Metrics details For an intervention to contribute to decreased health gaps people living in underserved areas must participate in the research-to-action process during the development of the intervention The purpose of this study was to collaborate with residents living in a Swedish underserved area to generate health and wellness priorities and actions We applied Group Level Assessment (GLA) together with people living in a Swedish neighborhood where obesity dental caries and other illnesses are prevalent participatory methodology that is designed for a large group to generate and evaluate relevant needs and priorities within a lens of action for positive social change Eight GLA sessions were held over a five-month time period proposals and actions for change by the residents improved communication and more meeting places were highlighted as priorities for promoting health and well-being The results were presented for stakeholders in a report and an exhibition and some of the participants started a language café GLA emphasised the participants’ perspective The participatory process helped them identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change The aim of this study was to collaborate with residents living in a Swedish underserved residential area to generate health and wellness priorities and actions We were particularly interested in issues related to dental health and nutrition Specific research questions were: How can GLA facilitate reflections and actions grounded in the community Which barriers and facilitators for a healthy life do inhabitants identify For the duration of this project, we formed a community-academic partnership composed of Gårdsten residents and researchers. The partnership worked collaboratively to make decisions and guide the work at each stage of the research process. The roles and responsibilities of this community-academic partnership are described in Table 1 The municipality approved the project and we used premises of the city of Gothenburg we collaborated with the personnel at a public meeting place in Gårdsten The project started with two groups of Gårdsten residents one during daytime and one in the evenings according to the participants’ preferences the residents decided to merge into one afternoon group All those who came to the sessions were informed about the aim of the study confidentiality and voluntariness and gave their written informed consent to participate All methods were carried out in accordance with relevant guidelines and regulations Residents of Gårdsten met in a house open for the public located in the middle of the housing complex to participate in the research project Residents were recruited through posters and postcards displayed at the housing complex and then by snowball sampling where residents invited neighbours and friends personally or by postcards distributed and posted on notice boards (e.g Since many languages and cultures were represented in the groups and many residents did not speak fluent Swedish we engaged intercultural mediators to attend each meeting to interpret and explain and for one of the meetings also sign language interpreters 2 to 6 members of the research group were present to organize and moderate the discussions and take notes The researchers had the intention to be facilitators of engagement as well as good listeners gathering information Great effort was made to make the process transparent and to contribute to a trustful and equitable setting food or snacks and beverages were provided and childcare if needed Following the steps of GLA methodology [16] the researchers facilitated group sessions over a period of 5 months for the participants to define their situation identify priorities and plan actions for change GLA proceeds through seven steps ─ climate setting selection and action and typically occurs in 1–2 sessions the seven steps of GLA were extended to guide the research process over multiple sessions and groups attempting to sustain engagement of Gårdsten residents members of the research team carried out a participatory observation and documented the discussions and the development and implementation of action plans in order to describe the process and the results the participants mapped the situation in Gårdsten reflected to understand each other’s perspective and discussed common views and desires (GLA steps 1–5) Climate setting: We started the first session by sharing a meal doing introductions of all that were present In Step 2, Generating, the participants were asked to answer pre-written, mostly open-ended, prompts related to health and wellbeing (Table 2) written on 20 flip charts placed on the walls in two rooms and a corridor The participants moved around randomly to respond to prompts-- that is the prompts were not placed in a set order for them to follow The research team members and intercultural mediators were available to support with translating In Steps 3–4 the participants read the responses had the opportunity to add new comments or mark their agreement to other’s comments (Appreciating) and spend time to reflect on what the data as a whole meant to them (Reflecting) the participants divided themselves into small groups of 4 to 8 people according to language spoken The research group helped to divide the flip charts among the groups according to which prompts they were interested in discussing and so that each small group had 4 to 7 charts discuss and identify 3–5 common and important themes across the charts representatives from the research group were available to facilitate discussion and record the final themes on a new flip chart All groups were then gathered to discuss their results A participant or facilitator from each small group then reported their themes and any insights regarding the themes The results from each small group and the overall results were discussed by the larger group and were complemented with a few new themes raised from the discussion or because the large group found that important aspects from the individual comments had been ignored Selection: In the second GLA session in each group the discussion continued and the participants reflected on different perspectives and began to develop goals and possible actions The themes and goals in the evening and daytime groups were very similar the discussion was focused on how to reach the goals a new common goal was decided among the group ─ to present the results of the discussions for key stakeholders (i.e describe the situation in Gårdsten and the group’s suggestions for improvement) The participants also discussed which stakeholders to address and how to reach them Two actions to reach this goal were discussed The participants were offered support with this and it was decided that the research group should do writing and layout based on the participants’ results and suggestions The participants invited other residents and other stakeholders to the exhibition and disseminated the report consisting of four committed Gårdsten residents who wanted to continue work after the exhibition An action group emerged during the sessions and continued after the research project with residents in Gårdsten intercultural mediators and researchers not included) In an iterative process where participants identified patterns in the responses across 4–7 wall charts (Step 5 they reflected on the situation and the needs in the neighbourhood and negotiated important themes on which to focus Thereafter they discussed goals and options to reach the prioritized themes In addition to being a support in this process the researchers compiled the results from the different groups and summarised the information We also took field notes from all GLA sessions These were used to describe the process and the discussion leading to the themes The narratives from some of the participants illustrate the discussion about the situation in Gårdsten and were not further analysed This interpretation was grounded in the belief of participants’ competence and willingness to describe their situation as they experienced it The standpoint was that our knowledge about life in Gårdsten was superficial and fragmentary and therefore we consciously strived to understand issues from insider perspectives We introduced the participants to the GLA steps and our role as facilitators of discussions and actions but gave no training in research methods we gave no instructions about how to perform a thematic analysis but rather emphasised the importance of prioritizing themes and goals that were important to them within the structured GLA process We conducted eight GLA sessions over a period of 5 months 47 Gårdsten residents participated in the sessions Three overarching themes were identified by Gårdsten residents: 1) pride in Gårdsten yet need for improvement; 2) adolescent and parent needs for support; and 3) the importance of communication and meeting places Although we had specific prompts related to dental health and nutrition these topics were not central in the discussions Gårdsten was depicted by the participants as a nice place to live in with beautiful surroundings and nice people who care for each other The best thing about Gårdsten is those who live here We have lived here for a long time and like it." (Interview 1 residents disliked how the area was portrayed in mass media This is illustrated by a quote from one woman: “Media describes Gårdsten as a problem area Even if Gårdsten mainly was described with pride by the participants they also emphasised two negative aspects One was problems with littering and garbage disposal The discussion was about “the other” not having knowledge and taking responsibility Blaming other groups was an element in this discussion about littering while most of the other reflections were built on the community as a whole The other problem mentioned was that public services and facilities are closed down or relocated to other areas They expressed a feeling of being abandoned by society Responses to the prompts and the subsequent discussions stressed adolescent and parent needs for support Support to revitalize parents’ night patrols (i.e people walking the neighbourhood to increase safety by being available and by marking the presence of adult society) and extended possibilities for children’s homework assistance were mentioned by the participants residents emphasised the need for improved collaboration between schools and parents Language and cultural differences were described as barriers to feeling supported in Gårdsten Children acting as interpreters for their parents was viewed as a failure and parents described the need for supportive interpreters who can act as liaisons with the school specifically “A young girl threw away all information received from the school Those at school booked time with her mother They told the mother that she did not manage school The daughter interpreted and said: “Your daughter is good at school!” The mother smiled They saw that she did not understand and explained that the daughter did not receive any grades The daughter said to her mother: “She has top grades!” The mother smiled and appeared even happier The school staff understood that something was wrong You should not allow children to interpret for their parents!” (Interview 3 "The school writes [messages] to parents and their child throws them … One child did not go to school for a year - sold drugs They signed even though they did not know what Emphasising communication as essential to health and wellbeing of their families residents who did not have Swedish as their native language were eager to improve their Swedish skills Residents expressed desire for public meeting places for practicing Swedish where they could bring their children One woman described that both parents and children need places to meet: Will then be easier to integrate into the Swedish society Those who have lived longer here can share experience with others The children also get to know the society in which they will grow up.” (Interview 5 In addition to emphasising the importance of learning Swedish the difficulties of understanding information and the Swedish society in general were highlighted by participants Residents said to achieve wellbeing they needed easily accessible information about many aspects of life in different languages Residents also expressed the need for multiple information formats including written text The need for receiving adequate information was described as a matter of safety One of the participants expressed it like this “You need information in your own language so that you understand 100% You have to understand everything that says It will then be easier to understand systems It is not the same here as where we come from the participants set four targets of action in Gårdsten: feelings and suggestions in a public report and an exhibition An overarching goal was to advocate for better and various ways of communication In addition to the specific suggested actions below this was a future mission for themselves and others They wanted better communication in the neighbourhood among the residents in Gårdsten and in the society in general Improved information from and access to authorities was considered important “Information in different languages is needed to be able to look for a job According to the wishes of the participants the research group took responsibility for the writing of a report and the arrangement of an exhibition where communication was one of the main themes The content of the report and the exhibition was developed together with the participants All texts were approved by the participants and the report was summarized in Arabic and Somali The participants identified stakeholders to receive the report and to invite to the exhibition The report was disseminated within Gårdsten in both printed form and electronically by residents participating in the project and by stakeholders in the municipality The researchers disseminated the report in their networks which included local public health officials and politicians of the city it was available at several public places in the neighbourhood The purpose of the exhibition was to gather strength to be able to continue work for a language café Places where people can meet and practice Swedish were ranked as a high priority It was considered as an important measure in the struggle against isolation There I can practice the language and get in touch with other people Participants formed an action group with the goals to inquire about the requirements and to find potential collaborators for a language café in or near Gårdsten The work of this group resulted in weekly open meetings run by some of the participants in cooperation with the Red Cross hosted in the premises of the municipality When planning this action one man argued for two necessary steps "One: The first needed is a place where it is possible to do long-term work Commitment must come from the heart." (Interview 2 The suggestion to arrange a clean-up day was not put into action This issue was an expression of different needs from the residents (e.g. some wanted to meet and discuss with children and young people how to take care of surroundings others hinted that certain “others” (lingual and cultural groups) were not keeping the area clean) the reason for suggesting a clean-up day was not only a matter of taking care of the environment but also a way to meet and communicate with other people in Gårdsten Participating residents decided to abandon the clean-up day since they learned that such clean-up days are arranged several times a year by the housing company although this was not known to all participants One woman described that she had been invited but not have had confidence to take part: "I have also received an invitation to a cleaning day After the report was disseminated in the community including not only the original participants the research group enabled the education by connecting dieticians and dental hygienists working within public child health care services with the visitors of the public meeting place This resulted in several meetings with information shared and discussion about healthy food and teeth the research group was invited to a youth recreation centre in the area to conduct similar GLA sessions and the participants gave some reflections individually and as a group One of the main themes for the youth was the importance of politicians knowing about the less-than-ideal situation in Gårdsten Another was mixed feelings toward the presence and behaviour of the police in Gårdsten and other areas in the suburb Some youth expressed that they felt safer when the police were around while other youth described that police were rude checking on people “just because we live here.” GLA helped Gårdsten residents identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change better community information and activities facilitating interpersonal interactions should be prioritized in Gårdsten The GLA method worked to create open-ended discussions where perspectives from residents were put at the centre Allowing for individuals to get support from intercultural mediators the method also facilitated for participants with other mother tongue than Swedish to formulate their views GLA was used in a community setting with a less homogeneous group and with the more general objective to explore if it can be used for health promotion with people living in a particular residential area Our results show that the method supported empowerment in that it could facilitate identification of important health issues and actions among involved residents in the community Each of the steps of the method worked as planned the resulting language café functioned for more than a year after the initial meetings vigorous and sometimes passionate with participants sharing information confidentially The GLA-process facilitated reflections and dialog among the participants The prompts inspired individual reflections and seeing others’ written comments expended those reflections and stimulated discussions Some of the women participants described themselves as isolated with many barriers for communication They expressed that they wanted to convey their views of the situation in the community to other stakeholders and people outside Gårdsten we felt an obligation to make this happen but considered the data from GLA to be insufficient for depicting a nuanced and in-depth description we conducted interviews with eight additional participants who each shared personal narratives These individual portrayals of the situation in Gårdsten illustrated the GLA sessions resulting themes and additional interviews were successful in representing lived experience in Gårdsten Our findings were supported by reflections from the participants and other residents when the report and exhibition were developed and launched the intervention may seem to have failed to fulfil its health promoting intentions since the themes and goals emanating from the participants did not concern nutrition and dental health it is rather pointless to inform people about health issues in which they are not interested an important conclusion is that health workers should discuss perceived needs with those concerned The fact that neither nutrition nor dental health were prominent topics in the participants’ discussions or among their proposals for health promotion indicates that the efforts to play down our own perspectives were successful it seems that it was possible for the participants to take the lead and set the agenda based on their own priorities It is also interesting that when the process had continued for some time residents asked for our expertise concerning nutritional and oral health Since the research project was anchored in the established local public health network it was possible to follow up on these requests and share the educational information within regular health services and to internalize such a view of the place where you live is harmful to central aspects of health (i.e. self-efficacy and the sense of belonging to society) We were aware of the risk of adding to this stigma by acting as if people in the area are weak and vulnerable Naming the community in this paper is a confirmation of the pride that residents felt for their neighbourhood and the contrasting picture (as compared to majority society’s) of it that they sketched out in the discussions All social planning should be done from the outset that you do not risk damaging it Pieces of the puzzle that need to be connected in order to make people’s everyday life work social services and health care need to develop trust among themselves Authorities who trust their residents dare to invite genuine community participation that enables ordinary people to have influence on important issues Most of the participants in this project seem to have opposite experiences describing a lack of trust both with the authorities and with other groups of people living in the area are left” illustrates the view of a forsaken community where access to social institutions services and other facilities are limited in contrast with more affluent parts of the city some of the writing and language barriers were overcome because of the nature of the GLA process and the cultural mediator bridging skills Even if some participants did not take an active part in starting the language cafe’ or the other action steps they were still able to make their voice heard individually and in smaller groups during the GLA sessions to avoid disturbing the reflections and discussions it was not possible to conduct deeper analyses beyond those of the participants detailed demographic information could not be presented since collection of such data might have influenced the participatory process by changing the focus and relations in the partnership No financial compensation was offered the participants (except for those who were employed at the meeting place or as intercultural mediators) There was no obvious impact of this imbalance but we concluded that it would have been better to have a plan and financial means to compensate people who were willing to engage We did not think it would be ethically correct to make specific attempts to re-include people who stopped coming to the sessions the process was directed by the participants and by the sequence of events Given the isolation and lack of voice of many vulnerable communities it is essential to develop strategies and methods to promote participation and empowerment within the research process conducting research within a CBPR framework is resource intensive and requires careful attention and commitment to both community engagement and action as well as research Improved individual and societal communication and trust are considered necessary for health Arenas like the open meeting place and professionals like the intercultural mediators are important bridges between health care and people when striving for health equity The collected qualitative Swedish data used and analysed during the current study are available from the corresponding author on reasonable request Noncommunicable diseases country profiles 2018 Nästa steg på vägen mot en mer jämlik hälsa : förslag för ett långsiktigt arbete för en god och jämlik hälsa Swedish Government Official Reports: SOU 2017:47 The next step towards more equity in health in Sweden: how can we close the gap in a generation Territorial stigmatization in the age of advanced marginality youth culture and territorial stigmatization in Swedish metropolitan districts The impact of income inequality on economic residential segregation: the case of Malmö Reducing health inequalities with interventions targeting behavioral factors among individuals with low levels of education - A rapid review How and why do interventions that increase health overall widen inequalities within populations Partnering with insiders: A review of peer models across community-engaged research Contextualizing CBPR: key principles of CBPR meet the indigenous research context Methods for community-based participatory research for health Community-based participatory research for health : advancing social and health equity Methodological Progress note: group level assessment Calling all stakeholders: group-level assessment (GLA)-A qualitative and participatory method for large groups The change handbook: the definitive resource on today’s best methods for engaging whole systems The world Café : shaping our futures through conversations that matter San Francisco: Berrett-Koehler Publishers; 2005 Design charrettes for sustainable communities The search conference : a powerful method for planning organizational change and community action Perceptions of physician bedside handoff with nurse and family involvement Developing strategies for positive change; transitioning foster youth to adulthood Factors influencing use of continuous physiologic monitors for hospitalized pediatric patients Partnering with students to explore the health needs of an ethnically diverse low-resource school: an innovative large group assessment approach A seat at the table: exploring the experiences of underrepresented minority women in STEM graduate programs Inpatient communication barriers and drivers when caring for limited English proficiency children Participatory research methods: Choice points in research process Svenskt kvalitetsregister för karies och parodontit (SKaPa) Multilevel analysis of dental caries in Swedish children and adolescents in relation to socioeconomic status Reflections on researcher identity and power: the impact of positionality on community based participatory research (CBPR) processes and outcomes A new Gårdsten: A case study of a Swedish municipal housing company Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in southern Sweden Experience of collaboration at a family Centre for preschool children in Sweden What are the roles of intercultural mediators in health care and what is the evidence on their contributions and effectiveness in improving accessibility and quality of care for refugees and migrants in the WHO European Region Immigrants as research partners: A review of immigrants in community-based participatory research (CBPR) Whole systems approaches to obesity and other complex public health challenges: a systematic review Factors that impact the success of Interorganizational health promotion collaborations: A scoping review The role of trust in shaping urban planning in local communities: the case of Hammarkullen Sweden Bulletin of Geography Socio-economic The ethics of community empowerment: tensions in health promotion theory and practice Community-based participatory research for health from process to outcomes San Francicso: John Wiley & Sons; 2008 Download references We are grateful for being able to work together with residents in Gårdsten and want to warmly thank them for their engagement and for sharing their thoughts and ideas Special thanks go to Cecilia Hedström and Moa Hallmyr for contributing with their networks and competence Open access funding provided by University of Gothenburg We received funding from the Västra Götaland Region in Sweden The funder had no role in the design of the study or in the collection and interpretation of data and writing of the manuscript University of Cincinnati College of Medicine/Cincinnati Children’s Hospital Medical Center Department of Internal Medicine and Clinical Nutrition CB) were involved in designing the study and writing the manuscript They also read and approved the final version of the manuscript KW HBF and CB coordinated the community-academic partnership facilitated the GLA sessions and community actions MM and KW also represented institutions with regular activities in the area (hospital and dental care respectively) which opened both for implementing learnings from the project and for being available for further collaboration with residents This study do not fall under the Swedish law (2003:460) regarding ethical vetting of research involving humans according to the Swedish Ethical Review Authority The research plan was submitted for approval by the former Regional Ethical Board (Dnr but was not considered for evaluation by the board with reference to the fact that vetting was not required according to the law The participants were informed about the aim of the study confidentiality and voluntariness and gave their written informed consent The authors declare that they have no competing interests Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations unless otherwise stated in a credit line to the data Download citation DOI: https://doi.org/10.1186/s12889-021-12431-y Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article You are using an outdated browser. Please upgrade your browser or activate Google Chrome Frame to improve your experience Swedish power distributor Göteborg Energi is planning to deploy two PV plants totaling 6 MW while initiatives for solar parks above 1 MW are being implemented in several regions Commercial and residential PV have prevailed so far in Sweden's solar energy landscape has announced plans for two solar parks with a combined capacity of 6 MW in Säve and Gårdsten near Gothenburg will be allocated to shared ownership for private individuals The 5 MW park in Säve will be located in the northern part of an airfield in an area owned by local industrial group Serneke which will also buy part of the energy produced The project is expected to be completed in the autumn the group said in a separate press release “Serneke has also reserved additional land alongside Göteborg Energi’s solar cell park for the purpose of expanding the solar cell facility under its own initiative,” the company stated Göteborg Energi said the proposal came from private citizens with no opportunity of deploying solar on their rooftops The plant is expected to be built as a community solar project with the support of the local municipality “Exactly how the ownership will be configured is not clear due in part to the outcome of a government investigation into tax reduction for jointly owned renewable electricity generation [that is] in progress,” the company said spokesperson for the Swedish Solar Association there are several operational and under development MW-sized solar parks in Sweden he revealed that the total capacity of centralized PV systems in in the Nordic nation was 11.7 MW at the end of 2017 including five plants that exceed 1 MW in size Two of the biggest parks are selling power through a private PPA while the remaining three are delivering electricity to the spot market and receiving bonus income from the Swedish green certificate system Some 33.1 MW of capacity is accounted for by existing and planned projects of 1 MW and larger That comprises 13 initiatives – including the two Göteborg Energi projects – with a size of 0.8 MW to 7 MW and developed by local municipality-owned utilities including Kalmar The business model for the planned projects is to sell shares to local businesses and individuals  Four of the projects are planned on former landfill sites Swedish PV has been driven mostly by the residential and commercial segments, as a result of a policy of rebates for rooftop PV. No support is being granted solar parks by the Swedish government, except through its green electricity certificate system The amount of installed solar in the Norwegian-Swedish electricity certificate system has increased considerably in the last three years The Norwegian-Swedish joint electricity certificate system for renewable energies was revived in April 2017 after both governments agreed to extend it through 2030 are traded on the Nord Pool exchange with the price agreed between purchasers and sellers The certificates are released to renewable energy producers by the Norwegian Water Resources and Energy Directorate (NVE) and the Swedish Energy Agency for the first 15 years of a power project’s lifetime More articles from Emiliano Bellini Please be mindful of our community standards and website in this browser for the next time I comment Δdocument.getElementById( "ak_js_1" ).setAttribute( "value" By submitting this form you agree to pv magazine using your data for the purposes of publishing your comment Your personal data will only be disclosed or otherwise transmitted to third parties for the purposes of spam filtering or if this is necessary for technical maintenance of the website Any other transfer to third parties will not take place unless this is justified on the basis of applicable data protection regulations or if pv magazine is legally obliged to do so You may revoke this consent at any time with effect for the future in which case your personal data will be deleted immediately your data will be deleted if pv magazine has processed your request or the purpose of data storage is fulfilled Further information on data privacy can be found in our Data Protection Policy Δdocument.getElementById( "ak_js_2" ).setAttribute( "value" This website uses cookies to anonymously count visitor numbers. 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