Research | Forskning - peer review

The growing incidence of chronic diseases and an ageing population, worldwide as well as in Greenland, call for an intensified focus on health promotion and rehabilitation. However, research shows that the existing disease-oriented healthcare system is not geared to manage the psychosocial problems… The growing incidence of chronic diseases and an ageing population, worldwide as well as in Greenland, call for an intensified focus on health promotion and rehabilitation. However, research shows that the existing disease-oriented healthcare system is not geared to manage the psychosocial problems of chronically ill or disabled citizens. The problem is related to the prevailing biomedical institutional structures where expert- and professional knowledge trumps the knowledge and perspectives of the users of the institutions. Speaking about health in the broad sense of WHO, there is a need for an intensified focus on wellbeing, not only physical health. The chapter presents the visions for an ongoing research project in Sermersooq Municipality. The research aims at developing knowledge about the citizens’ everyday lives with illness or disabilities, their cultural values and perspectives. Involving this kind of knowledge in professional practice requires the professionals’ reflection on means and ends in a welfare institution like home care. Welfare-professional contributions are meant to support citizen participation in social living. Therefore, professionals must learn about citizens’ social and cultural conditions for managing their lives. Furthermore, the project aims at revealing and describing the conditions for professional practice as a contribution to the professionals’ abilities to analyze their practice. The material is developed through participant observations in the municipality and the citizens’ homes, and qualitative interviews with citizens, care personnel, therapists, and leaders on different levels. The expected outcome is a set of tools for professional practice reflection following the principles described above. Atuaruk

Research | Forskning - peer review

A prospective national cohort study assessed the development of health‐related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ‐C30 version 3.0 questionnaire monthly for 4 months. Changes over time… A prospective national cohort study assessed the development of health‐related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ‐C30 version 3.0 questionnaire monthly for 4 months. Changes over time and between‐group comparisons were examined. Of 58 patients included in the study, 47% completed the questionnaire four times. Functioning was generally high, and improved social functioning was observed after 1 and 2 months. The highest symptom score was for fatigue followed by pain and nausea/vomiting. A high score for financial problems remained unchanged during the entire period. Patients with higher income had reduced pain intensity (p = .03) and diarrhoea (p = .05) than patients with income below the poverty line. After 1 month, reduction in pain intensity was observed for Nuuk citizens compared with non‐Nuuk citizens (p = .05). After 2 months, non‐Nuuk citizens reported improved social functioning compared with Nuuk citizens (p = .05). After 3 months, Global Health in Nuuk citizens was improved compared with non‐Nuuk citizens (p = .05). An important clinical finding was that patients’ needs for support are related to social status, and geographical factors should be taken into account when planning palliative care. Atuaruk

Communication | Formidling - peer review

While healthcare in many Nordic countries is increasingly centralized, some nurses are working very much on their own. This applies to nurses in Greenland, who provide care for patients in some of the world’s most rural and remote areas. Still, they share the same ambition of evidence-based care as… While healthcare in many Nordic countries is increasingly centralized, some nurses are working very much on their own. This applies to nurses in Greenland, who provide care for patients in some of the world’s most rural and remote areas. Still, they share the same ambition of evidence-based care as their colleagues around the world. Atuaruk

Research | Forskning - peer review

Background: During past decades the formerly active lifestyle in Greenland has become sedentary, and the intake of traditional food has gradually been replaced with imported food. These lifestyle and dietary habits may affect pregnant women. Aim: To describe age and regional differences in reproduct… Background: During past decades the formerly active lifestyle in Greenland has become sedentary, and the intake of traditional food has gradually been replaced with imported food. These lifestyle and dietary habits may affect pregnant women. Aim: To describe age and regional differences in reproductive factors, lifestyle and diet among Greenlandic pregnant women in their first trimester. Methods: A cross-sectional study during 2013–2015 including 373 pregnant women was conducted in five Greenlandic regions (West, Disko Bay, South, North and East). Interview-based questionnaires on reproductive factors, lifestyle and dietary habits were compared in relation to two age groups (median age ≤28 years and >28 years). Results: In total, 72.4% were Inuit, 46.6% had BMI >25.0 kg/m2, 29.0% were smoking during pregnancy and 54.6% had used hashish. BMI, educational level, personal income, previous pregnancies and planned breastfeeding period were significantly higher in the age group >28 years of age compared to the age group ≤28 years of age. In region Disko Bay, 90.9% were Inuit, in region South more had a university degree (37.9%) and region East had the highest number of previous pregnancies, the highest number of smokers during pregnancy and the most frequent intake of sauce with hot meals and fast-food. Conclusions: Overall a high BMI and a high smoking frequency were found. Age differences were found for BMI and planned breastfeeding period, while regional differences were found for smoking and intake of sauce with hot meals and fast-food. Future recommendations aimed at pregnant women in Greenland should focus on these health issues. Atuaruk

Research | Forskning - peer review

This article focuses on the methodology of the project Ageing in the Arctic (AgeArc) – Wellbeing, Quality of Life and Health Promotion among Older People in Greenland, and how the use of a collaborative approach aims at integrating ageing research, practices and policies to the benefit of the Greenl… This article focuses on the methodology of the project Ageing in the Arctic (AgeArc) – Wellbeing, Quality of Life and Health Promotion among Older People in Greenland, and how the use of a collaborative approach aims at integrating ageing research, practices and policies to the benefit of the Greenlandic society. Thus, the aim of the article is to discuss how collaboration between research and practice can be an important factor in sustainable development of welfare solutions for older people in Greenland. In the project we study ageing policy, homecare, institutions, professional practices and municipal administration of these as well as older people’s health, well-being, everyday life and historical perceptions of the roles of older people in Greenland. Moreover, researchers and municipalities collaborate on developing policies, initiatives within municipalities and civil society as well as creating network across the municipalities and between municipal administrations and civil society. In addition to this, we develop educational material for healthcare workers and professionals and work to create more public awareness about ageing in Greenland. We present three examples of our collaborative methods and discuss how the approach influences development and implementation of specific co-creation projects involving researchers, professionals and citizens on equal terms. Atuaruk

Research | Forskning - peer review

A prospective national cohort study assessed the development of health-related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ-C30 version 3.0 questionnaire monthly for 4 months. Changes over time… A prospective national cohort study assessed the development of health-related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ-C30 version 3.0 questionnaire monthly for 4 months. Changes over time and between-group comparisons were examined. Of 58 patients included in the study, 47% completed the questionnaire four times. Functioning was generally high, and improved social functioning was observed after 1 and 2 months. The highest symptom score was for fatigue followed by pain and nausea/vomiting. A high score for financial problems remained unchanged during the entire period. Patients with higher income had reduced pain intensity (p = .03) and diarrhoea (p = .05) than patients with income below the poverty line. After 1 month, reduction in pain intensity was observed for Nuuk citizens compared with non-Nuuk citizens (p = .05). After 2 months, non-Nuuk citizens reported improved social functioning compared with Nuuk citizens (p = .05). After 3 months, Global Health in Nuuk citizens was improved compared with non-Nuuk citizens (p = .05). An important clinical finding was that patients' needs for support are related to social status, and geographical factors should be taken into account when planning palliative care. Atuaruk

Research | Forskning

This article focuses on the methodology of the project Ageing in the Arctic (AgeArc) – Wellbeing, Quality of Life and Health Promotion among Older People in Greenland, and how the use of a collaborative approach aims at integrating ageing research, practices and policies to the benefit of the Greenl… This article focuses on the methodology of the project Ageing in the Arctic (AgeArc) – Wellbeing, Quality of Life and Health Promotion among Older People in Greenland, and how the use of a collaborative approach aims at integrating ageing research, practices and policies to the benefit of the Greenlandic society. Thus, the aim of the article is to discuss how collaboration between research and practice can be an important factor in sustainable development of welfare solutions for older people in Greenland. In the project we study ageing policy, homecare, institutions, professional practices and municipal administration of these as well as older people’s health, well-being, everyday life and historical perceptions of the roles of older people in Greenland. Moreover, researchers and municipalities collaborate on developing policies, initiatives within municipalities and civil society as well as creating network across the municipalities and between municipal administrations and civil society. In addition to this, we develop educational material for healthcare workers and professionals and work to create more public awareness about ageing in Greenland. We present three examples of our collaborative methods and discuss how the approach influences development and implementation of specific co-creation projects involving researchers, professionals and citizens on equal terms. Atuaruk

Research | Forskning - peer review

Background: During past decades the formerly active lifestyle in Greenland has become sedentary, and the intake of traditional food has gradually been replaced with imported food. These lifestyle and dietary habits may affect pregnant women. Aim: To describe age and regional differences in reproduct… Background: During past decades the formerly active lifestyle in Greenland has become sedentary, and the intake of traditional food has gradually been replaced with imported food. These lifestyle and dietary habits may affect pregnant women. Aim: To describe age and regional differences in reproductive factors, lifestyle and diet among Greenlandic pregnant women in their first trimester. Methods: A cross-sectional study during 2013–2015 including 373 pregnant women was conducted in five Greenlandic regions (West, Disko Bay, South, North and East). Interview-based questionnaires on reproductive factors, lifestyle and dietary habits were compared in relation to two age groups (median age ≤28 years and >28 years). Results: In total, 72.4% were Inuit, 46.6% had BMI >25.0 kg/m2, 29.0% were smoking during pregnancy and 54.6% had used hashish. BMI, educational level, personal income, previous pregnancies and planned breastfeeding period were significantly higher in the age group >28 years of age compared to the age group ≤28 years of age. In region Disko Bay, 90.9% were Inuit, in region South more had a university degree (37.9%) and region East had the highest number of previous pregnancies, the highest number of smokers during pregnancy and the most frequent intake of sauce with hot meals and fast-food. Conclusions: Overall a high BMI and a high smoking frequency were found. Age differences were found for BMI and planned breastfeeding period, while regional differences were found for smoking and intake of sauce with hot meals and fast-food. Future recommendations aimed at pregnant women in Greenland should focus on these health issues. Atuaruk

Research | Forskning - peer review

Background: During past decades the formerly active lifestyle in Greenland has become sedentary, and the intake of traditional food has gradually been replaced with imported food. These lifestyle and dietary habits may affect pregnant women. Aim: To describe age and regional differences in reproduct… Background: During past decades the formerly active lifestyle in Greenland has become sedentary, and the intake of traditional food has gradually been replaced with imported food. These lifestyle and dietary habits may affect pregnant women. Aim: To describe age and regional differences in reproductive factors, lifestyle and diet among Greenlandic pregnant women in their first trimester. Methods: A cross-sectional study during 2013–2015 including 373 pregnant women was conducted in five Greenlandic regions (West, Disko Bay, South, North and East). Interview-based questionnaires on reproductive factors, lifestyle and dietary habits were compared in relation to two age groups (median age ≤28 years and >28 years). Results: In total, 72.4% were Inuit, 46.6% had BMI >25.0 kg/m2, 29.0% were smoking during pregnancy and 54.6% had used hashish. BMI, educational level, personal income, previous pregnancies and planned breastfeeding period were significantly higher in the age group >28 years of age compared to the age group ≤28 years of age. In region Disko Bay, 90.9% were Inuit, in region South more had a university degree (37.9%) and region East had the highest number of previous pregnancies, the highest number of smokers during pregnancy and the most frequent intake of sauce with hot meals and fast-food. Conclusions: Overall a high BMI and a high smoking frequency were found. Age differences were found for BMI and planned breastfeeding period, while regional differences were found for smoking and intake of sauce with hot meals and fast-food. Future recommendations aimed at pregnant women in Greenland should focus on these health issues. Atuaruk

Research | Forskning

Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level of s… Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid's Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives' level of satisfaction with care and treatment and their current main concerns. The aim was to investigate relatives' level of satisfaction with advanced cancer care and bring to light their current main concerns. The FAMCARE-20 questionnaire was translated to Greenlandic and pilot tested. The questionnaire was supplemented by open-ended questions about relative's current main concerns and analyzed with a phenomenological hermeneutical approach. Greenlandic patients with advanced cancer who were previously participating in a prospective study were asked if their closest adult relative would participate in the study. Telephone interviews were conducted and relatives responded to the questionnaire. A total of thirty-two relatives were contacted by telephone and 30 (94%) completed the FAMCARE-20 questionnaire and answered open-ended questions. The highest rate of satisfaction was with the availability of a hospital bed (66%) and relatives were the most dissatisfied with the lack of inclusion in decision making related to treatment and care (71%) and the length of time required to diagnose cancer (70%). Responses to the open-ended questions revealed that relatives faced challenges in gaining access to information from health professionals. They experienced a lack of security, worries about the future and a lack of support at home. The study showed a substantial level of dissatisfaction among relatives of patients with advanced cancer. We strongly recommend a focus on psychosocial care, more access to information and to include relatives in decision making and in the future planning of palliative care services. An assessment of relatives' needs is essential to develop an adequate palliative care in a range of settings. Atuaruk

Research | Forskning - peer review

Purpose The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0. Methods A Greenlandic version of the EORTC QLQ… Purpose The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0. Methods A Greenlandic version of the EORTC QLQ-C30 v.3.0 was developed. The translation process included independent forward translation, reconciliation and independent back translation by native Greenlandic-speaking translators who were fluent in English. After pilot testing, a population-based cross-sectional study of patients with advanced cancer receiving palliative treatment was conducted. Internal consistency was examined by calculating Cronbach's alpha coefficients for five function scales and three symptom scales. Results Of the 58 patients who participated in the study, 47% had reduced social functioning, 36% had reduced physical and role functioning and 19% had reduced emotional and cognitive functioning. Furthermore, 48% reported fatigue, and 33% reported financial problems. The Greenlandic version of the EORTC had good applicability in the assessment of symptoms and quality of life. Acceptable Cronbach's alpha coefficients (above 0.70) were observed for the physical, role and social functioning scales, the fatigue scale and the global health status scale. Conclusions Patients with undergoing palliative treatment in Greenland for advanced cancer reported high levels of social and financial problems and reduced physical functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced cancer. Atuaruk

Research | Forskning - peer review

BACKGROUND: Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine.… BACKGROUND: Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine. OBJECTIVE: The aim of this study has been to explore how citizens living in the Greenlandic settlements experience the possibilities and challenges of telemedicine when receiving healthcare delivery in everyday life. MATERIALS AND METHODS: Case study design was chosen as the overall research design. Qualitative interviews (n = 14) were performed and participant observations (n = 80 h) carried out in the local healthcare center in the settlements and towns. A logbook was kept and updated each day during the field research in Greenland. Observations were made of activities in the settlements. FINDINGS: Data collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements. Regarding challenges in using telemedicine in Greenland, the geographical and cultural context hinders accessibility to the Greenlandic healthcare system, and telemedicine equipment is not sufficiently mobile. CONCLUSION: Greenlandic citizens are positive toward telemedicine and regard telemedicine as a facilitator for improved access for healthcare in the Greenlandic settlements. We have identified challenges, such as geographical and cultural context, that hinder accessibility to the Greenlandic healthcare system. Atuaruk

Research | Forskning - peer review

This study explores social workers’ experiences in a social service department in Greenland. The social workers described limiting factors, such as an absence of management and a dysfunctional interdisciplinary network. They described feelings of frustration and individualization, which are known st… This study explores social workers’ experiences in a social service department in Greenland. The social workers described limiting factors, such as an absence of management and a dysfunctional interdisciplinary network. They described feelings of frustration and individualization, which are known stressors. We found that the social workers were in a disempowered position that hindered their management of key welfare services. Serious problems were found that could have consequences for professional social work with clients. By drawing upon the traditions behind critical social work in our discussion of the findings, we have furthered our understanding of the workers’ conditions. We point to issues at local, interdisciplinary, and societal levels. One solution will be to work collaboratively with social workers by using empowerment strategies to strengthen a critical consciousness within the profession. The development of a critical capacity is essential if social workers are to organize anti-oppressive practices and interdisciplinary co-operation, and to engage proactively in the future development of the Greenlandic welfare system. This can be accomplished by working with educated social workers in a union and by introducing more critical understandings at the student level. Atuaruk

Research | Forskning - peer review

The social worker profession in Greenland has to some extent been overlooked in Greenlandic social research the last 50 years. Perhaps it is because the professionals have not had a voice in the social political debate, or it may be due to the fact that the majority of social research conducted in G… The social worker profession in Greenland has to some extent been overlooked in Greenlandic social research the last 50 years. Perhaps it is because the professionals have not had a voice in the social political debate, or it may be due to the fact that the majority of social research conducted in Greenland has a traditional approach to research as an objectifying activity. To counter-act these hypotheses, this research project is inspired by the work of Paulo Freire, modern Marxism, and critical theory. An analysis of how current working conditions and structures disempower the possibility of doing what social workers in Greenland view as good social work is followed by a discussion of how we have designed this study as a participatory action research project. Participation is about inviting social workers to collaborate with us during the project - a process we believe will result in democratic sustainable research. Moving from problem identification via participatory collaboration and on to problem solving through the transformative methodologies of focus groups and workshops, the empirical findings will guide the next steps of the research process towards creating a better understanding of social workers’ working conditions. Atuaruk

Research | Forskning - peer review

Background: Smoking-related illnesses, such as chronic obstructive pulmonary disease, cardiovascular disease and lung cancer, are common in Greenland. Factors such as age, gender, cigarette use, restricted smoking at home and socio-economic determinants are well-known predictors for smoking and smok… Background: Smoking-related illnesses, such as chronic obstructive pulmonary disease, cardiovascular disease and lung cancer, are common in Greenland. Factors such as age, gender, cigarette use, restricted smoking at home and socio-economic determinants are well-known predictors for smoking and smoking cessation. In 2005, 66% of the adult population in were Greenland smokers, despite widespread smoking cessation campaigns. It is therefore imperative to identify the factors that influence the low levels of smoking cessation to be able to offer cessation interventions of high quality. Aim: To develop knowledge about how smoking forms an incorporated part of a social and cultural context in the daily lives of unskilled residents of a small town in northern Greenland. Design: An ethnographic field study was carried out in 2010, including participant observation, informal conversation with health professionals and semi-structured interviews with 4 smokers (2 women and 2 men). Data were analysed with a phenomenological hermeneutic approach. Results: All informants were daily smokers. During work hours, they smoked fewer cigarettes due to control policy as well as having something to do. At home, they smoke more during leisure time. Having time on one's hands can be a factor in smokers remaining as smokers. It appears that smokers seem to consider themselves to be stigmatised. This may be one reason for wanting to stop smoking. Smokers ask how to quit and also ask for help to give up smoking with regard to medical treatment for withdrawal symptoms. Serious illness and pregnancy both appear to be triggers to consider giving up smoking. Severe withdrawal symptoms and lack of knowledge about how to give up smoking are barriers to participants achieving their goal. Conclusion: Prevention initiatives should be targeted at all smokers and a smoking cessation service should be developed, where smokers are supervised and receive medical treatment for withdrawal symptoms. Atuaruk

Research | Forskning

Background: The Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing. Aim. To investigate current nursing practice in Greenland and to identify whether it m… Background: The Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing. Aim. To investigate current nursing practice in Greenland and to identify whether it meets the requirements of healthcare reform. Design. This ethnographic study utilised documentary analysis, participant observation and qualitative interviewing carried out in remote areas of Greenland during 2011-2012. Eight registered nurses, four women and four men, aged between 35 and 55, participated in this study. Four were working at healthcare centres in towns and four were working at nursing stations in villages. The nurses were educated in Greenland or a Nordic country and had been practicing nursing for at least 2 years in an Arctic region. They were observed for 15 days, and subsequently interviewed. Interviews included in-depth questioning, based on emerging outcomes from observation. Interviews were recorded and transcribed; they were analysed within a phenomenologicalhermeneutic approach. Results. Nurses in rural and remote areas navigate their health promotion and preventive work with conflict between health strategies and everyday realities, where unpredictable tasks often lead to prioritisation of urgent, acute work. There is interaction between personal and professional skills. Everyday life is characterised by opportunities and challenges in the grey areas, namely nursing, medical and social work. Conclusion. The nature of nursing practice in rural and remote Greenland is characterised by a high degree of variability and complexity, with a requirement for a wide range of knowledge and skills. Nurses need to be better prepared with regard to acute medical care, preventive care, social work, humanistic approaches and information technology to implement the ideology of health strategies. Atuaruk

Research | Forskning - peer review

The theoretical concept of 'everyday life' is ambiguous. Different theoretic approaches offer different epistemological comprehensions of the concept. These have implications for research in everyday life. For the purpose of clarifying the analytical perspective in a Ph.D.-project carried out in and… The theoretical concept of 'everyday life' is ambiguous. Different theoretic approaches offer different epistemological comprehensions of the concept. These have implications for research in everyday life. For the purpose of clarifying the analytical perspective in a Ph.D.-project carried out in and around a hospital ward in Dr. Ingrids Hospital in Nuuk, the concept of everyday life is discussed from two different angles: a sociological-phaenomenological approach and an approach to everyday life based on a critical psychological theory of practice. Questions of subjectivity, practice and social change are put on the agenda in order to discuss how change can be brought about through humanistic health research. Atuaruk