Exploring the life contexts of patrolling police officers in the European Union – A scoping review

Abstract

Background
Patrolling police officers engage in different mentally, socially, and physically challenging life contexts which may affect their life and health. The aim of this scoping review is twofold, to explore life contexts of patrolling officers in the European Union, and to investigate how their lives and health are affected by environmental characteristics within these contexts.

Methods
The scoping review followed Arksey and O’Malley’s methodology and included a critical appraisal. The environmental model within Kielhofner’s Model of Human Occupation was used in the thematic analysis. The review was reported following PRISMA-ScR.

Results
In the 16 included studies, two contexts (where environments interact with persons on different levels) were discovered: the global and the immediate context. No local contexts were found. Primarily, research on the social, and occupational environments, including qualities identified in these environments were found. However, some environmental characteristics within patrolling officers’ physical environments were also discovered.

Discussion
This review contributes to the emerging research area of police officers’ life contexts, by mapping contexts and environments affecting their life and health. However, to get a deeper understanding of how officers are affected by their environments, interviewing them regarding how their different contexts affect their everyday living, would be important.

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Scandinavian Journal of Occupational Therapy
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Exploring the life contexts of patrolling police
officers in the European Union – A scoping review
Elin Granholm Valmari, Mehdi Ghazinour, Ulla Nygren & Kajsa Gilenstam
To cite this article: Elin Granholm Valmari, Mehdi Ghazinour, Ulla Nygren & Kajsa Gilenstam
(2022): Exploring the life contexts of patrolling police officers in the European Union – A scoping
review, Scandinavian Journal of Occupational Therapy, DOI: 10.1080/11038128.2022.2041088
To link to this article: https://doi.org/10.1080/11038128.2022.2041088
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REVIEW ARTICLE
Exploring the life contexts of patrolling police officers in the European
Union –A scoping review
Elin Granholm Valmari
a
, Mehdi Ghazinour
b
, Ulla Nygren
a
and Kajsa Gilenstam
a
a
Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden;
b
Police Education, Umeå University, Umeå, Sweden
ABSTRACT
Background: Patrolling police officers engage in different mentally, socially, and physically chal-
lenging life contexts which may affect their life and health. The aim of this scoping review is
twofold, to explore life contexts of patrolling officers in the European Union, and to investigate
how their lives and health are affected by environmental characteristics within these contexts.
Methods: The scoping review followed Arksey and O’Malley’s methodology and included a crit-
ical appraisal. The environmental model within Kielhofner’s Model of Human Occupation was
used in the thematic analysis. The review was reported following PRISMA-ScR.
Results: In the 16 included studies, two contexts (where environments interact with persons on
different levels) were discovered: the global and the immediate context. No local contexts were
found. Primarily, research on the social, and occupational environments, including qualities iden-
tified in these environments were found. However, some environmental characteristics within
patrolling officers’physical environments were also discovered.
Discussion: This review contributes to the emerging research area of police officers’life con-
texts, by mapping contexts and environments affecting their life and health. However, to get a
deeper understanding of how officers are affected by their environments, interviewing them
regarding how their different contexts affect their everyday living, would be important.
ARTICLE HISTORY
Received 15 March 2021
Revised 3 February 2022
Accepted 7 February 2022
KEYWORDS
Activity; environment;
health; MOHO;
occupational; patrol duty;
physical; social;
thematic analysis
Introduction
Police officers engage in different contexts during their
working day, which according to previous research have
been found to affect their health [1,2]. Some of these con-
texts are shared with other professions [3–5]. However,
police officers additionally face challenging situations as
part of their job description and also experience violence,
threats and harassment from the public [6–9]morefre-
quently than average professionals [10]. For example, in
the Swedish police force, 36% of work-related accidents
are related to threats and violence [10]. Additionally, inter-
national research shows that exposure to threats and vio-
lence at work has been found to affect police officers’
health [2,7,11]. And, work-related injuries could result in
psychological stress if occurring regularly [12].
Furthermore, physical environmental characteristics
such as wearing body armour [13] or sitting in a patrol
car [14] have been found to impact patrolling police offi-
cers’health. Additionally, taking their work issues home
has shown to be a common pattern for police officers
[15], also affecting their private lives [16,17]. This indi-
cates that the demands of work and private lives are
important environmental characteristics affecting the
health of police officers [18].
To summarise, the environmental characteristics influ-
encing patrolling police officers, including physically or
mentally stressful contexts, and occupations at work,
may ultimately result in poor health for many patrolling
police officers [12,19,20]. Thus, the contexts and environ-
ments of patrolling police officers warrant further investi-
gation. By locating studies on patrolling police officers’
contexts and environments, using theories within occu-
pational therapy, environmental characteristics affecting
patrolling officers’life and health can be found and syn-
thesised. This review defines a patrolling police officer as
a uniformed officer engaged in patrol duty while being
in daily communication with the public. All while patrol-
ling certain areas on foot or in a vehicle, while also keep-
ing the public safe and upholding the law [21,22].
Defining life contexts using theoretical models
within occupational therapy
The importance of the environment to individuals has
been a crucial part of occupational therapy since the
CONTACT Elin Granholm Valmari elin.granholm@umu.se Community Medicine and Rehabilitation, Umeå University, Umeå 90187, Sweden
ß2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-
nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed,
or built upon in any way.
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY
https://doi.org/10.1080/11038128.2022.2041088

profession was established [23]. In recent decades,
there has been a shift towards more ecological con-
ceptual frameworks [24–26] in which the individual is
intertwined with her environment, operating within
different contexts, encountering environments and
environmental characteristics. Contexts and environ-
ments are viewed as equally crucial as the person,
when identifying what influences a person’s occupa-
tional life [27,28].
Thus, every person’s life context is based on a sys-
tem of contexts and environments, consisting of their
own set of environmental characteristics. Even though
the available conceptual frameworks may differ in
terms of focus area and label systems, they all include
similar areas and concepts (see, for example,
Townsend and Polatajko 2013 [28], Christiansen and
Baum 2015 [29], Taylor 2017 [30], and Law et al.
1996 [31]). Additionally, several theories have been
developed in different professional fields that explain
the interrelationship between person and context, and
often also the relationship to health (see, for example,
Bronfenbrenner 1977 [32], Dunn et al. 1994 [26],
Townsend and Polatajko 2013 [28] and Wicker
1984 [33]).
For example, the environment is considered to be
multi-layered, both natural and constructed, interact-
ing with people as they perform their occupations in
different ways and places. In this article, environ-
ments are referring to physical, social and occupa-
tional components of one’s contexts. These life
contexts, including both contexts and environments,
will also change over time. Even though different
environments are discussed separately, in reality, they
are inseparable as they continuously affect each other,
as well as the person, occupations, and occupational
performance [26,28–31,34]. For example, Iwama [35]
has described the environments in a person’s life as
ever-changing riverbanks affecting the life flow in a
river, in which the river itself is the person’s life and
well-being, taking a complex journey through time
and space [35].
To further grasp the conceptualisation of environ-
ments, Fisher, Parkinson and Haglund [36] presented
a conceptualisation of environments within the theor-
etical framework of Kielhofner’s Model of Human
Occupation (MOHO) [30]. By applying the theories
of Bronfenbrenner [32,37] this conceptualisation
shows a transactional relationship between the person
and her environments (physical, social and occupa-
tional). The model is visualised multi-levelled since
the environments also exist in an immediate context
(for example, home or work), local context (for
example, community or neighbourhood), and global
context (for example, laws and policies) and there is a
continuous dynamic interaction between the different
levels that has an impact on a person’s life. In add-
ition to these contexts, other factors such as time,
economic, political, cultural (cuts across all contexts
in all environments), geographical, ecological and
social factors, also influence a person’s occupational
life [36].
Fisher, Parkinson and Haglund [36] also offer an
explanation as to how the environments influence
occupational participation by comprising different
environmental characteristics (components and qual-
ities). For instance, the environmental components
comprise spaces and objects (physical environment);
relationships and interactions (social environment);
and occupations and activities (occupational environ-
ment), together with overarching contexts (such as
cultural values and practices, as well as economic and
political influence) [36]. The three environments also
contain qualities, for example, the physical environ-
ment includes the availability of spaces and objects;
the social environment includes the availability of
people and relationships, emotional support, etc; and
the occupational environment includes, for example,
occupation and activity choices, time elements and
flexibility [36]. These environmental characteristics
interact with each other and influence the person
[34,36], and are also considered key elements to the
process of change [36].
Environmental characteristics impacting police
officers’life and health
Police officers’environments consist of high stress
and high strain contexts [1,3,38], which have been
found to affect both their health [2], but also their
private life [39]. Desch^
enes [40] defined the environ-
mental characteristics affecting the health of officers,
as socioeconomic, organizational and personal factors.
Socioeconomic factors include budgetary contexts and
social pressure [11,40]. Organizational factors com-
prise police culture, leadership issues and interper-
sonal trust [11,40], low work-related social support
and high job strain [41], high job demands [11], or a
lack of communication or support at work [42].
Personal factors include a sense of self-efficacy, emo-
tional skills and disillusionment regarding the job
description [40].
Police officers are also more exposed to traumatic
and stressful contexts than many other occupational
groups [10], which affect both their physical and
2 E. G. VALMARI ET AL.

psychological health [2]. These traumatic and stressful
contexts are not only related to health issues such as
cardiovascular disease, burnout, Post Traumatic Stress
Disorder (PTSD), and sleep disorders [2,43–45] but
also to dysfunctional behaviour [46] such as problem-
atic drinking [47–49], hyper-aggressiveness and vio-
lence both on and off duty [46,50].
Thus, police officers’health is affected by multiple
environmental characteristics in different environ-
ments and on diverse contextual levels [40], which
according to a previous review warrants further inves-
tigation when researching police officers’health [2].
Additionally, Abdollahi [51] found that the reasons
why police officers experience poor health are
ambiguous, suggesting that intra-personal, occupa-
tional and organizational reasons explain some of the
health consequences [51]. This stresses the need for
more knowledge regarding the health of police offi-
cers by investigating their life context. It is also the
reason why Abdollahi [51] suggests that to better
comprehend the complex nature of police officers’ill-
health, researchers should include conceptual frame-
works to offer explanations as to the origins of the
health issues [51]. Hence, studying the environments
and contexts, for example, home, work, community,
and laws and regulation, of patrolling officers, to
implicate what constitutes the health of patrolling
officers, is important. Thus, the aim of the present
study is twofold, to explore life contexts of patrolling
police officers in the European Union (EU), and to
investigate how their lives and health are affected by
environmental characteristics within these contexts.
Methods
The study commenced on 5 May 2020 with a prelim-
inary search to identify the research field and refine
the search string. A protocol was created, following
the Preferred Reporting Items for Systematic Review
and Meta-Analysis Protocols (PRISMA-P) guidelines
[52], where the guidelines were applicable for a scop-
ing review. The protocol was registered with OSF, a
register for scoping reviews [53], and it was also sub-
mitted to a journal prior to data extraction [54]. Any
amendments to the protocol have been reported in
this manuscript, while major changes were entered
into the OSF registry [53]. Ethical approval was
waived as the scoping review used publicly available
scientific literature.
Arksey and O’Malley’s methodology [55] was used
to conduct the scoping review, following the first five
stages. It is the most influential framework for
conducting scoping reviews and has been widely used
and refined since it was first created [55–58]. The
review was also performed in line with the Preferred
Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) statement [59] with the extension
for scoping reviews PRISMA-ScR [60]. The process is
described in a flowchart, displaying exclusion criteria
for why articles were excluded. Some studies were
excluded for more than one of these reasons, how-
ever, as soon as one criterion was met the study was
removed, see Figure 1.
Stage 1: Identifying the research question
The Population, phenomena of interest, Context
(PICo) search strategy [61] was used to formulate the
search string, see Table 1. The search strategy used
free-text words, together with the Boolean strategies
‘AND’and ‘OR’. An example of the full search string
for the EBSCO databases is included in the OSF regis-
try [53].
Stage 2: Identifying relevant studies
The search was conducted using eight different data-
bases (see Table 1) and six potentially relevant articles
from the reviewers’personal library that had not been
identified in the previously performed search were
manually included before examining ‘full texts’for
eligibility.
Once the search had been completed, all articles
were systemised in RAYYAN, a web application for
conducting systematic reviews [62]. The publication
period was the last 20 years. See Table 1 for the search
dates and publication periods for each search. When
the search was re-run prior to completion of the ana-
lysis, no new articles were found.
Stage 3: Study selection
Studies of patrolling officers from EU countries were
included. In addition, studies from other Nordic
countries (Iceland and Norway) and the United
Kingdom were included as well, due to the long-term
cooperation system with EU countries. The exclusion
criteria for the review regarding population and con-
text are presented in Table 1.
Since the study explored different life contexts
related to the occupational role of patrolling police
officers, no restrictions were applied regarding study
design. However, editorials, protocols and letters to
the editor were excluded. Grey literature in the form
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 3

Figure 1. Flowchart according to PRISMA-ScR.
a
Studies that did not match inclusion criteria were excluded when one exclusion
criteria was met.
b
Three of the included articles came from our personal library (other identified sources) and the rest
from databases.
Table 1. Identifying the research question and identifying and selecting relevant studies.
PICo
Databases and other sources for
including studies (search details) Search strategy with dates
Study selection criteria regarding
population and context
Population –
Patrolling police officers
phenomena of Interest –
Life contexts (contexts,
environments and
environmental
characteristics) affecting a
person’s health and life
Context –
EU -countries as well as
Norway, Iceland and the
United Kingdom
EBSCO databases (See protocol for
an example):
Academic Search Premiere
APA PsychINFO
CINAHL
SOCIndex
OpenGrey (Same as above)
Pubmed (MeSH terms were used for
the ‘Interest’term in the PICo
search strategy and a search was
conducted in ‘All fields’, not just
‘Titles, Abstracts and Keywords’)
Scopus (‘Title-Abs-Key’was searched)
Web of science (A ‘Topic search’was
conducted)
Personal library (Six articles from our
personal library that did not show
up in any of the searches)
Preliminary search:
5 May 2020
Main search:
8 June 2020 and 14 June 2020
(publication period last 20 years)
The search was re-run before the
final part of the analysis was
finished:
25 November 2020 (publication
period 8 June2020 and 25
November 2020)
Inclusion criteria:
Patrolling police officers from EU
countries were included
Studies conducted in EU countries, in
the Nordic countries (Iceland and
Norway), and the United Kingdom
Articles written in English, Swedish,
Norwegian and Danish
Exclusion criteria:
Studies focussing on specialized units
of patrolling officers, or other
occupational groups
Studies focussing on patrolling
officers who were not on active duty
(e.g. on sick leave or leave
of absence)
Patrolling officers and higher-ranking
active duty officers were excluded if
the study did not confirm that the
officers were also engaged in
patrolling services
a
The conceptual framework of MOHO [36] was used to create the search string, with a specific focus on the interactions between the police officer and
the physical, social and occupational environment [36] in order to analyse and examine the impact patrolling police officers’environments has on their
life and health.
4 E. G. VALMARI ET AL.

of research reports, were included to reduce publica-
tion bias, and enhance our comprehensibility of the
research field [63]. Hence, a specific grey literature
database was searched (See Table 1). Since the
research team lacked the resources to support the
translation of data, articles written in any other lan-
guage than English, Swedish, Danish or Norwegian
were excluded.
One reviewer (EGV) performed the search and
removed duplicates of the search results. Titles and
abstracts were then screened against the eligibility crite-
ria by two separate reviewers (EGV and UN). The
reviewers were blinded to each other and any study
generating ‘uncertain’to the eligibility criteria as well as
thereasonsforexcludingthearticles,promptedadis-
cussion between the two reviewers. Any disagreements
were resolved through discussion and no third party
(KG) was needed in the final decision-making. For one
article, the authors of the study were contacted for clari-
fication regarding the admissibility of the study. As the
last step, the six manually added articles were included.
After comparison and agreement of the first
screening process, the full texts were obtained and
examined for eligibility by one reviewer (EGV).
Another reviewer (KG) randomly selected and
checked 10% of the full texts for consistency. No dis-
crepancies were found. Thus, no third party (MG)
was required to make the final decision. A flowchart
of the entire process, from identifying relevant studies
to the inclusion of the final 16 articles in the scoping
review, is presented in Figure 1.
Before starting the data extraction, critical appraisal
was performed by two reviewers (EGV and MG) blinded
to each other. The Mixed Method Appraisal Tool
(MMAT) [64] was used, which evaluates studies using
qualitative, quantitative randomized controlled, quantita-
tive non-randomised, quantitative descriptive, and mixed-
methods study designs. It has been used in critical
appraisals globally and deemed valid in content, and reli-
able [65,66]. MMAT was chosen due to the possibility to
assess many different study designs with the same instru-
ment. Any lack of consensus regarding the critical
appraisal was resolved through discussion. Owing to the
consensus in our discussions, no third party (KG) was
required to make the final decision. Critical appraisal was
considered when conducting the last part of the analysis,
hence included in the result of the review.
Stage 4: Charting the data
After the selection and critical appraisal of the studies,
the data extraction began by charting the data. The
data extraction sheet was designed by two reviewers
(EGV and MG) and checked by a third reviewer
(KG), pre-piloted by two reviewers (EGV and KG),
and slightly revised afterwards (EGV and MG). The
following data were extracted: publication year, title,
authors, type of study, the aim of the study, method
of analysis and PICo.
One reviewer (EGV) extracted the data into an
Excel file [67] and, out of 16 articles, four randomly
selected articles were extracted by another reviewer
(KG) to check for discrepancies. Any discrepancies
were addressed through discussion between the two
reviewers. Owing to the consensus in our discussions,
no third party (UN) was required to make the final
decision. However, two articles had insufficient data
regarding age and gender. Thus, the authors of the
studies were contacted for clarification, and additional
information was received for one article.
Stage 5: Collating, summarising and reporting
the results
The analysis was conducted by one reviewer (EGV)
but discussed with all the other reviewers regularly.
The descriptive characteristics were analyzed and col-
lated in tables. Also, to locate complex multi-layered
dimensions of life contexts, clusters were created by
sorting articles according to life contexts in MOHO
[36]. The clusters were then grouped into both con-
texts and environments to identify gaps in the litera-
ture. This was undertaken using data from the
extraction table (‘PICo Interest of phenomena’).
Thematic analysis according to Clark and Braun
[68] was used to identify environmental characteris-
tics of the different environments and contexts. The
coding was first conducted inductively but sorted
deductively into themes using the environmental
qualities concepts in MOHO [36]. Environmental
components (for example, time, space, objective or
social interaction) from MOHO [36] are not included
in the analysis, since they were only used to describe
and explain the study setting or participant character-
istics in the articles. Thus, our thematic analysis only
focussed on the environmental qualities identified.
These qualities were visualised in a multi-layered fig-
ure, presenting the life contexts of patrolling officers
in the EU, which is the contexts, environments and
environmental qualities located in all the data.
All stages were conducted with the help of
MAXQDA 2020 [69] and Word [70] to aid the pro-
cess of coding and sorting the articles in a struc-
tured manner.
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 5

Results
The database search yielded a total of 2,001 articles,
leaving 1,494 articles after the removal of duplicates.
Eighty-five articles were left for full-text reading after
applying inclusion and exclusion criteria. The final
review comprised 16 articles for critical appraisal and
data extraction, see Table 2.
The publication period was from 2001 to 2020, and
most articles were published in 2013 or later. The
articles had different research designs: one qualitative
method, 13 quantitative methods and two mixed-
method studies, mainly conducted in Germany,
Sweden and The Netherlands (See Table 2). Table 2
also includes the population characteristics of age, sex
and sample size, as presented in each article, together
with the PICo ‘phenomena of Interest’used in
the review.
The life contexts of patrolling police officers in
the EU
The contexts and environments located on article
level, by clustering and grouping results, are shown in
Table 2. Many articles touch upon several contexts
and environments. However, no local contexts were
found. Also, most studies of the police officers’life
contexts are described in social and occupational
environments.
To answer the study’s aim, the environments and
contexts were also combined in a multi-layered figure
together with the identified environmental qualities
showing the transactions the environments have with
the officers. However, the environmental qualities are
listed according to the different environments, regard-
less of contextual level in this model (See Figure 2).
The environmental qualities affecting the health of
patrolling police officers
The environmental qualities found, according to the
environmental model in MOHO [36], are presented
in italic font together with one or more examples,
under the respective environment. Some environmen-
tal qualities were only slightly touched upon, while
other environmental qualities were not identified at
all (see Figure 2).
Physical environmental qualities
The physical environment describes the adequacy of
objects [71,75,82] related to police officers’duty belts,
safety vests, and thigh holsters, and their effect on e.g.
the officers’physical health, such as physical
discomfort or musculoskeletal issues, while wearing
the objects.
It also includes adequacy of spaces [71], namely,
the confined space in the police vehicle and the
inability to adjust the seats comfortably when wearing
both a duty belt and a safety vest. Also, accessibility
and safety of spaces [84] are considered regarding haz-
ardous situations, where the type of physical interven-
tion education had an impact on the physical health
of police officers in violent situations.
Social environmental qualities
The social environment describes the availability of
people and relationships [74,81,86] including the avail-
ability of a supervisor within different shift systems,
problems related to relationships in private life caus-
ing stress, as well as using the social network, such as
venting or religion, as a strategy to cope with stres-
sors. Another quality, adequacy of communication
[81,85,86], comprising different aspects of communi-
cation, both constructive and destructive. Having
good communication between officers was considered
important, and different shift systems seemed to affect
how feedback was given from supervisors. Officers’
verbal use of force towards civilians was also found
related to burnout, where officers who were observed
using verbal force also scored significantly higher
on burnout.
Emotional support revealed several different quality
dimensions in this review and is therefore presented
in three separate categories. For example, one cat-
egory trust [73,78,80,81,86] describes trust between
colleagues, as well as trust in leadership, what affects
commitment to the organization, and how trust is
affected by different kinds of scheduling. Another cat-
egory respect [73,80] describes the perceived lack of
respect from the public, and also respectful and dis-
respectful treatment between officers. As well as how
the officers’work environment and perception of
their work is affected by this lack of respect. The
third category collaboration [73,76,78,80,81,83,86]
comprises examples of social support and collabor-
ation between colleagues and with supervisors, as well
as examples of non-functioning relationships and lack
of collaboration.
Another important quality dimension was commu-
nity and broader societal attitudes in which the
dimension was slightly modified in this review to suit
the environmental qualities of police officers. It was
therefore separated into two categories in which the
first category represented attitudes of the police officer
affected by the environment [73,77,80,85,86]: attitude
6 E. G. VALMARI ET AL.

Table 2. Peer-reviewed articles’study and population characteristics including quality assessment, as well as results on an article level.
[Article identifier] Peer-
reviewed article Research context PICo ‘Interest of phenomena’
Sample
size
Population characteristics (age
and sex) Research design
Number
of articles
Results of the
quality
assessment
a
Contexts and
environments on an
article level
Qualitative
Focus group interviews 1
[71] Ramstrand N,
Larsen LB.
Musculoskeletal
injuries in the
workplace:
perceptions of
Swedish police. Int J
Police Sci Manag
2012;14:334–342.
Three regions in
Sweden
(J€
onk€
oping,
Norrbotten
and
Stockholm)
Police officers’experience of
for example wearing a
uniform, utility belt, safety
vest, sitting in police cars
and the perceived strain
this has on their bodies.
Focus is on the immediate
level but includes aspects
on a global level. Also,
time factors are included.
33 The study included 19 males
and 14 females. The
average age of the
participants was 33.5years
(range 25-45 years).
5/5 Yes Immediate context
Physical
environment
Global context
Occupational
environment
Physical
environment
Quantitative
Cross-sectional studies 13
[72] Takken T, Ribbink.
A, Heneweer H, et al.
Workload demand in
police officers during
mountain bike
patrols. Ergonomics.
2009;52:245–250.
Utrecht, the
Netherlands
Police officers’physical
workload during mountain
bike patrol. This affects
them on a physical level
but also on an
occupational level in
relation to time elements,
as well as occupation and
activity choices.
20 The study included 16 males
and 4 females, with a
mean age of 32 þ8 years
and 25 þ5 years.
2/5 Yes Immediate context
Physical
environment
Occupational
environment
[73] Terpstra J, Schaap
D. Police culture,
stress conditions and
working styles. Eur J
Criminol.
2013;10:59–73.
Southern
Gelderland,
the
Netherlands
The culture of police officers
in patrolling services. The
environments affect them
regarding cultural aspects
in different ways, as well
as how they view their
profession and the public.
260 Of the 260 participating in
the study, three had
missing data regarding age
and gender. 74% were
male and
20% were female. 5% were
younger than 25 years,
30% were between
25–34 years, 31% between
35–44 years, 21% between
45 and 54 years and 9%
above 54 years.
3/5 Yes Immediate context
Occupational
environment
Social environment
[74] Backteman-
Erlanson S, Padyab
M, Brulin C.
Prevalence of
burnout and
associations with
psychosocial work
environment,
physical strain, and
stress of conscience
among Swedish
female and male
police personnel.
Police
Authority,
Sweden
Psychosocial work
characteristics influencing
patrolling police officers
regarding organisational
culture and climate, but
also how decisions,
demands and social
support affect
police officers.
856 The study included 419 (53%)
males and 437 (56%). The
mean age was 34 years (SD
¼6.9) for women and
39 years (SD ¼10.7)
for men.
4/5 Yes þ1
can’t tell
Immediate context
Social environment
Occupational
environment
Global context
Occupational
environment
(continued)
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 7

Table 2. Continued.
[Article identifier] Peer-
reviewed article Research context PICo ‘Interest of phenomena’
Sample
size
Population characteristics (age
and sex) Research design
Number
of articles
Results of the
quality
assessment
a
Contexts and
environments on an
article level
Police Pract Res.
2013;14:491–505.
[75] Larsen LB,
Tranberg R,
Ramstrand N. Effects
of thigh holster use
on kinematics and
kinetics of active
duty police officers.
Clin
Biomech.
2016;37:77–82.
A middle-sized
municipality,
Sweden
Police officers carrying
different load carriage
systems and the effect
on gait.
19 The study included eight
females and nine men.
Average age of female and
male police officers
separately 32 years (SD ¼
4.2; range 26–41) and
34 years respectively (SD ¼
4.9; range 27–40).
3/5 Yes Immediate context
Physical
environment
[76] Padyab M,
Backteman-Erlanson
S, Brulin C. Burnout,
Coping, Stress of
Conscience and
Psychosocial Work
Environment among
Patrolling Police
Officers. J Police
Crim Psychol.
2016;31:229–237.
Police
Authority,
Sweden
Psychosocial work
characteristics influencing
patrolling police officers
concerning social support,
demands, decisions, and
coping methods used.
856 The study included 437
participants, of which
(56%) were female and
419
(53%) were male. Age
(years) women mean (34),
SD (7), men mean (40),
SD (11).
4/5 Yes þ1
can’t tell
Immediate context
Social environment
Occupational
environment
[77] Ellrich K. Burnout
and violent
victimization in
police officers: a dual
process model. Polic
An Int J.
2016;39:652–666.
Lower
Saxony,
Germany
Police officers being victims
of violence when
controlling a suspected
person while also being
the first police officer at
the scene together with a
colleague. The article
explains police officers’
strategies and attitudes.
1 931 The study primarily included
male officers. (Female
police officers 26.6%). The
age of the survey sample
ranged from 21 to
62 years, with an average
age of 39.6 years.
4/5 Yes Immediate context
Social environment
[78] Ellrich K. The
influence of violent
victimisation on
police officers’
organisational
commitment. J
Police Crim Psychol.
2016;31:96–107.
Lower
Saxony,
Germany
Work-related victimization of
uniformed patrol police
officers, and the
psychological and work-
related consequences. This
includes e.g. personal
accomplishment, self-
esteem and collaboration
with a supervisor.
1931 The study included 1931
participants. 27% of the
respondents were female,
and 73% were male. The
mean age of the survey
sample was 39.6, ranging
from 21 to 62 years of age.
4/5 Yes Immediate context
Social environment
Occupational
environment
[79] Ellrich K, Baier D.
The influence of
personality on
violent victimization
–a study on police
officers. Psychol
Lower
Saxony,
Germany
Police officers being victims
of violence when
controlling a suspected
person while also being
the first police officer to
arrive at the scene
together with a colleague.
1813 The study included almost
three quarters males
(72.6%). Respondents’age
varied between 21 years 
62 years with a mean age
of 39.1 years (SD ¼10.4).
4/5 Yes Immediate context
Social environment
Occupational
environment
(continued)
8 E. G. VALMARI ET AL.

Table 2. Continued.
[Article identifier] Peer-
reviewed article Research context PICo ‘Interest of phenomena’
Sample
size
Population characteristics (age
and sex) Research design
Number
of articles
Results of the
quality
assessment
a
Contexts and
environments on an
article level
Crime Law.
2016;22:538–560.
This includes e.g. the
match between the
demand of the activity at
hand and the police officer
both regarding strategies
but also capabilities.
[80] Wain N, Ariel B,
Tankebe J. The
collateral
consequences of
GPS-LED supervision
in hot spots policing.
Police Pract Res.
2017;18:376–390.
West Midlands –
Coventry and
Birmingham
South; England
Policing hot-spots with GPS-
LED supervision compared
to not policing hot-spots
and the difference
between the officers in
regard to leadership, trust
and cultural aspects.
38 þ42 (80
in total)
Not specified in the article-
and not received from
the authors.
4/5 Yes Immediate context
Social environment
Occupational
environment
[81]B€
urger B,
Nachreiner F.
Individual and
organizational
consequences of
employee-
determined flexibility
in shift schedules of
police patrols. Police
Pract Res.
2018;19:284–303.
Bavaria, Germany Police officers’experience of
working different shifts,
with different levels of
flexibility, its influence on
the organisation and on
the officers’private lives
927 In the study 20.5% of the
sample were females.
Almost 51% of the
participants were up to
34 years of age and around
12% were 50 years
or older.
4/5 Yes Immediate context
Social environment
Occupational
environment
Global context
Occupational
environment
[82] Larsen LB,
Andersson EE,
Tranberg R, et al.
Multi-site
musculoskeletal pain
in Swedish police:
associations with
discomfort from
wearing mandatory
equipment and
prolonged sitting. Int
Arch Occup Environ
Health.
2018;91:425–433.
Police
Authority,
Sweden
Police officers’physical work
environment regarding
carrying mandatory
equipment, sitting in a
police car, and the effects
it has on the
officers’bodies.
4114 Male police officers
represented 75% of the
participants and the
majority of participants
were 25–39 years of age.
4/5 Yes Immediate context
Physical
environment
Occupational
environment
[83] Engel S, W€
orfel F,
Maria AS, et al.
Leadership climate
prevents emotional
exhaustion in
German police
officers. Int J Police
Sci Manag.
2018;20:217–224.
One unspecified
police
department,
Germany
The effects of a positive
leadership climate on
patrolling police officers.
941 Male officers constituted 73%
of the sample and the
participants were between
21 and 59 years of age.
4/5 Yes Immediate context
Social environment
Occupational
environment
(continued)
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 9

Table 2. Continued.
[Article identifier] Peer-
reviewed article Research context PICo ‘Interest of phenomena’
Sample
size
Population characteristics (age
and sex) Research design
Number
of articles
Results of the
quality
assessment
a
Contexts and
environments on an
article level
[84] Vera Jimenez JC,
Fernandez F, Ayuso
J, et al. Evaluation of
the police
operational tactical
procedures for
reducing officer
injuries resulting
from physical
interventions in
problematic arrests.
The case of the
Municipal Police of
Cadiz (Spain). Int J
Occup Med Env
Heal. 2020;33:35–43.
C
adiz, Spain Police officers sustaining
injuries when performing
different physical
interventions in
problematic arrests, in
relation to different
education provided to the
police officer.
162 The study included eight
females and 154 males
aged 24–55 years.
3/5 Yes þ1
can’t tell
Global context
Occupational
environment
Mixed Methods
Participant observation
(qualitative) &
Questionnaire
(quantitative)
1
[85] Kop N, Euwema
MC. Occupational
stress and the use of
force by Dutch
police officers. Crim
Justice Behav.
2001;28:631–652.
Two middle-sized
cities in the
Netherlands
Police officers’interactions in
the social environment
with civilians, and the
police officers’perceptions
and experience of
using force.
358 The study included 83 %
males and 17 % females,
average of 32.7 years (SD
¼7.70).
4/5 Yes Immediate context
Social environment
Occupational
environment
Descriptive survey
analyzed
quantitatively and
qualitatively
1
[86] Maran DA, Varetto
A, Zedda M, et al.
Stress among italian
male and female
patrol police officers:
A quali-quantitative
survey. Policing.
2014;37:875–890.
The whole
of Italy
Gender aspects of patrolling
police officers as well as
experience of everyday
situations with colleagues
and the public.
485 The study included 255 males
and 230 females. The
mean age of the males
was 45.47 years (range 21-
65). The mean age of the
females was 42.55 years
(range 21–59).
4/5 Yes Immediate context
Social environment
Occupational
environment
Global context
Occupational
environment
a
According to MMAT ‘Yes’is rated if the article reports sufficient information according to the quality criteria, and ‘No’the opposite. The ‘Can’t tell’response category indicates that the paper does not report
appropriate information to answer, ‘Yes’or ‘No’, or that there is unclear information related to the criterion. Five questions are answered for every article according to the specific study design of the article [64].
10 E. G. VALMARI ET AL.

towards the public or supervisors, towards the use of
violence and force, opinions on police culture, and
the sense of unease when enforcing rules that they
felt were unfair. The second category included atti-
tudes towards the police officer from the environment
[73,86] in which the public’s attitude was categorised,
for example, in relation to their inability to under-
stand the importance of the police officers’work, why
they were warned or fined, or the general lack of
respect. Both categories show the interaction between
the community and broader societal attitudes and the
police officer. As an example, the officers feel stressed
when they are not understood or respected by the
public, or have to enforce rules that are unfair. In
turn officers with symptoms of burnout may interact
with the public in a more forceful manner.
Another quality, empowerment [78], was only
included in one study and only minimally, i.e. touch-
ing upon the concept of organization-based self-
esteem. Self-esteem was found positively related to
organizational commitment, as well as mediating the
organizational stressors and commitment relationship.
Occupational environmental qualities
Examples of some of the qualities of the occupational
environment includes occupation and activity choices
[72,74,76,78,79,83,85] which the officers lack at work.
Being a patrolling police officer include high demand-
ing or challenging job activities that has to be per-
formed as it is part of their job, e.g. informing
persons’relatives of deaths, or witnessing criminal
offences against children. These kinds of activities
affect their health, e.g. by experiencing stress or emo-
tional exhaustion. Funding and policies [71,84,85]
includes decisions made in a global context regarding
what to wear, job activities, and the education pro-
vided regarding how to handle physical interventions.
Funding and policies were found to e.g. affect the
physical health of officers. The appeal of occupations
and activities [73,80,85] comprises how the environ-
ment influenced e.g. officers’view on organizational
aspects differently, which job activities were appealing
and not, and how the environment shaped the appeal
to certain occupations at work. Cultural aspects
[71,73,74,80,81,85,86] were also of interest and touch
upon the work culture, police culture, and organiza-
tional culture, as well as the cultural preferences at
individual workplaces and group climates.
Participation [73,74,76,78,85] includes the scope of
opportunities for decision-making, or lack of deci-
sion-making, being in control of work, involvement at
work, and personal accomplishment and how it e.g.
Figure 2. The figure presents the located life contexts (contexts, environments and environmental characteristics) of patrolling
police officers. At the top the contexts are presented, along with environments found within these contexts. At the bottom the
environmental qualities are presented, regardless of contextual level. The qualities are arranged in order of appearance in the text-
ual description.
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 11

affected the mental health of the officers. Examples of
the quality of structure [71,74,82] includes frequency
regarding physical activity and issues such as fatigue
and sleep problems related to working hours.
Flexibility [71,73,81,86] comprises the possibility of
doing things the way one wanted. As well as the flexi-
bility of scheduling, and not being able to participate
in decisions regarding standard uniform and equip-
ment. It also included own flexibility and opportuni-
ties to adapt. Time elements [71,72,81–83,85,86]
comprises scheduling, length of service, sedentary
behaviour, and engaging in physical activity both at
home and at work. It also included demanding phys-
ical activity at work, and elements of not having time
to do things that were necessary or expected. There
were also other time factors related to different work
tasks, and how this affected the officers in differ-
ent ways.
Since a critical appraisal was conducted, it should
be incorporated in the analysis of the results. See
Table 2. Thus, we can conclude that the specific
results of some studies [72,73,75,84] should be consid-
ered with caution and that the findings include 16
articles representing 13 individual studies.
Discussion
This scoping review contributes to the emerging
research body of patrolling police officers’life con-
texts, by mapping several important contexts and
environments affecting the life and health of patrol-
ling officers in the EU. The analysis revealed know-
ledge gaps, e.g. regarding the officers’local context,
including minimal research on the officers’private
lives. However, the investigated contexts and environ-
ments were found to affect the working lives and
health of the officers. For example, the officers were
influenced by global and immediate contexts, and
while residing in different environments during their
workdays, different environmental qualities supported
the officer, while others did not.
The social and occupational environments were the
most frequently researched. This may be explained by
our social situatedness as human beings that forms
our identity and occupations. For example, we fluctu-
ate between acting as individuals or group members,
although we are influenced by, for example, ethnic or
gendered relations [87]. Being members of social sys-
tems also influences our choices [88].
The result is discussed from an environmental per-
spective, with environmental qualities in italic font.
Social environment
Several environmental qualities were facilitating the
police officers in their social environment. For
example, the importance of the availability of people
and relationships,adequacy of communication, and
emotional support. Our affiliations and the availability
of people and relationships are key to understanding
everyday behaviour and occupation, both privately
and at work. Earlier research has also shown that
these affiliations have the potential to affect our
health and well-being [87] both positively [89] and
negatively [90,91]. For example, general access to
social and emotional support both on duty and off
duty has been identified as being crucial for the
health [41,92–98] of police officers.
Likewise, the importance of adequate communica-
tion possibilities when interacting with others, particu-
larly with the public [99–104], has been previously
researched. Public interaction has been confirmed as
causing stress among police officers [77,105] and it
has been theorised that this stress could stem from
the risk of threats and violence [103,104] and the use
of force [106,107]. This may lead to health-related
problems [12], physical injuries [108] and sickness
absence on the part of the officer [19].
Other environmental characteristics seemed to
cause mostly stress for the officers, e.g. within the
community and broader societal attitudes and services.
Police officers are held accountable for the work per-
formed while upholding the law through force [109],
which could lead to difficult ethical issues. Our review
touched upon community and broader societal atti-
tudes and services, which included both police officers’
attitudes towards the public and their perceptions of
the public’s views of the police. Interestingly, previous
research has investigated that a police officer and the
public living in a community do not always share the
same view regarding police-community relations
[110] and this is something that needs further study-
ing, and how it affects the health of police officers.
Empowering was unfortunately only minimally
researched. Empowering police officers in their chal-
lenging work situations is important and previous
research among police officers has emphasised the
need for supportive feedback from supervisors [111].
Thus, this area needs further studying.
Previous research has shown that a good social
environment is important in terms of the health and
well-being of police officers [2,41,93]. Thus, it is
important to continue investigating the different qual-
ities of the social environment, since the patrolling
police officers’main task is to engage in different
12 E. G. VALMARI ET AL.

challenging social environments during their whole
working day, while also being in daily communication
with both the public living in the community they
protect, colleagues, as well as different institutions.
Occupational environment
Our findings show some environmental qualities facili-
tating the police officers in their occupational environ-
ment. For example, time elements and the importance
of cultural aspects. However, the hindering qualities
seemed to overtake the facilitating qualities.
Time elements,flexibility and structure are closely
linked in the review because they all relate to time in
different ways. For example, the qualities include
hours spent both at work and outside work, as well as
aspects of time regarding the opportunities for patrol-
ling officers to do what they want and when they
want to do it. They also include scheduling, leisure
time and the sense of not having enough time. These
findings are supported by other police research, in
which time, in different ways, relates to police offi-
cers’health. For example, long working hours and
shift work have been linked to poor health outcomes
[2,98,112–114]. Also, when examining leisure time
activities such as sport and recreational activities,
both have been shown to improve police officers’
health in different ways [115,116]. Work-life conflicts
and the family life of patrolling police officers have
been previously studied [2,15,16,39,117]. However,
such studies have not been conducted within the EU,
as far as we know, and time elements need further
research, particularly on time spent outside work.
The quality of participation is an interesting quality
in which opportunities for decision-making within the
police force and advancing professionally in different
ways is regarded as being important. Previous research
supports the finding of disparities between the job and
the job description [40], which has been found to nega-
tively affect police officers’health. Also, in previous
research, organizational and environmental factors such
as opportunities to innovate and job challenges have
been shown to affect the job satisfaction of police offi-
cers [118], as well as their ability to make their own
choices that promote personal accomplishment and
acknowledge a job well done [119]. Also, according to
Fisher, Parkinson and Haglund [36], understanding
how different environments influence human occupa-
tion is achieved by understanding the concept of ena-
bling. Since different environments can enable or
discourage a patrolling officer’s participation, it is an
important quality to study when considering police offi-
cers’health and well-being.
Likewise, funding and policies touch upon the qual-
ity of participation, since the uniform and equipment
used, as well as the educational possibilities provided
at work, are decisions that are made above the police
officers’heads. Professional education for police offi-
cers has been discussed as essential to organizational
and personal performance to provide better service to
the community safely and efficiently [120].
Occupational and activity choices are important
qualities for all human beings. For police officers,
they relate to the connection between challenges and
demands. This is particularly important since, accord-
ing to Fisher, Parkinson and Haglund [36], environ-
mental impact refers to the opportunity, support,
demand and constraints of the different environments
on particular individuals, in this case, police officers.
This varies since it depends on the values, interests,
personal causation, roles, habits and performance cap-
acity of the specific officer [36].
The quality of appeal of occupations and activities is
also important and this review is adjacent to the quality
of cultural aspects because it comprises aspects of the
concept of police culture, which includes status or
image of the job, as well as enjoyment of the job itself.
Thus, cultural aspects and the appeal of occupations
and activities include police culture, in which the organ-
izational culture and cultural preferences of different
workplaces, and the group climate are also included.
Organizational culture and police culture have been
connected in previous research [40] although, according
to Bowling, Reiner, and Sheptycki [121], police culture
as a concept is defined in the following four dimen-
sions: action orientation, the presence of a certain set of
values, a particular kind of identity, and the distinctive
meaning attached to police work [121]. However, police
culture has recently become more nuanced, focussing
on individual aspects and implying that there has been
a change in culture, including between different envi-
ronments [122]. This is also supported by our findings
where not only does the typical concept of police cul-
ture exist but also other aspects of work culture. Thus,
the meaning of these four key dimensions has been pre-
viously challenged and now potentially includes add-
itional aspects [123]. Consequently, it would be
beneficial to further study the police culture in Europe.
Physical environment
Qualities regarding the physical environments were
scarce, also which qualities would facilitate the health
SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 13

and life of police officers. However, the adequacy of
objects and adequacy of space were identified as two
qualities in the physical environment. These are
important issues regarding police officers’health and
previous studies have shown, for example, that body
armour has an impact on biomedical aspects and
physical performance and that these should be opti-
mised for the individual user [124]. Previous research
has also highlighted sedentary behaviour in, for
example, police vehicles, which may impact police
officers’health together with other work-related fac-
tors [1,14,125].
One key finding in this review is the need for fur-
ther study of the physical environment for patrolling
officers within the EU. For example, only one study
was found touching upon the quality accessibility and
safety of spaces. The study presents findings related to
the direct result of hazardous situations and being
affected physically by different education provided to
the officers. It is important to comprehend occupa-
tional hazards and exposure to threats in physical
environments as they have also been found to affect
both the physical and mental health of police officers
[1,11,108], sometimes resulting in death [126].
Strengths and limitations
A key strength of this review was the rigorous, sys-
tematic and standardised methodological approach to
addressing significant gaps in the literature.
A few limitations should be discussed, for example,
the exclusion of the sixth additional stage of Arksey
and O’Malley’s methodology, for practical reasons.
This would have provided an opportunity for know-
ledge transfer and exchange between police officers.
Such a knowledge transfer and exchange could not be
applied and thereby enhance the results.
Another limitation is that the scope of the review
may have been too narrow since none of the grey lit-
erature that had been identified remained after the
exclusion criteria had been applied. As an example,
we excluded specialised units within patrolling serv-
ices, such as traffic officers and dog handlers. Also,
we only included studies written in English and the
Scandinavian languages and had English words in the
search string. Hence, reliable and relevant studies
from countries not included in the study might have
been missed, particularly within the grey literature.
Although grey literature could have provided greater
strength in terms of representing the field, we now
had more control over the population we included in
the study, which is a strength of the study.
Another limitation was the search algorithm, which
excluded the frequently used keyword ‘policing’to
identify articles that only focussed on patrol duty. By
excluding the word, we might have missed articles,
but we also excluded an abundance of irrelevant
articles not related to our study’s aim. Also, the
articles’reference lists were not checked due to
resource limitations, meaning additional articles could
have been missed. To compensate for this, we how-
ever added articles we were aware of that did not
show up in the search.
Nevertheless, the scoping review was conducted
using systematic review software to minimise the
number of mistakes made by sorting articles, while
aiding in the blinding process. We searched eight dif-
ferent databases and conducted a second search at the
end of the analysis to enhance the correctness of the
study. To ensure the quality of the study, several steps
in the review were undertaken by two different
reviewers and the data extraction form was piloted
and revised. Hence, the study aimed to achieve pro-
cedural and methodological rigour and still has the
potential to contribute to future developments, within
theory, practice, education and research regarding
patrolling police officers’life contexts.
Conclusion and implications for
future research
The present review has identified and summarised life
contexts of patrolling police officers in the EU from
the perspective of the environmental model in
MOHO. It has also highlighted 20 years of peer-
reviewed literature on the different environmental
qualities that affect patrolling police officers’life and
health, mainly from their working life. Thus, due to
the gaps in the identified knowledge, our results sug-
gest there is a need for more research into police offi-
cers’all life contexts and how their health is affected
by the different environments they reside in. Hence,
to complement this review, further research is needed
also within their private life contexts and
environments.
The global context also needs further study since
police officers are frequently affected at work by new
laws, regulations, and policy changes, and we do not
know enough how this affects their health. These con-
texts and environments most likely make an impact
and should be considered to be crucial factors when
researching their health (see examples that describe
the current working life of police officers [127,128]).
Thus, new policy changes, new methods, and
14 E. G. VALMARI ET AL.

evidence-based police work within patrol duty should
always include the outcomes of changes in police offi-
cers’health, not least because, according to Taylor
[30], the demands and constraints of an environment
can negatively affect the motives and actions of
a person.
Since there was a gap in the geographical area of
the research that was identified, we would also
emphasise the need for research into patrolling offi-
cers’life contexts in more European countries. Our
results also indicate the need to use additional
research methods, since most studies in the review
comprised cross-sectional studies. For example, envir-
onmental components and qualities, and how these
empower police officers, could be identified if more
qualitative studies were to be conducted. Moreover,
longitudinal studies are required to study police offi-
cers’health over time in relation to ever-chang-
ing contexts.
Our findings show that working as a patrolling
police officer means engaging in various life contexts
in which several environments co-exist. While some
environmental qualities support the officers, others do
not. Patrolling police officers have a unique task in
constantly upholding the law and protecting the pub-
lic citizens while also dealing with public emergencies
and legal issues. Hence, it should be of particular con-
cern to focus on patrolling police officers’health to
enhance their occupational performance capacities. As
well as their opportunities to engage in a sustain-
able lifestyle.
According to Rowles [129], empirical and clinical
research must develop environment-focussed practice
strategies that support and encourage the continuing
search for meaning that remains the core motivation
of each person regardless of their life contexts [129].
However, within occupational therapy practice and
research, developing environment-focussed practice
strategies for patrolling police officers has so far been
excluded. Thus, our review will be used as a base for
developing an instrument measuring police officers’
life and health grounded in their contexts and envi-
ronments. The instrument could in the future be used
by occupational therapists to measure health promo-
tion programmes that contribute to the health and
well-being of police officers.
This review has also paved the way for studying
police officers’health from the perspective of occupa-
tional science. As of today, the health of police offi-
cers has mainly been a research field within
psychology and the social sciences. Thus, our inten-
tion is for the results to make an impact on future
research to include the conceptual frameworks of
occupational therapists when exploring police officers’
health, and the environments they exist in.
Disclosure statement
No potential conflict of interest was reported by
the authors.
Funding
The review, including the study design, data collection, ana-
lysis, and interpretation of data, as well as the writing of
the manuscript, were funded by the Department of
Community Medicine and Rehabilitation at Umeå
University, Sweden. However, the funding body had no
role in the preparation of this manuscript. Regarding the
sources of funding for the articles included in the review,
the data have not been collected.
ORCID
Elin Granholm Valmari http://orcid.org/0000-0003-
3659-1351
Mehdi Ghazinour http://orcid.org/0000-0003-1230-6720
Ulla Nygren http://orcid.org/0000-0002-3581-7980
Kajsa Gilenstam http://orcid.org/0000-0003-4690-6759
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