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Whilst policymaking will always remain a highly political process, especially amidst crises, evidence-based pandemic management can benefit from adopting a socioecological perspective that integrates multi- and trans-disciplinary insights: from biology, biomedicine, mathematics, statistics, social and behavioural sciences, as well as the perspectives and experiences of non-scientific stakeholders. We make a case for an “integrated inter- and transdisciplinarity” that overcomes the typical additive nature of current interdisciplinary work and better captures the inherent complexity of public health and other public policy problems. We propose systems science and systems thinking approaches as a useful meta-theoretical, self-reflecting approach for such integration to take place. Enabled by systems thinking, the praxis of “integrated inter- and transdisciplinarity” allows for an understanding of public health crises in a human-centred socio-ecological perspective. This grounds more holistic policy responses, which by mobilising the whole of government and whole of society, put individuals, groups, governments and society at large in critical dialogue to co-produce and co-design interventions that address crises in all their physical, social, psychological, economic and political dimensions.

The COVID-19 pandemic put the life science sector to the test. Vaccines were developed at unprecedented speed, benefiting from decades of fundamental research and now honoured by a Nobel Prize. However, we saw that the fruits of science were inequitably distributed. Most low- and middle-income countries were left behind, deepening the inequalities that the Sustainable Development Goals were set to reduce. We argue that the life science sector must reinvent itself to be better and more equitably prepared for the next health crisis and to ensure fair access to health across current and future generations. Our recommendations include global governance, national strategies and the role of universities and corporations. Improved and more equitable health care should be centre stage for global health action and a core mission of a reframed Life Science sector – what we call Life Science 2.0. Paper Context Main findings: During the COVID-19 pandemic the Life Science sector stepped up to the challenge, but vaccines and medicines were not equitably distributed. Added knowledge: Obstacles were identified that hindered global access to medical innovations. Global health impact for policy and action: Global and national governance, universities and the private sector should join forces to create a Life Science sector (Life Science 2.0) that affords equitable access to medical advances across geographical and generational boundaries and socio-economic strata.

This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples’ stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story – even when it conflicts with the rationality of science. Expanding ‘health preparedness’ to encompass ‘narrative preparedness’ complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients’ stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher’s narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only ‘what are the facts’ but ‘how do these facts make sense to people, and why.’ To be prepared for the next pandemic, health professionals must learn to engage with people’s stories and the processes by which they come to be understood and assessed differently by various constituencies.

Purpose Attention deficit hyperactivity disorder (ADHD) is currently the most prevalent childhood psychiatric diagnosis. This article reports how 10 young adults in Norway positioned themselves before they were diagnosed with ADHD either during early childhood or adolescence. A central theme is how these subject-positions relate to societal norms and mental well-being. Method Individual interviews were conducted, and the transcriptions of the interviews were analysed according to discourse theory. Result Six central subject positions were identified which in turn related to two major positions: 1) failure with schoolwork and 2) struggle in social interaction. The findings indicated specific emotional and environmental needs and that individuals were confronted with societal norms related to the criteria for ADHD prior to and regardless of whether one had received a formal diagnosis. Conclusion We argue that analysing subject positions provides important knowledge regarding ADHD that is useful for individuals, parents, teachers, practitioners, policymakers, and helping professionals in the field of mental health and education when it comes to interventions that support children who possess different temperaments.

In line with the global trend, the Middle East and North Africa (MENA) region has been growing vulnerable to the direct and indirect health effects of climate change including death tolls due to climatological disasters and diseases sensitive to climate change since the industrial revolution. Regarding the limited capacity of MENA countries to adapt and respond to these effects, and also after relative failures of the previous negotiation in Glasgow, in the upcoming COP27 in Egypt, the heads of the region’s parties are determined to take advantage of the opportunity to host MENA to mitigate and prevent the worst effects of climate change. This would be achieved through mobilizing international partners to support climate resilience, a major economic transformation, and put health policy and management in a strategic position to contribute to thinking and action on these pressing matters, at least to avoid or minimize the future adverse consequences.

BackgroundThe United Nations (UN) Sustainable Development Goals (SDGs) are parts of an ambitious framework for global development, the 2030 Agenda. Voluntary national reviews (VNRs) are described as “cornerstones” in the follow-up system, which is premised on international sharing of knowledge and experience. Norway and Sweden are among the world’s most sustainable countries, aiming to be leaders in the implementation of the SDGs. The objective of this article is to investigate and compare how health is framed in the VNRs of these two high-income countries, and to discuss the implications of these framings for potential actions. MethodsDiscourse analysis inspired by the concept of ‘framing,’ which refers to the discursive presentation of an issue where certain problem definitions and solutions are privileged over others. Frames are structures that organise and direct attention to particular aspects of reality, and define what is seen. ResultsOur analysis demonstrates that in the Norwegian VNR (NVNR), the issue of health is simplistically framed, focusing on the favourable situation of the majority, thus providing weak grounds for transformative action. In the Swedish VNR (SVNR), health is framed to highlight health as inextricably tied to societal inequalities. This underscores the need for integrated political action and leadership to counteract structural differences with negative consequences for health. ConclusionAnalysis of the two VNRs studied found a difference in how health is framed in these documents and these frames point to differences in approach and capacity to address health inequities and realise the holistic and integrative concept of health promoted in the 2030 Agenda. To realize the Agenda’s vision of “leaving no one behind” discourses of implementation that support the Agenda’s inclusive and holistic ambition must be developed. Further development of the follow-up and review system should acknowledge and address how frames can limit or enable integrative actions and are therefore important drivers of change.

In this article, and the topical collection accompanying it, we aim to challenge so-called knowledge translation (hereinafter KT) in medicine and healthcare. The abbreviation ‘KT’ refers to a variety of scientific practices and research activities, bound together by the common goal of ‘bridging the gap’ between science in laboratories and clinical application, and, more generally, putting research-based knowledge into policy and practical care. Our objective, then, is to challenge KT by working through and with the convergence and divergences between different translational epistemologies. As KT has had a massive impact on practical healthcare, global health, and knowledge policy, as well as governance relating to sustainability, a critical examination of KT is of huge academic and societal significance. The point of departure for the contributors to this collection is the observation that KT is based upon a reductive understanding of translation and knowledge transmission. Standard models of KT take translation and knowledge transmission as a phenomenon for granted, and accordingly downplay the complexity of translation as an entangled material, textual and cultural process, which inevitably affects the ‘original scientific message’. By contrasting KT with historical, cultural, and epistemic differences from its scientific ‘prehistory’, and by analysing it with reference to broader humanistic and material views of translation, we aim to develop concepts of medical translation that can cope with contemporary epistemic and cultural differences.

Objective To develop a co-designed health literacy (HL)-informed intervention for people with chronic obstructive pulmonary disease (COPD) that enables them to find, understand, remember, use and communicate the health information needed to promote and maintain good health.Design This study used a co-design approach informed by the programme logic of the Ophelia (Optimising Health Literacy and Access) process. The co-design included workshops where possible solutions for an HL-informed intervention were discussed based on an HL needs assessment study.Settings Five workshops were performed in a local community setting in the specialist and municipality healthcare services in Oslo, Norway.Participants People with COPD, multidisciplinary healthcare professionals (HCPs) from the municipality and specialist healthcare services, and researchers (n=19) participated in the workshops. The co-designed HL-informed intervention was based on seven focus groups with people with COPD (n=14) and HCPs (n=21), and a cross-sectional study of people with COPD using the Health Literacy Questionnaire (n=69).Results The workshop co-design process identified 45 action points and 51 description points for possible intervention solutions to meet the HL needs of people with COPD. The final recommendation for an HL-informed intervention focused on tailored follow-up after hospitalisation, which uses motivational interviewing techniques, is based on the individual’s HL, self-management and quality of life needs and is implemented in cooperation with HCPs in both the specialist and municipality healthcare services.Conclusion During the codesign process, the workshop group generated several ideas for how to help patients find, understand, remember, use and communicate health information in order to promote and maintain good health. People with COPD need tailored follow-up based on their individual HL needs by HCPs that have knowledge of COPD and are able to motivate them for self-management tasks and help them to improve their quality of life (QOL) and decrease hospitalisation.

Abstract Background Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients’ knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting. Methods The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health. Results No statistically significant changes were found from baseline to T1, T2, and T3. Participants’ levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation. Conclusion Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT’s. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.

Introduction Most research on loneliness comes from the health sciences, statistically seeking to measure the health-related effects of feeling alone or isolated. There is a need to expand on this understanding and explore loneliness as a more complex social phenomenon. In this article, we present a qualitative design for studying the intersection between loneliness, technology and culture. Conceptualising this as the cultural dialectic between loneliness and technology, we aim to unpack the reciprocal ways by which understandings of loneliness shape technology, while technologies also affect society’s understandings of loneliness. In elucidating this dialectic, we aim to develop new knowledge and a novel theoretical framework for understanding loneliness and its technological solutions, which, in turn, can enable better solutions to contemporary problems of loneliness.Methods and analysis We will adopt a qualitative approach that combines interviews, participant observation and textual analysis to explore loneliness and its technological solutions from the perspectives of policy-makers, producers, professionals and users in Norway and the UK. The data will be analysed through an analytical framework combining insights from discourse theory and philosophical debates on presence, which will allow us to capture and rethink fundamental assumptions about loneliness and technology. Outcomes will be revised understandings of loneliness, relevant to researchers, entrepreneurs, policy-makers, clinicians, educators and the broader public.Ethics and dissemination The project has been evaluated and approved by the data protection officer at Oslo Metropolitan University and by the Norwegian Social Science Data Services. Additional ethical approval for data collection in the UK has been provided by the University of Oxford Interdivisional Research Ethics Committee. Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications, international conference presentations and lay media.

Abstract Background There is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents’ experiences of factors promoting improvement in psychodynamic therapy. Methods Eight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work – In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation. Results The analysis revealed four main themes. ‘Exploring oneself’ comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. ‘Therapist relation and characteristics’ includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. ‘Focusing on everyday life’ includes learning and practical orientation. ‘Time factors’ refers to duration and frequency. Conclusions Together with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one’s place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life. Trial registration ClinicalTrials.gov. Id: NCT01531101. Date of registry: 8 February 2012, retrospectively registered.

Abstract Background Few early intervention programs aimed at maternal and child health have been developed to be integrated in the existing Child Health Service in a country where the service is free, voluntary and used by the majority of the eligible population. This study presents the process and the critical steps in developing the “New Mothers” program. Methods Formative research uses a mixed method, allowing us to obtain data from multiple sources. A scoping review provided information on early intervention programs and studies, clarifying key elements when framing a new program. Key informant and focus group interviews offered insight of existing challenges, perceptions, identified power structures and offered reflections germane to the identified framework, securing user involvement at all stages. Monthly meetings with the project group enabled feedback loops for the data, securing program advancement. Results The “New Mothers” program was formed based on a salutogenic theory, emphasizing resistance and strengths. Public health nurses in the existing Child Health Service were to offer universally all first-time mothers and children home visits from gestational week 28 until the child reached 2 years, with motivational interviewing and empathic communication as methods to mentor the mothers, help them identify their strengths and resources, and provide support and information. Conclusions Using formative research as mixed method ensures incorporation of detailed information from multiple resources when an early intervention program is developed. This method secured program appropriateness, both culturally and at system level, when integrating new elements in the existing service.

Abstract Background Medical certificates influence the distribution of economic benefits in welfare states; however, the qualitative aspects of these texts remain largely unexplored. The present study is the first systematic investigation done of these texts. Our aim was to investigate how GPs select and mediate information about their patients’ health and how they support their conclusions about illness, functioning and fitness for work in medical certificates. Methods We performed a textual analysis of thirty-three medical certificates produced by general practitioners (GP) in Norway at the request of the Norwegian Labour and Welfare Administration (NAV).The certificates were subjected to critical reading using the combined analytic methods of narratology and linguistics. Results Some of the medical information was unclear, ambiguous, and possibly misleading. Evaluations of functioning related to illness were scarce or absent, regardless of diagnosis, and, hence, the basis of working incapacity was unclear. Voices in the text frequently conflated, obscuring the source of speaker. In some documents, the expert’s subtle use of language implied doubts about the claimant’s credibility, but explicit advocacy also occurred. GPs show little insight into their patients’ working lives, but rather than express uncertainty and incompetence, they may resort to making too absolute and too general statements about patients’ working capacity, and fail to report thorough assessments. Conclusions A number of the texts in our material may not function as sufficient or reliable sources for making decisions regarding social benefits. Certificates as these may be deficient for several reasons, and textual incompetence may be one of them. Physicians in Norway receive no systematic training in professional writing. High-quality medical certificates, we believe, might be economical in the long term: it might increase the efficiency with which NAV processes cases and save costs by eliminating the need for unnecessary and expensive specialist reports. Moreover, correct and coherent medical certificates can strengthen legal protection for claimants. Eventually, reducing advocacy in these documents may contribute to a fairer evaluation of whether claimants are eligible for disability benefits or not. Therefore, we believe that professional writing skills should be validated as an important part of medical practice and should be integrated in medical schools and in further education as a discipline in its own right, preferably involving humanities professors.

The main objective of this study was to explore how kidney transplant recipients find, understand, and use health information, and make decisions about their health-also known as health literacy. Kidney transplant recipients must take an active part in their health following the transplantation, since a new organ requires new medication and focus on lifestyle to prevent side-effects and signs of organ rejection. Consequently, it is of major clinical relevance to explore how kidney transplant recipients understand and relate to health literacy. Ten kidney transplant recipients were interviewed at three weeks and again at six months post-transplantation. Design and analysis were inspired by constructivist grounded theory. The results of the study are presented through a model consisting of three phases: the trigger phase, the information phase, and the response phase. The participants were influenced by context and personal factors as they moved between three phases, as information seekers, recipients, and sharers. This study illustrates health literacy as an active process. It gives new insight into what motivates kidney recipients to find, share, and receive information, and how a hierarchy of resources is built and used.

In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms’ conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation.

In this paper we emphasize the importance of questioning the global validity of significant concepts underpinning global health policy. This implies questioning the concept of global health as such and accepting that there is no global definition of the global. Further, we draw attention to ‘quality’ and ‘empowerment’ as examples of world-forming concepts. These concepts are exemplary for the gentle and quiet forms of power that underpin our reasoning within global health.