extends the school day with additional physical activity in Sweden.Material and methodsThis inductive explorative qualitative study involved 16 participants. Three focus groups with school staff, including principals (n = 3), teachers (n = 6), and students (n = 4), and three interviews with experts were conducted. The planned intervention and its components were presented to the participants in the focus group and interviews to discuss them based on their previous experiences and thoughts of implementing physical activities or health promotion programmes in their schools or with adolescents. Data were analysed using qualitative content analysis.ResultsThree categories emerged: (1) “types of activities offered”, highlighting the importance of designing activities that are fun, inclusive and unusual; (2) “integration of the activities into school curriculum” to promote sustainability of the intervention and incorporate physical activity throughout the school day and across school subjects, and (3) “Management support and funding” referring to the funded time and facilities that teachers leading the activities need to facilitate implementation.ConclusionsBefore implementing extra physical activity in a school setting, it is important to understand what activities enhance students' motivation and the type of support teachers need from the school principal and administration. This includes funding for teachers' time, appropriate scheduling of the activities, and access to facilities.

In Sweden, childhood overweight and obesity rates have risen significantly over the last decades, necessitating scalable interventions. The evidence-based Healthy School Start (HSS) program integrates school and family components to promote healthy habits and prevent overweight and obesity among children. The IMPROVE trial aimed to compare the effect of two tailored implementation strategy bundles (Basic and Enhanced) on fidelity to the HSS program. A hybrid type III cluster-randomized trial with two parallel arms was conducted in 45 schools (cluster) in three municipalities in Stockholm Sweden from August 2021 to June 2024. The program was implemented in two consecutive cohorts over two academic school years. Fidelity was measured with an adherence score (0–4) and parent’s responsiveness (1–5) to the four intervention components (health brochure, motivational interviewing health talk, classroom module and type 2 diabetes risk test). Data were analyzed using mixed-effects linear and logistic regression models. A total of 946 parents and 655 children participated. Overall fidelity, assessed as an adherence score, was around 75

Background: Effective implementation and sustainability of evidence-based public health interventions is vital to reducing the burden of chronic diseases. Suboptimal implementation due to contextual barriers reduce effectiveness and can be difficult to identify and predict. The aim of this study was to investigate the change in readiness and implementation outcomes of school staff implementing the universal family support program A Healthy School Start pre- and post-intervention in three municipalities in Sweden. Methods: Embedded in a hybrid type 3 implementation-effectiveness trial, validated questionnaires were used to assess readiness and implementation outcomes (acceptability, appropriateness, feasibility) at two time points. Data was collected from 39 school principals (implementation leader), 72 teachers (providing a classroom component to children) and 39 school nurses (providing a health talk with parents) between September 2021 – May 2023. A summative score was created for the outcomes. Median and interquartile ranges (IQR) were presented. Results: Readiness scores of all personnel were positively correlated with the acceptability (0.66), appropriateness (0.70), and feasibility (0.71) pre-intervention scores in the municipalities. Three distinct patterns were found in the implementation outcomes in the municipalities (M). In M1, all three implementation outcomes were high pre-intervention (16 IQR:14-19, 16 IQR:15-18, 16 IQR:14-18). Post-intervention acceptability and feasibility significantly decreased (12.5 IQR:9-17 and 15 IQR:9-17). In M2, implementation outcomes were low (12 IQR:10-16, 12.5 IQR:10-16.5, and 12 IQR:8-16) pre-intervention and remained low post-intervention. In M3, all three outcomes were high pre-intervention (16 IQR:14-18, 16 IQR:14-18, 16 IQR:13.5-17.5) and remained unchanged. School personnel in M3 experienced higher readiness and acceptability (53%) than in M1 (45%) and M2 (23%). School nurses scored lower (p=0.059) than principals and teachers regarding their perception of the feasibility of the program both pre- and post- implementation. Conclusion: This study provides useful insights into the implementation of a new school-based family support program in three municipalities. Further studies are needed to identify factors at school and municipality level which may have influenced the school personnel’s readiness to implement the program. A combined pre-implementation assessment of readiness, and acceptability, appropriateness and feasibility could be one way to identify organizations which are not yet ready to adopt a new program. Trial registration: Registered prospectively at ClinicalTrials.gov ID: NCT04984421, registered July 30, 2021

IntroductionStress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women’s sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women’s suffering. But knowledge on women’s experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood.MethodsRicoeur’s interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion.ResultsThese women’s experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women’s suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

To study cross-sectional relationships between step-up height and waist circumference (WC), a potential proxy for sarcopenic obesity, in Swedish children and parents. Participants were recruited from Swedish schools in disadvantaged areas in 2017. Height, body weight, WC and maximal step-up height were measured in 67 eight-year-old children and parents: 58 mothers, with a mean age of 38.5 and 32 fathers, with a mean age of 41.3. Sedentary time and physical activity were registered by an accelerometer. Associations between maximal step-up height and WC were analysed using Pearson's correlation and adjusted linear regression. Abdominal obesity, WC ≥ 66 centimetres (cm) in children, ≥88 cm in women and ≥102 cm in men, was observed in 13% and 35% of girls and boys, and in 53% and 34% among mothers and fathers, respectively. Negative associations between maximal step-up height and WC were found for children ( r  = −0.37, p  = 0.002) and adults (mothers r  = −0.58, p  < 0.001, fathers r  = −0.48, p  = 0.006). The associations remained after adjustments for height, body mass index (BMI) and physical activity in adults. Reduced muscle strength clustered within families ( r  = 0.54, p  < 0.001). Associations between reduced muscle strength and abdominal obesity were observed in children and parents. Sarcopenic obesity may need more attention in children. Our findings support family interventions.

AIM:To study cross-sectional relationships between step-up height and waist circumference (WC), a potential proxy for sarcopenic obesity, in Swedish children and parents. METHODS:Participants were recruited from Swedish schools in disadvantaged areas in 2017. Height, body weight, WC and maximal step-up height were measured in 67 eight-year-old children and parents: 58 mothers, with a mean age of 38.5 and 32 fathers, with a mean age of 41.3. Sedentary time and physical activity were registered by an accelerometer. Associations between maximal step-up height and WC were analysed using Pearson's correlation and adjusted linear regression. RESULTS:Abdominal obesity, WC ≥ 66 centimetres (cm) in children, ≥88 cm in women and ≥102 cm in men, was observed in 13% and 35% of girls and boys, and in 53% and 34% among mothers and fathers, respectively. Negative associations between maximal step-up height and WC were found for children (r = -0.37, p = 0.002) and adults (mothers r = -0.58, p < 0.001, fathers r = -0.48, p = 0.006). The associations remained after adjustments for height, body mass index (BMI) and physical activity in adults. Reduced muscle strength clustered within families (r = 0.54, p < 0.001). CONCLUSION:Associations between reduced muscle strength and abdominal obesity were observed in children and parents. Sarcopenic obesity may need more attention in children. Our findings support family interventions.

Background As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. ‘ Saga Stories in health talks’ is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the ‘Saga Stories in health talks’ material. Methods This study used a qualitative design. The material ‘ Saga Stories in health talks’ was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis. Results Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks , (2) Illustrations to capture children’s interest in the conversation with families , and (3) Barriers and facilitators. Saga Stories in health talks’ was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child’s interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts. Conclusions This pilot study show that the material ‘ Saga Stories in health talks’ was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

Objective Mobile health (mHealth) services suffer from high attrition rates yet represent a viable strategy for adults to improve their health. There is a need to develop evidence-based mHealth services and to constantly evaluate their feasibility. This study explored the acceptability, usability, engagement and optimisation of a co-developed mHealth service, aiming to promote healthy lifestyle behaviours. Methods The service LongLife Active® (LLA) is a mobile app with coaching. Adults were recruited from the general population. Quantitative results and qualitative findings guided the reasoning for the acceptability, usability, engagement and optimisation of LLA. Data from: questionnaires, log data, eight semi-structured interviews with users, feedback comments from users and two focus groups with product developers and coaches were collected. Inductive content analysis was used to analyse the qualitative data. A mixed method approach was used to interpret the findings. Results The final sample was 55 users (82% female), who signed up to use the service for 12 weeks. Engagement data was available for 43 (78%). The action plan was the most popular function engaged with by users. The mean scores for acceptability and usability were 3.3/5.0 and 50/100, respectively, rated by 15 users. Users expressed that the service’s health focus was unique, and the service gave them a ‘kickstart’ in their behaviour change. Many ways to optimise the service were identified, including to increase personalisation, promote motivation and improve usability. Conclusion By incorporating suggestions for optimisation, this service has the potential to support peoples’ healthy lifestyle behaviours.

Introduction and aimEthnically diverse neighborhoods encounter pronounced inequalities, including housing segregation and limited access to safe outdoor spaces. Residents of these neighborhoods face challenges related to physical inactivity, including sedentary lifestyles and obesity in adults and children. One approach to tackling health inequalities is through family-based programs tailored specifically to these neighborhoods. This study aimed to investigate parents' experiences and perceptions of the family-based Open Activities, a cost-free and drop-in program offered in ethnically diverse and low socioeconomic neighborhoods in Sweden.MethodsResearchers' engagement in 15 sessions of the Open Activities family-based program during the spring of 2022, and individual interviews with 12 participants were held. Data were analyzed using reflexive thematic analysis.ResultsThe analysis resulted in three main themes and seven sub-themes representing different aspects of the program's meaning to the participants as parents, their families, and communities. The main themes describe how parents feel valued by the program, which actively welcomes and accommodates families, regardless of cultural differences within these neighborhoods. The themes also show how cultural norms perceived as barriers to participation in physical activity can be overcome, especially by mothers who express a desire to break these norms and support girls' physical activity. Additionally, the themes highlight the importance of parents fostering safety in the area and creating a positive social network for their children to help them resist criminal gang-related influences.ConclusionsThe program's activities allowed parents to connect with their children and other families in their community, and (re)discover physical activity by promoting a sense of community and safety. Implications for practice include developing culturally sensitive activities that are accessible to and take place in public spaces for ethnically diverse groups, including health coordinators that can facilitate communication between groups. To enhance the impact of this program, it is recommended that the public sector support the creation of cost-free and drop-in activities for families who are difficult to reach in order to increase their participation in physical activity, outreach, and safety initiatives.