To Örebro University

Autistic students participate less in Physical Education (PE) than their peers. Motivation is a primary driver of participation in PE, yet little is known about factors influencing the motivation of autistic youth in PE. This qualitative study explored the experiences of Australian autistic youth aged 7-18 years (N = 26) in mainstream PE. A deductive content analysis approach, informed by Self-Determination Theory (SDT), directed the development of the interview guide and analysis. Deductive responses (k = 526) were related to the Basic Psychological Needs postulated by SDT: relatedness (k = 165), competence (k = 124), and autonomy (k = 76) and included 33 conceptual categories. Inductive responses capturing autistic differences were mapped to the Conditional Participation Model themes: Adjustment to external demands (k = 52), predictability (k = 41), and affective experiences (k = 68), incorporating 16 conceptual categories. Autistic differences underpin Basic Psychological Needs satisfaction/frustration. Supporting the Basic Psychological Needs of autistic students differs from their neurotypical peers, with PE teachers best positioned to facilitate a need-supportive environment for autistic students.Lay AbstractAutistic youth participate less in Physical Education (PE) than their classmates. We do not know much about the motivation of autistic students to participate in PE. Self-Determination Theory says our motivation is affected by the satisfaction of our Basic Psychological Needs of competence (can I do it), autonomy (is there a choice), and relatedness (do I belong). We investigated what impacts the psychological needs of autistic youth in PE. We also explored how autistic differences affect motivation using the Conditional Model of Participation that considers exercise participation for autistic youth. We interviewed 26 Australian autistic youth, (7-18 years) investigating factors impacting their Basic Psychological Needs in PE. This is a deductive approach, as we considered specific themes and used these to analyse responses. We also recorded patterns relating to autistic differences. This was an inductive approach as themes emerged from the responses. Participants provided 365 responses in relation to competence (124), relatedness (165), and autonomy (76). In addition, 161 responses linked to autistic differences. We mapped responses to the Conditional Participation Model themes of adjustment to external demands (52 responses), predictability (41 responses), and emotions (68 responses). Autistic differences underpinned the Basic Psychological Needs of participants. The PE teacher had the biggest impact on supporting these needs.

BACKGROUND: The number of adults in need of psychiatric care is increasing in Sweden. To meet this need, new working methods are implemented. Home-based mobile specialist psychiatric nursing teams (SPOT) are being introduced to function as a complement to outpatient care and inpatient care, but still little is known about how healthcare professionals experience such efforts. The purpose of this study was thus to capture mental healthcare professionals' experiences of the early phase of the introduction of SPOT.

METHODS: Focus group discussions and semi-structured interviews were conducted with 11 mental healthcare professionals, including nurses, psychiatric aides working within psychiatric care and on the SPOT team and psychiatrists who had a consultative role in SPOT. The data was inductively analysed through reflexive thematic analysis.

RESULTS: The discussions and interviews revolved around three themes: The phases and conditions of the change, Opportunities and challenges in the new form of intermediate care and Care in the patient's home for patient empowerment and engagement. Different perspectives on the new form of care emerged and many were positive about patients' increased engagement in care when it was offered in the home environment. However, it was also emphasised that the need for different forms of care remains and that a new level of care should not exclude other forms of care. The results further showed a need to engage and offer continuous support to healthcare professionals at different levels when new working methods are introduced. Specifically, support from managers and increased competence and skills development in performing new work tasks were requested.

CONCLUSIONS: Providing care in the home environment through SPOT interventions can help increase patients' engagement in their own care. Preparing and equipping healthcare professionals at all levels and offering them knowledge support and influence in the introduction of new forms of care is important to reduce the vulnerability that professionals may initially experience in change processes and new ways of working.

OBJECTIVES: To explore and describe how healthcare professionals within the oncological outpatient setting perceive quality of care.

DESIGN: A qualitative, descriptive design with a phenomenographic approach was used, with focus group discussions as the means of data collection.

SETTING: Primary care in oncological outpatient units in four hospitals in Sweden.

PARTICIPANTS: Through purposive sampling, 20 healthcare professionals entered and completed the study by participating in four focus groups, five participants in each group. Inclusion criteria were assistant nurses, nurses or physicians delivering treatment and care with radiation and/or anticancer drugs in oncological outpatient units. Excluded were healthcare professionals who had worked less than 3 months at the oncological outpatient unit.

RESULTS: Two descriptive categories emerged from the data: 'The professional's personal ability for good care' and 'The structural conditions for good care'. These categories consist of descriptions of quality of care being perceived as a good meeting with patients, patient participation, continuity, accessibility and care grounded in science.

CONCLUSIONS: According to the healthcare professionals, quality of care relies on organisational structures in combination with a professional and personal interaction between the patients and the healthcare professionals. Knowledge about what healthcare professionals believe constitutes quality of care should therefore be highly valuable to policymakers and hospital management.

To review the longitudinal trajectories - and the factors influencing their development - of mental health problems in children with neurodevelopmental disabilities. Systematic review methods were employed. Searches of six databases used keywords and MeSH terms related to children with neurodevelopmental disabilities, mental health problems, and longitudinal research. After the removal of duplicates, reviewers independently screened records for inclusion, extracted data (outcomes and influencing factors), and evaluated the risk of bias. Findings were tabulated and synthesized using graphs and a narrative. Searches identified 94,662 unique records, from which 49 publications were included. The median publication year was 2015. Children with attention deficit hyperactivity disorder were the most commonly included population in retrieved studies. In almost 50% of studies, trajectories of mental health problems changed by < 10% between the first and last time point. Despite multiple studies reporting longitudinal trajectories of mental health problems, greater conceptual clarity and consideration of the measures included in research is needed, along with the inclusion of a more diverse range of populations of children with neurodevelopmental disabilities.

INTRODUCTION: The rising prevalence of autism spectrum disorder (ASD) among children poses significant challenges for healthcare services. Research has underscored the crucial role of children's involvement in their healthcare. However, due to the intricate nature of ASD, marked by communication and social interaction differences, healthcare providers face challenges in tailoring their services to accommodate these children. This project aims to explore the impact of two distinct needs assessment models on children's participation in the needs assessment process.

METHODS AND ANALYSIS: We will conduct a prospective observational study comparing responses from children subjected to two different needs assessment procedures: survey-based and meeting-based. Supplementary data will be collected from the children's parents/guardians and healthcare professionals. Data collection methods will include questionnaires, interviews and document analysis of individual habilitation plans. We aim to recruit 120 children aged 7-17 diagnosed with ASD but without intellectual disability, with 60 undergoing the survey-based needs assessment and 60 undergoing the meeting-based assessment. The primary outcome measure will be the perception of participation in the needs assessment procedure. Secondary outcomes will include the children's quality of life and mental health; the parents' knowledge of their child's strengths, abilities and special needs; and the parents' perception of the quality of collaboration with the healthcare team.

ETHICS AND DISSEMINATION: The study received ethics approval from the Swedish Ethical Review Authority on 4 March 2024 (reference number 2024-00227-01). All children and their caregivers will receive both verbal and written information about the study before being asked to provide written informed consent to participate. The findings will be disseminated through publication in peer-reviewed journals and presentation at conferences. Additionally, a popular science report summarising the data and its interpretation will be published.

TRIAL REGISTRATION NUMBER: NCT06381856.

BACKGROUND: Participation in physical activity among adolescents with autism is often conditional. However, there is a lack of methods for identifying these specific conditions. Therefore, the purpose of this study was to develop and investigate the feasibility of a Q-sort tool to map individual-specific conditions for participation in physical activity among adolescents with autism and to identify different viewpoints regarding conditions for such participation.

METHOD: An exploratory mixed-methods design was employed to investigate the feasibility of using Q methodology and the Q-sort procedure to identify what individual-specific conditions are important for participation in physical activity for adolescents with autism.

RESULTS: The adolescents ranked the statements with varying levels of ease. Two viewpoints were identified: Autonomous participation without surprises and Enjoyment of activity in a safe social context.

CONCLUSION: Q-sort is a feasible method for mapping conditions for participation, which can guide the development of tailored physical activity interventions.

PURPOSE: Various stakeholders contribute to the development of healthy physical activity habits in adolescents with autism spectrum disorder (ASD). Parents and stakeholders seek collaborative actions but little is still known about such efforts. The purpose of this study was thus to explore how professionals from different services experience stakeholder collaboration when promoting participation in physical activity for these adolescents.

METHOD: Five focus group discussions were held with 17 professionals from education, health care, community, and sports organizations, engaged in the promotion of physical activity in adolescents with ASD. The data were analyzed with qualitative content analysis.

RESULTS: . The professionals though experienced that this collaboration was hampered by the low priority given to physical activity issues within different organizations, by limited resources, lack of knowledge, and unclear roles.

CONCLUSIONS: Notwithstanding the professionals' different roles, all agreed that physical activity issues need to be prioritized and that each stakeholder needs to acknowledge the shared responsibility of collaboration. However, more clear routines for collaboration that include joined efforts but also highlight the organization-specific responsibilities might enhance the collaborative efforts.

• In-depth understanding of both the adolescents' needs and the environments in which physical activity is promoted is required if participation in physical activity among adolescents with ASD is to be enhanced.
• Families and professionals within different organizations need to be supported to collaborate when mapping and meeting the adolescents' physical activity needs.
• Issues regarding developing physical activity habits need to be prioritized.
• Professionals, such as education, health, and community professionals who are important for the promotion of healthy physical activity habits need to be included in multi-stakeholder meetings.

Findings from previous research show generally lower levels of physical activity (PA) among adolescents with autism spectrum disorder (ASD). The reasons for the low PA participation are complex and depend on several factors, often described as barriers to PA. However, the overall picture concerning participation in PA among adolescents with ASD remains incomplete, as it lacks the adolescents’ own perspectives. The mission to promote healthy PA habits is shared by several actors, including the family or parents and the education, health and municipal services. In order to understand and comprehensively describe these adolescents’ PA participation, different PA contexts and perspectives need to be included. The overall aim of this thesis was therefore to study participation in PA among adolescents with ASD from the adolescents’ (study I), parents’ (study II) and professionals’ (study III) perspectives. The findings from study I showed a conditional participation behaviour in PA among adolescents with ASD. In studies II and III, the results revealed a need to give PA issues increased priority and support through collaborative efforts. Complementary roles are needed to promote participation in PA. In study IV, the feasibility of using a Q-sort tool to map conditions for participation in PA was investigated. The results showed that Q-sort is a feasible method that can be used to offer tailored support according to the adolescents’ individual-specific conditions for participation. In conclusion, a condition-controlled behaviour when participating in PA was described in all four studies. When promoting participation in PA, these individual-specific conditions for participation need to be recognized and tailored support offered. 

The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits, and they possess important knowledge about the adolescents' needs when it comes to enhancing participation in physical activity. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe parents' perceptions of their adolescent child's participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12-16 years with autism spectrum disorder were interviewed. The interviews were analyzed using an inductive content analysis approach. The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents' physical activity participation. Lay abstract What is already known about the topic?The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe the parental perceptions of their adolescent child's participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12-16 years with autism spectrum disorder were interviewed. What this paper adds?The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own. Implications for practice, research, or policy.The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents' physical activity participation.