Lydia Nadine Kwak

Lydia Nadine Kwak

Senior Lecturer | Docent
Telephone: +46852487129
Visiting address: Nobels väg 7, 17165 Solna
Postal address: C6 Institutet för miljömedicin, C6 IIR Kwak, 171 77 Stockholm
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About me

  • My research area is intervention and implementation research within the field of worker health. I have been an associate professor since 2017, and a senior lecturer in health promotion since 2019. In 2019, I become head of the unit for Intervention and Implementation Research for worker health at the Institute of Environmental Medicine. I am also assistant study director of the doctoral education at the Institute of Environmental Medicine and involved in several teaching activities. 

    I have a master’s degree in health sciences, specializing in Health Education and Promotion, and Biological Health Sciences, from Maastricht University in the Netherlands. In 2007, I defended my doctoral thesis at Maastricht University with the title: the NHF-NRG-In Balance-project: development, implementation and evaluation of a weight gain prevention program. In 2007, I moved to Sweden and started my research-career at Karolinska Institutet as a post-doctor.  

Research

  • My research area is intervention and implementation research within the field of worker health. This means that I conduct research on how the health of the working population can be promoted at the workplace and how ill-health can be prevented. This research encompasses a broad range of research activities including gaining knowledge on determinants of health and health behaviour through observational studies, testing the effectiveness of methods targeting these determinants through intervention studies, and gaining knowledge on how effective interventions can be most effectively implemented into practice through implementation research studies. My main focus is currently on implementation research. 

    I am currently leading a large cluster randomized controlled trial financed by Forte among four municipalities and over 50 public schools in Sweden. The implementation research trial is the third step in facilitating the implementation of evidence-based methods for the prevention of mental ill-health within the workplace. In step one, we developed the Guideline for prevention of mental ill-health in the workplace consisting of evidence-based recommendations describing how organizations can prevent mental ill-health at the workplace through the management of social and organizational risks. In step two, implementation strategies were developed aimed at enhancing the adoption and implementation of the guideline within organizations. The effectiveness of the developed implementation strategies was tested in a cluster-randomized controlled trial among twenty schools in two municipalities in Sweden. Schools were chosen as the setting for implementation given the high prevalence of mental ill-health among teachers and the lack of a structured approach to the management of social and organizational risks within schools. In the current trial, we are testing the implementation mechanisms through which the implementation strategies impact guideline adherence in the workplace. This knowledge will propel the implementation research field toward a better understanding of how, when, where, and why implementation strategies are effective in integrating evidence-based methods into practice. 

    I am also leading a new project with start June 2024 financed by AFA-insurance aimed at examining the implementation of support-staff in schools. To increase our understanding of how support staff can better support teachers, the overall aim of this project is to increase knowledge of both the effectiveness of support staff on teacher’s workload and stress, and how support staff are to be implemented and organized in schools. The project applies a mixed-methods design and focuses specifically on public compulsory schools. 

Teaching

  • I am the assistant study director of the doctoral education at the Institute of Environmental Medicine. Moreover, I have since 2011 been course leader of the doctoral course Public Health Intervention and Implementation research, which has now be renamed into Implementation Research in health. In addition, I give lectures for undergraduate and graduate programmes on the topic of intervention and implementation research and supervise master-and doctaral students as main and co-supervisor. 

Articles

All other publications

Grants

  • Swedish Research Council for Health Working Life and Welfare
    1 January 2025 - 31 December 2027
    Research problem and hypothesisThis project aims to co-design and evaluate a novel model for family support (Co-fam) linking school and primary health care to promote healthy lifestyle and prevent and manage overweight and obesity among children 6-12 years. Two evidence-based family support programs, the universal Healthy School Start (HSS) and the targeted More and Less (ML) will be combined and delivered in a municipality with a high level of childhood obesity. We hypothesize that Co-fam is effective and feasible to implement with high fidelity and acceptable to professionals and families.Data and methodThe project will be carried out in two phases. In phase 1, the research team together with school and primary health care personnel and parents will co-design the model based on the implementation framework EPIS (Exploration, Preparation, Implementation, Sustainment). We will define referral criteria, identify barriers and facilitators of implementation, and design suitable implementation strategies. Adaptations will be made in both programs to children 6-12 years. Phase 2 consists of an 18-month controlled hybrid type 2 effectiveness-implementation study using mixed methods. Quantitative data will be collected on child and parent level and on fidelity to the model components and costs. Interviews will be performed with key personnel to assess acceptability and feasibility.Societal relevance and utilization The high prevalence of unhealthy behaviors, overweight and obesity among children underlines the societal relevance of this project. Combining a universal and a targeted program creates a new synergistic model tailored to all children’s and families’ needs with potential to be scaled up, lacking today. Bridging the gap between school and primary health care to reduce health inequalities has been urgently requested in national guidelines and recommendations.Plan for project realizationThis project will be performed by skilled intervention and implementation researchers in collaboration with personnel from schools, primary health care and parents. HSS, launched in 2022 in the municipality in collaboration with the education administration, is well-established in all public schools. A primary health care unit in the municipality, partner in this project, has started to implement ML with parents of pre-school age children. This means that the project partners are in the starting blocks and highly motivated to participate in this study.
  • Swedish Research Council for Health Working Life and Welfare
    1 January 2025 - 31 December 2027
    Research problem and specific questionsTeacher retention is a problem for many schools. In some municipalities 15-25% of teachers quit every year. While some turnover is necessary, too much instability is harmful for both students’ results and teachers’ health. There is therefore an urgent need to minimize teacher turnover. Limitations of studies examining work-characteristics associated with teacher turnover are that they have mainly been cross-sectional register studies. Knowledge is lacking on the relative importance of these work-characteristics in teachers’ retention decision, and whether teachers are willing to make trade-offs between these characteristics. This project aims to investigate which work-related factors teachers consider in their decision to remain in the profession (aim 1)
    to examine the preferences of teachers and the trade-offs they are willing to make to stay in their profession (aim 2)
    to assess how national reforms align with teacher’s work-characteristic preferences (aim 3).Data and methodThe project applies a discrete-choice experiment (DCE), consisting of three parts: a Delphi-survey (n=30 teachers
    Aim 1), a DCE-survey (n=1500 teachers
    Aim 2), and four focus-group interviews (Aim 3). The Delphi-survey and DCE-survey allow for the quantification of the relative importance of teachers´ work characteristics and the trade-offs they are willing to make to remain in their profession. The interviews allow for situational context to be explored and influential ‘hidden’ variables to be elucidated. The interviews provide a more nuanced understanding of the preferences identified in the DCE-survey and of whether national reforms match teacher’s preferences.Societal relevance and utilisationDespite national reforms to attract and retain teachers, a shortage of ~12 000 teachers in Sweden is prognosed by 2035. This project will inform policymakers and schools on how to facilitate a work-environment that ensures teacher’s motivation to remain in their profession.Plan for project realisationPlan for realisation includes recruitment of participants, data-collections, statistical analysis, reporting and communicating results. The multidisciplinary group has extensive experience with the proposed methodology, including DCEs, and with conducting research in schools. Costs are mainly related to salaries.
  • Bank of Sweden Tercentenary Foundation
    1 January 2025 - 31 December 2027
    Despite national reforms and measures to attract and retain teachers, a shortage of ~12 000 teachers in Sweden, is prognosed by 2035. The project will provide insights into the factors that impact teacher retention and inform policies aimed at improving teacher job satisfaction and reducing turnover rates. The purpose is to examine teachers’ perceptions concerning the relative importance of different personal and work factors for their retention and to examine how existing national reforms and measures to attract, recruit and retain teachers align with teacher preferences, e.g., teacher salary structure, the introduction of support staff. The multidisciplinary group has experience with the methodology, and with conducting research in schools. The 3-year project consists of three consecutive studies combining a Delphi-method (n=30 teachers), a discrete choice experiment (DCE) conducted through a quantitative survey (n=1500 teachers), and a qualitative study using focus-group interviews. The Delphi-method and DCE allow for the quantification of the relative importance of teachers' work characteristics and the trade-offs they are willing to make. The interviews allow for situational context to be explored and influential ‘hidden’ variables to be elucidated and will provide a more nuanced understanding of the preferences identified and whether national reforms match teacher’s preferences.
  • Swedish Research Council for Health Working Life and Welfare
    10 December 2024 - 30 November 2026
    For decades, JEMs have been used to classify occupational exposures in large scale epidemiological studies, where the study participants were too many to be able to carry out individual exposure measurements, or where exposure backwards in time had to be assessed. With a Job Exposure Matrix (JEM), one can assess the exposure of several different occupational exposures in a cohort or registry study, using only an occupational code and knowledge of the time period of the exposure. SweJEM is a Swedish infrastructure that contains JEMs for chemicals, particles, metals, noise, vibrations, physical (ergonomic) strain, psychosocial working conditions, and low employment quality. SweJEM was launched externally in autumn 2023, https://ki.se/imm/swejem and JEMs has since then been sent out to research groups around the country. In addition, the JEMs have formed the basis for regions and authorities´ risk assessment of the work environment. Already during the development phase, it has followed exposure trends in over time in Sweden and have evaluated occupational exposures during pregnancy and health effects in the mother and child as well as occupational exposures in relation to our most common public diseases such as cardiovascular disease and cancer. The first version of this unique national infrastructure now needs further development to become more detailed and more comprehensive than before. To achieve this, we need funds to collect new data from workplaces in Sweden. New data increases the relevance of the infrastructure by adding new later years of exposure, as well as improving the exposure history going back in time. In addition, we want to receive data from different types of employers, in order to e.g. be able to observe difference in exposure between large and small companies or for different demographic groups so that we can study differences in exposure patterns between men and women and between different age groups. Right now, this is only covered in parts of SweJEM. Finally, we also want to collect new occupational exposures such as UV-light, heat and cold in order to better cover the climate changes that affect the working environment. The aim is to keep the relevance of the infrastructure so that research groups, occupational and environmental medicine clinics, regions, occupational health care and authorities around Sweden can have access to the best possible exposure classification.
  • Swedish Research Council for Health Working Life and Welfare
    10 December 2024 - 30 November 2027
    In this application we are applying for funding to convert our effective implementation strategy into a digital tool. The implementation strategy consists of the following components: educational meeting, implementation team, workshops, iterative problem-solving method and internal facilitator and supports organisations with the implementation of the national, evidence-based Guideline for the prevention of mental ill-health at the workplace. The goal of the tool is to make the strategy widely accessible and usable for organisations that seek support with the systematic prevention of mental ill-health among employees. The tool is expected to impact organisations’ routines and work-methods towards psychosocial risk management and employees’ mental health. By applying a user-centred approach, we will in a participatory manner include end-users’ perspectives, and ideas in converting the components of the implementation strategy to the digital tool. This will be done via design sessions and usability-testing. The tool will provide support through web-based education (e.g., pre-recorded webinars, training (e.g., video tutorials), manuals and worksheets. The target audience will be public-sector organisations (e.g., schools, elderly care, and social services), however the generic nature of the guideline and implementation strategy will make the tool applicable to other organisations.  The application builds on our previous projects and ongoing Forte-financed project, in which we tested the effectiveness and functioning of the implementation strategy in six Swedish municipalities among over 70 schools. The strategy was shown to be effective in improving adherence to the guideline. Moreover, results show that guideline adherence is associated with improvements in health outcomes and psychosocial work environment. The focus is now on the scale-up of the implementation strategy for widespread use through a digital tool to increase its uptake and population health impact.
  • Swedish Research Council
    1 December 2024 - 30 November 2028
    Purpose and aimsThe aim is to co-design and evaluate a novel model for family support (Co-fam) linking school and primary health care to effectively promote health and prevent and manage obesity among children 6-12 years. Two evidence-based family support programs, the universal Healthy School Start and the targeted More and Less will be adapted and combined and delivered in a municipality with high levels of childhood obesity. We hypothesize that Co-fam is effective and feasible to implement with high fidelity and acceptable to professionals and families.Project organization, timeplan and methodsThe project will be carried out over 4 years consisting of a preparation phase where the model will be co-designed with stakeholders and an implementation and evaluation phase based on an implementation framework. Evaluation will take place in a controlled hybrid type-2 effectiveness-implementation study using mixed methods. Quantitative data will be collected on child and parent level and on fidelity to the model, and costs. Interviews will be performed with personnel and parents to assess acceptability and feasibility.SignificanceBridging the gap between school and primary health care to reduce obesity and health inequalities has been urgently requested in national guidelines and recommendations but is still not done. By combining a universal and a targeted program we will create a new model tailored to family needs leaving no child behind and with great potential to be scaled up.
  • Swedish Research Council for Health Working Life and Welfare
    1 December 2024 - 28 February 2026
  • Swedish Heart-Lung Foundation
    1 January 2024 - 31 December 2026
    Background Unhealthy diets, low physical activity and obesity are strong risk factors for chronic diseases. Schools are an ideal setting for implementing health promotion programs reaching all children. The universal Healthy School Start program (HSS) improves diet and physical activity of 6 7-year-old children and moderately reduces BMI in children with obesity. For younger children with overweight or obesity, the targeted parent support program More and Less (ML) effectively improves weight status and maintains effects long term. By combining and adapting the two evidence-based programs to older children, families with children 6-12 years can be offered a seamless family support program (Co-fam) tailored to individual needs and in line with national guidelines to improve child health and prevent future heart disease. Objectives Our hypothesis is that a family support program (Co-fam), co-designed between school and primary health care personnel and parents, is effective and feasible to implement with high fidelity, and acceptable by professionals and families. 1. Co-design a family support program for children 6-12 years including universal and targeted components together with school and primary health care to promote health, reduce overweight and obesity and prevent future CVD. 2. Evaluate the model in a case-control effectiveness-implementation study with health outcomes at child level, and fidelity and cost at organizational level. 3. A qualitative interview study with health professionals and parents to assess acceptability and feasibility of the model. Work plan Year 1: Co-design workshops facilitated by the research team to define the components of Co-fam and adapt it to the age group 6-12 years. Implementation strategies will be developed based on an analysis of barriers and facilitators. Year 2-3: An 18-month effectiveness-implementation study in disadvantaged areas in Region Stockholm. Interviews will be held with health professionals and participating parents. Significance Two evidence-based programs will be combined to create an urgently needed model counteracting the increase in unhealthy eating, physical inactivity and obesity in children, all risk factors for CVD. This unique family support model is ready to be developed and implemented in a relatively short time. Bridging the gap between school and primary health care to reduce social inequalities in health has been urgently requested in recent governmental enquiries.
  • AFA Försäkring
    1 January 2024 - 1 January 2027
  • Forte i sambarbete med Försäkringskassan
    1 December 2023 - 1 November 2026
  • Swedish Research Council for Health Working Life and Welfare
    1 December 2023 - 30 November 2027
    Research problem and specific questionsThe profession of publicly financed personal assistant provides opportunities for persons with disabilities (‘assistance users’) to participate fully in society. The profession has specific working conditions that make it essential to study from a health perspective: personal assistants work in various environments, they often work alone in the user’s home, under varying terms of employment depending on whether the assistance organizer is private, public, cooperative or the users themselves. Moreover, the profession has high levels of sickness absence, is female-dominated, low-waged, and requires no formal education. Therefore, research on how health and the work environment interact in this profession is necessary to ensure a sustainable working life. Previous research has highlighted the importance of employers (with responsibility for safety and health at work) in the return to work process.The aim is to examine personal assistants’ and their employers’ perceptions of facilitators and barriers for return to work after sickness absence due to common mental disorders (CMDs).Data and MethodThe project has a qualitative approach. Data will be collected through two semi-structured interviews three months apart with 20–25 personal assistants and 20–25 employers/ managers.Societal relevance and utilisationCMDs are common causes of sickness absence, and women have a higher risk of becoming sick-listed than men. The profession of personal assistants suffers from high sickness absence and various insecure working conditions. Knowledge should be translated into practical measures through collaboration, remain sensitive to the legal rights of assistance users, and be useful in employers’ occupational safety and health management.Plan for project realisationThe main costs consist of salaries for the projects’ researchers. Additional costs include fees for ethical review, transcription services, language review, and collaboration.
  • Swedish Research Council for Health Working Life and Welfare
    1 July 2020 - 30 June 2027
    There is an urgent need for more knowledge on effective implementation strategies, as two-thirds of implementation efforts fail to achieve the intended change, and half have no effect on outcomes of interest. These implementation failures are partly due to the limited understanding of how implementation strategies work—the mechanisms of change through which implementation strategies affect implementation. This project will fill this research-gap by incorporating mediation analyses into a cluster randomized controlled trial that compares the effectiveness of two implementation strategies for implementing the Guideline for the prevention of mental ill-health at the workplace in schools. Schools are chosen as the setting for implementation given the high prevalence of mental ill-health among teachers. Moreover, they lack a structured approach to the prevention of mental ill-health. The aim of the project is to investigate how implementation strategies affect the defined mechanisms and guideline implementation. The mechanisms of the following implementation strategies will be compared: a discrete strategy that includes an educational meeting (control group) and a multifaceted strategy (intervention group) that combines the educational meeting with workshops, implementation teams and evaluative and iterative strategies (e.g. Plan-Do-Study-Act cycles). Our hypothesis is that schools that receive the multifaceted implementation strategy will show a greater increase in guideline adherence at follow-up than schools that only participate in an educational meeting. Mechanisms that will be tested include hypothesized mediators originating from the individual behavior change theory COM-B. The project will be conducted in primary schools (n=50) in four municipalities in Sweden. Adherence to the guideline will be assessed at baseline and 6, 12- and 24-months follow-up, and mediators at baseline and 3, 6, 9, 12- and 24-months follow-up. Mixed methods will be used.
  • Swedish Research Council for Health Working Life and Welfare
    1 July 2020 - 30 June 2026
  • Swedish Research Council for Health Working Life and Welfare
    1 January 2020 - 31 December 2024
  • Swedish Research Council for Health Working Life and Welfare
    1 July 2019 - 30 November 2023
  • Swedish Research Council for Health Working Life and Welfare
    1 September 2017 - 31 August 2020
  • Postdoc contribution: Determination factors for physical activity from childhood to youth and from adolescence to adulthood.
    Swedish Research Council for Health Working Life and Welfare
    1 January 2009 - 31 December 2010

Employments

  • Senior Lecturer, Health Promotion, Institute of Environmental Medicine, Karolinska Institutet, 2019-

Degrees and Education

  • Docent, Karolinska Institutet, 2017

Supervision

  • Supervision to doctoral degree

    • Elinor Forsheden Sidoli, Organisational and social work environment within the construction industry: which managing practices work?, 2024-

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