Seksuel sundhed i Grønland - Forebyggelse og implementering

Abstract

Resume Titel: Seksuel sundhed i Grønland - Forebyggelse og implementering. Baggrund: Problemstillinger relateret til seksuel sundhed udgør et folkesundhedsmæssigt problem i Grønland i form af en stigende incidens ved seksuelt overførte infektioner, høj abortrate, lav seksuel debutalder og et stort antal som angiver manglende medbestemmelse ved seksuelt samvær. Der eksisterer på nuværende tidspunkt ingen nationale målsætninger for forebyggelse af problemstillingerne i relation til seksuel sundhed i Grønland. Formål: Formålet var at undersøge, hvordan seksuel sundhed forbedres på baggrund af en forandring af forebyggende sundhedsstrategier, således at problemstillingerne relateret til seksuel sundhed forebygges. Metode: En systematisk litteratursøgning blev udført i databaserne PubMed, Embase, Cinahl, Cochrane, Sociological Abstracts og ProQuest. Efterfølgende en dokumentanalyse af udvalgte dokumenter i form af grønlandske folkesundhedsprogrammer og dertilhørende midtvejsevalueringer, med anvendelse af tematisk analyse strategi. Teoretisk inddragelse af den Socio-økologiske model af Dahlgren og Whitehead fra 1991, teori om forebyggelsesstrategier af Rose fra 2001, implementeringsteori af Fixsen fra 2005 og 2015 og forandringsteori af Leavitt fra 1965. Resultater: Ved den systematiske litteratursøgning blev der identificeret fem relevante artikler. Dokumentanalysen genererede fire temaer i form af udfordringer i forhold til en succesfuld implementering af seksuel sundhed i det kommende folkesundhedsprogram. Der er udledt udfordringer i form af ledelsesmæssige udfordringer, organisatoriske udfordringer, ustabil personalesituation og manglende monitorering og evaluering, samt udfordringer i form af anvendelse af ensartet forebyggelsesstrategi. Konklusion: Der er behov for, at seksuel sundhed inkluderes som fokusområde i det grønlandske Folkesundhedsprogram Inuuneritta III, med fem anbefalinger til implementering af forebyggelsesstrategier rettet mod problemstillingerne i relation til seksuel sundhed ved; 1: Bedre koordinering mellem de organisatoriske niveauer i den grønlandske sundhedsorganisation. 2: Inuuneritta III suppleres med retningsangivende dokumenter. 3: Større fokus på monitorering og evaluering. 4: Øget fokus på kombination af forebyggelsesstrategier. 5: Øget fokus på aktører i den forebyggende indsats. Der konkluderes yderligere, at der til hver af de fem ovenstående anbefalinger konsekvent tages højde for kulturelle og kontekstuelle betingelser ved implementeringen af forebyggelsesstrategierne.

Abstract Title: Sexual Health in Greenland - Prevention and implementation Background: Problems related to sexual health constitute a public health problem in Greenland with an increasing incidence of sexual transmitted infections, a high number of abortions, low sexual onset age, and a large number who reports lack of co-determination in sexual intercourse. There are currently no national targets for preventing the issues related to sexual health in Greenland. Objective: The aim of the study was to investigate, how sexual health is improved based on change in existing preventive health strategies, based on change of preventive health strategies, with the aim to prevent problems related to sexual health. Method: A systematic search was performed in the databases PubMed, Embase, Cinahl, Cochrane, Sociological Abstracts and ProQuest. Furthermore, a document analysis was performed of selected Greenlandic Public Health Programs and related mid-term evaluations, using a thematic analysis strategy. Theoretical use of the Socio-ecological Model by Dahlgren and Whitehead from 1991, Theory of prevention strategies by Rose from 2001, Implementation Theory by Fixsen from 2005 and 2015, and Theory of change by Leavitt from 1965. Results: In the systematic literature search, five relevant articles were identified. The document analysis generated four themes in the form of challenges in relation to successful implementation of sexual health in the upcoming Public Health Program. The themes identified challenges in relation to dealing with managerial challenges, organizational challenges, unstable staff situations and lack of monitoring and evaluation as well as challenges with the use of uniform prevention strategy. Conclusion: Sexual health need to be included in the Greenlandic Public Health Program Inuuneritta III, with recommendations for implementation of prevention strategies regards sexual health. 1: Improved coordination between organizational levels in the Greenlandic health organization. 2: Supplement of directional documents to Inuuneritta III. 3: Improved focus on monitoring and evaluation. 4: Increased focus on combination of prevention strategies. 5: Increased focus on actors in preventive action. It further concludes that each of the five recommendations consistently considers cultural and contextual conditions at the implementation of prevention strategies.

A master thesis from Aalborg University

Seksuel sundhed i Grønland - Forebyggelse og implementering

[Sexual health in Greenland - Prevention and implementation]