Petter Viksveen

Clear recommendations for how to best adapt mental health services for adolescents with a background as asylum seekers and refugees are lacking. This study therefore explored healthcare professionals’ experiences and perspectives on mental health needs of these groups of youth in Norway. The objectives were to explore healthcare professionals’ perspectives on what is needed for adolescents with status as asylum seekers or refugees to seek professional help for mental health problems and what is important for them to experience the offered help as beneficial. A qualitative interview study was carried out to explore the perspectives of healthcare professionals ( n = 11) in primary and secondary healthcare settings. Systematic text condensation was used for data analysis. Four themes were developed through the study: (a) culturally sensitive and adapted services; (b) low threshold and outreach services; (c) building a trusting relationship; and (d) user involvement. The study provides a constructivist understanding of cultural competence including several suggestions for how to overcome barriers to service use among adolescents who have a background as asylum seekers or refugees. Some of the recommendations include an ongoing collaboration with youth and their families to better understand their culture; healthcare professionals who acquire cultural competence, practice cultural humility and are mindful of their own cultural backgrounds. There should be comprehensive education and training programmes for healthcare professionals. Services should be easily accessible with simplified referral procedures and arena flexibility. Skilled interpreters should be used, including cultural interpreters. Shared decision-making should be used to actively engage youth in their treatment.

Background: Worldwide, minority youth receive culturally sensitive mental health services less often than the majority peer population. In Norway, limited research exists on the mental health and service use among youth from national minority (Forrest Finns, Kven or Norwegian Finns, Jews, Roma, and Romani), Indigenous (Sámi), and refugee backgrounds. Although the Norwegian government provides a public communication channel for youth, including mental health information and support, digital services have not been adapted to meet the needs of these groups. There is currently no research to determine the use, acceptability, effectiveness, cost-effectiveness, and safety of these services for these youth. Objective: The main aim of the InvolveMENT project is to improve the mental health of national minority, Indigenous, and refugee youth. The project’s objectives are, for these groups of youth, to (1) determine the mental health and digital support needs and possible barriers to and facilitators of service use; (2) assess the use of and satisfaction with digital services to meet their mental health needs; (3) explore their perspectives on digital mental health services; (4) develop recommendations that can be used to adapt digital services to meet their needs and rights; and (5) assess the use, acceptability, satisfaction, effectiveness, cost-effectiveness, and safety of adapted services. Methods: The 4-year InvolveMENT project consists of four phases: (1) establishing a longitudinal cohort consisting of national minority, Indigenous, and refugee youth, using surveys to assess their mental health, well-being, digital support needs, use and satisfaction with digital services, and possible barriers to and facilitators of service use; (2) conducting qualitative interviews with minority youth to explore their perspectives and synthesizing data from phases 1 and 2 for a mixed methods analysis; (3) involving youth and health care and other professionals to develop proposals to adapt and improve the existing digital services; and (4) a randomized controlled trial and a qualitative study to evaluate the adapted services. Results: Cohort and qualitative study designs have been completed. Ethics applications have been approved, and recruitment to the cohort and qualitative studies has started. Conclusions: The InvolveMENT project has the potential to enhance the accessibility and quality of health care services and early interventions, reduce inequality in service provision for minority groups, and strengthen collaboration between youth, public, and research organizations. Through this, it has the potential to improve the mental health of youth from these groups. The findings might be transferable to other minority groups, both nationally and internationally.

Older adult care systems face severe workforce shortages, rising demands, and high levels of stress and burnout, undermining the quality of care and organizational resilience. Support4Resilience (S4R, 2024-2028) aims to improve working conditions and mental well-being by equipping leaders with an evidence-based, organizational-level intervention. The project develops and evaluates a digital S4R Toolbox consisting of 3 tools: (1) mapping and identification (MAP); (2) reflection and education (IMPROVE); and (3) reorganization (REMOVE). The project aims to strengthen resilience and mental well-being among health care workers and informal caregivers in older adult care across Europe and Australia through the development and implementation of the digital S4R Toolbox. Secondary objectives are identifying determinants of resilience and mental well-being across diverse contexts; exploring needs and perspectives that inform successful adaptation to changing working conditions and ethical challenges; designing the S4R Toolbox; evaluating its relevance, effectiveness, and cost-effectiveness across health care systems; advancing theory on the relationship among individual resilience, organizational resilience, and leadership; and producing research-based recommendations and interventions through the open-access S4R Resource Bank. S4R applies an exploratory, longitudinal, mixed-methods co-design approach across 4 phases. The input phase gathers evidence through literature reviews, context mapping, and qualitative and quantitative data collection in 7 countries. The co-design and prototype testing phase involves developing the S4R Toolbox and conducting pilot testing. The implementation, evaluation, and finalization phase includes a 1-year implementation period, followed by process, effectiveness, and cost-effectiveness evaluations and final refinement of the Toolbox. The output phase disseminates the results through the open-access S4R Resource Bank. The project has achieved substantial early progress, including 5 literature reviews, completed and published context mapping, and comprehensive data collection involving health care workers, leaders, and informal caregivers in 7 countries. Toolbox development is well advanced, and pilot testing has been completed. S4R will deliver a research-based digital Toolbox that supports leaders in strengthening the resilience and mental well-being of health care workers and informal caregivers in older adult care. By integrating the perspectives and experiences of leaders, health care workers, and informal caregivers, identifying resilience factors, and developing theory-informed, cost-effective interventions, S4R will provide actionable resources through an open-access platform, contributing to more resilient older adult care systems. ClinicalTrials.gov NCT07504042; https://clinicaltrials.gov/ct2/show/NCT07504042. DERR1-10.2196/73701.

Background: Adolescents’ involvement in their mental healthcare is considered a fundamental human right. However, there is a lack of consensus regarding the extent and nature of user involvement and limited research on user involvement in adolescent mental healthcare has previously been identified. Given the evolving focus on this area, this study explores the experiences with, the effectiveness of, and safety issues related to adolescents’ user involvement in mental healthcare. Method: We conducted a systematic review, updating our original review with current research evidence relating to adolescents’ involvement in mental healthcare at individual and organizational levels. Searches across six databases, screening of reference lists, and suggestions from experts within the field helped to identify 5,527 records, of which 251 full text articles were screened. Established guidelines were used for data extraction, critical appraisal, and reporting of results. Results: Collectively, the literature searches resulted in 36 eligible studies, of which 28 provided qualitative data and eight provided quantitative data. The quantitative studies identified the importance of personal help and online tools to support adolescents’ involvement in their mental healthcare. A few qualitative studies suggested shared decision-making is associated with improved self-reported mental health and treatment satisfaction. No studies focused on safety issues. A thematic synthesis of qualitative studies yielded four themes at the individual level and two themes at the organizational level. The findings highlight the growing recognition of adolescents' right to be involved and their capacity to take part in decision-making, emphasizing shared decision-making, two-way communication, and trust as key components of a collaborative relationship fundamental to user involvement. Further facilitators for user involvement at both individual and organizational levels are described. Conclusion: The significance of user involvement in adolescent mental healthcare is underscored by a sense of increased empowerment and services tailored to meet adolescents’ needs. The evidence gathered from qualitative studies suggests involving adolescents in their treatment contributed to greater motivation for treatment, higher attendance rates, and treatment continuation. User involvement should emphasize adolescents’ preferences and a collaborative relationship that incorporates shared decision-making. Further implications for future practice and research are discussed.

BACKGROUND Worldwide, minority youth less commonly receive culturally sensitive mental health services than the majority peer population. In Norway, limited research exists on the mental health and service use among youth from national minority (Forrest Finns, Kven/Norwegian Finns, Jews, Roma, and Romani), Indigenous (Sámi), and refugee backgrounds. Although the Norwegian government provides a public communication channel for youth, including mental health information and support, digital services have not been adapted to meet the needs of these groups. There is no research to determine the use, acceptability, effectiveness, cost-effectiveness and safety of these services for these youth. OBJECTIVE The main aim of the InvolveMENT project is to improve the mental health of national minority, Indigenous and refugee youth. The project’s objectives are, for these groups of youth, to: (1) Determine mental health and digital support needs, and possible barriers and facilitators to service use; (2) Assess use of and satisfaction with digital services to meet their mental health needs; (3) Explore their perspectives on digital mental health services; (4) Develop recommendations which can be used to adapt digital services to meet their needs and rights; and (5) Assess the use, acceptability, satisfaction, effectiveness, cost-effectiveness and safety of adapted services. METHODS The four-year InvolveMENT project consists of four phases: 1) Establishing a longitudinal cohort consisting of national minority, Indigenous and refugee youth, using surveys to assess their mental health, wellbeing, digital support needs, utilization and satisfaction with digital services, and possible barriers and facilitators to service use. 2) Conducting qualitative interviews with minority youth to explore their perspectives, and synthesizing data from phase 1 and 2 for a mixed methods analysis. 3) Involving youth, and healthcare and other professionals to develop proposals to adapt and improve the existing digital services. 4) A randomized controlled trial (RCT) and a qualitative study to evaluate the adapted services. RESULTS Cohort and qualitative study designs are completed. An ethics application has been submitted, and recruitment is scheduled to begin after its approval. CONCLUSIONS The InvolveMENT project has the potential to enhance the accessibility and quality of healthcare services, early interventions, reduce inequality in service provision for minority groups, and strengthen collaboration between youth, public and research organizations. Through this, it has the potential to improve mental health of youth from these groups. Findings might be transferable to other minority groups, both nationally and internationally. CLINICALTRIAL ISRCTN21223142. Available at https://doi.org/10.1186/ISRCTN21223142

Background: Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question “What matters to you?”. However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. Methods: Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. Results: Overall, there was considerable correspondence between the four stakeholder groups’ perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) “self-reliance – living independently at home as long as possible”; (2) “remaining active and social within the community”; (3) “support for living at home as long as possible”; (4) “accessible information and services”; (5) “continuity of services”; and (6) “compassionate and competent healthcare professionals”. Conclusions: In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens’ autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens’ needs.

Introduction: Despite increased focus on development of mental health services worldwide, many adolescents still hesitate to reach out to the services when they need them. This might be linked to the lack of adolescent involvement in the development of services. This study aimed to explore adolescents' perspectives on the ideal healthcare services to meet their mental health needs.Methods: A two‐stage qualitative study was carried out to explore the perspectives of adolescents on the healthcare services to support their mental health. In the first stage, data from 295 adolescents attending a mental health seminar were analysed using qualitative content analysis. In the second stage, in‐depth perspectives of 10 adolescent coresearchers were gathered through self‐reflection and group discussions to further explore the categories developed in the first stage. Thematic analysis was used to develop the themes answering the research question. Ten adolescent coresearchers planned the study, collected and analysed data and authored the manuscript, with the support of a senior researcher.Results: Five themes describe adolescents' perspectives on the ideal healthcare services to meet their mental health needs: (1) Culturally Sensitive and Responsive; (2) Communication of Information; (3) Easy Access; (4) Variety of Support; and (5) Consistency. Culturally Sensitive and Responsive services influenced all other themes. The themes describe suggestions for mental health service improvement, including how to manage the barriers that adolescents face to receive help from the mental health services.Discussion: This study highlights the importance of culturally sensitive and responsive services. It raises the need for an expanded definition of culture going beyond nationality and ethnic background. Adolescents need flexible services that meet their individual mental health needs. This has implications for practitioners, educators, system organizers and researchers, who should also involve adolescents in planning, implementing and assessing the services. There is a need for a self‐learning system to continuously adapt to user feedback.Conclusion: This study provides insight into adolescents' perspectives on the ideal mental health services. It offers suggestions for ways to improve services to better meet the individual mental health needs of adolescents. Additional research is needed to further develop and implement service changes, as well as to assess their acceptability, effectiveness, cost‐effectiveness and safety.Patient or Public Contribution: This is a study lead by adolescents. Adolescent coresearchers have, with the support of a senior researcher, planned and carried out the study, collected and analysed data and authored the manuscript.

Objectives Measure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on Patient Safety Culture instrument for use in homecare services. Design Cross-sectional survey with psychometric testing. Setting Twenty-seven publicly funded homecare units in eight municipalities (six counties) in Norway. Participants Five-hundred and forty health personnel working in homecare services. Interventions Not applicable. Primary and secondary outcome measures Primary: Patient safety culture assessed using the NHSOPSC instrument. Secondary: Overall perception of service users’ safety, service safety and overall care. Methods Psychometric testing of the NHSOPSC instrument using factor analysis and optimal test assembly with generalised partial credit model to develop a short-version instrument proposal. Results Most healthcare personnel rated patient safety culture in homecare services positively. A 19-item short-version instrument for assessing patient safety culture had high internal consistency, and was considered to have sufficient concurrent and convergent validity. It explained a greater proportion of variance (59%) than the full version (50%). Short-version factors included safety improvement actions, teamwork, information flow and management support. Conclusion This study provides a first proposal for a short-version Homecare Services Survey on Patient Safety Culture instrument to assess patient safety culture within homecare services. It needs further improvement, but provides a starting point for developing an improved valid and reliable short-version instrument as part of assessment of patient safety and quality improvement processes.