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Background: Physical exercise (PE) is important for health. Girls are reported to participate less compared to boys. Multiple factors influence participation and non-participation, including neighborhood, socioeconomic status, social support, and disability. Factors may combine and form paths to participation or non-participation, yet these paths are unknown. To our knowledge, this is the first study to combine cluster analysis with a configurational comparative method to explore paths to participation and non-participation in PE among adolescents.

Methods: Data from 178 Swedish 15–18-year-olds revealed two exercise-related clusters: Not exercising and Sporting & Exercising. Girls and boys in these clusters were analyzed separately by coincidence analysis to identify paths leading to membership in each cluster. The initial analysis included 41 questions aggregated into 24 variables.

Results: Not having quick access to pocket money is a path by itself to Not exercising among girls and part of the path to Sporting & Exercising. The paths to Not exercising are more complex for boys. Participation in adult-led activities differs between boys in the Not exercising and Sporting & Exercising clusters. Having a disability is only a difference-making factor among boys when combined with “not avoiding anyone in the neighborhood” and “sometimes meeting friends in person.”

Conclusion: Multiple distinct paths lead to Sporting & Exercising and Not exercising, and these differ between girls and boys. Paths to exercising and non-exercising can be multi-factorial in nature, where several factors must be jointly present to explain membership in a particular exercise-related cluster. Future research may wish to adopt a similar configurational approach to explore other high-priority activities in which adolescents do or do not participate to improve interventions and policies aimed at increasing adolescent participation in PE.

Participation, encompassing both attendance and involvement in daily and physical activities, is vital for the development and health of children and adolescents. Combinations of activities, places, people, objects, and time create contexts for participation. Participation varies with disabilities, socioeconomic status, gender, and age, factors which individually or collectively interact with these contexts. While assessments of participation commonly focus on activities, it is necessary to understand the contexts to promote participation. It remains unclear which contexts for daily activities are assessed by the Swedish participation instrument FUNDES-Child-SE, and how participation in moderate to vigorous physical activity (MVPA) contexts is distributed and shaped among adolescents. Therefore, this thesis aims to explore contexts for participation in daily activities, and the patterns and conditions for adolescents’ participation in MVPA contexts.

Two studies were conducted and presented in four articles. In Study I, data from 163 caregivers of 6-18-year-olds with disabilities were analyzed. Exploratory and confirmatory factor analysis, and coefficient alpha, were used to assess the structural validity of the FUNDES-Child-SE and identify contexts for participation in daily activities. In Study II, data from 3494 adolescents were analyzed through cluster analysis and coincidence analysis to explore patterns of and conditions for participation in MVPA contexts of sports and physical exercise.

Study I found that FUNDES-Child-SE assesses participation in both informal (activities within and outside the home) and formal contexts (activities at school and in society). In Study II, two clusters characterized by participation in sports were associated with having a disability. Among older adolescents, most of the identified clusters were associated with sex, with female sex being linked to half of the non-participation clusters in MVPA. The conditions for the non-participation cluster in physical exercise differed for girls and boys. While socioeconomic status was a key condition for girls, boys had several interrelated conditions for belonging to this cluster.

The discussion focuses on access to contexts through accommodation and affordability. To facilitate participation in formal contexts such as sports, adolescents with disabilities may need accommodations including aids, organizational adaptations, and peer support. Organizational adaptations and peer support may also accommodate girls’ participation. The influence of socioeconomic status on girls’ participation in MVPA may be due to gender stereotypes affecting affordability. Researching contexts for organized activities is complex, as these activities may be inseparable from other contextual factors such as people or places. 

In conclusion, this thesis emphasizes the importance of considering contexts broadly to promote adolescents' participation in daily and physical activities. Facilitating access and participation involves more than simply focusing on the activities. Future research should employ interdisciplinary multi-method designs to further investigate the participation construct, to examine the sports and physical exercise contexts for MVPA more deeply, and to investigate the acceptability of MVPA contexts, specifically for adolescents with disabilities and for girls.

Adolescents' participation in physical exercise (PE) in sports clubs and self-organised training has decreased over time, while screen-time (ST) has increased. Boys exercise more and play more video games than girls, and adolescents without disabilities exercise more than adolescents with disabilities. This study aims to explore trends in patterns of PE and ST, and the association with gender and disability. Cross-sectional data from 3949 Swedish adolescents aged 12–14 and 15–18 years were used. Participation in sports, training, watching TV & movies, and playing video games was analysed annually for 2013–2019 by hierarchical cluster analysis with k means rotation. Clusters' centroids were compared across years. Associations with gender and disability were tested with regression analysis. In both age groups, five to six clusters were identified each year. Most adolescents are in exercising patterns. The proportions in patterns of sporting and ST increased between 2013–2015 and 15–18-year-olds in not-exercising patterns decreased continuously. Exercising and not-exercising patterns show stable trends, while ST patterns no longer have similar structures after 2016. More clusters in 2013–2016 than 2017–2019 are associated with gender. No cluster in 12–14-year-olds and four clusters in 15–18-year-olds are associated with disability. The study provides a new perspective on trends in patterns of PE and ST from 2013 to 2019 in Swedish adolescents. Results indicate an increased polarisation in activity patterns yet decreased polarisation between genders, and that adolescents with disabilities have the same activity patterns as other adolescents. Further research into other factors potentially influencing adolescents' activity patterns is needed.

PurposeThis study is a first exploration of health promotion messages during a mega sports event. In total, 12 countries were examined for how health-related messages were communicated in relation to the Paris 2024 Olympic and Paralympic Games via global and national partners.Design/methodology/approachIn this study, 12 countries were examined to investigate how the Paris 2024 Olympic and Paralympic Games promoted health. The Global Health Promotion and Sport Events Survey was applied to identified messages produced by global sponsors and national-level sponsors that related to community health, physical health, mental health, environmental health and nutritional health.FindingsIn total, 238 health-related messages were examined. The vast majority of these messages came from commercial, for-profit entities. When only one type of health was presented, this was often either community/social health, physical health or mental health. Environmental health and nutritional health appeared least often. Nearly half of the messages involved a combination of health types.Research limitations/implicationsParis 2024 was used by many corporate partners and National Olympic Committees to actively promote health-related messages around the world. A strength of this study was that it involved data collection from a range of countries.Practical implicationsThere are increasing concerns about detrimental effects from commercial determinants of health. Governing bodies of sport are encouraged to review partnerships which do not promote health.Social implicationsThere is opportunity to use the mega events to promote more specific actions relating to health, since the Olympic and Paralympic Games are occasions where social connection and celebration are likely to be inevitable.Originality/valueThis study offers an audit tool and sets a benchmark for understanding how health promotion messages are manifested at sport events.

Background: FUNDES-Child-SE is a proxy rating questionnaire for measuring participation and independence in children with disabilities in a Swedish context. It includes the components of frequency of attendance, engagement and independence. The original, Taiwanese FUNDES-Child 7.0, has previously been found to have a four-factor structure for frequency of participation and a two-factor structure for independence. The aim of this study was to test the factor structure in FUNDES-Child-SE. The factor structure is an important part of construct validity. Methods: Caregivers of 163 children with disabilities aged 6–18 years participated in this cross-sectional study. Exploratory factor analysis was used to find the factor structure for Engagement. Confirmatory factor analysis was used to test the factor structure for all three components. Results: The proposed factor structure for frequency of participation (daily living participation frequency, mobility participation frequency, learning participation frequency and community participation frequency) and independence (daily living independence and social participation independence) fit with data from FUNDES-Child-SE after excluding three to five items and adding two to five covariances of residuals. In the engagement component, two factors, named engagement in informal activities and engagement in formal activities, were found. After excluding one item and adding 10 covariances of residuals, the factor structure had an acceptable fit to data. Conclusions: Differences in components' factor structure indicate that attendance and engagement are separate aspects of participation. Before using numeric scores from FUNDES-Child-SE in clinical settings, responsiveness and interpretability should be evaluated.

Background: There is a need for an instrument to measure participation and independence in children with disabilities. FUNDES-Child-SE has its origin in the participation questionnaire Child and Adolescent Scale of Participation. Aims: Test the psychometric properties of internal consistency and test-retest reliability. Material and methods: This cross-sectional study included caregivers of 163 children with disability aged 6–18 years, 59 of whom were also included in the test-retest study. Descriptive statistics were used to evaluate the proportions of valid ratings. Internal consistency and test-retest reliability were tested through Cronbach’s alpha and the intra-class correlation coefficient. Results: The amount of not relevant/not applicable ratings was substantial but varied between items and subdomains. Internal consistency was acceptable (0.8–0.95), and the test-retest was marginal to excellent (0.73–0.95). Conclusions: The reliability together with the content validity support the use of the FUNDES-Child-SE to measure participation and independence in children with disabilities. However, results should be interpreted with caution due to the small sample size and possible selection bias. Modifications to reduce the not relevant/not applicable responses should be investigated together with the instrument’s responsiveness. Significance: FUNDES-Child-SE can be used to facilitate a discussion of participation and independence and to plan interventions in a habilitation setting. 

Childhood obesity is increasing in Sweden. All children are offered regularly spread health visits to a school nurse. As health visits include a measure of height and weight and a health dialogue, school nurses can discover, disclose, and treat a child's weight gain. The aim of this study was to describe school nurses’ experiences and challenges in working with childhood obesity. This qualitative study collected data through focus-group discussion and semi-structured interviews with ten female school nurses from six municipalities. Data were analysed inductively using manifest qualitative content analysis. The study was reported using the COREQ guidelines. Stigmatization and lack of resources are major challenges for school nurses working with childhood obesity, and they experience frustration, powerlessness and feel that they provide unequal treatment. The present study concludes that obesity stigmatization is a widespread challenge for school nurses. They cannot alone generate all the resources needed or conquer all challenges. Evidence-based guidelines, increased knowledge, time for reflections and peer support could potentially empower school nurses, reduce frustration, and improve the quality of and equality in childhood obesity treatment.

The current study investigated the structural validity and internal consistency of the Strengths and Stressors (SSF) questionnaire. The SSF is used in Swedish habilitation services to measure the positive and negative consequences that the fostering of a child with a developmental disability can have on family functioning in six domains: parent's feelings and attitudes, social life, family finances, relationship to the other parent, siblings, and professional support. The proposed six-factor model was tested with confirmatory factor analysis with data collected from 291 parents of children with developmental disabilities. The six-factor model had an acceptable fit according to most fit indices, but two items were non-significant. Overall, the internal consistency was acceptable or good. The SSF, with the proposed six-factor solution, can be a useful tool when assessing parental perspectives on the impacts of having a child with a developmental disability in clinical settings and research.