Research | Forskning - peer review

Parents’ perspectives on the role of kin in child-rearing: a qualitative study on Greenland’s universal parenting programme MANU

Nurturing care and protection from parents and community in the early years of life are fundamental for a child's development. The article aims to explore what relations parents see as meaningful in their child's upbringing and how these are shaped, and how these perspectives are reflected in MANU.… Nurturing care and protection from parents and community in the early years of life are fundamental for a child's development. The article aims to explore what relations parents see as meaningful in their child's upbringing and how these are shaped, and how these perspectives are reflected in MANU. MANU is a universal parenting programme in Greenland. Ten of 40 interviews with parents were selected for the analysis of this article's objective. Five grandparents were interviewed. Grandparents are the child's closest extended family members and provide support to parents. Parents placed between one to 19 extended family members in their child's network. Eating and being in nature together, along with familial and intergenerational connectedness, were deemed valuable and important aspects in child-rearing. Parents? own experiences in childhood can influence and complicate how parents place their new family within the extended family. The MANU materials address aspects in the role of kin that parents and grandparents described in interviews. The format and delivery of MANU aims to be universal and mostly addresses Western epistemologies, but both Western and Inuit epistemologies coexists in Greenland. This article creates a window into the existing context parents navigate in. It is important that initiatives are built within this context to ensure they are relevant to families. Atuaruk

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. Atuaruk

Research | Forskning - peer review

Parents’ perspectives on preparing for parenthood: a qualitative study on Greenland’s universal parenting programme MANU 0–1 year

Background: The transition to parenthood has received increasing attention in research, partly due to evidence pointing out the crucial developmental period of a child’s first thousand days. Parenting programmes aim to prepare and support families in their transition and distress. For a programme to… Background: The transition to parenthood has received increasing attention in research, partly due to evidence pointing out the crucial developmental period of a child’s first thousand days. Parenting programmes aim to prepare and support families in their transition and distress. For a programme to be implemented successfully it is important to consider parents’ needs and resources. Bringing parents’ perspectives and experiences to the forefront of the implementation of the Greenlandic parenting programme MANU 0–1 Year (MANU) is important for determining if the programme can meet its aim of contributing to thriving families. This study aims to investigate how parents’ notions and experiences of parenthood are reflected and challenged in MANU. Method: Data were collected in three of Greenland’s five municipalities. Qualitative interviews were held with 38 mothers and 12 fathers either individually or as couples: a total of 40 interviews. Additionally, a Sharing Circle with three fathers was held. Interviews were in Greenlandic or Danish. A thematic, inductive analysis was applied. Results: In their transition to parenthood, participants experienced a reprioritisation of their life and changes in their network. It is important to parents that their child experiences security and care, and participants describe this in contrast to their own childhood. Community is the most important value in child‑rearing. Conversations and advice from family members and friends are mentioned as a means to prepare for birth and parenthood. Additionally, conversations with midwives and MANU sessions were also used for preparation. Parents appreciated learning from and listening to other parents in MANU sessions. However, accessing MANU depends on the individual parent’s interest and ability to attend sessions. Conclusions: Parents’ notions and experiences of parenthood are addressed in the programme, but the use of MANU depends on the parents’ attendance and how it is organised and locally offered. The study suggests that MANU has the possibility to create a space for parents to reflect and prepare. However, for MANU to be universal as intended and to reach both mother and father the facilitation of sessions could be revisited. Atuaruk

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. Atuaruk

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. Atuaruk

Research | Forskning - peer review

Patient experience studies in the circumpolar region: a scoping review

Objectives: Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients’ interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the rang… Objectives: Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients’ interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the range and nature of peer-reviewed literature on patient experience studies conducted within the circumpolar region. Design: In a partnership between Danish/Greenlandic, Canadian and American research teams, a scoping review of published research exploring patient experiences in circumpolar regions was undertaken. Data sources: Seven electronic databases were queried: MEDLINE, Embase, Scopus, ‘Global Health 1910 to 2019 Week 11’, CINAHL, PsycINFO and SveMed+. Eligibility criteria: Articles were eligible for inclusion if they (a) took place in the circumpolar region, (b) reported patients’ perspective and (c) were focussed primarily on patient experiences with care, rather than satisfaction with treatment outcome. Data extraction and synthesis: Title and abstract screening, full-text review and data extraction was conducted by four researchers. Bibliometric information such as publication date and country of origin was extracted, as was information regarding study design and whether or not the article contained results relevant to the themes of Indigenous values, rural and remote context, telehealth and climate change. Two researchers then synthesised and characterised results relevant to these themes. Results: Of the 2824 articles initially found through systematic searches in seven databases, 96 articles were included for data extraction. Findings from the review included unique features related to Indigenous values, rural and remote health, telehealth and climate change. Conclusions: The review findings provide an overview of patient experiences measures used in circumpolar nations. These findings can be used to inform health system improvement based on patient needs in the circumpolar context, as well as in other regions that share common features. This work can be further contextualized through Indigenous methodologies such as sharing circles and community based participatory methods. Atuaruk

Research | Forskning

Nabo–unges stemmer om social inklusion i Grønland

Nabo er et projekt, der blev lanceret under det svenske formandskab i Nordisk Ministerråd 2018. Projektet ledes af den svenske Myndigheten för ungdoms- och civilsamhällesfrågor i perioden 2018-2020 og sigter mod at skabe nordiske unges perspektiver på det sociale inklusion. Unges stemmer høres i spø… Nabo er et projekt, der blev lanceret under det svenske formandskab i Nordisk Ministerråd 2018. Projektet ledes af den svenske Myndigheten för ungdoms- och civilsamhällesfrågor i perioden 2018-2020 og sigter mod at skabe nordiske unges perspektiver på det sociale inklusion. Unges stemmer høres i spørgsmål om deres liv. og baseret på denne viden, får de muligheden for at deltage i og påvirke politiske beslutninger. Unge mennesker bliver bedt om at beskrive deres hverdag og hvordan de oplever deres muligheder og forhindringer. Fra deres historier bygger Nabo en ramme af succesfaktorer for social integration i de nordiske lande. Denne rapport er baseret på fokusgruppeinterviews med unge mennesker forskellige steder i Grønland. Lignende undersøgelser gennemføres i de andre nordiske lande på Færøerne og Åland. Atuaruk

Research | Forskning

Brugernes oplevelse af det grønlandske sundhedsvæsen: En pilotundersøgelse

Center for Folkesundhed i Grønland har i sommeren 2019 gennemført en kvalitativ pilotundersøgelse, der har undersøgt borgernes oplevelse af det grønlandske sundhedsvæsen. Formålet med undersøgelsen har været at give et indblik i, hvordan adgangen til sundhedsvæsenet opleves af borgerne, og hvad der… Center for Folkesundhed i Grønland har i sommeren 2019 gennemført en kvalitativ pilotundersøgelse, der har undersøgt borgernes oplevelse af det grønlandske sundhedsvæsen. Formålet med undersøgelsen har været at give et indblik i, hvordan adgangen til sundhedsvæsenet opleves af borgerne, og hvad der er vigtigt for borgerne, når de møder sundhedsvæsenet som brugere. Dermed giver undersøgelsen os et vigtigt grundlag for at arbejde videre med udviklingen af et langsigtet og nationalt design for øget brugerinddragelse og brugerevaluering i det grønlandske sundhedsvæsen - et grundlag, der tager udgangspunkt i borgernes egne perspektiver, og som er kulturel relevant. Atuaruk

Communication | Formidling - peer review

Symposium on “parental education” at the ICCH17

This symposium report provides a brief overview of the six programmes and studies on parental education and maternal health services within the circumpolar region presented in the symposium “parental education” at the 17th International Congress of Circumpolar Health in Copenhagen, Denmark, August 2… This symposium report provides a brief overview of the six programmes and studies on parental education and maternal health services within the circumpolar region presented in the symposium “parental education” at the 17th International Congress of Circumpolar Health in Copenhagen, Denmark, August 2018. Atuaruk

Research | Forskning - peer review

Befolkningsundersøgelsen i Grønland 2018. Levevilkår, livsstil og helbred - Oversigt over indikatorer for folkesundheden

Befolkningsundersøgelsen i 2018 er den seneste i en række af fem landsdækkende sundhedsundersøgelser, der er gennemført siden 1993. Befolkningsundersøgelsen i 2018 omfatter 19 af de 38 indikatorer for folkesundheden i Grønland relateret til de indsatsområder som er beskrevet i folkesundhedsprogramme… Befolkningsundersøgelsen i 2018 er den seneste i en række af fem landsdækkende sundhedsundersøgelser, der er gennemført siden 1993. Befolkningsundersøgelsen i 2018 omfatter 19 af de 38 indikatorer for folkesundheden i Grønland relateret til de indsatsområder som er beskrevet i folkesundhedsprogrammet Inuuneritta II. Disse dækker over befolkningens brug af alkohol og hash, rygevaner, kostmønstre og fysisk aktivitet samt en række forhold i opvæksten med betydning for helbredet langt ind i voksenlivet. Undersøgelsen handler i høj grad også om mental sundhed og trivsel, og der er som noget nyt et særligt fokus på unge og ældre. Atuaruk

Consultancy | Rådgivning

Kortlægning af rygestoptilbud: Undersøgelse af borgernes adgang til rygestop i kommuner og sundhedsvæsenet i Grønland

Undersøgelsens formål er at få et tydeligt overblik over, i hvilket omfang borgerne i Grønland (både børn og voksne) har adgang til rygestoptilbud i regi af sundhedsvæsenet og kommunerne, herunder hvilke typer af rygestoptilbud, der udbydes, og i hvilket omfang.

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. Atuaruk

Consultancy | Rådgivning

Evaluering af Grønlands Sundhedsreform: Oplevede og målbare effekter 2017

Formålet med denne evaluering af Sundhedsreformen er at gøre status på den ledelsesmæssige oplevelse af organiseringen af sundhedsvæsenet efter den fulde implementering af regionaliseringen. Dette er gjort dels gennem dokumentanalyse af en stor mængde rapporter, notater og oversigter fra Sundhedsled… Formålet med denne evaluering af Sundhedsreformen er at gøre status på den ledelsesmæssige oplevelse af organiseringen af sundhedsvæsenet efter den fulde implementering af regionaliseringen. Dette er gjort dels gennem dokumentanalyse af en stor mængde rapporter, notater og oversigter fra Sundhedsledelsen, og dels gennem 17 kvalitative interviews med repræsentanter fra regions-, område- og sundhedsledelse, der har været med til at gennemføre regionaliseringen, samt med enkelte medarbejdere fra forskellige sektorer og regioner med erfaring fra før og efter reformen. Atuaruk

Consultancy | Rådgivning

A scoping review: Well-being among indigenous children and youth in the Arctic – with a focus on Sami and Greenland Inuit

Children and young people from the Inuit and Sami populations in the Nordic countries can be identified as a vulnerable group. Young Sami and Inuit experience a higher degree of violence, abuse, suicidal thoughts and suicide rates compared to their peers in the majority populations in the Nordic cou… Children and young people from the Inuit and Sami populations in the Nordic countries can be identified as a vulnerable group. Young Sami and Inuit experience a higher degree of violence, abuse, suicidal thoughts and suicide rates compared to their peers in the majority populations in the Nordic countries. Their living conditions are in most cases influenced by a limited access to welfare benefits such as the healthcare system, social services and educational opportunities. Career prospects in the Arctic region are also narrow compared to the more densely populated and central regions in the Nordic countries. In order to understand and act upon the challenges the populations face, an in-depth and systematic review of the existing literature and experiences of children’s and youth’s well-being and their existing living conditions in the Arctic Region is essential. Atuaruk

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. Atuaruk