Publikationer

Research | Forskning - peer review

Historically, public health interventions in Greenland are primarily adopted from a Scandinavian context or developed centrally in the capital city instead of building on communities’ local resources and strengths. The aim of this article is to identify implementation determinants from professionals… Historically, public health interventions in Greenland are primarily adopted from a Scandinavian context or developed centrally in the capital city instead of building on communities’ local resources and strengths. The aim of this article is to identify implementation determinants from professionals’ perspectives in the implementation of the parenting programme Meeraq Angajoqqaat Nuannaarneq (MANU, meaning child’s and parent’s happiness) 0–1 Year, at the local level in three of Greenland’s five health regions. The study applied the Consolidated Framework for Implementation Research. Semi-structured interviews with 18 health professionals and six managers in healthcare and with four municipality personnel were held. Additionally, data on staffing from the Board for Health and Prevention was gathered. Professionals agree on the importance of having a universal parenting programme, but it is not a priority to them. Characteristics of the programme were a barrier in implementation in some local contexts, such as professionals experiencing parents being uncomfortable with participating in group sessions. Many professionals felt it was a daunting task to facilitate a group session. MANU was also incompatible with existing workflows. High turnover in the healthcare system makes it difficult to implement and sustain programmes. Professionals found it difficult to apply supervision provided by the MANU team and, at times, did not feel recognised in their efforts. Adaptations were made to MANU to fit local contexts. The identified determinants hindering local implementation link back to MANU’s complexity and inadequate preparatory investigations made into aspects influencing implementation during MANU’s conceptualisation and development. Many of the barriers identified could have been prevented by involving local community perspectives from professionals and families from the outset of MANU. Læs mere

Research | Forskning - peer review

An in-depth implementation study of the Greenlandic parenting program MANU’s initial stages of implementation

In Greenland, the universal parenting programme MANU was developed in 2016. After documenting the initial years of MANU’s implementation, this study aimed to identify implementation determinants focusing on i) which context MANU was conceptualised in and how it was developed and ii) how MANU was imp… In Greenland, the universal parenting programme MANU was developed in 2016. After documenting the initial years of MANU’s implementation, this study aimed to identify implementation determinants focusing on i) which context MANU was conceptualised in and how it was developed and ii) how MANU was implemented and initially received in the healthcare system. A qualitative in-depth implementation study was conducted: document analysis, 38 interviews, one focus group discussion, and observations at two trainings for professionals and four parent sessions. Participants included stakeholders from both the health and social sector and from management to practitioner level. MANU was conceptualised based on a political desire to ensure children’s well-being by providing parents with the essential parenting skills, and a desire to create a programme for the Greenlandic context. Professionals welcomed the MANU materials, but anticipated or experienced barriers in implementing MANU. The first years of MANU focused on disseminating material and training professionals. Despite political support and financial security enabling implementation, an assessment of the implementation capacity from the very beginning could have prevented some of the implementation challenges identified. Insights on parents’ perspectives and local implementation are lacking and need to be brought to the forefront of the implementation process. Læs mere

Research | Forskning - peer review

Community health workers as a sustainable health care innovation: Introducing a conceptual model

Health care delivery in the Circumpolar North is challenged by a scarcity of culturally relevant health care services, few medical providers trained in cross-cultural care, and high costs of transportation. Community health workers (CHWs) are primarily Indigenous individuals who provide on-the-groun… Health care delivery in the Circumpolar North is challenged by a scarcity of culturally relevant health care services, few medical providers trained in cross-cultural care, and high costs of transportation. Community health workers (CHWs) are primarily Indigenous individuals who provide on-the-ground health care and health promotion services in their own communities.The CHWs’ scope of work varies from health education to clinical care and often focuses on upstream factors that impact the public’s health. Although often overlooked and underutilized, the CHW role is an innovative approach to promoting more sustainable and culturally relevant care within health systems. Investigating and understanding the potential ways that CHW-integrated health care systems support health and wellness could allow for a clearer understanding of how to translate this approach to other regions seeking a transition to sustainability in health and wellness. Drawing on experiences with CHWs in the Circumpolar North, this article introduces a conceptual model summarizing pathways that describe how integrating CHWs supports wellness in their communities. The proposed model includes five pathways for how CHWs could support wellness: (1) the recruitment of CHWs from within a community promotes community capacity and control; (2) the CHW role allows them to advocate to address structural and systemic inequalities that contribute to ill health, if CHWs are supported to organize their communities around wellness; (3) CHWs have the potential to support and empower community members; (4) CHWs have the potential to develop culturally relevant, feasible, and effective health promotion strategies; and (5) CHWs have the potential to build on community strengths. This model allows for CHW-integrated health care systems to be critically examined to both test and refine this proposed model, and support and empower community health workers as a transition to a more sustainable health care delivery system that reduces inequities and promotes health. Læs mere

Research | Forskning - peer review

The background of the study reported in this chapter was the growing number of chronically ill patients. The purpose was to explore patients’ perspectives on life with chronic illness and how it relates to healthcare practice. The research was conducted as an ethnographic field study. A conclusion o… The background of the study reported in this chapter was the growing number of chronically ill patients. The purpose was to explore patients’ perspectives on life with chronic illness and how it relates to healthcare practice. The research was conducted as an ethnographic field study. A conclusion of the study is that the disease-oriented healthcare system is not geared to deal with rehabilitation because of a narrow focus on disease and treatment, and the exclusion of patients’ knowledge. However, knowledge about patients’ everyday life and perspectives hold potentials for rehabilitative and health promotional professional interventions. Læs mere

Research | Forskning - peer review

Determinants of an integrated public health approach: the implementation process of Greenland’s second public health program

Background: Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single,… Background: Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined. Methods: Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II’s implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination. Results: Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee. Conclusion: Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II’s integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation. Læs mere

Consultancy | Rådgivning

Midtvejsevaluering af Inuuneritta II: Gennemført i 2017

Rapporten er en midtvejsevaluering af folkesundhedsprogrammet Inuuneritta II. Der er tale om en procesevaluering, der fokuserer på, hvordan det er gået med at føre programmet ud i praksis. Formålet med rapporten er at give konstruktive input, mens det stadig er muligt at justere og tilpasse program… Rapporten er en midtvejsevaluering af folkesundhedsprogrammet Inuuneritta II. Der er tale om en procesevaluering, der fokuserer på, hvordan det er gået med at føre programmet ud i praksis. Formålet med rapporten er at give konstruktive input, mens det stadig er muligt at justere og tilpasse programmet. Ved udgangen af 2016 havde alle 4 programområder i Inuuneritta II haft hvert deres indsatsår, og alle områder bør derfor ifølge planen være overgået til drift. Det derfor et oplagt tidspunkt at gøre status på implementeringen af programmet fra 2013-2016, det vil sige de første 4 år af programmets levetid på i alt 7 år. Læs mere

Research | Forskning

This dissertation concerns childbirth and its position within the Greenlandic society, taking a holistic health promotional view of the perinatal period and focusing on the importance of the women, the children, their families and the local community as equal pieces of a whole. The aim of the disse… This dissertation concerns childbirth and its position within the Greenlandic society, taking a holistic health promotional view of the perinatal period and focusing on the importance of the women, the children, their families and the local community as equal pieces of a whole. The aim of the dissertation is to present new concepts and knowledge concerning the health of the perinatal family in Greenland. It seeks to present childbirth and its position within the Greenlandic society and to link the changes in choice related to birth and place of birth with the concepts of family, attitude and community structure. It looks holistically at the place of birth with focus on the issue of support during the perinatal period. It draws on statistical, historical, anthropological, biophysical and cultural data within the context of perinatal health in Greenland. The dissertation is comprised of four studies and uses multidisciplinary methods including literature studies, narrative interviews and focus groups in the collection of data. Ethnographic content analysis, cultural resiliency, storytelling and narrative theory are used as the theoretical bases and analysis tools. The mode of conducting focus groups and interviews was based on the principles in the Helsinki Declaration. Over an eight-year period from 2003 to 2011, literature studies, focus groups and individual interviews were conducted. Two literature studies were carried out and empirical data was collected at four sites in Greenland: Nuuk, Ilulissat, Sisimiut and Tasiilaq. Data included seven focus groups with 33 participants, supplemented with 18 individual interviews of women, fathers and Culture Bearers. Post-colonially birth was considered to be a personal matter for women and is therefore a lack of information on childbirth in Greenland. Perinatal policies and guidelines are presented to the communities by policymakers, and officials, but seldom negotiated with the women and communities before implementation. The perinatal family’s concepts of safety are often connected directly to access to family and community. Family is perceived as security, and lack of family support and network as insecurity. The concept of responsibility to family and community is culturally specific and connected to the immediate family, extended family and kin. There is a cultural room for birth in Greenland, where the health of the perinatal family lies in their ability to strengthen the bonds within the families and kinships and community networks. Greenlandic families have risen to the challenges engendered by global economic development and modernization of their society. The communities, families and women of the study perceived themselves as the bearers of their children; the fathers considered themselves to be the artisans and caregivers for their family; the community, including the extended family, deemed an important support network for the families. Læs mere