Emmie Wahlström

Implementation of evidence-based interventions requires professionals to manage fidelity and adaptation in everyday practice. From a deliverer-centered perspective, this work may have implications for professionals’ psychosocial working conditions. This study examined professionals’ perceptions of their psychosocial working conditions when using an evidence-based intervention called “All Children in Focus” under different forms of implementation support targeting fidelity and adaptation. Using a longitudinal within-person repeated-measures design, 25 Swedish professionals were surveyed across three scenarios: (1) practice as usual; (2) after structured reflection on fidelity and adaptation; and (3) after participating in a decision-support intervention about fidelity and adaptation (the Adaptation and Fidelity Tool–A-FiT), designed to facilitate fidelity–adaptation decisions. Psychosocial working conditions were assessed using validated self-report measures, including unreasonable tasks, role conflict, quantitative demands, knowledge, skills, openness, and work-related self-efficacy. Data were analyzed using Friedman’s ANOVA and Wilcoxon signed-rank tests. Across the three scenarios, professionals reported generally favorable psychosocial working conditions, with no statistically significant changes over time on most measures. A statistically significant decrease in perceived skills was observed following structured reflection ( p = 0.024), but this change was not sustained following participation in A-FiT. Overall, the findings indicate that, in this sample, implementation support targeting fidelity and adaptation was not associated with statistically significant deterioration in professionals’ psychosocial working conditions. The findings have implications for deliverer-centered evaluation of implementation strategies and for understanding conditions that may support sustainable use of evidence-based interventions in practice. Larger studies are needed to confirm findings and examine generalizability across other contexts.

For 75 years, the WHO health definition has been the most influential and widely accepted definition of health globally, having a profound impact on policy making, professional practice, and people’s overall understanding of health. Although there are alternative notions and definitions of health, it is argued that this definition has enjoyed an almost hegemonic position in the health discourse. Still, it has rarely been systematically deconstructed. This text aims to deconstruct the WHO 1948 definition of health in its entirety as well as its parts. This is done to highlight the epistemological variations and potential contradictions embedded within, and the possible consequences of the definition. The findings indicate a multitude of occasionally ambiguous or conflicting readings depending on how the reader and contemporary ideas conceptualize words and phrasing in the definition. For example, interpreting health as binary can be challenged by ideas of the present as constantly changing, suggesting that health in the definition is conceptualized along a continuum. Such alternative – and sometimes contradictory readings – call for clarifications on how the definition is used and interpreted in different contexts. Still, its ambiguity might have helped it remain relevant and applicable across different societies and time periods.

This article examines how the Swedish child welfare services (CWSs) are described in Arabic‐speaking social media, with a focus on the ‘LVU campaign.’ The material consists of Facebook and YouTube posts and comments about the Swedish CWSs' actions in child mistreatment cases involving migrant families. These posts and comments were written in Arabic, had a substantial number of interactions (likes, shares etc.), were openly accessible and were published between January 2021 and December 2023. Through thematic analysis of posts and comments, four themes emerge: ‘The heartless CWS bandits,’ ‘Sweden in moral decline (the land of haram),’ ‘The infidel West at war with Islam and God’ and ‘Faithful, just and loving families.’ These themes are further examined through three conceptual dichotomies: particularism–universalism, reality–hyperreality and the construction of ‘us’–‘them.’ The analysis shows that social media accounts shape perceptions of ‘the other’ and fuel mistrust in the commentary fields of posts of ‘real’ events. The accounts illustrate the challenge of balancing universal rights with respect for cultural differences and the minority rights of migrant families. The study highlights how such dynamics can accentuate in‐group preferences and fuel inter‐group polarization by amplifying certain versions of reality to explain the CWSs' actions towards migrant families.

Introduction: Culture underpins social interaction between school health professionals and children. Both practice and research suggest that cultural variations, migration and intercultural interactions pose potential challenges in encounters between school health professionals and children and may relate to the health professionals’ understanding of their own culture as a factor in such encounters. Still, for the school health services (SHS), reviews collating existing research on school health professionals’ understanding of culture are lacking. Objectives: This review aims to identify, describe and analyse existing research on school health professionals’ (ie, school nurses, school social workers, school doctors and school psychologists) understanding of culture. Design: A scoping review of peer-reviewed and published scientific articles on school health professionals’ understanding of culture. Inclusion criteria: Articles published between 2013 and 2024 on culture, SHS and school nurses, school doctors, school social workers or school psychologists. Methods and analysis: Searches were conducted in October 2023 and September 2024 in 10 databases. Two reviewers independently screened the article titles, abstracts and full texts for inclusion. Extracted data were analysed using descriptive statistics and qualitative content analysis. The qualitative content analysis focused on content related to theoretical considerations, key findings and conceptualisations of culture. Results: From 1784 screened articles, 100 articles were screened in full text and 21 articles fulfilled the eligibility criteria. After identifying two additional articles through manual searches, a total of 23 articles were included in the review. The findings show that the articles primarily applied a quantitative study design, focused on school psychologists and school nurses and were conducted in the USA and Nordic-Baltic area. Self-understanding was mainly studied using validated instruments, leaving the conceptualisation of culture to the researchers. Still, only about half of all the articles described the theoretical conceptualisation of culture. Studies of intercultural interaction focused on the challenges of encountering ‘diverse’ children and raised concerns about barriers and hindrances to the encounters. Conclusions: This review shows that SHS professionals’ understanding of culture has mainly been studied within two SHS professions, within a narrow geographical sphere and without a theoretical stance on culture. Thus, more qualitative research, a clearer theoretical conceptualisation of culture and more research on SHS professionals’ practice and self-understanding are needed.

Background: Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI ( n = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi ² -test. Results: The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer “removing,” “substituting,” and “integrating another framework” adaptations and more “loosening structure” and “departing from the intervention” adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency. Conclusions: The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.

Aim: To explore the experiences of health visits within the school health services from the perspective of adolescents with migration experiences.Design: A descriptive qualitative study.Methods: Data were collected using focus groups and semi‐structured individual interviews with adolescents with migration experiences aged 13–17 years old. Analysis was conducted using reflexive thematic analysis.Results: The results described adolescents reading the signs in the guided interaction between them and the school nurses. Reading the signs illustrated the adolescents' continuous interpretation of the interaction with the school nurse, and their decisions on how to respond throughout the health visit. These interpretations influenced the adolescents' shifting willingness to talk about their health and how they adapted to the space of participation provided by the school nurse. The interpretation also influenced their experiences of health visits as focusing on their health without making them feel singled out.Conclusion: Although individual considerations might be warranted in health visits with adolescents with migration experiences, the results indicate that similarities in intrapersonal communication in various encounters between adolescents and health professionals might be greater than any differences. Healthcare encounters with adolescents with migration experiences might thus need to be conducted with an awareness that adolescents read the signs in the guided interaction and that similarities in this interaction are greater than any differences.

Introduction: Culture is highlighted in previous research as important in encounters where health professionals and children do not share a language or culture. In these encounters, culture is described as mainly related to the child, whereas the health professionals’ understanding of their own culture as impacting the encounter tends to be left out. To clarify how culture is understood and conceptualised among professionals, it is of relevance to collate previous research on health professionals’ understanding of culture. In the scoping review that this protocol describes, we aim to focus on the context of the school health services, being a context accessible to many children in their everyday life. The aim of the review will be to identify, describe and analyse previous research concerning school health professionals’ (ie, school nurses, school social workers, school doctors and school psychologists) understanding of culture. Methods and analysis: This scoping review will be guided by the methodology described by Peters et al and Khalil et al . Searches will be conducted in Scopus, PubMed, Cinahl Plus, SocIndex, Sociological Abstracts, Social Services Abstracts, APA PsycInfo, APA PsycArticles, Web of Science and Applied Social Sciences Index & Abstracts (ASSIA). Any published scientific papers focusing on school health professionals’ understanding of culture (conceptualised through a variety of related terms) and school health services conducted within the last 10 years (2013–2023) will be included. Two reviewers will independently screen all titles and abstracts for inclusion. Two reviewers will conduct the screening of full-text documents and the extraction of information. Qualitative content analysis as well as discourse analysis will be employed. Ethics and dissemination: Ethical approval is not required for this study. The findings will be disseminated through peer review publication as well as presentation at conferences and to relevant stakeholders.

Background: Migration affects the health of children worldwide. Therefore, school nurses who encounter these children as part of their everyday practice need support from guidelines on how to promote the health of children who have migrated or whose parents have migrated. Yet knowledge regarding such content in guidelines of school nursing practice is sparse. Therefore, this study aims to investigate how municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include factors related to migration that affect children’s health. Methods: A document analysis of municipal and regional guidelines and health questionnaires guiding school nurses’ practice in health visits was conducted during the autumn of 2020. In total, 687 guidelines and health questionnaires were analyzed using deductive content analysis. Results: The results show that municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include content on many factors related to migration that affect children’s health. Yet the content was limited, and none was found on factors related to discrimination based on ethnicity or origin. Conclusion: Guidance related to promoting the health of children who have migrated or whose parents have migrated should include all factors affecting these children’s health. Therefore, to strengthen school nurses’ evidence-based practice, guideline development might be needed, although guidelines and health questionnaires exist and include content on many factors related to migration affecting the health of children in order to provide equitable healthcare for all children, regardless of country of origin.