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  • 1.
    Hellzén, Ove
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Kristiansen, Lisbeth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    En studie i kvantitetssäkring av omvårdnad – En möjlig metod att fokusera kvaliteten?2003In: Incitament : för en hälso- & sjukvård i förvandling, ISSN 1103-503X, Vol. 12, no 7, p. 638-640Article in journal (Other academic)
  • 2.
    Holmström, Malin
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Olofsson, Niclas
    Folkhälsocentrum, Landstinget Västernorrland, Härnösand, Sweden.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Exploring the development of school children´s health2012In: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827, Vol. 7, no 4, p. 189-197Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the association between positive self-reported health (SRH) in pre-school and 4th grade SRH in a long–term prospective population-based study in Sweden.

    Methods: Data originated from the Health Dialogue (HD) a structured instrument used by school nurses. 1084 children participated. Odds ratios were analyzed.

    Results: In 10-year-old children’s SRH, comfort in school, normal BMI and absence of headaches were shown to be significantly important health indicators. Normal BMI showed to have a potentially causal effect on 10-year-old girls and absence of headaches showed a potentially causal effect among 10-year-old boys.

    Conclusion: Schools should be designed to meet the children’s needs so that they are perceived as comfortable, safe and secure places. Schools should advocate physical activity and play, serve healthy nutritious food in order to motivate, support and promote a healthy lifestyle. Schools are a unique arena for health promotion as they reach practically all school-age children.

  • 3.
    Häggström, Marie
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    How can nurses facilitate patient’s transitions from intensive care?: A grounded theory of nursing2012In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 4, p. 224-233Article in journal (Refereed)
    Abstract [en]

    Objectives: Intensive care patients often experience feelings of powerlessness and vulnerability when being transferred from an intensive care unit to a general ward. The aim of this study was to develop a grounded theory of nurses care for patients in the ICU transitional care process.

    Methods: Group interviews, individual interviews and participant observations were conducted with nurses in two hospitals in Sweden and were analysed using grounded theory.

    Result: The substantive theory shows the process of nursing care activities — from the contexts of the ICU and the general ward. The main concern was to achieve a coordinated, strengthening, person-centered standard of care to facilitate patient transitions. The core category ‘‘being perceptive and adjustable’’ was a strategy to individualise, that was related to the other categories; ‘‘preparing for a change’’ and ‘‘promoting the recovery’’. However, the nurses were forced to ‘‘balance between patient needs and the caregivers’ resources’’ and consequently were compromising their care.

    Conclusions: To facilitate an ICU-patient’s transition, individual care planning is needed. It is also essential that the patients are adequately prepared for the change to facilitate the transitional care. Knowledge about transitional needs, empowerment and patient-education seems to be important issues for facilitating transitions.

  • 4.
    Häggström, Marie
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Important quality aspects in transfer process2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 2, p. 123-139Article in journal (Refereed)
    Abstract [en]

    Purpose: Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward. Design/methodology/approach: The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden. Findings: A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU. Research limitations/implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality. Practical implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality. Originality/value: The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

  • 5.
    Häggström, Marie
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Struggle with a gap between intensive care units and general wards2009In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 3, p. 181-192Article in journal (Refereed)
    Abstract [en]

    Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process-the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' "struggling with a gap." The "gap" was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: Sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

  • 6.
    Häggström, Marie
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    To reduce technology prior discharge from intensive care –important but difficult?: A grounded theory2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 506-515Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to provide a deeper understanding of the experience of intensive care staff regarding the reduction in the use of medical technology prior to patients’ transfer from the ICU.

    Background: The goal of ICU transitional care, provided for intensive care patients before, during and after the transfer from the ICU to another care unit, is to ensure minimal disruption and optimal continuity of care for the patient. To smooth this transition, there is a need to prepare for a less technological environment and therefore also a need for a gradual reduction in the use of monitoring equipment.

    Method: Group interviews and individual interviews, together with participant observations, were conducted with ICU staff in two hospitals in Sweden. The data were analysed using classic grounded theory.

    Results: The main concern was the ICU staff’s ambiguity regarding whether and how to reduce the use of medical technology devices. Insecurity about weaning patients from medical equipment combined with a lack of standardized routines made it difficult for staff to reduce the technical support. The core category describes how the ambiguity was solved primarily by ’prioritizing control’. However, this often caused the ICU staff to use advanced technology while the patients were in the ICU until the ward staff arrived, even if this should have been handled otherwise. Why and how the ICU staff used the strategy of ’prioritizing control’ is further explained in the categories ’being affected by cultural/contextual aspects’, ’searching for guidance and a shared understanding’ and ’weighing advantages with more v s less technology’.

    Conclusion: It is important to consider ICU staff ambiguity concerning the reduction in technology and to establish strategies for a safe and structured transitional phase with step-down procedures in which technology and monitoring is gradually reduced prior to transfer from ICU.

  • 7.
    Kristiansen, Lisbeth
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Dahl, Annika
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Hellzén, Ove
    Mittuniversitetet, Institutionen för hälsovetenskap.
    The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients2005In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 12, no 6, p. 719-727Article in journal (Refereed)
    Abstract [en]

    The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients For people afflicted with different kinds of psychiatric disorder, suffering is a common denominator. The time the nurses spend with psychiatric clients may mirror their attitudes towards and feelings for these clients. The aim of this study was to investigate the connections between the time spent together and the nurses' opinion of client behaviour and social functioning in community-based psychiatry. In this quantitative study, 29 clients were assessed by 30 nurses, who answered the Global Assessment of Functioning Scale (GAF) and the Positive and Negative Syndrome Scale (PANSS). At the same time, 11,200 non-participant observations of clients were registered using the Patient Activity Classification (PAC) to investigate how they spent their time at two psychiatric group dwellings. The PAC instrument revealed that clients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses. Based on a factor analysis, indices were made by setting cut-off points for the PANSS and the GAF scores, and four small groups of clients were generated: a relatively high level of social functioning and a low degree of psychiatric symptoms (A); a relatively high level of social functioning and a high degree of psychiatric symptoms (B); a low level of social functioning and a low degree of psychiatric symptoms (C); and, finally, a low level of social functioning and a high degree of psychiatric symptoms (D). The clients judged as having a low level of social functioning in combination with high degrees of psychiatric symptoms, that is, the most vulnerable and dependent individuals, receive less staff attention (18%) and are the clients who spend the most time alone (71.4%). It might be possible to interpret the results of this study in the light of a process of dehumanization.

  • 8.
    Kristiansen, Lisbeth
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Hellzén, Ove
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Left alone - Swedish nurses' and mental health workers' experiences of being care providers in a social psychiatric dwelling context in the post-health-care-restructuring era: A focus-group interview study2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, p. 427-435Article in journal (Refereed)
    Abstract [en]

    The professional role of nurses and mental health workers in social psychiatry is being re-defined towards a recovery, client-focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long-term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses' and mental health workers' views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: 'Being a general human factotum not unlike the role of parents', 'Having a complex and ambiguous view of clients', 'Working in a mainly 'strangled' situation', and 'Feeling overwhelming frustration'. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.

  • 9.
    Kristiansen, Lisbeth
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall; Karolinska institutet, Stockholm.
    Hellzén, Ove
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Swedish assistant nurses´experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances: An interview study2006In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 1, no 4, p. 245-256Article in journal (Refereed)
    Abstract [en]

    Job satisfaction is complex and is an important component in facilitating high quality nursing care. Behavioural and psychological symptoms of dementia (BPSD) can be clustered into one of five syndromes: psychosis, aggression, psychomotor agitation, depression and apathy, and comprise signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia. BPSD can cause tremendous distress both for the patients and for their caregivers and they have been seen as the most stressful aspect of care giving. Two registered nurses, 16 assistant nurses and two nursing assistants in Sweden talked about their job satisfaction when caring for residents suffering from dementia and BPSD. Thematic content analysis was conducted. The nurses' narrations indicate exposure, insufficiency, not being valued and doubt, as well as respect and importance and devotion towards the residents. One core theme was formulated: "Job satisfaction as a process moving between breaking down and occasionally building up the working person". A positive relationship with colleagues was the primary reason for nurses continuing to work at the group dwellings. The organization and resident behaviours were seen as very negative. Some nurses described insecurity in terms of how long they could continue to take rudeness, being spat at, being scratched or physically hit by residents, without "hitting back". In order to increase the well-being of the nurses, the pressure on them needs to be relieved. The development of leadership, education, supervision and reflection might be one possible way of reducing the prevalence of BPSD-related violence, enhancing job satisfaction and handling moral stress.

  • 10.
    Olsson, Helen
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Strand, Susanne
    Avdelningen för samhällsvetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Turning points and treatment readiness in forensic patients: A study based on staff experiences.2014In: Nordisk sygeplejeforskning, ISSN 1892-2678, E-ISSN 1892-2686, Vol. 4, no 3, p. 175-188Article in journal (Refereed)
    Abstract [en]

    Many individuals sentenced to forensic psychiatric care fail in the rehabilitation process, resulting in long-term inpatient hospital care. The concepts of turning points and treatment readiness in forensic settings should therefore be afforded more attention. Much can be learned from the features that characterize trajectories of recovery and processes related to turning points. The aim of this study was to explore forensic nursing staff’s experiences of forensic psychiatric patients’ turning towards recovery. A qualitative content analysis was used to analyse interviews with 13 forensic psychiatric nursing staff. Analysis of the data revealed two main themes with implications for clinical practice: promoting a turning point and recognizing a turning point. In the first of these, the emphasis was on actions and conditions that must exist to promote a turning. In the second, the main experiences related to recognizing a turning point were stories about visible and perceptible changes in the patient. The experiences that stood out most distinctly were those of being able to wait out the patient, and having patience when there was a lack of progression. The composition of staff and patients contributed to whether or not the environment was perceived as salutary.

  • 11.
    Olsson, Helen
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Strand, Susanne
    Avdelningen för samhällsvetenskap, Mittuniversitetet, Sundsvall; Sundsvall Forensic Psychiatric Hospital, Sweden.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Sjöling, Mats
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Decreased risk for violence in patients admitted to forensic care, measured with the HCR-202013In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 27, no 4, p. 191-197Article in journal (Refereed)
    Abstract [en]

    Aim: To explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the Clinical (C) and Risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data.

    Methods: The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment.

    Results: The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce.

    Conclusion: The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patient's risk for violence in order to work with the patient's specific risk factors to reduce the risk.

  • 12.
    Rising Holmström, Malin
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Promoting a relationship-based health practice: A challenge for school nurses2013In: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827, Vol. 8, no 1, p. 30-38Article in journal (Refereed)
    Abstract [en]

    Background:

    School nurses have a unique opportunity to promote health when they meet school children during the Health Dialogue. The Health Dialogue concept is used by all the school nurses in a county in Mid Sweden.

    Aim:

    To describe school nurses' experiences of the Health Dialogue concept.

    Methods:

    A qualitative descriptive study with latent content analysis of interviews performed during February–April 2012, where 16 school nurses participated.

    Findings:

    The school nurses experienced the Health Dialogue concept as a useful tool to work with school children's health in a relationship-based, child focused, structured, and systematic way, which was reflected in one overarching theme: 'To be in a relationship-based, health-promoting practice.' However, school nurses also experienced loneliness and frustration from the many difficult situations with school children, and they indicated needs for further collaboration.

    Conclusions:

    The Health Dialogue concept is child-focused, systematic and structured, but it requires further development and continuing work on statistical feedback. School nurses indicated a need for collaboration with teachers, parents, and other health professionals, as well as professional-reflective supervision.

  • 13.
    Rising Holmström, Malin
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Olofsson, N.
    Public Healthcare Center Härnösand, County Council Västernorrland, Härnösand, Sweden.
    Kristiansen, Lisbeth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Health among 6-year-old children in a Swedish county: Based on the Health dialogue2011In: Acta Paediatrica. Supplement, ISSN 0803-5326, Vol. 100, no 463, p. 105-106Article in journal (Refereed)
  • 14.
    Rising Holmström, Malin
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Olofsson, Niclas
    Folkhälsocentrum, Landstinget Västernorrland, Härnösand, Sweden.
    Asplund, Kenneth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Transitions in the Swedish school system and the impact on student's positive self-reported-health2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 1045Article in journal (Refereed)
    Abstract [en]

    Background: To explore three school based transitions and their impact on positive self-reported-health (SRH), pre-school to elementary school (6-10 y), elementary school to junior high school (10-13y), and junior high school to upper secondary school/high school (13-16y), in a long-term longitudinal population based study. Methods: The study followed three cohorts through one school transition each. A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007-2012 with school children age 6-16 years old. Results: Several significant factors were identified with an impact for a positive self-reported-health among children age 6-16y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age. Conclusion: The study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

  • 15.
    Rising Holmström, Malin
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Olofsson, Niclas
    Landstinget Västernorrland.
    Kristiansen, Lisbeth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Health among 6-year-old children in a Swedish county: based on the health Dialogue2012In: Vulnerable Groups & Inclusion, ISSN 2000-8023, E-ISSN 2000-8023, Vol. 3, no 1, article id 8416Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the experiences of self-reported health (SRH) of 6-year-old boys and girls.

    Background: The goals for the Swedish School Health Services (SHS) are to identify health problems, take measures to prevent illness, and promote health. One approach used to achieve this is the use of the Health Dialogue (HD) questionnaire. The HD is offered at three occasions during compulsory school and once in high school; it follows the child’s development and growth from 6 to 16 years old.

    Methods: The HD is a structured questionnaire consisting of 15 questions related to health, each phrased in a positive manner. The HD represents a cross-sectional image of the child’s SRH according to the child and parents. The SRH in this study is based on the results from the 5259 HD questionnaires conducted during 20062009 with 6-year-old children and parents. OR were analyzed for the HD.

    Results: Experiencing comfortableness in preschool, good sleep, absence of severe headaches, being physical active/play every day, and not being a victim for bullying shows to be important preschool indicators for boys and girls. Discussion: The most important health variable tagging in the preschool children’s positive SRH was comfortableness in preschool. Both boys and girls need to feel comfortable in preschool to report a positive SRH in school. The girls seem to be more dependent on comfortableness, being physical active, and not being bullied while the boys need to have lunch in school every day and not to show symptoms like severe headaches.

    Conclusion: The most important health variable tagging the preschool children’s SRH is comfortableness in school. The HD can increase the knowledge of 6-year-old children’s SRH and also be a tool to gain further insight into children’s health by highlighting patterns in children’s SRH

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