Introduction PTSD is defined by the presence of a qualifying traumatic event (Criterion A), yet considerable debate remains regarding how this criterion should be operationalized, as individuals exposed to non–Criterion A stressors may develop clinically significant PTSD-like symptoms. This diagnostic complexity poses challenges for identification and treatment of trauma-related distress in primary care settings. Objective The aim of the study was to investigate whether Coping School , a psychoeducational group for patients and their relatives, is feasible and associated with symptom reduction, how participants experience the intervention, and therapists’ perspectives on recruitment difficulties. Method Eleven assessment interviews with potential participants were conducted, of which only four were deemed eligible. The study used a within-group design with measurements conducted pre, mid, and post intervention, and three-month follow-up. Results At follow-up, changes in symptom ratings relative to baseline varied across participants. Participants perceived the intervention as valuable for increasing self-understanding, but that an overly condensed intervention led to the loss of important therapeutic elements. Therapists were also interviewed (n = 11) regarding their views on the intervention and factors that may have contributed to recruitment difficulties. The thematic analysis resulted in three themes: A limited eligible patient population, Hesitation toward group treatment, and Organizational barriers to collaboration and development. Conclusions These preliminary findings suggest that Coping School may be feasible and acceptable for some participants, but recruitment challenges – including how to engage and motivate other therapists to refer patients – highlight the need for further development and larger studies to evaluate effectiveness and generalizability. 

There is a risk of diagnostic overshadowing between traumatic stress reactions and ADHD and autism. The prevalence of potentially traumatic events (PTE) and associated posttraumatic mental health problems was investigated among children referred for assessment for ADHD and autism at the Child and Adolescent Psychiatry in Sweden. The study included 62 Swedish children (34 boys, 28 girls) between the ages 8-16. The children self-reported the prevalence of PTEs and associated stress reactions on Life Incident of Traumatic Event (LITE), Trauma Symptom Checklist for Children (TSCC), and Strengths and Difficulties Questionnaires (SDQ), at an appointment with a licensed psychologist. Sex and age differences were analyzed, and the results were compared with Swedish norms for children when possible. The children in this study reported a high prevalence of PTEs on LITE, and half of the girls reported scores above the clinical cut-off on the TSCC scale, post-traumatic stress reactions, as well as significantly higher scores (M = 60.87) in comparison to the boys (M = 35.94). Most children (74.2%) scored above the SDQ cut-off value for total difficulties. Conclusively, children referred for assessment for ADHD and autism report high levels of exposure to PTEs and post-traumatic stress symptoms. This calls for immediate action in overseeing the procedures and reliability for trauma screening and strategies to protect these children from exposure to PTEs.

Children under the age of six are disproportionately exposed to traumatic experiences and seem especially vulnerable. Trauma often affects both children and caregivers and their relationships. Trauma-focused treatment and its long-term effects for young children are of prime interest, but research is limited and lacks follow-up data. The current study explored the long-term effects of Child-Parent Psychotherapy (CPP) treatment and potential predictors of outcome. The sample included 37 traumatized young children, aged 2–6 years, who had received the dyadic treatment together with their caregiver in a multi-site clinical setting. The majority had been exposed to several potential traumatic events, including interpersonal trauma. The study was a naturalistic one-group, pre-post design study with a 6-month follow-up. Outcome measures comprised child and caregiver post-traumatic stress symptoms and signs of caregiving disorganization reported by caregivers. Piecewise Linear Mixed Models were applied to explore long-term treatment effects. Within-group effect sizes were calculated using model-estimated differences in mean values. Possible predictors of outcome were analyzed by adding them as covariates in the model and interacting them with time. The outcomes remained consistent six months after treatment. Positive effects were reduced child and caregiver post-traumatic stress symptoms (d = 0.62; d = 0.57, respectively) and signs of caregiving disorganization (d = 0.64). A higher degree of child trauma symptoms predicted less reduction in caregiver traumatic stress. The results indicate that children, caregivers, and their relationship benefit from CPP and that results are sustainable. The naturalistic design strengthens the applicability of CPP.

Background: Previous reports have highlighted the abundance of cognitive constructs in insomnia research as a growing issue. Several questionnaires that measure sleep-related cognitions have been developed and there are indications of conceptual overlap between different cognitive constructs and the questions used to operationalize them. Objectives: This study examines the convergent validity of three established questionnaires measuring cognitive processes in insomnia: the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10), and the Pre-Sleep Arousal Scale (PSAS-C). Another objective was to explore how a briefer scale can be structured as well as to investigate this scale’s ability to predict incident and persistent insomnia compared to the established scales. Methods: 2333 participants from the general population completed surveys on insomnia symptoms and cognitive processes at baseline and 18 months later. Confirmatory factor analysis was used to investigate the scales’ conceptual overlap as well as distinctive factors. An exploratory factor analysis was conducted to investigate the underlying factor structure of the items from the APSQ, the DBAS-10 and the PSAS-C. This analysis formed the basis of the creation of a new short scale: Sleep Worry 7. Binary logistic regressions were used to assess all scales’ abilities to predict incident and persistent insomnia. Results and conclusions: The overlap between the three scales was neither large enough to conclude that they are measuring the same construct, nor could it be confirmed that they measure three distinct questionnaire-specific cognitive processes within insomnia. The brief scale created within this study was able to predict persistent insomnia at similar levels to the three established scales combined, indicating that it captures important cognitions involved in the maintenance of insomnia. Measuring sleep-related cognitions with fewer items might be beneficial in both clinical contexts and research. 

Introduction: Trauma affects a child’s mental health and appears to be associated with challenges in caregiver-child dynamics. Nearly half of child trauma victims are under the age of six, yet few interventions are designed for this age group. Child-Parent Psychotherapy (CPP) is an attachment-based trauma treatment for preschool-aged victims of adversities and their caregivers. This study examines the effectiveness of CPP when implemented in a Swedish naturalistic multi-site clinical setting. Method: 57 children (age 2–6 years) with potentially traumatic experiences and their caregivers participated. They were recruited from 12 mental health services providing child treatment. The study has a one-group, pretest-posttest design. Outcome measures covered posttraumatic stress and general psychological symptoms in children and caregivers and caregivers’ perceptions of their relationship with their child. Paired t-tests were used to calculate within-group differences. Effect sizes were computed as Cohen’s d and associations between child and caregiver outcomes as Pearson’s correlation coefficient (r). A hierarchical regression analysis was tested to explore the correlation analysis. Results: Reductions in posttraumatic stress and general psychological symptoms with small-to-medium effect sizes were found in children and caregivers. Caregivers reported perceived improvements in their relationship with their child, with associations to findings in child posttraumatic stress reduction. Discussion: Findings support earlier results that CPP may be a suitable choice of treatment for preschoolers exposed to potentially traumatic events, such as violence. The dyadic treatment model seems to address the association between child traumatic stress and caregivers’ perceptions of the caregiving relationship. Further dissemination testing is suggested.

Background Older adults are insufficiently physically active, despite its importance for healthy aging. To develop appropriate physical activity interventions, it is necessary to understand their physical activity. This study applies a theoretical perspective, the COM-B model, and a mixed-method design to examine what influences older adults' physical activity levels with three questions: (1) What individual and external factors predict older adults' physical activity levels? (2) What do older adults perceive as influencing their levels of physical activity? (3) To what extent do the quantitative results on older adults' physical activity levels agree and disagree with the qualitative findings on older adults' physical activity levels? Methods A convergent mixed-method design was used with questionnaire (n = 334) and interview (n = 14) data from adults 65 years and older. Regression analyses were used for quantitative measurements: physical activity, age, subjective socioeconomic status, health status, capability, opportunity, motivation, and depression. Content analysis was applied to the qualitative data. The two forms of data were then integrated to provide greater insights than would be obtained by either dataset separately. Results The regression analyses showed that previous physical activity, current motivation, health status, and age significantly predicted older adults' physical activity levels. The content analysis revealed that participants addressed all subcomponents of the COM-B model, indicating its pertinence in understanding how older adults discuss their current physical activity levels. The integrated findings showed convergent and divergent results. Overall results indicated that previous physical activity engagement, present motivation, capability, and opportunity influenced older adults' physical activity levels. Conclusions This study is the first to use this mixed-methods design to examine factors influencing physical activity levels among older adults living in rental apartments with community hosts. The integrated result reveals convergence for findings on motivation and physical capability but divergence on psychological capability, opportunity, and previous physical activity. The findings underscore a complex interplay of factors influencing older adults' physical activity levels and indicate relevance for the COM-B model. The results can guide future research on theoretically informed interventions to promote physical activity and healthy aging. Future research should clarify the role of opportunity for older adults' physical activity.

Det finns ett starkt samband mellan psykisk ohälsa hos föräldern och psykisk ohälsa hos barnet. Barnen tycks även ha en förhöjd risk att utveckla psykisk och fysisk ohälsa som unga vuxna. Eftersom en stor del av patienter med psykisk ohälsa finns i öppenvårdspsykiatrin eller primärvård är andelen barn som lever med föräldrar med psykisk ohälsa  förmodligen mycket större än vad vi tror. Föräldrar med psykisk ohälsa kan behöva stöd i sitt föräldraskap för att bli den bästa föräldren de kan. Syftet med projektet är att identifiera behov av stöd i föräldraskapet som föräldrar eller blivande föräldrar med psykisk ohälsa upplever. Vi genomförde tio intervjuer med föräldrar med psykisk ohälsa och skickade ut en enkät. Slutsatserna från resultatet var att det finns ett behov av stöd i föräldraskapet bland föräldrar med psykisk ohälsa. Vi fann att Familjecentralen lyfts fram som ett gott exempel och här skulle ett samarbete med psykiatrin främja relationen barn - förälder, samt att patient-anhörigförening spelar en viktig roll för föräldrar med psykisk ohälsa. Att synliggöra dessa ännu mer kan bidra till situationen på ett positivt sätt. Slutligen, det behövs inte några komplexa insatser, för många handlar det om att få träffa likasinnade i grupp, eller en samtalskontakt i svåra situationer.

Background: Digital health interventions, such as personalized SMS coaching, are considered affordable and scalable methods to support healthy lifestyle changes. SMS, or texting, is a readily available service to most people in Sweden, and personalizedSMS coaching has shown great promise in supporting behavior changes.

Objective: This study aims to explore the effectiveness of highly personalized SMS coaching for behavior change according to the Capability, Opportunity, Motivation–Behavior (COM-B) model on a sample of physically inactive adults in a nonprofit fitness organization in Sweden.

Methods: The study used a mixed methods design in which clients acted as their own controls. The participants were clients(n=28) and fitness consultants (n=12). Three types of data were collected: (1) quantitative data at baseline and after the SMS intervention and the waitlist from the clients, (2) qualitative data from semistructured interviews with the fitness consultants, and(3) pseudonymized texting conversations between the fitness consultants and clients.

Results: Overall, the results showed that personalized SMS coaching was effective in supporting the clients’ behavior changes. The quantitative analysis showed how the clients’ capabilities (Cohen d=0.50), opportunities (Cohen d=0.43), and relationship with the fitness consultants (Cohen d=0.51) improved during the SMS intervention in comparison with baseline. Furthermore, the qualitative analysis revealed how personalized texts added value to existing work methods (eg, increasing continuity and flexibility) and how the relationship between the clients and fitness consultants changed during the intervention, which helped motivate the clients.

Conclusions: Personalized SMS coaching is an effective method for supporting healthy behavior changes. The human connection that emerged in this study needs to be further explored to fully understand the effectiveness of a digital health intervention.

This study focuses on how fitness technology services can be designed in order to support the co-creation of motivation to sustain a healthy behavior. The study used an exploratory qualitative design in which we interviewed eight seasoned runners about their running routines and their use of fitness trackers. The result shows that the fitness routines require careful planning and deliberation, and that the maintenance of a healthy lifestyle relies more on what happens between the activities than during said activity. Thus, fitness trackers should focus on feedback that allows users to co-create motivation during intermissions between health promoting behaviors. 

Purpose and motivation: Research has repeatedly shown that physical activity contributes to physical and mental wellbeing. Nevertheless, the gap between intentions and behavior results in sedentary lifestyles, unhealthy habits, and lower wellbeing persists. This Transformative Service Research (TSR) project focuses on creating novel services that enhance the wellbeing of individuals, regardless of resources.

Myriad digital services have been designed to support behavioral changes with the goal of stimulating health, such as starting to exercise, losing weight, or sleeping better. These technological innovations help users integrate resources and manage their value-creation process toward health.

One important strategy for supporting behavior change is to provide feedback that helps users regulate their own behavior. Behavior change requires that digital solutions be designed for motivation and not just loaded with technical features. However, few digital solutions are equipped with functions, such as coaching, that can be adapted to fit the individuals’ value-creation process towards a better health and wellbeing. Therefore, the aims of this study were to explore whether an individually tailored digital service solution could support individual behavior changes, and to examine how the coaches experienced their situation. 

Methodology: We tested how people in need of behavior changes experienced individually tailored digital support. This was done by implementing a protocol for motivational communication via short text messaging (SMS). The participants in this study were clients and wellness consultants at a non-profit organization that helps individuals who need lifestyle changes regarding, for example, unhealthy dietary habits or sedentary lifestyles. The majority of the clients have been prescribed physical activity by a physician. Data consisted of both interviews with the wellness consultants and the clients, and their SMS conversations. The interviews and SMS conversations were analyzed with the aim of identifying themes in the data. The study was approved by an ethical advisor at Karlstad University.

Findings: The preliminary results show that both the wellness consultants and the clients found that the digital solution supported the clients’ motivation for behavior change, and hence goal achievements. The results further indicate that the SMS coaching enhanced the clients’ motivation and maintained an easy rapport between the face-to-face meetings. The added value provided by the SMS coaching to the existing service provision for both wellness consultant and client has led the non-profit organization to permanently offer this service to its clients.  

Originality/value: This study contributes to the growing body of TSR by showing how the application of digital solutions and service research perspectives can support individuals’ behavior change processes and wellness promotion.