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Background Partnerships between researchers and food retailers are advocated as necessary for developing sustainable and effective health-promotion initiatives in supermarkets. However, little is known about how such partnerships evolve and influence different phases of intervention research. This study explores how partnerships between researchers and food retailers develop during the pre-intervention phase and examines the factors that influence both the partnerships and the initiatives they produce. Methods The empirical case used in the study is a partnership between intervention researchers, food retailers, and public health advocates that aimed to develop and test healthy food retail initiatives to make healthy food choices easy for customers. We conducted an ethnographic study covering the pre-intervention phase from the establishment of the partnership in 2019 to the feasibility test of the initiatives in 2021. We used participant observation of meetings and intervention development activities, qualitative interviews with partners, and document analysis of email correspondence and project materials. We analysed the data abductively, drawing on a narrative analytical approach and theoretical concepts of institutional logics and negotiation. Findings We present a narrative in six chapters illustrating how market logic dominated the selection and development of healthy food retail initiatives, ultimately compromising the researchers’ original research interests. Furthermore, the pre-intervention phase was challenged by an unclear division of roles and responsibilities, misaligned expectations, high staff turnover in the retail organisation, and the Covid-19 pandemic. These challenges resulted in growing mistrust and an asymmetric partnership that undermined the progress and potential of the project. Conclusions Using the lens of institutional logics, we show how differing interests and perspectives between partners – for example regarding health and consumer behaviour – can make it difficult to realize the original research ideas and build a trusting relationship. Overall, this study illustrates the complexity of research partnerships with commercial actors such as food retailers. To develop and implement effective health-promotion initiatives in a food retail setting, researchers must stay mindful of their initial research interest, integrity, and study design, ensuring they are not compromised in the collaboration.

Background Many children, in particular girls, do not reach the recommended amount of daily physical activity. School recess provides an opportunity for both boys and girls to be physically active, but barriers to recess physical activity are not well understood. This study explores gender differences in children’s perceptions of barriers to recess physical activity. Based on the socio-ecological model four types of environmental barriers were distinguished: natural, social, physical and organizational environment. Methods Data were collected through 17 focus groups (at 17 different schools) with in total 111 children (53 boys) from fourth grade, with a mean age of 10.4 years. The focus groups included an open group discussion, go-along group interviews, and a gender segregated post-it note activity. A content analysis of the post-it notes was used to rank the children’s perceived barriers. This was verified by a thematic analysis of transcripts from the open discussions and go-along interviews. Results The most frequently identified barriers for both boys and girls were weather, conflicts, lack of space, lack of play facilities and a newly-found barrier, use of electronic devices. While boys and girls identified the same barriers, there were both inter- and intra-gender differences in the perception of these barriers. Weather was a barrier for all children, apart from the most active boys. Conflicts were perceived as a barrier particularly by those boys who played ballgames. Girls said they would like to have more secluded areas added to the school playground, even in large schoolyards where lack of space was not a barrier. This aligned with girls’ requests for more “hanging-out” facilities, whereas boys primarily wanted activity promoting facilities. Conclusion Based on the results from this study, we recommend promoting recess physical activity through a combination of actions, addressing barriers within the natural, social, physical and organizational environment.

Background Improving food environments like supermarkets has the potential to affect customers’ health positively. Scholars suggest researchers and retailers collaborate closely on implementing and testing such health-promoting interventions, but knowledge of the implementation of such interventions is limited. We explore the implementation of four health-promoting food retail initiatives selected and developed by a partnership between a research institution, a large retail group, and a non-governmental organisation. Methods The four initiatives included downsizing of bags for pick’n’ mix sweets and soda bottles at the check-out registers, shelf tags promoting healthier breakfast cereal options, and replacing a complimentary bun with a banana offered to children. The initiatives were implemented for 6 weeks (or longer if the store manager allowed it) in one store in Copenhagen, Denmark. Data were collected through observations, informal interviews with customers, and semi-structured interviews with retailers. We conducted a thematic analysis of transcripts and field notes inspired by process evaluation concepts and included quantitative summaries of selected data. Results Two out of four initiatives were not implemented as intended. The implementation was delayed due to delivery issues, which also resulted in soda bottles not being downsized as intended. The maintenance of the shelf tags decreased over time. Retailers expressed different levels of acceptability towards the initiatives, with a preference for the complimentary banana for children. This was also the only initiative noticed by customers with both positive and negative responses. Barriers and facilitators of implementation fell into three themes: Health is not the number one priority, general capacity of retailers, and influence of customers and other stakeholders on store operation. Conclusions The retailers’ interests, priorities, and general capacity influenced the initiative implementation. Retailers’ acceptability of the initiatives was mixed despite their involvement in the pre-intervention phase. Our study also suggests that customer responses towards health-promoting initiatives, as well as cooperation with suppliers and manufacturers in the development phase, may be determining to successful implementation. Future studies should explore strategies to facilitate implementation, which can be applied prior to and during the intervention.

Background In Denmark, around 500 adolescents and young adults (AYAs) aged 15–29 are diagnosed with cancer each year. AYAs affected by cancer constitute a vulnerable group in need of special support in pursuing everyday life as young people. These needs are, however, not currently being adequately met. This study explores the distinctive needs of AYAs aged 15–25 and affected by cancer with the aim of developing and designing an intervention that accommodates these needs and allows AYAs to pursue everyday life following active cancer treatment. Methods We combined multiple qualitative methods to conduct six sub-studies: 1) participant observation among support groups for AYAs affected by cancer, 2) field visit at a large Danish hospital, 3) qualitative interviews with AYAs currently or previously diagnosed with cancer, 4) qualitative interviews with practitioners working with young cancer patients or AYAs with chronic conditions, 5) an interactive workshop with practitioners, and 6) an interactive workshop with AYAs. The empirical material was collected between May 2016 and April 2019. The empirical material was read, analysed thematically and coded into the themes; 1) diagnosis and treatment, 2) form of education and 3) age, financial challenges and legal entitlements. Results Across the empirical material, we found that AYAs’ cancer experience was heterogeneous. The needs of AYAs differed according to 1) diagnosis and treatment, 2) type of education and 3) age, financial situation and legal entitlements. The findings demonstrate a need for a tailored intervention accommodating the variety of opportunities, requirements and challenges of AYAs with cancer. We propose an intervention consisting of a multidisciplinary team sited at the hospital where the individual AYA receives treatment. The team’s main task will be to maintain AYAs’ social competences and ease their return to everyday life after serious illness by balancing educational requirements with cancer treatment. Conclusion Based on the perspectives of practitioners and AYAs affected by cancer, this study outlines an intervention designed as a care pathway in which a multidisciplinary team provides individual and tailored support to AYAs with cancer from the time of diagnosis during and beyond active cancer treatment.

Background For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling. Methods On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts. Results By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action. Conclusion We argue that the ‘myth’ of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.

ObjectiveTo explore how physiotherapists (PTs) and occupational therapists (OTs) perceive upper limb (UL) prediction algorithms in a stroke rehabilitation setting and identify potential barriers to and facilitators of their implementation.DesignThis was a qualitative study.SettingThe study took place at a neurorehabilitation centre.ParticipantsThree to six PTs and OTs.MethodsWe conducted four focus group interviews in order to explore therapists’ perceptions of UL prediction algorithms, in particular the Predict Recovery Potential algorithm (PREP2). The Consolidated Framework for advancing Implementation Research was used to develop the interview guide. Data were analysed using a thematic content analysis. Meaning units were identified and subthemes formed. Information gained from all interviews was synthesised, and four main themes emerged.ResultsThe four main themes were current practice, perceived benefits, barriers and preconditions for implementation. The participants knew of UL prediction algorithms. However, only a few had a profound knowledge and few were using the Shoulder Abduction Finger Extension test, a core component of the PREP2 algorithm, in their current practice. PREP2 was considered a potentially helpful tool when planning treatment and setting goals. A main barrier was concern about the accuracy of the algorithm. Furthermore, participants dreaded potential dilemmas arising from having to confront the patients with their prognosis. Preconditions for implementation included tailoring the implementation to a specific unit, sufficient time for acquiring new skills and an organisation supporting implementation.ConclusionIn the present study, experienced neurological therapists were sceptical towards prediction algorithms due to the lack of precision of the algorithms and concerns about ethical dilemmas. However, the PREP2 algorithm was regarded as potentially useful.

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

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.

Based on extensive ethnographic material from in-depth interviews with Danish cancer patients after treatment, this study analyzes their stories to explore how interactions with the physician configures and situates a need for rehabilitation. We identify three themes in the illness stories: (1) attentiveness and care; (2) fragmentation and objectification; and (3) mistrust and dehumanization. These are all closely tied to the concept of recognition, showing how the themes are configured by the social interaction between the patient and the physician and how the need for rehabilitation is shaped by this encounter. The significance of the social encounters in cancer treatment is elucidated through this analysis, and we demonstrate how the need for recognition of the complex effects of cancer on one's life is central to counter experiences of objectification and dehumanization.

Objective: Little is known about how strategies of retaining patients are acted out by general practitioners (GPs) in the clinical encounter. With this study, we apply Grimens' (2009) analytical connection between trust and power to explore how trust and power appear in preventive health checks from the GPs' perspectives, and in what way trust and power affect and/or challenge strategies towards retaining patients without formal education. Design: Data in this study were obtained through semi-structured interviews with GPs participating in an intervention project, as well as observations of clinical encounters. Results: From the empirical data, we identified three dimensions of respect: respect for the patient's autonomy, respect for professional authority and respect as a mutual exchange. A balance of respect influenced trust in the relationship between GP and patients and the transfer of power in the encounter. The GPs articulated that a balance was needed in preventive health checks in order to establish trust and thus retain the patient in the clinic. One way this balance of respect was carried out was with the use of humour. Conclusions: To retain patients without formal education in the clinical encounter, the GPs balanced trust and power executed through three dimensions of respect. In this study, retaining patients was equivalent to maintaining a trusting relationship. A strategic use of the three dimensions of respect was applied to balance trust and power and thus build or maintain a trusting relationship with patients. KEY POINTS   Little is known about how strategies for retaining patients are acted out by GPs in preventive health checks.  *  Retaining patients requires a balance of trust and power, which is executed through three dimensions of respect by the GPs.  *  Challenges of recruiting and retaining patients in public health initiatives might be associated with the balance of respect.