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  • 1.
    Ahlgren, Asa
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mid Sweden University, Östersund, Sweden.
    Broman, Lisbet
    Karolinska Institutet, Stockholm, Sweden.
    Bergroth, Alf
    Mid Sweden University, Östersund, Sweden.
    Ekholm, Jan
    Mid Sweden University, Östersund, Sweden.
    Disability pension despite vocational rehabilitation?: A study from six social insurance offices of a county2005In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 28, no 1, p. 33-42Article in journal (Refereed)
    Abstract [en]

    Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.

  • 2.
    Ahlstedt, C.
    et al.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Eriksson Lindvall, C.
    Department of Business Studies Uppsala University, Uppsala, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    Muntlin Athlin, Å.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
    What makes registered nurses remain in work?: An ethnographic study2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 32-38Article in journal (Refereed)
    Abstract [en]

    Background: Registered nurses’ work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses’ workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses’ work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses’ development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation. 

  • 3.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Blev det ett genombrott?: Utvärdering av det nationella lärandeprojektet – Vård på lika villkor2014Report (Other academic)
    Abstract [sv]

    Sjukvården i Sverige är i dag inte jämlik, har brister i tillgänglighet och erbjuds inte på likvärdiga villkor trots Hälso- och sjukvårdslagens mål om en god hälsa och en vård på lika villkor för hela befolkningen.

    För att bryta den pågående trenden och öka jämlikheten gjordes en överenskommelse mellan regeringen och SKL om lärandeprojektet Vård på lika villkor (under åren 2011–2014). Syftet med projektets har varit att inom socioekonomiskt resurssvaga bostadsområden öka jämlikheten i första linjens vård. Detta genom att testa, utveckla och identifiera effektiva arbetssätt och metoder vid sju primärvårdsverksamheter från fem landsting i Sverige.

    Mälardalens högskola, Akademin för hälsa, vård och välfärd, fick av SKL i uppdrag att svara för forskarstöd och att genomföra en utvärdering av de metoder och arbetssätt som utvecklades och testades i lärandeprojektet.

    Resultatet från den genomförda utvärderingen som belyser den genomförda processen, mål- och resultat samt hälsoekonomiska aspekter beskrivs närmare i denna rapport.

  • 4.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Temaledare: Vård på lika villkor – Vad kan vi lära av Lärandeprojektet?2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 103-106Article in journal (Other academic)
  • 5.
    Amin, Mahgol
    et al.
    Mälardalen University, School of Business, Society and Engineering.
    Kubo, Tomomi
    Mälardalen University, School of Business, Society and Engineering.
    KANBAN Implementation from a Change Management Perspective: A Case Study of Volvo IT2014Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this thesis is to investigate and analyze the implementation process of KANBAN, a lean technique, into a section of Volvo IT (i.e. BEAT). The KANBAN implementation into BEAT when ‘resistance for change’ and ‘forces for change’ arise is also analyzed. This implementation of KANBAN is equivalent to change taking place in the Volvo IT’s operational process. The thesis follows theories and literature on change management and lean principles in order to support the research investigation.

    How has KANBAN, with respect to change management, been implemented into an IT organization for its service production? How has KANBAN changed the operational process of the organization?

     The research conducted in the thesis is based on qualitative case study. Focused and in-depth interviews, combined with observations, are carried out to obtain the primary data for the case study. The collected primary and secondary data stems from the literature reviewed, which covers the lean principles, KANBAN, and change management. Moreover, the thesis adopts an abductive approach that goes back-and-forth between the theory and the empirical findings in order to develop a model.

    Due to various factors already existing in the BEAT, minimal resistance to change implementation was found to be present in Volvo IT. This finding indicates that change initiatives found a way to implementation because the predominance of the ‘forces for change’, as compared to, the ‘resistance to change’ is higher in BEAT. The KANBAN implementation into the IT service production is identified to be aligned with Volvo IT’s change implementation objectives. The visualization of the ‘intangible service’ workflow on the Kanban board contributes to identify the source of bottlenecks, which has been removed through effective communication in the BEAT team and better linkages between tasks. The KANBAN effectively deals with change implementation by modifying the way team members work.

  • 6.
    Andersson, Mona
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Ett nytt sätt att övervaka palliativpatienter: Exemplet Kullbergska sjukhuset2011Report (Other academic)
    Abstract [sv]

    Denna rapport beskriver ett nytt sätt att monitorera eller övervaka palliativa patienter inomden avancerade hemsjukvårdens domäner jämfört med ett mer traditionelltomhändertagande inom slutenvården. I det nyare sättet vistas patienterna i hemmet sålångt det är möjligt innan en ev. inläggning på sjukhuset behövs. Monitoreringen sker genomkontinuerlig kontakt via främst ett frågeformulär, som patienten eller dennes anhörigaoch/eller distriktssköterska skickar in till samordnande sjuksköterska inom palliativ vård.Genom att data kontinuerligt registreras av hur patienten mår kan läkaren se hursjukdomsbilden utvecklar sig och sätta in de resurser som behövs efter varje patient behov.Vid ev. behov av slutenvård ligger dessa patienter inne kortare tid eftersom derasallmäntillstånd inte är lika dåligt som för patienter, som direkt kommer till sjukhusetsakutavdelning eller slutenvårdsavdelning, enligt traditionellt omhändertagande. Dessa patienter behöver vistas längre tid på sjukhuset och behöver dyra och omfattandebehandlingar för att förbättra sin hälsostatus, så att de kan skickas hem igen. En fråga som därför har ställts i studien är om det nya sättet att monitorera är mer kostnadseffektivt ändet traditionella eftersom vårdtid och därtill hörande kostnader skiljer sig åt mellan dessabåda system att vårda palliativa patienter. För att svara på denna fråga har en jämförelseavseende vårdtillfällen, vårddagar och kostnader gjorts för åren 2003 och 2004, då ett traditionellt synsätt användes på Kullbergska sjukhuset med åren 2008 och 2009 då manövergått till avancerad vård i hemmet (ASIH) för de palliativa patienterna.

    Resultatet visar att antalet anslutna palliativa patienter år 2003 var 82 stycken, vilka hade 90 vårdtillfällen tillsammans. Det genomsnittliga antalet vårdtillfällen per patient (exklusive 26 patienter, som aldrig anslöts eller kom hem från sjukhuset) var 1,6 och det genomsnittligaantalet dagar som dessa låg inne var 17,3. Spridningen i antalet dagar var från 1 till max 76 dagar och totala antalet vårddagar var 971.

    År 2009 visar resultatet att antalet anslutna palliativa patienter ökat till 117 stycken och attde hade 60 vårdtillfällen tillsammans samtidigt som antalet som ej anslöts eller kom hemfrån sjukhuset har ökat till 37 stycken. Det genomsnittliga antalet vårdtillfällen per patient ärnu 0,8 dvs. en minskning med 50 % från 2003. Antalet vårddagar har nu minskat till 543 stycken och i genomsnitt ligger patienterna inne 6,8 dagar. Spridningen av vårdagar är från 1 dag till max 51 dagar.

    Sammanfattningsvis har det trots fler anslutna palliativa patienter, från 82 stycken år 2003till 117 år 2009, en ökning med 43 %, skett en minskning av det totala antalet vårdtillfällen,från 90 tillfällen till 60 det vill säga en reduktion med 33 %. Detta har också fått till följd enhalvering av antalet vårdtillfällen per patient mellan dessa år. Det totala antalet vårddagarhar minskat från 971 till 543, en reduktion med 428 dagar eller 44 %. Detta har medfört attdet genomsnittliga antalet inneliggande dagar minskat från 17,3 till 6,8, en reduktion med 10,5 dagar eller 60 %. Det som dock kan ses som förvånande är att antalet patienter som inte kom hem eller anslöts till ASIH har ökat mellan dessa år, från 26 till 37, en ökning med 11 patienter eller 42 %. Orsaken kan sannolikt finnas i det som kallas för brytpunkten, ett tillfälle som ses som en gräns för ändring av innehållet i vården och som innebär attlivsförlängande insatser inte längre har effekt eller att effekten är marginell eller till och mednegativ för patienten. Studier visar att läkare tycker att det är svårt att tala om för en patientatt livet snart är slut och att de kurativa insatserna inte längre har effekt.

    Den kostnadskalkyl som gjort utifrån ovanstående data visar att den totala kostnaden för å r2003 var 2 225 532 (971 vårddagar x 2 292 kr/dygn) medan den för 2009 hade sjunkit tilltotalt 1 672 983 (543 vårddagar x 3 081 kr/dygn). Frågan som ställdes i denna rapport var omdet nya sättet att monitorera palliativa patienter var kostnadsbesparande. Utifrån ovanstående resultat är svaret entydigt ja - den har varit kostnadsbesparande förlandstinget. Mot denna kostnadsbesparing bör man också ställa intäkter eller effekter förpatienterna, i form av påverkan på deras livskvalitet. Genom monitoreringen finns såväl enkontinuerlig uppföljning som stor tillgänglighet för patienterna. Resurser sätts in efter varjepatients behov varför patienten inte behöver förlora så mycket av sin livskvalitet och sinakrafter. Om en inläggning dock måste göras blir vårdtiderna korta. Genom dennamonitorering kan patienterna delta i ”vardagslivets lunk” så länge som möjligt och dettaligger i linje med den palliativa vårdens filosofi. Jag har inga speciella skäl att anta attlivskvaliteten har blivit sämre trots att jag inte själv genomfört någon studie av detta.

    Att monitorera på detta sätt kan också vara ett svar på den fråga som Socialstyrelsenefterlyst om vad som kan göras för att minska eller förhindra onödig sjukhusvistelse. Jag seringa skäl till varför det här nya sättet att monitorera inte skulle vara möjligt även på andra orter eller sjukhus.

  • 7.
    Ardalan, A.
    et al.
    Tehran University of Medical Sciences.
    Mazaheri, Monir
    Karolinska Institute, Stockholm, Sweden; Tehran University of Medical Sciences, Tehran, Iran.
    Vanrooyen, M.
    Harvard University, Cambridge, MA, United States.
    Mowafi, H.
    Harvard University, Cambridge, MA, United States; Boston University, Cambridge, MA, United States.
    Nedjat, S.
    Tehran University of Medical Sciences, Tehran, Iran.
    Naieni, K.H.
    Tehran University of Medical Sciences, Tehran, Iran.
    Russel, M.
    University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Post-disaster quality of life among older survivors five years after the Bam earthquake: implications for recovery policy2011In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 31, no 2, p. 179-196Article in journal (Refereed)
    Abstract [en]

    Older people are among the most vulnerable in major disasters. In their aftermath, it is crucial to institute efforts that will maintain a high level of elders' quality of life (QoL). This paper presents QoL assessments of elderly survivors five years after the Bam earthquake in Iran, and evaluates the determinants. A cross-sectional analysis of 210 randomly-selected survivors was carried out in 2008 using the WHOQOL-BREF questionnaire. A comparison of the results with data on the general population showed that experiencing the earthquake may adversely affect psychological dimensions of QoL even five years after, but paradoxically the earthquake resulted in better social relationships in affected communities than in the general population. Lower QoL associated with female gender, higher age, living alone, severe earthquake-related injury, poor quality of living conditions, increased dependency in the activities of daily living, living in an urban area, and being temporarily housed. Recovery experts and donors should carry out long-term monitoring of health status and QoL in disaster-affected communities, with a focus on psychological wellbeing. Intervention programmes that emphasise post-disasterquality of care and satisfactory housing may lead to better QoL of the victims and may shorten the recovery phase.

  • 8.
    Ardalan, Ali
    et al.
    Tehran University of Medical Sciences, Tehran, Iran.
    Mazaheri, Monir
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    VanRooyen, Michael
    Harvard University, Boston, USA.
    Teimoori, Fariba
    University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Abbasi, Reza
    Kerman University of Medical Sciences, Kerman, Iran.
    Impact of the Bam Earthquake, 26 December 2003, on Activities of Daily Living and Instrumental Activities of Daily Living of Older People2011In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, no 2, p. 99-108Article in journal (Refereed)
  • 9.
    ARDALAN, ALI
    et al.
    School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.
    Mazaheri, Monir
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden..
    KOUROSH, HOLAKOUIE NAIENI
    School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran..
    REZAIE, MOHSEN
    School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran..
    TEIMOORI, FARIBA
    Iranian Research Centre on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    POURMALEK, FARSHAD
    Iran University of Medical Sciences, Tehran, Iran..
    Older people´s needs following major disasters: a qualitative study of Iranian elders´ experiences of the Bam earthquake2010In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 30, p. 11-23Article in journal (Refereed)
    Abstract [en]

    Elders have long been recognised as among the most vulnerable people in disaster events. This paper reports a qualitative study of the self-perceived needs of older people in the aftermath of the Bam earthquake in Iran in 2003. A total of 56 people aged from 65 to 88 years were recruited to the study using purposive sampling, including 29 men and 27 women. Six focus group discussions and ten semi-structured individual interviews were conducted. Each focus group involved six to ten people from the cities of Bam and Baravat and their rural suburbs. Content analysis was used to analyse the transcribed data. The analysis identified four major themes among the informants' concerns: inappropriate service delivery, affronts to dignity, feeling insecure and emotional distress. A disaster-prone country like Iran needs to be appropriately prepared with culturally sensitive plans to meet the needs of those who suffer from their effects, not least older people. Emergency relief managers should note that for many older people in a disaster zone, customary forms of relief are neither required nor appropriate, and that their distinctive immediate and long-term needs should be assessed and met. Relief agencies need to be trained to be age-sensitive and should mainstream older people's rights in the planning and implementation of both the response and recovery phases of assistance.

  • 10.
    Astnell, Sandra
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden.
    Augustsson, Hanna
    Karolinska Institutet, Stockholm, Sweden.
    Stenfors-Hayes, Terese
    Karolinska Institutet, Stockholm, Sweden.
    Integrating health promotion with quality improvement in a Swedish hospital2015In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 31, no 3, p. 495-504Article in journal (Refereed)
    Abstract [en]

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  • 11. Athlin, Muntlin Å
    et al.
    Farrokhnia, N
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Sweden.
    Teamwork in the emergency department-a systematic evaluation of a new working routine2011Conference paper (Refereed)
  • 12.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    ”Ja, så tänker vi också …”: – Ett programteoretiskt perspektiv på det nationella Lärandeprojektet – Vård på lika villkor2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 116-131Article in journal (Refereed)
    Abstract [en]

    Developing a program theory for a project and evaluate the project based on this program theory has both its merits and limitations. These merits and limitations in turn may be depend on the existing attitude towards a particular program theory. This study is about exploring how different phases and parts of the national learning project Care on equal terms (2011-2014) functioned in relation to the program theory developed in the beginning of the project. The result shows that the program theoretical perspective on the project contributed to a better structuring of the various forms of evaluation, given a broader understanding of the project's components and provided better opportunities to improve monitoring of the project by the research team in collaboration with the project management of the Swedish Association of Local Authorities and Regions (SALAR) and the participating health care units.

  • 13.
    Aytar, Osman
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Att utvärdera med processtänkande för lärande2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 162-175Article in journal (Refereed)
    Abstract [en]

    Change-projects can be evaluated in different ways. One of the ways is to evaluate with process thinking, which means that evaluators are involved in the process from the very beginning. Involvement of evaluators already in the beginning of a project can mean several challenges for both the project itself and the evaluators. This study is about describing and analyzing how and with what results the perspective of process thinking on evaluation of the national learning project Care on equal terms was used. The results indicate, among other things, that it was a good choice to bring in evaluation perspective at the beginning of the project. Process thinking has, among other things, contributed to the activities throughout the project, and played a role in learning from and implementation of the project itself.

  • 14.
    Aytar, Osman
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Health Care Provider’s Perceptions about and Experiences of Achieving Equitable Health Care: An Evaluation Study2017In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 25, no 5, p. 289-296Article in journal (Refereed)
    Abstract [en]

    Background: In June 2011 the Swedish government signed an agreement with The Swedish Association of Local Authorities and Regions (SALAR), for a three year project to develop and implement “Health care on equal terms.” The project, which involved seven Primary Health Care Units (PHCU) from five county councils in different parts in Sweden, was completed in early 2014. The aim of the project was to develop methods and activities that could promote more equal health care provision in socio-economically disadvantaged areas.

    Aim: To assess and compare health care providers’ experiences of and perceptions about equitable health care at the beginning and end of the national project “Health care on equal terms”.

    Methods: A web survey was sent to all staff at the seven participating Primary Health Care Units (PHCU) at the beginning (2012) and the end (2013) of the project. Data were analyzed with descriptive statistics and the open issues with content analysis.

    Results: In 2013, the percentage of health care providers who reported thinking patients’ ethnicity had no or very little impact on access to care increased, but the proportion of those who reported that they had “no idea” that patients’ gender, age, mental health and physical functioning were significant for access to care was lower in 2013 than in 2012. The results from analysis of the open-ended questions did not show meaningful changes in the respondents’ perceptions of the issues addressed in 2012-2013, but the analysis contributes to a deeper explanation of the answers.

    Conclusion: The main conclusion is that it was possible to implement changes aiming for more equitable care through projects with a focus on learning.

  • 15.
    Christensson, Kyllike
    et al.
    Mälardalen University, Department of Caring and Public Health Sciences. Karolinska Institutet, Stockholm, Sweden.
    Odberg Pettersson, K.
    Karolinska Institutet, Stockholm, Sweden.
    Bugalho, A.
    Maputo Central Hospital, Mozambique.
    Cunha, M.M.
    Maputo Central Hospital, Mozambique.
    Dgedge, C.
    Maputo Central Hospital, Mozambique.
    Johansson, E.
    Karolinska Institutet, Stockholm, Sweden.
    Bergstrom, S.
    Karolinska Institutet, Stockholm, Sweden.
    The challenge of improving perinatal care in settings with limited resources: Observations of midwifery practices in Mozambique2006In: African Journal of Reproductive Health, ISSN 1118-4841, Vol. 10, no 1, p. 47-61Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to observe and analyse midwifery care routines related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre- and post-intervention observation study of midwifery a performance during childbirth was conducted at a labour ward in Maputo. The observed groups consisted of 702 and 616 midwifery-attended deliveries. Examination was also conducted of the partographs (702 vs. 616). The quality of midwifery care related to prevention and early detection of asphyxia and hypothermia was found to be inadequate and the intervention had no significant effect upon the midwives' performances. This could be attributed to the quality of the intervention itself or to failure of implementing managerial decisions such as transfer of partograph documentation from obstetricians to midwives. Change in professional performance does not automatically follow awareness of evidence-based midwifery practices, but requires behavioural change, which may be more difficult to achieve.

  • 16.
    Dong, Hengjin
    et al.
    Zhejiang University, Center for Health Policy Studies, China.
    Duan, Shengnan
    Zhejiang University, Center for Health Policy Studies, China.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Global health, Sweden.
    Wu, Yuan
    Zhejiang University, Center for Health Policy Studies, China.
    You, Hua
    Zhejiang University, Center for Health Policy Studies, China.
    Chen, Jinhua
    Zhejiang University, Center for Health Policy Studies, China.
    Ye, Xujun
    Zhejiang University, Center for Health Policy Studies, China.
    Seccombe, Karen
    School of Community Health, Portland State University, Portland, Oregon, USA.
    Yu, Hai
    Zhejiang University, Center for Health Policy Studies, China.
    The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system2016In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 31, no 1, p. 36-48Article in journal (Refereed)
    Abstract [en]

    In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.

  • 17.
    Engström, Johanna
    Mälardalen University, School of Health, Care and Social Welfare.
    En mer jämlik tobaksavvänjning: En kvalitativ intervjustudie i Landstinget Sörmland2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 18.
    Fagerberg, Ingegerd
    Mälardalen University, Department of Caring and Public Health Sciences. Karolinska Institutet, Sweden.
    Registered nurses, work experiences: personal accounts integrated with professional identity2004In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 46, no 3, p. 284-291Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The work context is important for the development of Registered Nurses' skills and identity as professionals, but the work context and organization can also hinder their professional development. AIM: This paper reports a study whose purpose was to understand the meaning of Registered Nurses' narratives of their work experience 5 years after graduation. RESEARCH METHOD: Data were collected in 2001 from interviews with 16 Registered Nurses 5 years after graduation and analysed using a phenomenological hermeneutic method, influenced by the philosophy of Paul Ricoeur. RESULTS: Analyses of the narratives resulted in three themes: 'The meaning of caring and protection of patients', 'The meaning of work organization in nurses' work' and 'The implied meaning of using one's individual attributes in one's professional role'. Since the number of nurses participating in the study is small, it is important to re-contextualize the results when transferring them to other contexts. CONCLUSIONS: There is a complex interrelationship between the health care organization, individual attributes of nurses (including self-esteem) and patient care. Provision of adequate resources and support for nurses' professional and personal development is needed to ensure high quality patient care, and these are political issues.

  • 19.
    Finer, David
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Tillgren, Per
    Mälardalen University, Department of Social Sciences. Karolinska Institutet, Stockholm, Sweden.
    Guldbrandssom, Karin
    Karolinska Institutet, Stockholm, Sweden.
    Haglund, Bo JA
    Karolinska Institutet, Stockholm, Sweden.
    Implementation of a Health Impact Assessment (HIA) tool in a regional organization in Sweden – a feasibility study.2005In: Health Promotion International, ISSN 0957-4824, Vol. 20, no 3, p. 277-284Article in journal (Refereed)
    Abstract [en]

    During the last decade, Health Impact Assessment (HIA) has been discussed worldwide as being an important tool for the development of healthy public policy. In Sweden, the Swedish Federation of County Councils and the Swedish Association of Local Authorities have taken the initiative to and are responsible for the development of an HIA tool concerning proposed policy decisions at local and regional levels. The HIA tool was developed as three different templates to be adapted to local conditions and needs: the Health Question, the Health Matrix and the Health Impact Analysis. In this paper we present a feasibility study of the experiences of implementing this HIA tool at regional level in a Health Care District (SWHCD) of Stockholm County Council, based on an inductive approach and on principles of data triangulation. The main findings include the need for continuous revision of the HIA templates during the pilot period. The following factors were instrumental in successfully using the HIA tool in local policy making and management: political consensus, agreement between politicians and public officials on political intentions, a clear-cut decision from management, and offering an opportunity for training. Respondents felt that all public officials should use the HIA as part of their normal work routines. In conclusion, the HIA tool has to be locally adapted and the implementation process has to include close collaboration between politicians and public officials and be followed by continuing education, providing possibilities for a dialogue around the HIA tool, in order to ensure the quality of the instrument. Implications of the study are that the process of developing the tool has worked well but that the possible impacts of its use in this case remain an open question. However, this was not the focus of our study.

  • 20.
    Frykman, Mandus
    et al.
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Muntlin Athlin, Åsa
    Uppsala Universitet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    Mazzocato, Pamela
    Karolinska Institutet, Sweden.
    The work is never ending: uncovering teamwork sustainability using realistic evaluation2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 1, p. 64-81Article in journal (Refereed)
    Abstract [en]

    Purpose-The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork. Design/methodology/approach-Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamworkat an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used. Findings-The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced. Practical implications-The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period. Originality/value-By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

  • 21.
    Granlund, Anna
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Wiktorsson, Magnus
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Automation in Healthcare Internal Logistics: A Case Study on Practice and Potential2013In: International Journal of Innovation and Technology Management (IJITM), ISSN 0219-8770, Vol. 10, no 2Article in journal (Refereed)
    Abstract [en]

    The current demographic development puts even greater demands on the healthcare sector which already struggle with scarce resources and constant pressure of cost reductions. This paper aims at through a multiple case study describe how automation of hospital internal logistics can be a tool in improving the efficiency. The results include several potential implementations for patient transports, waste handling and small goods transports. However, organizational issues as lack of ownership and a strategic view render difficulties and needs to be dealt with. The authors conclude that transfer of knowledge and technology used in manufacturing industry would be beneficial. 

  • 22.
    Gustafsson, Gunnel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Områdesbeskrivningar av sju vårdverksamheter: Primärvårdens förutsättningar och befolkningens vårdbehov2014Report (Other academic)
    Abstract [sv]

    Lärandeprojektet Vård på lika villkor har varit en överenskommelse mellan staten och Sveriges Kommuner och Landsting som pågått mellan 2011 och 2014. Målet med projektet har varit att utveckla arbetssätt och metoder som kan främja en mer jämlik första linjens vård. Inom ramen för projektet har SKL uppdragit åt forskare vid Mälardalens högskola att göra områdesbeskrivningar för de sju medverkande vårdverksamheterna.

    Syftet med områdesbeskrivningarna är försöka ge en jämförbar beskrivning av de medverkande sju verksamheterna i projektet. Beskrivningen är gjord utifrån relevant statistik och demografi ska data på patientnivå, samt utifrån organisatoriska förutsättningar och resurser. Förhoppningen är att dessa uppgifter kan ge ökad förståelse för vilka patienter som fi nns i området och fungera som ett stöd i arbetet för en mer jämlik vård.

  • 23.
    Gustafsson, Gunnel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Primärvårdens förutsättningar och befolkningens behov i sju vårdverksamheter2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 132-143Article in journal (Refereed)
    Abstract [en]

    Developing a program theory for a project and evaluate the project based on this program theory has both its merits and limitations. These merits and limitations in turn may be depend on the existing attitude towards a particular program theory. This study is about exploring how different phases and parts of the national learning project Care on equal terms (2011-2014) functioned in relation to the program theory developed in the beginning of the project. The result shows that the program theoretical perspective on the project contributed to a better structuring of the various forms of evaluation, given a broader understanding of the project's components and provided better opportunities to improve monitoring of the project by the research team in collaboration with the project management of the Swedish Association of Local Authorities and Regions (SALAR) and the participating health care units.

  • 24.
    Hafskjold, L.
    et al.
    Buskerud and Vestfold University College, Drammen, Norway.
    Sundler, Annelie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundling, V.
    Buskerud and Vestfold University College, Drammen, Norway.
    Van Dulmen, S.
    Buskerud and Vestfold University College, Drammen, Norway.
    Eide, H.
    Buskerud and Vestfold University College, Drammen, Norway.
    A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 4, article id e007864Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. Methods and analysis: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. Ethics and dissemination: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people. 

  • 25.
    Hidman, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Jahr, Catarina
    Mälardalen University, School of Health, Care and Social Welfare.
    Copingstrategier hos personer som varit sjukskrivna mellan 3 och 6 månader2011Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: People with musculoskeletal and mental disorders account for 57% of sick leave in Västerås. The majority of these are women. It has become more common in rehabilitation that also to take into account psychological aspects, such as coping strategies. Objective: To identify the most prevalent coping strategies in persons on sick leave between 3 and 6 months and to analyze possible differences in coping strategies between men and women as well as between people with mental and  musculoskeletal disorders. Method: A questionnaire-based descriptive cross-sectional study. A convenience sample was invited to participate the sample was recruited in cooperation with Sjukskrivningskommittén and Försäkringskassan in Västerås. Eighty persons were asked for participation of which 40 were on sick leave due to mental disorders and 40 due to musculoskeletal disorders. Results/Conclusion: Twenty people participated in the study. Of these were 17 women and three were men. Of those, 16 people had a musculoskeletal disorder and four had a mental disorder. The most prevalent coping strategies within the group long-term sickness was increasing activity, pain anxiety and self-reinforcing. People with musculoskeletal disorders had more catastrophizing thoughts than people with mental disorders. No difference between men and women were possible to analyse because the gender distribution among the participants were uneven. The small sample size and high drop- out rate does not allow any absolute conclusions based on the study results.

  • 26.
    Hollmark, Malin
    et al.
    Uppsala universitet, Industriell teknik.
    Lefevre Skjöldebrand, Anna
    Andersson, Christoffer
    Uppsala universitet, Industriell teknik.
    Lindblad, Ragnar
    Technology Ready to be Launched, but is there a Payer?: Challenges for Implementing eHealth in Sweden2015In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 211, p. 57-68Article in journal (Refereed)
    Abstract [en]

    The development of a sustainable, high-quality, affordable health care is today a high priority for many actors in the society. This is to ensure that we will continue to afford to care for the growing portion of elderly in our population. One solution is to enable the individual's power over her own health or illness, and participation in her own care. There are evidently opportunities with the rapid development of eHealth and wearable sensors. Tracking and measuring vital data can help to keep people out of the hospital. Loads of data is generated to help us understand disease, to provide us with early diagnostics and warnings. It is providing us with possibilities to collect and capture the true health status of individuals. Successful technologies demonstrate savings, acceptance among users and improved access to healthcare. But there are also challenges. Implementing new technologies in health care is difficult. Researchers from around the world are reporting on similar problems, such as reimbursement, interoperability, usability and regulatory issues. This paper will discuss a few of these implementation challenges as well as a few of the efforts in meeting them. To conclude, eHealth solutions can contribute to patient empowerment and a sustainable health care. Our assumption is however, that as long as we do not face the implementation challenges and invest in overcoming the pressing obstacles, society will not be able, or willing, to pay for the solutions.

  • 27.
    Jansson, Katarina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Fernström, Linda
    Mälardalen University, School of Health, Care and Social Welfare.
    Kommunala chefers medvetenhet om påverkan på och ansvaret för medarbetarnas hälsa2008Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    Changes in working life, such as higher demands, increase the importance of health promotion in this arena. Several studies show the great importance of leadership, but only a few studies look into the awareness among leaders about their influence on their subordinates’ health. The leader’s self-awareness about their own leadership has a great impact on the health of subordinates; in fact, the leader is the out most important factor for the working environment in several workplaces. The aim of this study is to explore the view on health, the awareness of the impact of leadership on the health of subordinates and to examine the sense of responsibility for the health of subordinates among municipality leaders. The subject was approached by using a qualitative study method with semi structured personal interviews. The result shows that all respondents regard good health to be an important element of a good life and value good health highly. The awareness about how leadership influences the health of the subordinates varies among the respondents. The awareness of the leadership’s impact exists among the respondents, but not to the full extent of its impact. There also exists a sense of responsibility for the health of the subordinates among most of the respondents. This sense of responsibility is founded upon the importance of the subordinate’s health as an important factor in achieving the goals of the corporation.

    Keywords: awareness, health, influence, leadership, responsibility, subordinate

  • 28.
    Jernehed, Martin
    Mälardalen University, School of Health, Care and Social Welfare.
    Vad formar en lokal folkhälsopolicy?: En kvalitativ studie om policyprocessen i en mellansvensk kommun2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Public health politics creates opportunities for population health. Public health efforts must be politically supported to be able to enhance public health at national, regional and local level. Health policy triangle is a tool for operators who want to create or revise action plans that are used to control and monitor the municipal public health work. The purpose of this study was to describe the process of policy formulation for Eskilstuna action plan for public health from an actor's perspective. The study design was qualitative with deductive manifest content analysis supplemented by the analysis tool of health policy triangle. A total of five interviews with politicians, officials and municipal managers were conducted. The result shows that the interviewees described the work in policy formulation as democratic, that there was no hierarchy because they strove toward a common goal of public health. It also emerged that they see policy formulation as a central and vital role in the policy process of the action plan. It is where decisions are made and about what should be included and what public health actions that the municipality should do. The action plan for public health greeted appearance mirrored by municipal policy focus on public health, previous public health works and policy documents. The conclusions were that participants describe the work of policy formulation as unpretentious and democratic order to achieve the common goals of public health in the municipality. Policy formulation was perceived by participants as a central and important part of the policy process and that local public health policy, along with previous experience in local public health and regulatory documents for public health serve as underlying factors in the design of Eskilstuna Municipality's action plan. 

  • 29.
    Johansson, K.
    et al.
    Linköping University, Sweden.
    Bendtsen, P.
    Linköping University, Sweden.
    Åkerlind, Ingemar
    Linköping University, Sweden.
    Factors influencing GPs' decisions regarding screening for high alcohol consumption: A focus group study in Swedish primary care2005In: Public Health, Vol. 119, no 9, p. 781-788Article in journal (Refereed)
    Abstract [en]

    Department of Health and Society, Social Medicine and Public Health Science, Linköping University, S-581 83 Linköping, Sweden. kjell.johansson@lio.se

    OBJECTIVE: The aim of this study was to explore factors that influence general practitioners' (GPs') decisions regarding screening for high alcohol consumption. METHODS: GPs working at three primary healthcare centres in Sweden participated in focus group interviews. The interviews were recorded and transcribed verbatim, and a deductive framework approach was used for the analysis. RESULTS: The majority of the participating GPs did not believe in asking all patients about their alcohol consumption. Reported factors that influenced how many and which patients were questioned about alcohol consumption were time, age of the patient, consultation setting, patient-physician relationship, what symptoms the patient presented with, and knowledge of measures if patients appear to have a high alcohol consumption. Thus, alcohol screening and intervention were not performed in all patient groups as was originally intended, but were performed in limited groups of patients such as those with alcohol-related symptoms. CONCLUSIONS: Although the number of participants in this study was small and the conclusions cannot be generalized, the results provide some valuable insights into why GPs are hesitant to engage in screening for high alcohol consumption. Since prevention of alcohol-related health problems is an important public health issue, many different screening and intervention strategies have to be formulated and evaluated in order to reach patients with both hazardous and harmful alcohol consumption within the healthcare system. Screening all consecutive patients for a limited period or screening patient groups known to include a fairly high frequency of high alcohol consumers are two ways of limiting the time requirements and increasing role legitimacy. Still, there is a need for a broader public health strategy involving many players in the community in alcohol preventive measures, especially in more primary preventive approaches.

  • 30.
    Johansson, K.
    et al.
    Linköping University, Sweden.
    Åkerlind, Ingemar
    Linköping University, Sweden.
    Bendtsen, P.
    Linköping University, Sweden.
    Under what circumstances are nurses willing to engage in brief alcohol interventions? A qualitative study from primary care in Sweden.2005In: Addictive Behaviors, ISSN 0306-4603, Vol. 30, no 5, p. 1049-53Article in journal (Refereed)
    Abstract [en]

    To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Ostergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

  • 31.
    Korlén, Sara
    et al.
    Karolinska Institutet, Sweden.
    Amer-Wåhlin, Isis
    Karolinska Institutet, Sweden.
    Lindgren, Peter
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Professionals’ perspectives on a market-inspired policy reform: A guiding light to the blind spots of measurement2017In: Health Services Management Research, ISSN 0951-4848, E-ISSN 1758-1044, Vol. 30, no 3, p. 148-155Article in journal (Refereed)
    Abstract [en]

    Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals’ analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations.

  • 32.
    Lie, Birgitta
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Ledarskapsaspekter på implementering av evidensbaserad medicin och nationella riktlinjer2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 33.
    Lindberg, Inger
    et al.
    Luleå University of Technology, Sweden.
    Christensson, Kyllike
    Mälardalen University, School of Health, Care and Social Welfare.
    Öhrling, Kerstin
    Luleå University of Technology, Sweden.
    Midwives' experience of organisational and professional change2005In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 21, no 4, p. 355-364Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe midwives' experiences of changes in their caring role and professional function in postpartum wards in the northern part of Sweden. In this part of the country, three out of eight maternity departments have been closed over the last 5 years. During the same period, hospital stays have reduced in length, and an early discharge model has been introduced. DESIGN: focus-group discussions. SETTING: four focus groups at two hospitals in northern Sweden. PARTICIPANTS: 21 midwives experienced in midwifery practice in maternity wards. FINDINGS: the analysis revealed four categories of comments: 'to have limited time when caring for the mother and the baby'; 'no longer being valued as the expert'; 'a wish to have responsibility for childbirth in its entirety'; 'to see future possibilities in the development of the profession'. The theme identified is 'being ahead in ideas about caring but still partly caught up in the past'. KEY CONCLUSIONS AND IMPLICATIONS: the identified theme of being ahead in ideas about caring but still partly caught up in the past can be understood as representing a transition. The midwives experienced loss and grief over their former midwifery practice, but had ideas and visions for developing and expanding their future professional role. A healthy transition requires support, participation and skilled management.

  • 34.
    Martin, Lene
    Stockholm University, Sweden.
    'Shared care' and computer assistance in glaucoma management1997In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 46, p. 288-290Article in journal (Refereed)
    Abstract [en]

    Primary open angle glaucoma afflicts 1-2% of people over 50 years of age. The diagnosis relies on a number of examinations, many of them performed by ophthalmic nurses, and the care of glaucoma patients has become one of their main tasks. A knowledge-based system for decision support in glaucoma management has been developed and validated. The aim of the current study is to evaluate the influence of computerised decision support on a 'shared care' organisation for the management of glaucoma patients.

  • 35.
    Matz, Bergström
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Eek, Thomas
    Akademin för hälsa, vård och välfärd.
    Studiesocial verksamhet, hälsa och delaktighet: En webbenkätundersökning på Mälardalens högskola2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Active participation and social capital are important factors for good health. The underlying components of these terms are; social network, social support and social trust. These are the basis for further discussion of participation in nonprofit organizations and unions. Sweden has a strong cultural tradition of membership in such groups and roughly half of the population work in one.

    The aim of this study survey was to monitor student’s participation in study related social activities and examine relations between student’s participation levels and ther overall health. To answer the aim of the study a web survey was sent to all second year students at the School of Sustainable Development of Society and Technology. Of those who received the questionnaire around 20 percent answered.

    Results suggested that two thirds of students had taken part in student union activities while about 40 percent had worked in some kind of union organization. The main motives for participation were to meet other people and to build social networks. Due to the fact that the survey data was too small and not equally divided

    , statistical significant test could not be performed. Correlations between taking part in union activities or working in student unions and practical support, emotional support or health was not possible to test. However, there were notable connections between both, participation in union activities, and working in a student union, and social trust.

  • 36.
    Mosson, Rebecca
    et al.
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Richter, Anne
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    The Impact of Inner and Outer Context on Line Managers’ Implementation Leadership2018In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 48, no 5, p. 1447-1468Article in journal (Refereed)
    Abstract [en]

    Line managers have an important role in leading implementation of evidence-based practice (EBP). In this task, they are highly influenced by their context. However, little is known about how contextual factors impact managers’ implementation leadership. The aim of the present study is to explore how contextual factors influence line managers’ leadership when implementing EBP. Twenty-eight semi-structured interviews were performed with line managers in social care. A hybrid thematic analysis was carried out. The Consolidated Framework for Implementation Research Framework (CFIR) was used to guide the deductive analysis approach. Findings showed that contextual factors in all of CFIR’s inner setting constructs and in two constructs of the outer-setting domain (Cosmopolitanism and External resources and funding) had a high practical impact on managers’ implementation leadership. However, many of the contextual factors were either not offered to or did not actually reach the managers, which means that they had a limited impact in practice. Moreover, several factors only had a positive practical impact in interaction with other factors, rather than independently. Future research should systematically consider interactions between contextual factors. Identifying factors that have a potential impact in practice may help inform support initiatives to aid managers in developing their implementation leadership. 

  • 37.
    Renbro, Gunnar
    Mälardalen University, School of Health, Care and Social Welfare.
    Palpationsömhet i perifer nerv och känseltest med sporre på friska försökspersoner2010Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Leg pain is common and neuropathy (nerve disease) is one reason which probably is under diagnosed. Bimanual (bilateral) nerve palpation and sensory test with spurs has been shown to be quite reliable. Furthermore, the tests are straight forward detecting nerve disease but have not been tested on a healthy population.

    Purpose: The purpose was to investigate whether peripheral nerve palpation in fossa poplitea induces pain/discomfort, and if side difference exists in a sensibility test with spurs on the lower leg in healthy subjects.

    Method: A bimanual palpation test of the tibial and peroneal nerve in fossa poplitea and also a bimanual sensibility test with spurs of dermatome L4, L5 and S1 on the lower leg were carried out. In order to find healthy subjects a purposive sampling was made. A total of 37 subjects between 20 and 57 years with a median age of 23 participated in the study.

    Results: At the palpation test the intensity of pain/discomfort had a median of 1 (range 3) in the 11 degrees of pain scale. A large part estimated differences between the sides in both the palpation test (11 of 37) and the sensibility test with spur (25 of 37). There was no significant difference between the sexes.

    Conclusion: When performing these nerve tests it is important to keep in mind that even healthy individuals might perceive some pain/discomfort as well as side difference. However, we need more studies to confirm these results.

  • 38.
    Rodrigues, Rashmi
    et al.
    St John's National Academy of Health Sciences, Bangalore, India.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Global health, Sweden.
    Shet, Anita
    St John's National academy of Health Sciences, Bangalore, India.
    Kumar, Dodderi Sunil
    Karnataka AIDS Prevention Society, Bangalore, India.
    De Costa, Ayesha
    Karolinska institutet, Sweden.
    Mobile phones to support adherence to antiretroviral therapy: what would it cost to the Indian National AIDS Control Programme?2014In: Journal of the International AIDS Society, ISSN 1758-2652, E-ISSN 1758-2652, Vol. 17, p. Article Number: 19036-Article in journal (Refereed)
    Abstract [en]

    Introduction: Adherence to antiretroviral treatment (ART) is critical to maintaining health and good clinical outcomes in people living with HIV/AIDS. To address poor treatment adherence, low-cost interventions using mobile communication technology are being studied. While there are some studies that show an effect of mobile phone reminders on adherence to ART, none has reported on the costs of such reminders for national AIDS programmes. This paper aims to study the costs of mobile phone reminder strategies (mHealth interventions) to support adherence in the context of India's National AIDS Control Program (NACP). Methods: The study was undertaken at two tertiary level teaching hospitals that implement the NACP in Karnataka state, South India. Costs for a mobile phone reminder application to support adherence, implemented at these sites (i.e. weekly calls, messages or both) were studied. Costs were collected based on the concept of avoidable costs specific to the application. The costs that were assessed were one-time costs and recurrent costs that included fixed and variable costs. A sequential procedure for costing was used. Costs were calculated at national-programme level, individual ART-centre level and individual patient level from the NACP's perspective. The assessed costs were pooled to obtain an annual cost per patient. The type of application, number of ART centres and number of patients on ART were varied in a sensitivity analysis of costs. Results: The Indian NACP would incur a cost of between 79 and 110 INR (USD 1.27 - 1.77) per patient per year, based on the type of reminder, the number of patients on ART and the number of functioning ART centres. The total programme costs for a scaleup of the mHealth intervention to reach the one million patients expected to be on treatment by 2017 is estimated to be 0.36% of the total five-year national-programme budget. Conclusions: The cost of the mHealth intervention for ART-adherence support in the context of the Indian NACP is low and is facilitated by the low cost of mobile communication in the country. Extending the use of mobile communication applications beyond adherence support under the national programme could be done relatively inexpensively.

  • 39.
    Sandström, Ulla
    et al.
    Stockholm Centre for Public Health, Stockholm, Sweden .
    Stålsby-Lundborg, Cecilia
    Karolinska Institute, Stockholm, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Holmström, Inger
    Uppsala University, Uppsala, Sweden.
    Variation in views on clients in interprofessional work for vocational rehabilitation in Sweden2007In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 21, no 5, p. 479-489Article in journal (Refereed)
    Abstract [en]

    To deal with long-term sickness absence, inter-organizational and interprofessional projects for rehabilitation were established in Sweden in the late 1990s. This study explores the different views about the clients of such a project from the professionals of the organizations involved. Twenty-one key informants were interviewed in 1999 and 22 in 2002. The interviews were semi-structured and analysed with a phenomenographic approach. Four descriptive categories emerged: (A) the individual as consisting of components, (B) the individual in his/her context, (C) the individual as part of a group, and (D) the individual as part of the population. Category A included a paternalistic view and B included a maternalistic as well as an autonomous view. Both paternalism and maternalism imply an inequality in the relationship between the professional and the client. Category C had an organizational perspective, whereas category D had a community perspective. Both of these perspectives included an abstract view of the client. The conclusions were that the professionals had qualitatively different views on clients, which might lead to unequal encounters as well as differences in opportunities for rehabilitation. The results stress the importance of discussing what ethical values are desirable, not least in inter-organizational and interprofessional projects.

  • 40.
    Schölin, Karin
    Mälardalen University, School of Health, Care and Social Welfare.
    Ensam är aldrig stark: En kvalitativ studie om samverkan under arbetet med Lokala välfärdsbokslut2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Welfare is every person's right. To create conditions for a good welfare it requires coordinated strategic interventions at national and local level. Efforts must be politically supported to be able to strengthen public health. Local welfare management is a measure used to control and monitor public health. The purpose of this study was to investigate local actors perceptions of collaboration in strategic public health efforts with local welfare management in a municipality in central Sweden. The methodology approach was qualitative with a manifest content analysis and sentence concentrator. A total of five interviews with two politicians, two officials and a public health planner were conducted. The results showed that the respondents had an understanding of the benefits of collaboration. The strategic work was influenced by the interaction while working with local welfare accounts. Various collaborative projects had been started and there was a potential to incorporate public health in the strategic work. Participants experienced that health promotion effects of interaction gave them empowerment and good experiences that they carried with them in the continued strategic public health efforts. The conclusions were that local welfare management might be a success factor that spurs the strategic public health efforts in the community. As a result of the work the municipal actors became aware of each other and this could be important for future collaboration on public health between different actors in the municipality.

  • 41.
    Söderbäck, Maja
    Mälardalen University, School of Health, Care and Social Welfare.
    Mälardalen encontra-se com Maciene: - 9 estudos universatarios2009Collection (editor) (Other (popular science, discussion, etc.))
  • 42.
    Söderbäck, Maja
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Udén, Malin
    Mälardalen University, School of Health, Care and Social Welfare.
    We are the First Doctors Here at Home:: Women’s Perspectives on Sanitary Conditions in Mozambique2009In: Poverty in Africa / [ed] Thomas W. Beasley, © 2009 Nova Science Publishers, Inc. , 2009, 4th quarter, p. 41-74Chapter in book (Other academic)
    Abstract [en]

    Lack of sanitation is an important public health issue in low-income countries. Globally, the lack of sanitation affects some 2.8 billion people, mainly the poor, women and children. The people affected are deprived of their dignity and at risk for several severe diarrheal diseases. However, improvements are often hindered by the fact that human excrement is a sensitive issue, and feasible solutions fail to consider cultural and gender issues.

    With this background, this chapter focuses on women’s sanitary conditions in a rural African village (Mozambique). An ethnographic approach was used to investigate the everyday sanitary conditions, understood through a theoretical framework of equity in health, and gender was used for understanding. During a two-month stay in the village, women in three households were followed and observed in their everyday work to explore the sanitary prerequisites. Furthermore, official and traditional leaders in the village were interviewed about their perceptions of the women’s sanitary situation.

    The findings show that every woman and her family members are obligated to deal with their human waste on an individual basis, creating solutions mostly from what could be obtained free within the confinements of their yard. This unhygienic situation rendered the women fearful of disease and accidents, especially for their children, resulting in both psychological and physiological discomfort. Maintaining sanitation was female work. However, only men were allowed to build new latrines, causing difficulties for the many women without husbands. Several positive forces also existed: openness, interest, knowledge and an already existing net of community development. Improvements are instead held back by poverty and gender disparities, depriving women of control over their own home and health.

  • 43.
    Söderkvist, Sofia
    Mälardalen University, School of Health, Care and Social Welfare.
    Ordinerad fysisk aktivitet: En studie av avdelningschefers uppfattningar vidDivision Närsjukvård i Västmanland2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Physical activity decreases among the population. A more sedentary life style contributes to overweight and obesity which can cause life style related diseases. In the work to increase physical activity among the population physical activity on prescription has developed as a method in health care. In the County Council of Västmanland this working method applies under the concept Prescribed Physical Activity (OFA). This study was accomplished commissioned by the County Council of Västmanland. The aim of the study was to examine the opinions of the head of department, in the department of rehabilitation and the department of medicine in the County Council of Västmanland, about the work with OFA and the work on physical activity targeted to the employees and the population. A qualitative approach was applied for the study through interviews. The results show the difficulties with the introduction of OFA in the departments. The departments lack of routines and objectives for OFA as a work method. But the willingness to work with OFA and the understanding of its significant health effects for patients occurs in the departments. Employees of the department have taken note of the materials and educations available but the work with OFA is making slow progress. Benefits for the employees, regarding physical activity, is compensation from the County Council of Västmanland, and for some departments, half an hour of health related activities a week is available. Several departments are involved in activities to increase physical activity among the employees. The departments have no direct work to the population regarding physical activity. There are no guidelines on how this work should be carried out. The potential for a population-oriented work is considered to be small.

  • 44.
    von Thiele Schwarz, Ulrica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Förberg, U.
    Karolinska Institutet, Stockholm, Sweden.
    Sundell, K.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Colliding ideals - An interview study of how intervention researchers address adherence and adaptations in replication studies2018In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 18, no 1, article id 36Article, review/survey (Refereed)
    Abstract [en]

    Background: For an intervention to be considered evidence-based, findings need to be replicated. When this is done in new contexts (e.g., a new country), adaptations may be needed. Yet, we know little about how researchers approach this. This study aims to explore how researchers reason about adaptations and adherence when conducting replication studies, describe what adaptations they make and how these are reported in scientific journals. Methods: This was an interview study conducted in 2014 with principal investigators of Swedish replication studies reporting adaptations to an intervention from another country. Studies (n = 36) were identified through a database of 139 Swedish psychosocial and psychological intervention studies. Twenty of the 21 principal investigators agreed to participate in semi-structured telephone interviews, covering 33 interventions. Manifest content analysis was used to identify types of adaptations, and qualitative content analysis was used to explore reasoning and reporting of adaptations and adherence. Results: The most common adaptation was adding components and modifying the content to the target population and setting. When reasoning about adaptations and adherence, the researchers were influenced by four main factors: whether their implicit aim was to replicate or improve an intervention; the nature of evidence outlying the intervention such as manuals, theories and core components; the nature of the context, including approaches to cultural adaptations and constraints in delivering the intervention; and the needs of clients and professionals. Reporting of adaptations in scientific journals involved a conflict between transparency and practical concerns such as word count. Conclusions: Researchers responsible for replicating interventions in a new country face colliding ideals when trying to protect the internal validity of the study while considering adaptations to ensure that the intervention fits into the context. Implicit assumptions about the role of replication seemed to influence how this conflict was resolved. Some emphasised direct replications as central in the knowledge accumulation process (stressing adherence). Others assumed that interventions generally need to be improved, giving room for adaptations and reflecting an incremental approach to knowledge accumulation. This has implications for design and reporting of intervention studies as well as for how findings across studies are synthesised. 

  • 45.
    Wallin, Peter
    Mälardalen University, Department of Social Sciences.
    Vad kan skolan göra för att hjälpa barn med övervikt eller fetma?2007Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [sv]

    Syftet med den här studien var att belysa i vilken utsträckning skolan arbetar i linje med styrdokumenten, avseende hälsa, begränsat till övervikt och fetma. Läroplanen (Lpo 94) visar att skolan bland annat skall ge barnen en kunskap och förståelse kring att sättet att leva påverkar den egna hälsan. För att belysa hur skolan arbetar i enlighet med detta, intervjuades fyra lärare samt en rektor. Rektorer från sju andra skolor fick dessutom besvara enkätfrågor kring hur de arbetar med övervikt och fetma vid sina skolor. Resultatet visar att de medverkande skolorna i den här studien anser att de arbetar aktivt i frågan om hanteringen av barn med övervikt eller fetma. Metoder de använder för att uppnå detta är bland annat att uppmuntra daglig rörelse, servera bra och näringsrik mat, samt att låta barnen pröva på olika idrotter och dessutom via skolhälsovården stödja de barn och föräldrar som är i behov av hjälp.

  • 46.
    Wanger, Peter
    et al.
    St. Erik's Eye Hospital, Stockholm, Sweden.
    Martin, Lene
    Stockholm Univ. Coll. of Hlth. Sci., Stockholm, Sweden .
    Management of ocular hypertension and open-angle glaucoma: clinical practice and computer-assisted decision-making1997In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 75, no 6, p. 700-704Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the feasibility of computerized decision support in the management of patients with open angle glaucoma or ocularhypertension. Method: Based on a Swedish consensus document a computer program was developed, which provided one of 25 different recommendations for appropriate action. In 373 patient visits to seven different eye clinics, the program's recommendations were compared to the actual decisions made by the responsible ophthalmologists. Results: Notable differences were observed between the clinics' managementstrategies, especially regarding follow-up frequency and start or increase of antiglaucoma treatment. The program's recommendations conformed with the clinical decisions in 23 to 92% of the cases when a standard management strategy was simulated. The concordance increased to 93 to 100%, when policy differences between the clinics were taken into account. Conclusion: Clinical decision-making in the management of patients with ocular hypertension or open angle glaucoma can be implemented in a computer program. The optimum management protocol remains to be defined.

  • 47.
    Wihlman, Ulla
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Stålsby-Lundborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden .
    Holmström, Inger
    Uppsala University, Uppsala, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Organising vocational rehabilitation through interorganisational integration – a case study in Sweden2011In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, no 3, p. 169-183Article in journal (Refereed)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

  • 48.
    Zvar Hurtig, Robert
    Mälardalen University, School of Health, Care and Social Welfare.
    Mäns erfarenheter och värderingar av fetma och fetmakirurgi: En intervjustudie i Västmanlands län2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Fetma är en medicinsk diagnos och många av kroppens biologiska funktioner är i obalans med ökad risk för följdtillstånd. För att motverka ohälsan är viktminskning ofta det enda alternativet. Fetmakirurgi är en hållbar viktminskningsmetod, vanligast är gastric bypass, med snabba långsiktiga effekter på följdtillstånd. I riket, liksom i Västmanlands län opereras en övervägande majoritet kvinnor. Varför män i Västmanland opereras i lägre utsträckning än kvinnor är okänt.

    Syfte: Studiens syfte var att erhålla och analysera mäns värderingar och drivkrafter bakom fetmakirurgi. Målet var även att studera mäns subjektiva uppfattningar av västerländska kroppsideal och dess roll bakom beslutet till fetmakirurgi, samt deras förväntningar av det kirurgiska ingreppet.

    Metod: Informanterna rekryterades genom Överviktigas riksförbund i Västmanland. Urvalet bestod av fem män i åldern 40-49 år som samtliga intervjuades om subjektiva erfarenheter av och attityder till fetma och fetmakirurgi. Intervjuerna utfördes med hjälp av ett intervjuschema och en tematisk tankekarta baserade på Hälsouppfattningsmodellen.

    Resultat: Den övergripande drivkraften bakom beslutet var männens hälsa och välbefinnande. Att orka jobba och vara aktiv med familj och vänner beskrevs även som avgörande. Rådande kroppsideal eftersträvades inte. Enligt männen var fetmakirurgi resultatet av insiktsprocesser och ett tillräckligt socialt stöd; fler bör se fetmakirurgi som en hållbar viktminskningsmetod

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