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  • 1.
    Alayed, Abdulrahman S.
    et al.
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Saudi Arabian ICU safety and nurses' attitudes2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 7, p. 581-593Article in journal (Refereed)
  • 2.
    Lööf, Helena
    Sophiahemmet University.
    A journey through Cross-cultural adaptation, Psychometrics and Phenomenological design in research projects2016Conference paper (Other academic)
    Abstract [en]

    Focus of the first study in my doctoral thesis (dissertation Karolinska Institutet, May 2015) was a body awareness questionnaire. I used a method for cross-cultural adaptation of self-reporting measures. I initially translated a version of a body awareness questionnaire (into Swedish), and I also pretested the translated version. By using think-aloud interviews I measured the content validity. I also performed a psychometric evaluation of the Swedish translated version, trough confirmatory factor analysis (measure the construct validity).

    Focus of the second study was pain and fatigue in persons with rheumatoid arthritis, and focus of the third study was fear-avoidance beliefs about physical activity in persons with rheumatoid arthritis. Studies two and three were crosssectional survey studies. In study two I used univariate analysis of variance and backwards stepwise multiple regression and in study three I used univariate analysis of variance and backwards stepwise logistic regression. Focus of the forth study was body awareness in persons with rheumatoid arthritis.

    A phenomenological study design, using the Empirical Phenomenological Psychological (EPP) method was used. The purpose of choosing narrative interviews was that they can provide valuable information about the phenomenon (body awareness) from the patient’s perspective. The life world perspective includes the world in which we live and to which we ascribe meaning, which means that our experience is always subjective and relative. According to the method the researcher does not attempt to validate a hypothesis (nor does the researcher seek to prove theoretical constructions).

  • 3.
    Lööf, Helena
    Sophiahemmet University.
    Kroppsmedvetande vid reumatoid artrit - den problematiska och den hanterliga kroppen: ett skifte av uppmärksamhetsfokus2015In: Ä : en tidning för Riksföreningen sjuksköterskan inom äldrevård : geriatriker, dietister inom geriatrik samt alla professioner runt den äldre patienten, ISSN 2001-1164, no 4, p. 38-39Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Lööf, Helena
    Sophiahemmet University.
    “Let me be a meaningful part in the outside world”: A caring perspective on long-term rheumatic pain and fear-avoidance beliefs in relation to body awareness and physical activities2019In: Meanings of pain: Common types of pain and language / [ed] Simon van Rysewyk, Springer , 2019, 2, p. 103-115Chapter in book (Other academic)
  • 5.
    Lööf, Helena
    Sophiahemmet University.
    Pain, fatigue and fear-avoidance beliefs in relation to physical activity and body awareness in persons diagnosed with rheumatoid arthritis2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Pain and fatigue are highly common and a major concern for persons diagnosed with rheumatoid arthritis (RA). Having physical limitations, which have a significant effect on daily life, is also described as a major problem for persons with RA. Research findings show that a minority of persons with RA perform maintained health-enhancing physical activity (HEPA), and that psychosocial factors seem to be the most salient and consistent factors to explain variations in HEPA. Furthermore, fear of physical activity and exercise has been described as major barriers for persons with chronic pain. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature as having either a positive or a negative impact on a person’s health and well-being. However, the concept of BA is complex and therefore greater insight into this phenomenon is needed.

    Aim: The overall aim of this thesis was to investigate pain, fatigue and fear-avoidance beliefs in relation to physical activity and their correlates in persons with RA. A further overall aim was to develop a psychometric measurement of BA. A final overall aim was to deepen our understanding of BA in persons with RA.

    Methods: Study I was a psychometric evaluation of a Swedish version of the Body Awareness Questionnaire (BAQ) in a student population and in adults with RA. Studies II - III were a cross-sectional survey studies in adults with RA. Study IV was a phenomenological study using the empirical phenomenological psychological (EPP) method in adults with RA.

    Results: In study I, the value of Cronbach's alpha coefficients for the total score in the Swedish version of the BAQ was satisfactory. According to confirmatory factor analysis (CFA), neither a one-factor model nor a four-factor model tested in this study fulfilled the pre-specified criteria. In study II, pain was significantly associated with health-related quality of life (HRQoL) and disease activity. Fatigue was significantly associated with disease activity, BA and positive affect. The adjusted R2 was 28.6% for fatigue and 50.0% for pain. Study III showed that, for socio-demographic factors, being male and having a below average income were associated with an increased risk of high fear-avoidance beliefs about physical activity (mFABQ high). Moreover, the two disease-specific factors, which are most indicative of mFABQ high, were high level of pain and poor health. Concerning psychosocial factors, low HRQoL and low exercise self- efficacy were significantly associated with mFABQ high. The model fit was 0.27 (Nagelkerkés R2). In study IV, some general characteristics were found, which had to do with the disease giving rise to a higher degree of negatively toned BA. BA was a reactive process of searching or controlling for disease-related symptoms, or a reactive process that was triggered by emotions. In addition, BA was an active process in the sense of taking an inventory of abilities. All the participants had the ability to shift focus from BA to the outside world.

    Conclusions: This thesis showed that pain, fatigue and fear-avoidance beliefs about physical activity in persons with RA have several potential correlates, including socio-demographic, disease-specific and psychosocial factors for the variables investigated. The Swedish version of the BAQ is simple to administer and should be used as a tool to measure self-reported attentiveness to normal body processes. Cronbach’s alpha coefficient for the total score was satisfactory; nevertheless, since neither of the models fulfilled the pre-specified criteria further testing of the Swedish version of the BAQ is required. BA was found to be both positively and negatively toned in persons with RA, though RA resulted in a higher degree of negatively toned BA. Thus, the ability to shift attention, from BA to activities in the outside world, could sometimes be beneficial for the person’s general health and well-being. Having the opportunity to participate in meaningful and purposeful daily real-world activities keeps the mind busy (and distracted) and can decrease the negative BA.

  • 6.
    Lööf, Helena
    Sophiahemmet University.
    Rädsla-undvikande-föreställningar i relation till kroppsmedvetande och fysisk aktivitet hos personer med reumatoid artrit2015In: Best Practice, ISSN 1329-1874, Vol. 7, no 24, p. 20-21Article in journal (Other academic)
  • 7.
    Lööf, Helena
    Sophiahemmet University.
    Smärta i relation till rädsla - undvikande för fysisk aktivitet och kroppsmedvetande2015In: Smärta, ISSN 1402-1048, Vol. 20, no 4, p. 23-Article in journal (Other (popular science, discussion, etc.))
  • 8.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Demmelmaier, I
    Welin Henriksson, E
    Lindblad, S
    Nordgren, B
    Opava, C H
    Johansson, Unn-Britt
    Sophiahemmet University.
    Fear-avoidance beliefs of physical activity in adults with rheumatoid arthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Suppl 2, p. 92-93Article in journal (Refereed)
  • 9.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Demmelmaier, I
    Welin Henriksson, E
    Lindblad, S
    Nordgren, B
    Opava, Ch
    Johansson, Unn-Britt
    Sophiahemmet University.
    Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis2015In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, p. 93-99Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA). Method: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed. Results: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2)). Conclusions: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

  • 10.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    "A body in transformation"-An empirical phenomenological study about fear-avoidance beliefs towards physical activity among persons experiencing moderate-to-severe rheumatic pain2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 1-2, p. 321-329Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To gain a better understanding of fear-avoidance beliefs towards physical activity and body awareness in people experiencing moderate-to-severe rheumatic pain.

    BACKGROUND: Rheumatoid arthritis and psoriatic arthritis are long-term conditions with pain as the prominent symptom. Health-promoting physical activity is recommended and can have an analgesic effect. High self-rated pain has previously been reported to be associated with increased fear-avoidance behaviour in relation to physical activity. Body awareness, which includes attentional focus and awareness of internal body sensations, could be valuable in the nursing care of long-term diseases.

    DESIGN: Empirical phenomenological.

    METHODS: An empirical phenomenological psychological method was applied. The interviews took place between autumn 2016-spring 2017 with 11 informants (eight women and three men, age range 44-71 years) who were diagnosed with rheumatoid arthritis (n = 7) or psoriatic arthritis (n = 4), with a disease duration ranging from 3-35 years. The mean visual analogue scale score in the study sample was 60 mm.

    RESULTS: Three typologies were identified: "My relatively fragile physical status", "I am an active creator" and "Part of something bigger than myself."

    CONCLUSIONS: The current findings indicated that pain anticipation and fear-avoidance beliefs towards physical activity sometimes affected the behaviour of individuals with long-term rheumatic pain syndromes. People experiencing moderate-to-severe rheumatic pain tended to focus on their fragile physical and emotional state. By adopting a more favourable attitude towards the self, the body could be restored to a state of calm and balance.

    RELEVANCE TO CLINICAL PRACTICE: The current findings are relevant for healthcare professionals engaged in health-promotion clinical practice.

  • 11.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Kroppsmedvetande hos personer med reumatoid artrit2014In: Best Practice, ISSN 1329-1874, Vol. 6, no 21, p. 22-23Article in journal (Other academic)
  • 12.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Long-term rheumatic pain, body awareness and fear-avoidance beliefs2018Conference paper (Other academic)
  • 13.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    ”Part of something bigger than myself”: En forskningsstudie om kroppsmedvetande ochrädsla - undvikande för fysisk aktivitet hos personer med medel till svårreumatisk smärta2018Conference paper (Other academic)
  • 14.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Bullington, Jennifer
    Body awareness in persons diagnosed with rheumatoid arthritis2015In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl 2, p. 1327-Article in journal (Refereed)
  • 15.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Bullington, Jennifer
    Body awareness in persons diagnosed with rheumatoid arthritis2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, p. 24670-Article in journal (Refereed)
    Abstract [en]

    Living with rheumatoid arthritis (RA) poses physiological and psychological demands on a person. RA is a autoimmune disease that can cause pain, disability, and suffering. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a person's health. The concept of BA is complex and a thorough understanding is needed about what BA means from the patient's perspective. This study was therefore conducted to acquire greater insight into this phenomenon. The study is grounded in a phenomenological life-world perspective. Eighteen narrative interviews were conducted in patients (age range 23–78 years) with RA. The interviews were analyzed using the Empirical Phenomenological Psychological method. General characteristics were found running through all 18 interviews, indicating that the disease resulted in a higher degree of negatively toned BA. BA was either a reactive process of searching or controlling after disease-related symptoms or a reactive process triggered by emotions. BA was an active process of taking an inventory of abilities. All participants had the ability to shift focus from BA to the outside world. Four typologies were identified: “A reactive process on symptoms,” “A reactive process on emotional triggers,” “An active process of taking an inventory of abilities,” and “A shifting from BA to the outside world.” In conclusion, because BA can be both positively and negatively toned, health care professionals must have a good understanding of when BA is positive and when it is negative in relation to the patient. RA had caused a higher degree of negatively toned BA. Thus, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patient's general health.

  • 16.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Saboonchi, Fredrik
    Sophiahemmet University.
    Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, p. 1643-1651Article in journal (Refereed)
    Abstract [en]

    Aim

    This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention.

    Background

    The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available.

    Method

    A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The ‘concurrent think aloud’ method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity.

    Results

    According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory.

    Conclusion

    Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may

  • 17.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Saboonchi, Fredrik
    Pain and fatigue in adult patients with rheumatoid arthritis: association with body awareness, demographic, disease-related, emotional and psychosocial factors2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 2, p. 293-300Article in journal (Refereed)
    Abstract [en]

    Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors. Method: Data were collected from a sample of patients with RA (n = 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 - 80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied. Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.

  • 18.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Saboonchi, Fredrik
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Johansson, Unn-Britt
    Sophiahemmet University.
    "Pain and fatigue in adult patients with rheumatoid arthritis: association with demographic factors, disease related factors, body awareness, emotional and psychosocial factors"2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10 (suppl), p. 671-672Article in journal (Refereed)
  • 19.
    Lööf, Helena
    et al.
    Sophiahemmet University.
    Saboonchi, Fredrik
    Sophiahemmet University.
    Welin Henriksson, Elisabet
    Lindblad, Staffan
    Johansson, Unn-Britt
    Sophiahemmet University.
    Psychometric testing of the body awareness questionnaire in an Swedish sample of patients diagnosed with rheumatoid arthritis2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no Suppl 3, p. 734-Article in journal (Refereed)
  • 20.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Hagströmer, Maria
    Yngve, Agneta
    Exploration of study participants experiences following Sophia Step Study: A two-year physical activity intervention2016Conference paper (Other academic)
  • 21.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Yngve, Agneta
    Hagströmer, Maria
    Brismar, Kerstin
    Johansson, Unn-Britt
    Sophiahemmet University.
    'This is why I'm doing a lot of exercise': A qualitative study of participant's experiences of the Sophia Step Study2018In: International Diabetes Nursing, ISSN 2057-3316, E-ISSN 2057-3324Article in journal (Refereed)
    Abstract [en]

    Introduction: Support for physical activity (PA) is central in diabetes care. The Sophia Step Study is a three-armed randomised controlled trial aiming to evaluate different levels of support for increased PA in prediabetes and Type 2 diabetes. With the purpose to reveal the programme components and the mediating factors from the participants’ perspective this paper aims to report a qualitative exploration of adhering participants’ experiences after two years’ study participation.

    Methods: Semi-structured interviews were conducted with 18 participants (men, n = 11, women, n = 7, prediabetes, n = 5, Type 2 diabetes, n = 13, median age 68.5 years) who completed a two-year multi-component (n = 7), singlecomponent (n = 6) intervention or served as controls (n = 5) at a primary care center in Stockholm, Sweden. The interviews were analysed using content analysis with an inductive approach. Sophia Step Study is registered at ClinicalTrials.gov with Identifier: NCT02374788.

    Results: The participants recalled the frequent study assessments as providing feedback of health outcomes; positive reinforcement; a sense of sentinel and a personalised approach. Group meetings, pedometers and health check-ups were valued as resources for increased awareness and motivation of PA; establishment of new routines and control over the own health. The long program duration allowed for maintenance of awareness and routines for PA

    Conclusion: Adhering participants in theory-based interventions, but also in the control group, identified key mediators to support for PA. Feedback of results, personalised encouragement, emotional support and selfmonitoring should be regarded in self-management of PA to optimise patient motivation and outcomes.

  • 22.
    Rossen, Jenny
    et al.
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Yngve, Agneta
    Sophiahemmet University.
    Hagströmer, Maria
    Brismar, Kerstin
    Johansson, Unn-Britt
    Sophiahemmet University.
    Using pedometers for self-management of physical activity: Participants' experiences from Sophia Step Study: A physical activity promotion intervention in pre- and type 2 diabetes2017Conference paper (Other academic)
  • 23.
    Saboonchi, Fredrik
    et al.
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Body awareness, perfectionism and pain2009In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 24, no Supp 1, p. 347-347Article in journal (Refereed)
1 - 23 of 23
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  • en-US
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