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Objective: International collaboration in science has received increasing attention given emphases on relevance, generalizability, and impact of research. Implementation science (IS) is a growing discipline that aims to translate clinical research findings into health services. Research is needed to identify efficient and effective ways to foster international collaboration in IS. Concept-mapping (CM) was utilized with a targeted sample for preliminary exploration of fostering international collaboration. Concept-mapping is a mixed-method approach (qualitative/quantitative) particularly suited for identifying essential themes and action items to facilitate planning among diverse stakeholders. We sought to identify key factors likely to facilitate productive and rewarding international collaborations in implementation research. Results: We identified eleven dimensions: Strategic Planning; Practicality; Define Common Principles; Technological Tools for Collaboration; Funding; Disseminate Importance of Fostering International Collaboration in IS; Knowledge Sharing; Innovative & Adaptive Research; Training IS Researchers; Networking & Shared Identity; Facilitate Meetings. Strategic Planning and Funding were highest rated for importance and Strategic Planning and Networking and Shared Identity were rated most feasible to institute. Fostering international collaboration in IS can accelerate the efficiency, relevance, and generalizability of implementation research. Strategies should be developed and tested to improve international collaborations and engage junior and experienced investigators in collaborations advancing implementation science and practice. 

In the realm of work environment improvements, the Nordic countries have led the way in demonstrating that employee participation is a key requisite for achieving improvements. Despite this, there is a lack of precision as to what ‘participatory’ in a participatory work environment intervention means. In this study, the authors present a conceptual model for participation in work environment interventions and apply it to protocols and manuals from eight participatory interventions to determine the form of participation used in each intervention. The authors suggest that the conceptual model can be applied in the design and assessment of participatory work environment interventions. 

AimWe aimed to identify measures used to assess the participation of disabled children and to map the measures' content to the family of participation-related constructs (fPRC) to inform future research and practice. MethodSix databases were searched to identify measures used to assess participation in health, psychology, and education research. Included studies involved children aged 0 to 18 years with a permanent impairment or developmental disability and reported use of a quantitative measure of participation. A second search sought relevant literature about each identified measure (including published manuals) to allow a comprehensive understanding of the measure. Measurement constructs of frequently reported measures were then mapped to the fPRC. ResultsFrom an initial yield of 32 767 articles, 578 reported one or more of 118 participation measures. Of these, 51 measures were reported in more than one article (our criterion) and were therefore eligible for mapping to the fPRC. Twenty-one measures quantified aspects of participation attendance, 10 quantified aspects of involvement as discrete scales, and four quantified attendance and involvement in a manner that could not be separated. InterpretationImproved understanding of participation and its related constructs is developing rapidly; thoughtful selection of measures in research is critical to further our knowledge base.

The evidence and effectiveness of physiotherapy interventions in treatment of patients with confirmed or suspected coronavirus disease 2019 (COVID-19) is limited. Routinely used interventions in physiotherapy imply a very high risk for physiotherapists because the duration of direct contact with patients is quite long. Physiotherapy may need to be administered by weighing the benefit-risk ratio. Therefore, there is a critical and urgent need to adopt alternatives or modified forms of physiotherapy interventions. As the situation for management of COVID-19 in low-resource contexts could differ from that in high resource context, interventions need to be adapted to the available resources and technology in various settings. Tele-physiotherapy could be a viable option for patients who are in acute care in the hospital, in rehabilitation unit or under quarantine at home due to confirmed or suspected COVID-19. Modification in physiotherapy interventions and adjustment in intervention parameters may serve as an alternative strategy. This article describes alternatives to and/or modification of routinely used physiotherapy interventions for achieving maximum patients' benefits and minimising therapists' exposure in treatment of individuals with confirmed or suspected COVID-19.

Aims and objectives: To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit. Background: The best interests of the child are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations. Design: A qualitative descriptive study with overt, non-participant observations fulfilling the COREQ criteria. Methods: Thirty-two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and abstraction of observed patterns of the best interest of the child. Results: Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child. Conclusions: Determining the best interest of the child requires a case-by-case basis, as it is context-dependent, situational, flexible and dependent on all actors involved and actual decisions made. Relevance to clinical practice: Healthcare professionals’ actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals’ communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.

Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R2= 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

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. 

he aim of this article is to elucidate and discuss the results of the 2016 Diversity Barometer (Mångfaldsbarometern) and compare these results with those obtained from ten years of the longitudinal Diversity Barometers for 2005?2014. An additional aim is to demonstrate whether and how Swedish people?s experiences of and attitudes toward people with a foreign background and ethnic diversity have changed.A random sample of the Swedish population took part in the annual study, which was carried out in the form of a nationwide postal survey. The results show that negative attitudes toward ethnic and cultural diversity in general, and migrant population in particular, have increased to some extent and with respect to certain issues. Views on diversity in relation to culture and religion ? especially Islam ? were more negative than views on diversity in relation to work. Those who have larger experience of contact with foreigners show a more positive attitude toward diversity compared with those with limited experience and contact. Individuals who have higher education, those who identify themselves as female, younger persons and those living in large cities are more positive than other groups. In our analysis of the empirical data, we proceeded from a social work perspective and applied contact theory and group conflict theories relating attitudes to group position.

This article aims to discuss changes in attitudes towards immigrants in Sweden from 2015 onwards, based on the results of the longitudinal Diversity Barometer studies from 2005-2014, 2016 and 2018. The Diversity Barometer studies are based on a national, representative, and randomly selected sample from the Swedish population, with a new sample selected each time. We have analyzed the changes from a sociological perspective, using theories such as contact theory and group conflict theory. The results show an increase in negative attitudes towards ethic and cultural diversity generally, and towards immigrants specifically. Diversity in culture and religion – especially towards Islam – is more negatively perceived as compared to diversity in the work domain. Societal groups with extensive experience from contact with foreigners, those who identify themselves as women, those who are more educated, younger people and city dwellers, have all a more positive attitude towards diversity than others.

Bakgrund: Stroke är ett allvarligt medicinskt tillstånd där syretillförsel i hjärnan är hämmad på grund av blodpropp eller blödningar i hjärnan. Utöver funktionsnedsättningar som sjukdomen medför som rörelsebegräsningar, minnesförlust, förlamningar och kognitiva svårigheter upplever också patienter med stroke psykiska påfrestningar som depression, ångest, oro och känsla av uppgivenhet. Syfte: Att beskriva sjuksköterskors upplevelser av att stödja patienters återhämtning efter stroke. Metod: En systematisk litteraturstudie baserad på tio vårdvetenskapliga artiklar. Resultat: I resultat framkom två teman och sex tillhörande subteman där sjuksköterskors upplevelser av att stödja patienters återhämtning efter stroke belystes. I första temat: Organisatoriska förutsättningar med tillhörande subteman, mer kunskap behövs, att ha mer tid och att samarbeta i teamet. I andra temat: förutsättningar i vårdande med tillhörande subteman kommunikation betydelse, relation med patienter och relation med anhöriga. Slutsats: Tid respektive kunskapsbrist leder till hinder som gör att sjuksköterskor upplever begränsningar i deras arbete att stödja återhämtning på patienter med stroke. För att motverka dessa hinder och minska sjukdomens negativa påverkan behöver patienter mer tid och tydliga mål för snabbare återhämtning.

Background Visually impaired older persons need support in daily activities, e.g. moving around inside the house; making and eating food and taking medicine independently. A system that simulates the environment based on both dynamic and static objects, identify obstacles, navigates and translates sensory information in voice would be valuable to support their daily activities. Today several sensors and camera-based systems are popular as ambient-assisted living tools for older adults. However, intelligent assisting aid (IAA) to support older individuals with a recently acquired visual impairment is limited. The proposed system ‘Third Eye’ focuses on the advanced research and development of an IAA to support older individuals with a recently acquired visual impairment. The main goal in this system is to provide a usable, feasible and cost-effective solution for older persons to support their daily activities using intelligent sensor based system. Method The system consists of the following five phases to meet several central challenges in developing IAA in such domain. • User-perspective, focuses on user-driven technical development, investigating needs of potential users. The study will have a participatory design with focus group interviews of lead users. • Sensor-based system, focuses on the identification obstacles based on ultrasounds and/or radio frequencies embedded in white-cane or weaker. • Camera-based system, focuses on image based information translation into voice embedded in white-cane or weaker or glasses. • System of systems, focuses on integration of above systems where knowledge is engineered and suitable representations are learned and reasoning for decisions are made [9]. • Experimental, focuses on usability and feasibility of the IAA, with idiographic and group studies Results The initial results have shown the necessity of the proposed AAI systems for older individuals with a recently acquired visual impairment. However, more extension work e.g., process and analyze the information and synthesize it with existing literature for developing the system is ongoing.

Syftet med studien var att beskriva och analysera kvinnors självupplevda erfarenheter av prostitution. Studien önskade besvara frågeställningen: vilka förväntningar, händelser, upplevelser och känslor som format dessa kvinnors resa i steget in, genom och ur prostitution? Studien som var av en kvalitativ ansats har baserats på sex ostrukturerade livsberättelser av kvinnor med erfarenhet av prostitution. Fokus vid intervjuerna har varit kvinnornas egna beskrivningar, upplevelser och känslor av resan in, under och ur prostitution. Studien har haft ett socialpsykologiskt perspektiv som utgångspunkt och dess teoretiska ramverk har bestått av Scheffs begrepp om skam, Goffmans teori om stigma samt Fuchs Ebaugh’s teori “the process of role exit”. Studiens resultat visade på att flera samverkande händelser och upplevelser i kvinnornas liv påverkade deras känslor och förväntningar på sig själva, vilket var framträdande inslag i kvinnornas livsberättelser om deras process, in- genom och ut ur prostitution. Kvinnornas upplevelser och känslor kring prostitutionen framkom vara komplexa. För att kunna bemöta och stödja kvinnor med prostitutionserfarenhet krävs av socialarbetare en förmåga att lyssna utan att döma och kunskap om prostitutionsprocessen. Detta för att inte ytterligare skambelägga och stigmatisera kvinnor med prostitutionserfarenhet.

Physically demanding work in middle-aged and ageing employees is associated with poor physical functioning. Also younger employees have limitations in their daily functioning, but there is no research on the associations between physically demanding work and physical functioning during early careers. This study investigated whether physically demanding work is associated with physical functioning in employees aged 18–39 years.  The data were collected in autumn 2017 from the City of Helsinki employees born in or after 1978 (n=11,459). Out of them, 5,111 responded online or via a mailed paper survey. We included those 4,585 (40% of all those invited) who had responded to all necessary questions for the present study. Physical functioning was assessed by the SF-36 questionnaire, and poor physical functioning was defined as the lowest quarter of the physical functioning score (PCS ≤48.80, total scale 1-100). Physical workload was determined with a multi-part question about factors related to work and the work environment, and the degree of perceived harm caused by them. The physical workload scores were divided into thirds. Logistic regression analysis was used to examine the associations between physically demanding work and physical functioning, while adjusting for health behaviours, sleep problems, body mass index, education and marital status.  Poor physical functioning was associated with physically moderately (OR 1.70, 95%CI 1.43-2.00) and highly (OR 3.56 [2.70-4.70]) demanding work. In addition, frequent sleep problems (OR 1.90 [1.67-2.22]), obesity (OR 1.89 [1.56-2.30]) and low education (OR 1.37 [1.10-1.71]) were associated with poor physical functioning.  Tackling physically demanding work may play a role in maintaining physical functioning (and subsequently) working capacity.

Keywords: physical functioning, work load, young workers, health behaviour

Background: Female genital mutilation/cutting (FGM/C) may increase the risk of health consequences in girls and women. Public health policies and guidelines on providing care for this target group should be implemented in the healthcare services. Objectives: The aim of this brief report was to introduce innovations in Swedish healthcare for women and girls who have been subjected to FGM/C in order to advance our knowledge and understanding the adoption, implementation, and potential scale-up of healthcare services for this target group in Iran. Methods: Data were collected from a register study, an inventory of regional guidelines in Sweden, and a literature review. Results: The results show that care offers can be categorized as obstetric and gynecological care, psychosexual consulting, and plastic surgery. The results can be adapted and implemented in an Iranian context by preparing guidelines for providing care for this target group at the region, province, and country level. Conclusions: Another suggestion for improvement of care for women and girls exposed to FGM/C in Iran is the use of diagnosis codes recommended by WHO to register, map, and follow up these patients. Obstetric and gynecological, plastic surgery, psychosexual consulting may be recommended to provide person-centered care.

Objectives: This study aimed to systematically review the literature on the Iranian healthcare system in the time of increasing privatization. Methods: A systematic literature review was conducted using MEDLINE, CINAHL, APA PschInfo, and Cochrane databases to identify various concepts in the literature concerning the privatization of healthcare in Iran between September and November 2020. All the included articles were assessed using the John Hopkins Nursing Evidence-Based Practice Research tool. In addition, grey literature was searched using Google targeted at academic websites and key organizations and online newspapers and magazines in the Persian language. This screening resulted in a total of 70 articles, reports, and documents. The PRISMA guidelines were followed for abstracting data and assessing the quality of the studies. Results: Six health-related items were identified at the time of increased privatization in the healthcare system. These items consisted of medical establishments, accessibility, and privatization, catastrophic health expenditure (CHE), out-of-pocket payment (OOP), health inequality, privatization, and healthcare providers, and the policy and finance of privatization. Conclusions: The review identified that the process of privatization of the healthcare system in Iran occurred with poor monitoring and evaluation mechanisms. Privatization rested on neoliberal arguments, and for-profit care has worsened healthcare performance and created an unfair, expensive healthcare system of lower quality in Iran.

To find out the patients’ perceptions of the care and welfare services is important in order to develop the quality of care. The purpose of this study was to investigate the patients’ perspectives on care on equal terms and on their ideas about methods for a more equitable care. To achieve the purpose, qualitative methods were used in form of conducting interviews with patients’ and representatives of patient organizations. The results show that patients’ perceive that in order to achieve a more equitable care continuity, time during consultations, availability, communication and encounter should evolve and become better.

Equity in access to primary health care services is a central objective of the Swedish health care system. Yet, several reports have illustrated that disparities still exist in the primary health sector, and have increased since the beginning of the 1990s. This commentary analyzes and explains the reasons for continuing inequality in access to and utilization of primary health care services in a welfare system. Social and structural factors, communication, macro-sociological aspects and health care providers’ attitudes and perceptions are discussed as substantial contributors to inequality in access to and utilization of primary health care services. In conclusion, some intervention strategies for promoting more equitable primary health care are suggested.

Equity in health and providing care on equal terms is one of the most important aspects of a welfare society. Several reports indicate that the health care services are not equal. The purpose of this study was to study health care providers’ perceptions on equitable care and their ideas about methods to achieve a more equitable care. An web survey was sent to health care providers whose unit were involved in the project "Care on equal terms" before and after the project period. The results show that health care providers perceived that the factors that influence clients’/ patients’ access to care on equal terms consists of: structural / organizational factors in the health care organization or in the society and clients’/ patients’ social situation.

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.

To investigate variations in explanations given for disparities in health care use between migrant and non-migrant groups, by clients and care providers in Sweden. Qualitative evidence collected during in-depth interviews with five 'migrant' health service clients and five physicians. The interview data generated three categories which were perceived by respondents to produce ethnic differences in health service use: "Communication issues", "Cultural differences in approaches to medical consultations" and "Effects of perceptions of inequalities in care quality and discrimination". Explanations for disparities in health care use in Sweden can be categorized into those reflecting social/structural conditions and the presence/absence of power and those using cultural/behavioural explanations. The negative perceptions of 'migrant' clients held by some Swedish physicians place the onus for addressing their poor health with the clients themselves and risks perpetuating their health disadvantage. The power disparity between doctors and 'migrant' patients encourages a sense of powerlessness and mistreatment among patients.

Abstract Introduction: To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden's national Care on Equal Terms project. Methods: Mixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used. Results: The interview data were divided into two main categories and three subcategories. The first category "Perception of equitable health care" had two subcategories, namely "Health care providers' perceptions" and "Fairness and participation". The second category "To achieve more equitable health care" had four subcategories: "Encounter", "Access", "Interpreters and bilingual/diverse health care providers" and "Time pressure and continuity". Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful. Conclusions: Clients/patients perceived health care providers' perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter if needed. Employing bilingual/diverse kinds of health providers is a way of providing more equitable primary health care.

Introduction: The Swedish Health Care Law requires the health system to provide good care on equal terms to all. However, several reports from different governmental agencies have revealed that health care is uneven in quality, lacking in accessibility, and not offered on equal terms to all people. Recent public health reports show that inequalities in health in the population have increased. To provide health care on equal terms has become a challenge for health care.

In order to apply methods for developing practice and policy in promoting health and equity the Swedish Association of Local Authorities and Regions developed and implemented a national project entitled Care on Equal Terms. The project began in 2011 and was completed in 2014 at seven Primary Health Care Units (PHCUs) in five regions. The aim of this study was to evaluate the outcomes of this project.

Methods: Based on a program theoretical approach an evaluation design was developed which included process, results and economical evaluation. In the data collection and analysis mixed methods were applied.

Results: According to the process evaluation, seven different strategies were applied in the process to develop primary health care on equal terms. One of the key observations was that in order to achieve health on more equal terms, health care needs to be provided on unequal terms, i. e. more needs to be done to reach those who need more assistance to access health services. Health promotion was one of the applied strategies and it was the most common strategy at some of the health care centers with the aim of developing patients' knowledge, awareness and understanding about health, care and self-care. The results evaluation showed that the PHCUs staff identified structural and organizational factors in health care as important factors for developing health promotion and equity in access. The health economic evaluation showed that the costs for implementing the activities for an improved equity were limited. Yet the majority of the PHCUs thought that the detailed regulation of their financing and reporting requirements were a limitation in their work for improved equity. Four of five county councils have recently introduced a primary care provider payment system (ACG) which may not be supportive of efforts to improve equity in access.

Conclusions: It is possible to develop and maintain practices that can contribute to more equitable care and increase health care personnel’s awareness about practice and policy in promoting health and equity.

Background: Risk perception has been studied concerning the use of marijuana and it impacts the intention to use that specific substance.

Aim: The aim was to study the association between the perceived risk of cannabis use and cannabis use among Swedish youth after controlling for gender, age, and education. The aim was also to study whether the association between the perceived risk of cannabis use and cannabis use was different according to gender.

Method: The thesis project was based on data from the Flash Eurobarometer 330 - Youth Attitudes on Drugs.

Results: When age and education were controlled for, both among Swedish youth and among male participants, the perceived risk had an association with cannabis use - higher risk perception entailed a lower use.

Discussion: The association between the perceived risk of cannabis use and cannabis use appears to be due to the impact of risk perception on behaviour.

Conclusion: By preserving the risk perception that Swedish youth have of cannabis, it may be possible to protect them from the potential harm that cannabis use cause.

Andra generationens invandrare slits enligt tidigare studier mellan två kulturella världar och ställs därav inför utmaningen att skapa en fungerande helhet mellan världarna. Syftet med studien var att undersöka vad upplevelsen av att tillhöra två kulturer kan betyda för självbilden hos andra generationens invandrare. Deltagarna var 10 kvinnor och fem män. Vi utgick ifrån ett hermeneutiskt perspektiv och intervjuerna transkriberades och tematiserades utifrån fokus på meningen. I resultatet redovisades tre huvudteman och 12 underteman. Resultatet för första huvudtemat visade att omgivningen har en inverkan på känslan av tillhörighet. För andra huvudtemat visade det sig att ha två kulturer bidrog med ett flertal faktorer som påverkade deltagarna. Sista huvudtemat visade att språket var en viktig del av självuppfattningen. Samtliga av dessa huvudteman kan tänkas ha påverkat självbilden både negativt och positivt. Resultatet visar bl.a. att omgivningen har en inverkan på självbilden och att deltagarna påverkades av hur de vill bli sedda.

Children’s experiences of empowerment in relation to preschool peers and in child–adult interactions were studied, involving 25 four-to six-year-olds from four Swedish preschools. Group interviews using puppets comprised pre-constructed scenarios to examine preschools’ activities. Children took photos of indoor and outdoor preschool environments, followed by a photo-elicitation interview. Data were analysed by content analysis. Results showed that authority was expressed in relation to teachers and parents. Children negotiated about handling situations and described relations with teachers as uncomplicated; the contrary was the case with peers. Structure meant that children could choose between courses of action within set frames, describing empowerment as decision-making within limitations. Results indicated the importance of preschool teachers stimulating children to reflect on their own ability by discussing issues concerning children’s sense of empowerment, using methods similar to the ones in this study.

Sweden is well known for its family policy and this study explores whether fathers’ parental leave is related to later division of childcare and housework. Two materials were used; a panel survey (2003, 2009) and an interview study (2008). Respondents in the survey had their first child between the waves and the interview-study focused on parents of 2–3 year olds. The survey is analyzed by logistic regression and the interviews by grounded theory. The results indicate that when fathers took long leave parents shared both household tasks and childcare more equally after the leave. Higher expectations of sharing childcare is related to a higher share of divided childcare once becoming parents, although it seems that some tasks are more often shared than others. When the father took long leave both parents mention that the child relates to the father as much as the mother in everyday life.

This paper investigated Swedish and US fathers’ experiences of work-family conflict, possible solutions, and actual changes to their work situation in relation to becoming a parent. The Swedish data were drawn from interviews completed in 2008 with 16 fathers with a child born in 2005 or 2006. The US data came from interviews conducted between 2005 and 2007 with 26 fathers with at least one child age five or younger. The semi-structured interviews were analyzed according to grounded theory. In terms of conflicts, half of the Swedish fathers mention time pressures or stress, with some referring to work-life balance as a puzzle. Findings indicate that the US fathers think that they work too much overtime as well as shift hours, and they also mention arguments with their partner about responsibility at home. At the same time, a majority of both US and Swedish fathers emphasize family as a priority over work. In terms of possible solutions, a common theme among Swedish fathers is to mention that ideal work hours would be less than their current hours, with some wishing for a shorter work week (e.g., 4 days) and others a shorter work day (e.g., 6 hours). US fathers most commonly wish for a more flexible work-life situation. In terms of actual changes, several fathers adjust their work lives in response to their family life. Among Swedish fathers, the most common changes involve working fewer hours, adjusting their start and end times, and taking advantage of flexible hours. Swedish fathers also emphasize trading off with their partners, including ‘shift parenting.’ As for US fathers, some have changed their job to be more at home, some changed from working three shifts and some fathers solved the situation by intense work during a limited time.

This chapter investigated Swedish and US fathers’ experiences of work-family conflict, possible solutions, and actual changes to their work situation in relation to becoming a parent. The Swedish data were drawn from interviews completed in 2008 with 16 fathers with a child born in 2005 or 2006. The US data came from interviews conducted between 2005 and 2007 with 26 fathers with at least one child age five or younger. The Swedish semi-structured interviews were analyzed according to grounded theory. In terms of conflicts, half of the Swedish fathers mention time pressures or stress, with some referring to work-life balance as a puzzle. Findings indicate that the US fathers think that they work too much overtime as well as shift hours, and they also mention arguments with their partner about responsibility at home. At the same time, a majority of both US and Swedish fathers emphasize family as a priority over work. In terms of possible solutions, a common theme among Swedish fathers is to mention that ideal work hours would be less than their current hours, with some wishing for a shorter work week (e.g., 4 days) and others a shorter work day (e.g., 6 hours). US fathers most commonly wish for a more flexible work-life situation. In terms of actual changes, several fathers adjust their work lives in response to their family life. Among Swedish fathers, the most common changes involve working fewer hours, adjusting their start and end times, and taking advantage of flexible hours. Swedish fathers also emphasize trading off with their partners, including ‘shift parenting.’ As for US fathers, some have changed their job to be more at home, some changed from working three shifts and some fathers solved the situation by intense work during a limited time.

Increasing mental ill-health among youth and young people sent back and forth between different welfare state actors have been subjects of concern in Sweden in recent years. These young people are often labelled as having ‘complex needs’, with a placement as the social services’ possible intervention. What do young people stress as positive as well as negative experiences with placements? How can the concept ‘complex needs’ be understood in relation to placements? Semi-structured interviews were made in 2018, in two municipalities, with 9 young people between 15-22 years. They have received support from social services and psychiatric care, often related to substance abuse. The young people’s history is often a long-term process of different forms of placements, both in families as well as in residential care. Too short-term interventions may lead to discontinuity in care. Residential care is often perceived of as more storage than treatment and care. Implications are that the young person’s placement need to be more carefully monitored. Treatment introduced at the placement need to be better coordinated and evaluated jointly by social services and psychiatric care. It is important that professionals have more interventions to suggest and are working proactively to avoid future placements.

The aim of this integrative review is to investigate research of social work practices for adolescents and young adults with complex needs. The research questions are: What are the major themes in studies of practices for young people with complex needs? How do studies suggest that complex needs can be met in ways that are beneficial for young people? A young person with complex needs is in this review defined as an adolescent or young adult who, due to mental ill-health in combination with different types of social vulnerabilities, is receiving assistance from multiple welfare services. Searches were conducted in seven databases. These searches resulted in a sample of 1677 records, published 2007-2016, which in the screening process were reduced to 24 publications, all peer-reviewed articles. The participants in the studies in the articles consisted of young people, parents and professionals from mainly Anglo-Saxon countries. The articles were analyzed with qualitative summative content analysis. Three empirically generated themes were found in studies of work practices targeting young people with complex needs: collaboration-, relationship- and empowerment-oriented practices. In conclusion, the practices contain a wide variety of features, but with the joint aim of acknowledging young people's needs. The results can be used by practitioners and policymakers to further the development of services for youth with mental ill-health and social vulnerabilities, who use multiple welfare services.

The paper uses the concept of recognition to investigate how young people labelled as having ‘complex needs’ experience their encounters with welfare state actors. Semi-structured interviews were held in 2018 with 14 young people, aged 15–22 years, in two Swedish municipalities. The participants have received multiple, long-term interventions from social services and psychiatric care. Research questions are: What aspects in the encounters between welfare state actors and young people may contribute to complexity in their life situations? How can Honneth’s concept of recognition illuminate this complexity? Aspects that have contributed to complexity in young people’s life situations are related to acts of dismissal. These dismissals by welfare state actors are interpreted as forms of disrespect as regards affection, rights or solidarity. Barriers to recognition are also related to the participants’ young age and position as children, and what this implies in a particular society. Our findings show that the difficulties young people face in their encounters with welfare state actors are partly due to the high level of specialization which contributes to an increased organizational complexity. Implications include that, when encountering young people in complex life situations, welfare state actors need to consider the importance of recognition as regards affection, rights, and solidarity. Recognition is central to achieving a positive outcome in working with young people in complex life situations and is expressed in social interactions. Therefore, building relationships needs to be more highly prioritized in welfare state organizations. young people in complex life situations and is expressed in social interactions. Therefore, building relationships needs to be more highly prioritized in welfare state organizations.

Mental ill-health among young people has increased in the past decades in Sweden as well as in other western countries. When mental ill-health is connected with social vulnerability such as difficulties in completing education, unemployment or substance abuse you may be considered to have “complex needs”. This paper presents findings from a project (2016-2018) in two municipalities. The data consists of semi-structured interviews from two sub studies. One with 13 young persons (15-25 years) who have been or are recipients of long-term support from social services as well as psychiatric care, and one with 24 professionals from social services and psychiatric care. The aim is to investigate young people’s and professionals’ experiences of work practices aiming at increased well-being for young people labelled as having complex needs. The research questions are: What barriers for work practices for sustainable support are there from the young people’s perspective? How to overcome work practice barriers for giving sustainable support, from the professionals’ perspective? The questions are reflected in three themes; empowerment, relationships and collaboration. Barriers mentioned by the young people are high employee turnover as well as too many professionals involved in activities. Professionals might have their own ideas about what should be done, not taking the wishes of the young person into consideration to a satisfying level. In collaboration between different organizations, the professionals consider it important with at least one person who has the influence in several of them. To take the young person seriously as well as staying on in difficult times are considered important. We argue that the expression complex needs, when used as a way to categorize young people, may obscure that the problem also lies with highly specialized and complex welfare state organizations.  They do not always succeed in catering for the interconnected needs of their clients.

This paper presents findings from a Swedish interview study from 2016-2017 with 20 professionals working with young people, who suffer from a combination of mental ill-health and social vulnerability. They have been recipients of long-term support from multiple welfare service actors with the aim of promoting the young people’s wellbeing. The aim of the study is to investigate professionals’ experiences of work practices aiming at increased wellbeing for this group of young people. Mental ill-health among young people has increased in the past decades in Sweden as well as in many other western countries. Mental ill-health has also been connected with social vulnerability such as difficulties in completing education, unemployment, out-of-home care or substance abuse. This group of young people are sometimes referred to as youth with complex needs. Complex needs is a concept used to categorize people that have multiple interconnected needs that span medical and social issues, people that are considered as especially disadvantaged, or presenting challenges to welfare services. Categorizations of people and needs are prerequisites for legal, bureaucratic and professional systems within the welfare state. Welfare organizations construct knowledge and strategies regarding specific target groups according to these categorizations. In the paper we argue that the expression complex needs, when used as a way to categorize young people, not necessarily take into consideration that the problem instead may be the complex organizations that young people meet. These organizations may not always succeed in catering for the needs of young people.

This paper concerns preconditions for the well-being of young people with mental ill-health combined with social vulnerabilities, also referred to as youth with complex needs. Research questions are: What barriers to sustainable work practices for young people labelled as having complex needs do professionals encounter? What do professionals identify as possible ways to overcome these barriers? Sustainable work practices are reflected in three themes: empowerment, relationships and collaboration. The findings are based on semi-structured interviews with 24 professionals, 3 men and 21 women, working in psychiatric care and the social services in two Swedish municipalities in 2016 and 2017. Major barriers are lack of continuity and co-ordination in staff and support, and fragmentation of work practices. As a consequence of the increased specialization of human service organizations, young people have to interact with many different professionals which could cause disparate interventions. Possible ways mentioned to overcome these barriers are supported through good interactional skills, using keyworkers as well therapeutic alliances, wrap-around services and case management. Complexity is linked to organizations and work practices rather than to young people. An often dysfunctional service delivery system in organizations with rigid boundaries may also affect professionals’ aim for sustainable support.

A Japanese Narrative 1992 - 2016.

Applying a Relational Perspective on Ageing, Life and Care

 A qualitative longitudinal study evolved as I followed the Suzuki couple in Japan for more than two decades through life turning points and crises. Would the traditions of filial duty guide their choices, or would the Suzuki couples’ clearly voiced wish to live on their own and take care of themselves be respected?  I have followed their temporary move to their daughter’s residence following upon the 1995 Hanshin Earthquake when they lost their house, their permanent move to a condominium purchased by son, and a couple of years thereafter, the sudden death of Mr Suzuki. Since his death, I met Ms Suzuki every or every other year, last time was in 2016  when she still lived at home (with dementia) and enjoyed regular visits to a day care center

This paper will discuss views on ageing, care and life from a relational point of view and within a life course perspective. This paper also encounters death as part of life and relations    Though a one case study, this paper will also draw on some previous studies in the fields of social and cross-cultural gerontology.

Title: Dementia care and “best practice” - in everyday life until end of life

Background: This study is part of a project financed by Mälardalen Skill Centre for Health and Welfare (MKHV) 2016-2018, aiming at providing practitioners bases to develop evidence based activities in municipal eldercare.

Aim: To search for “best practice” within municipal care for older persons with dementia (PWD), through a knowledge overview.

Methods: Based on a literature review with search words taking a broad view, 36 articles were analyzed and categorized into three areas: 1. End of life care (EOL) 2. Education for staff and 3. Knowledge of caring and interacting from the perspectives of PWD, next of kin, care professionals and management. The results were presented at three seminars for practitioners who were invited to give feedback.

Results: EOL: Findings show diversity between different care professionals, the PWD and next of kin. Care professionals and next of kin seldom regard dementia as the terminal illness it is. This makes the border between everyday life and end of life care blurred which complicates care and interactions. Education: Intervention studies with education program based on a learning philosophy and focusing on communication are promising. Interprofessional education may help staff to think outside the box. When structural reforms are included in interventions there is a potential for lasting change. Knowledge of caring and interacting showed diverse views on therapies, where intentions of therapies may clash with PWD´s perspectives, such as symptom control rather than adding quality of life. Care management assessments risk being discriminatory if PWD are treated as objects. Nuanced examples of life review and validation method challenge routines and show potentials to enrich life and care of PWD.

Conclusions: A broad view on “best practice” informs dementia care with a holistic perspective encompassing art, communication skills, life history, interprofessional cooperation as well as environmental aspects of everyday life until end of life. More participant observation type of studies are welcome to capture the interplay between the actors: older PWD, their next of kin and care professionals. PWD´s voices are crucial to develop best practices.