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Håkansson Eklund, J., Holmström, I. K., Ollén Lindqvist, A., Sundler, A. J., Hochwälder, J. & Marmstål Hammar, L. (2019). Empathy levels among nursing students: A comparative cross-sectional study. Nursing Open, 6(3), 983-989
Open this publication in new window or tab >>Empathy levels among nursing students: A comparative cross-sectional study
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2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 983-989Article in journal (Refereed) Published
Abstract [en]

Aim: Empathy is a crucial component of the nurse–patient relationship, but knowledge is lacking as to when empathy develops during nursing education. The aim of the present study was to compare empathy levels at different stages of undergraduate nursing education and different master's nursing programmes. Design: The design was a comparative cross-sectional study. Methods: A total of 329 participants in Sweden, comprised of nursing students in their second and sixth semesters in an undergraduate nursing programme as well as master's nursing students, rated their own empathy using the Jefferson Scale of Physician Empathy. Results: Students in their sixth semester in an undergraduate nursing programme expressed more empathy than did students in their second semester and master's nursing students. Among the five master's programmes, public-health nursing students expressed the most empathy and intensive-care nursing students the least. 

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd, 2019
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-44968 (URN)10.1002/nop2.280 (DOI)000467003100009 ()31367422 (PubMedID)2-s2.0-85069773206 (Scopus ID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-15Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E. & Söderlund, A. (2019). Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students. Physical Therapy, 99(8), 964-976
Open this publication in new window or tab >>Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students
2019 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, no 8, p. 964-976Article in journal (Refereed) Published
Abstract [en]

Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-a-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. This study used an exploratory cross-sectional design. The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R-2=0.04; SBC change in R-2=0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. The limitations of this study are that it was cross-sectional. Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.

National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-42932 (URN)10.1093/ptj/pzz044 (DOI)000482424200003 ()30869789 (PubMedID)2-s2.0-85070756500 (Scopus ID)
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-10-14Bibliographically approved
Hochwälder, J. (2019). Sense of Coherence: Notes on Some Challenges for Future Research. SAGE Open, 9(2)
Open this publication in new window or tab >>Sense of Coherence: Notes on Some Challenges for Future Research
2019 (English)In: SAGE Open, ISSN 2158-2440, E-ISSN 2158-2440, Vol. 9, no 2Article in journal (Refereed) Published
Abstract [en]

Antonovsky introduced the salutogenic model whose aim is to explain the origins of health and to describe how health can be promoted. Sense of coherence (SOC) is the core concept in the model and is defined as the degree of meaningfulness, comprehensibility, and manageability that people feel in their life. The aim of this article is to bring attention to some topics on SOC that need to be explored in future research. First, SOC and how it is measured are briefly described. Thereafter, there is a brief discussion of the following seven topics: (a) the dimensionality of the SOC scale, (b) SOC as the causal variable, (c) SOC as the outcome variable, (d) general SOC versus domain-specific SOC, (e) the concept of boundary in the measurement of SOC, (f) SOC as a continuous versus a dichotomized or trichotomized variable, and (g) the importance of relating SOC to salutogenic outcome measures. In conclusion, the salutogenic model, with its core concept of SOC, is an excellent guide for research on health and well-being, but there are still some parts of this model that deserve further theoretical and empirical attention. 

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-43450 (URN)10.1177/2158244019846687 (DOI)000466361200001 ()2-s2.0-85065083544 (Scopus ID)
Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2019-05-24Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E., Hällman, O. & Söderlund, A. (2018). Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'. AIMS PUBLIC HEALTH, 5(3), 235-259
Open this publication in new window or tab >>Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'
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2018 (English)In: AIMS PUBLIC HEALTH, ISSN 2327-8994, Vol. 5, no 3, p. 235-259Article in journal (Refereed) Published
Abstract [en]

Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (alpha range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Place, publisher, year, edition, pages
AMER INST MATHEMATICAL SCIENCES-AIMS, 2018
Keywords
assessment, behaviour change, clinical reasoning, education, physiotherapy, psychometrics, reliability, validity, web application
National Category
Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-40738 (URN)10.3934/publichealth.2018.3.235 (DOI)000442478900004 ()30280115 (PubMedID)
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2019-03-21Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E. & Söderlund, A. (2018). Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change. Physiotherapy Theory and Practice, 34(5), 367-383
Open this publication in new window or tab >>Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change
2018 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 34, no 5, p. 367-383Article in journal (Refereed) Published
Abstract [en]

Background and Aim: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. Methods: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Results: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. Conclusions: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

Keywords
Behavior change, clinical reasoning, instrument development, physiotherapy, validity
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-42887 (URN)10.1080/09593985.2017.1419521 (DOI)000425789400004 ()29405848 (PubMedID)2-s2.0-85041579507 (Scopus ID)
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-04-11Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E. & Söderlund, A. (2018). Predictors of clinical reasoning focused on clients’ behavior change among physical therapy students. In: Dyer, Joseph-Omer (Ed.), Raisonnement Clinique 2018: Textes del la 4e Conférence Internationale de Montréal sur le Raisonnment Clinique.. Paper presented at 4th Montréal International Conference on Clinical Reasoning 2018 Montréal, Canada..
Open this publication in new window or tab >>Predictors of clinical reasoning focused on clients’ behavior change among physical therapy students
2018 (English)In: Raisonnement Clinique 2018: Textes del la 4e Conférence Internationale de Montréal sur le Raisonnment Clinique. / [ed] Dyer, Joseph-Omer, 2018Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Although physical therapy students need to be well prepared to integrate strategies to effect health-related behavior change into their clinical reasoning, educators lack knowledge regarding which factors contribute to such competence. This study’s aim was to investigate the degree to which knowledge, cognitive, psychological and contextual factors as well as curriculum orientation influences students’ clinical reasoning focused on behavior change.

151 physical therapy students in the final semester completed the web-based Reasoning 4 Change instrument (1). 61 students attended a physical therapy education program with a behavioral medicine approach. Hierarchical multiple regression analysis was used to investigate the degree to which curriculum orientation, self-rated knowledge, cognition, metacognition, attitudes, self-efficacy and contextual factors influence three outcomes of the clinical reasoning process, i.e., Input from Client, Functional Behavioral Analysis (FBA) and Strategies for Behavior Change (SBC).

37% of the total variance in Input from Client was explained by all variables (p<.001), except contextual factors. Cognitive and metacognitive factors and attitudes were most important. Attending a physical therapy program with a behavioral medicine curriculum orientation was the only variable in the model that explained FBA (adjusted R2=.04;p<.05) and SBC (adjusted R2=.04;p<.01).

National Category
Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41533 (URN)978-2-89799-017-6 (ISBN)
Conference
4th Montréal International Conference on Clinical Reasoning 2018 Montréal, Canada.
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2018-12-12Bibliographically approved
Hochwälder, J. & Saied, V. (2018). The relation between sense of coherence and daily hassles among university students. HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE, 6(1), 329-339
Open this publication in new window or tab >>The relation between sense of coherence and daily hassles among university students
2018 (English)In: HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE, ISSN 2164-2850, Vol. 6, no 1, p. 329-339Article in journal (Refereed) Published
Abstract [en]

Based on Antonovsky's salutogenic model, it was hypothesized that persons with a high sense of coherence (SOC), compared to persons with a low SOC, (1) experience fewer hassles and (2) experience hassles as less stressful. In addition to each of the two main hypotheses, gender differences and interaction between SOC and gender were also explored. Two hundred and fifty-eight female students (M-age = 23.77 years) and 136 male students (M-age = 24.02 years) participated in a survey where they responded to a questionnaire that was designed to measure some demographic variables, SOC and daily hassles. The data were analysed by two 3 (SOC-groups) x 2 (Gender) ANOVAs for independent measures, with frequency and intensity as dependent variables, followed up with Tukey's HSD post-hoc tests. The results confirmed both main hypotheses. In addition, the results showed no interaction between SOC and gender, no differences between female and male students with regard to the number of experienced hassles but that female students experienced the hassles more intensively. These findings further corroborated the two fundamental parts of Antonovsky's salutogenic model concerned with avoidance and appraisal of stressors.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2018
Keywords
Salutogenic model, sense of coherence, daily hassles, university students, gender differences
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-44867 (URN)10.1080/21642850.2018.1538802 (DOI)000472538400019 ()
Available from: 2019-07-11 Created: 2019-07-11 Last updated: 2019-10-14Bibliographically approved
Hochwälder, J., Brucefors, A. B. & Hjelte, L. (2017). Psychometric evaluation of the Swedish translation of the revised Cystic Fibrosis Questionnaire in adults. Upsala Journal of Medical Sciences, 122(1), 61-66
Open this publication in new window or tab >>Psychometric evaluation of the Swedish translation of the revised Cystic Fibrosis Questionnaire in adults
2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 1, p. 61-66Article in journal (Refereed) Published
Abstract [en]

Aim: The CFQ-R is one of the most established disease-specific, health-related quality of life (HRQOL) measurements for patients with cystic fibrosis (CF). The aim was to evaluate the psychometric properties of the Swedish translation of CFQ-R in adults. Method: A total of 173 CF patients answered the CFQ-R. The CFQ-R was evaluated with regard to: (1) distributional properties; (2) reliability; and (3) construct validity. Results: The majority of scales were negatively skewed with ceiling effects. Eight of the 12 scales had satisfactory homogeneity; 10 of the 12 scales had satisfactory test-retest reliability. On many of the CFQ-R scales expected differences were observed when patients were divided regarding disease severity, nutritional status, age, and gender. Conclusion: Some weaknesses were detected, but overall the instrument has satisfactory psychometric properties.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Adults, cystic fibrosis, CFQ-R, health-related quality of life, psychometrics
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-35128 (URN)10.1080/03009734.2016.1225871 (DOI)000396476600009 ()27628957 (PubMedID)2-s2.0-84987876555 (Scopus ID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2017-11-29Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E. & Söderlund, A. (2016). An innovative instrument to assess physiotherapists’ clinical reasoning focused on clients’ behaviour change: Its development and validation.. Paper presented at The 4th European Congress of the European Region of the World Confederation of Physical Therapy (ER-WCPT). Liverpool, UK, 11-12 November 2016. Physiotherapy, 102(s1), e155-e155
Open this publication in new window or tab >>An innovative instrument to assess physiotherapists’ clinical reasoning focused on clients’ behaviour change: Its development and validation.
2016 (English)In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 102, no s1, p. e155-e155Article in journal, Meeting abstract (Refereed) Published
National Category
Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-36292 (URN)10.1016/j.physio.2016.10.181 (DOI)
Conference
The 4th European Congress of the European Region of the World Confederation of Physical Therapy (ER-WCPT). Liverpool, UK, 11-12 November 2016
Available from: 2017-08-31 Created: 2017-08-31 Last updated: 2018-01-03Bibliographically approved
Manasatchakun, P., Chotiga, P., Hochwälder, J., Roxberg, Å., Sandborgh, M. & Asp, M. (2016). Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand. Journal of Cross-Cultural Gerontology, 31(4), 369-384
Open this publication in new window or tab >>Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand
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2016 (English)In: Journal of Cross-Cultural Gerontology, ISSN 0169-3816, E-ISSN 1573-0719, Vol. 31, no 4, p. 369-384Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand’s aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors. 

Keywords
Cross-sectional study, Healthy aging, Northeastern Thailand, Older persons
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-32517 (URN)10.1007/s10823-016-9296-y (DOI)000408865400003 ()27432370 (PubMedID)2-s2.0-84978718906 (Scopus ID)
Available from: 2016-08-18 Created: 2016-08-18 Last updated: 2017-09-14Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8865-6818

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