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  • 1.
    Jansson, Elisabeth
    Mälardalen University, Department of Caring and Public Health Sciences.
    Tobaksavvänjningsverksamhet i Västmanland.2005Report (Other (popular science, discussion, etc.))
  • 2.
    Jansson, Elisabeth
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fosse, Elisabeth
    Bergen University, Norway.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Is there a gap in the health equity expressed in policy and practice2016Conference paper (Refereed)
    Abstract [en]

    Objectives

    The aim was to study the occurrence and how equality in health was expressed in policy and activities in four Swedish municipalities in the years 2006 and 2012.

    Methods

    A deductive content analysis of interviews with local municipal key persons, politicians and chief executives and policy documents in the form of annual reports, in four strategically selected municipalities in the region of Mälardalen in Sweden.

    Results

    In the documents, terms of equality, justice and vulnerable groups did not occur. However, these themes were mentioned by politicians and officials in most of the municipalities studied, and the issues of vulnerability and exclusion occur in both documents and interviews in most municipalities. These issues were conceptualized as various support measures, such as social and economic support, integration efforts, appropriate housing, promotion of employment and to provide security and a safe childhood. These issues occurred in all the documents and in some of the interviews. Priority groups in all municipalities were children, young people and older people but also immigrants. Barriers mentioned were the lack of qualified personnel such as social workers and support staff in schools.

    Conclusions

    Equality, health equity and reducing the gaps are not explicitly stated in the study of the municipalities. But the insight that disadvantaged groups needs support through actions and tailored training programs and work based on the individuals’ different conditions was emphasized.

  • 3.
    Jansson, Elisabeth
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Fosse, Elisabeth
    University of Bergen, Norway.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare.
    Jansson E, Fosse E, Tillgren P. The local perspective on the implementation of a national public health policy in Sweden – a case study from two municipalities. Abstract accepted for oral presentation at Symposium How to transfer public health research into practice – Challenges in implementation research. Stockholm, Sweden 2010-11-15—16.2010Conference paper (Other academic)
    Abstract [en]

    The local perspective on the implementation of a national public health policy in Sweden – a case study from two municipalities

    Author names (surname, initials): Elisabeth Janssona,b, , Elisabeth Fossec, Per Tillgrena,b

    Affiliations:

    School of  Health, Care and Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden

    b Department of Public Health Sciences, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden

    c Department of Health Promotion and Development, University of Bergen, Christiegt. 13, 5015 Bergen, Norway

     Background:

     In 2003 the Swedish parliament adopted a wide-ranging national objective for public health, focusing specifically on health determinants. It is envisaged that the overall objective will be achieved through the efforts of different bodies, including agencies, county councils and municipalities. Responsibility for implementation is located at regional and local level, without any specified guidelines or, for example, economic incentives for how the work should be performed.

     

    This study’s intention is, from a bottom-up perspective, to investigate public-health policies in two municipalities, and to see whether municipal policies can be related to the national objective.  The bottom-up perspective focuses on the actors, the people responsible for implementation, and on the process as seen from their own perspective. The implementers play a key role, as mediators of empirical knowledge and bases for decisions to the national decision-makers. Thus, in the implementation of national policy at local level, decision-makers are dependent on the decisions made and priorities set by the municipalities in their own local settings, as these are related to competing or similar laws, policies, stakeholders and needs. Local and committed actors have an important function in the implementation process. Serious commitment and occupying a position of power are important aspects of success, but so too is professional expertise. At the same time, local actors’ opportunities to act and implement national targets within their own organization is restricted by surrounding structures, e.g. the party-political (partisan) composition of the municipality and its administrative organization, and also the presence or not of formal or informal support networks.

     

    Methods:

     Scrutiny of documents and interviews provided a foundation for a qualitative case study.

    Results:

    The results reveal a loose fit between policy implementation and the national public health policy. The local level does not regard the national objective as implementable; instead, it has, to varying degrees, chosen to redefine its goals according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local public-health promotion.

     

    Discussion /Conclusions:

    Problems that accompany major, ambitious and non-specific goals, like those in the Swedish public health policy, are that they risk being integrated into a solely symbolic structure, entailing formal adoption but with only a superficial finish.  Below the surface, the informal, original organization remains in the administrations, which hinders implementation.

    Swedish municipal self-governance, with its enhanced scope for local action, offers an opportunity for communities to shape their own politics and policies. But, at the same time, this acts as a barrier to opportunities for decision-makers at national-government level to influence and guide the municipalities towards the national objective of more organized and structured health promotion focusing on the determinants of health enhanced knowledge of the policy, and of its specific focus on health determinants, is needed to increase understanding/motivation to implement the national policy locally.

     

     

     

     

  • 4.
    Jansson, Elisabeth
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fosse, Elisabeth
    Bergen University.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Municipalities setting approaches in local health promotion: A swedish case study2013Conference paper (Refereed)
    Abstract [en]

    Objective: Gain knowledge about municipalities’ setting approaches by studying four Swedish municipalities’ and how they practices settings in their organized and conducted local health promotion.Methods: A multiple case study design with content analysis of key person interviews and documents. Results: The municipalities stressed the importance of enable the inhabitants’ and staffs’ possibilities to maintain and achieve better health. In the case an explicit local health policy existed the focus was on specific target groups e.g. children, problem areas e.g. alcohol or on health outcomes as e.g. decreases in days of sick leave. Dependent on the nature of the problem, the strategies implicitly focused on intersectoral collaboration within the municipal administration and sectors or/and with external actors as official authorities, private companies, NGOs and neighboring municipalities, as well as between different levels and professions. Health promotion actions implemented were mainly established in more traditional and locally well-known local settings as schools, workplaces, family centers or libraries, but there were examples on efforts to create new venues to enable social wellbeing and supportive settings. Conclusions: The setting approach is consistent with the municipalities’ views and possibilities to handle complex public health issues, hence the setting approach is still going strong. Locally prioritized health issues based on local needs and prerequisites are preferably performed in traditional settings. The development and sustainability is seen as possible and achievable by intersectoral collaborations with engaged and committed actors in established arenas. Challenges in the municipalities’ setting approaches are related to factors like sectorial pipe-line organizations and e.g. confidentiality regulations in collaborations between the municipality and health care sector.

  • 5.
    Jansson, Elisabeth
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Fosse, Elisabeth
    HEMIL-sentret, Universitetet i Bergen.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare.
    National public health policy in a local context: implementation in two Swedish municipalitis2011In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 103, no 2-3, p. 219-227Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In 2003 the wide-ranging Swedish National Public Health Policy (SNPHP), with a focus on health determinants, was adopted by the Swedish parliament. In the context of multilevel governance, SNPHP implementation is dependent on self-governed municipalities and counties. The aim of the study is, from a municipal perspective, to investigate public-health policies in two municipalities. METHODS: Content analysis of documents and interviews provided a foundation for an explorative case study. RESULTS: The SNPHP at national level is overriding but politically controversial. At local level, a health-determinants perspective was detectable in the policies implemented, but none regarding to health equality. At local level, the SNPHP is not regarded as implementable; rather, limited parts have, to varying degrees, been reconciled with local public-health goals, according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local health promotion. CONCLUSIONS: The contents of national and local public-health policies differ, and municipalities that have implemented their own local health policies do not seem to regard the SNPHP as justifiable or adoptable. If the SNPHP overall aim regarding equal health is to be achieved homogeneously in Swedish municipalities, its contents and purpose need clearer management and negotiation, so that implementation of the national policy locally is understandable and motivated.

  • 6.
    Jansson, Elisabeth
    et al.
    Mälardalen University, Department of Caring and Public Health Sciences.
    Tillgren, Per
    Mälardalen University, Department of Caring and Public Health Sciences.
    Bracht et al five stage model.: A planning tool for case study rsearch.2006Conference paper (Refereed)
  • 7.
    Jansson, Elisabeth
    et al.
    Mälardalen University, Department of Caring and Public Health Sciences.
    Tillgren, Per
    Mälardalen University, Department of Caring and Public Health Sciences.
    Det lokala folkhälsoarbetets kontext - begreppets definition och position i nationella folkhälsodokument.2004In: Den 2:a nationella folkhälsostämman, Stockholm 11-13 oktober., 2004Conference paper (Other (popular science, discussion, etc.))
  • 8.
    Jansson, Elisabeth
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare.
    Health promotion at local level: A case study of content, organization and development in four Swedish municipalities2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no Article Number: 455Article in journal (Refereed)
    Abstract [en]

    Background: Several health determinants are related to local conditions and prerequisites at community level. For this reason, strengthening community action has been one of five strategies implemented in health promotion since the end of the 1980s. Such action includes setting priorities, making decisions, planning strategies, and implementing them to achieve better health. The aim of this paper is to obtain a deeper understanding of content, organization and processes in the development of local health promotion.

    Methods: A qualitative multiple case study of four Swedish municipalities. The cases were analyzed in accordance with the principles of cross-case study analysis, and a content analysis of documents and interviews was conducted in two steps. First, a manifest content analysis was performed to identify present and former actors and measures. Thereafter, a latent content analysis was performed to investigate structures and processes in local contexts.

    Results: The results of the inductive content analysis showed development of local health promotion in three phases: initiation, action, and achievement. Strengthening factors were local actors, health statistics and events. Hindering factors were lack of resources and vague objectives. External factors, e.g. national policies, were not perceived as prominent influencing factors. Media reports were regarded as having had an influence, but only to some extent. The content of local health promotion has developed from ad-hoc lifestyle and behaviour-related actions into structural, intersectoral actions related to determinants of health.

    Conclusions: The municipalities have organized and developed their health promotion targets, actions and priorities on the basis of local needs and prerequisites. The three phases in the identified health promotion processes were experienced and documented as being subject to greater influence from internal rather than external strengthening and hindering factors in their local contexts.

  • 9.
    Jansson, Elisabeth
    et al.
    Mälardalen University, Department of Caring and Public Health Sciences.
    Tillgren, Per
    Mälardalen University, Department of Caring and Public Health Sciences.
    Local politicians and Officials perspective on Health Promotion activities in four municipalities in Sweden.2007Manuscript (preprint) (Other (popular science, discussion, etc.))
    Abstract [en]

    Introduction: In the Swedish National Public Health Policy (SNPHP) from year 2003 the overall aim is "to create social conditions which ensure good health for the entire population". The policy includes three levels of determinants for health; structural factors, living conditions and lifestyles.

    The aim of this study was to gain knowledge about local politicians and officials definitions of local health promotion and activities in comparison with the SNPHP.

    Method: An empirical study based on semi structured interviews with 35 local government politicians and officials in four Swedish municipalities was conducted in year 2006. Content analysis has been used as the analytical approach to get systematic information from the transcripts of the interviews in order to gain deeper understanding of how the interviewed described local health promotion.

    Findings: The interviewed key persons define health promotion as wide-ranging incorporation of several actors in order to improve populations living conditions such as safe and healthy environments. Lifestyle issues mentioned is e.g. alcohol and tobacco prevention. Prioritized target groups for actions are children and adolescents. Politicians speak more about responsibility and structural issues and local officials talk more about community action.

    Conclusion: Local politicians and officials define health promotion as an extensive population-oriented phenomenon dependent of factors related to SNPHPs three levels of determinants for health. Also highlighted is the guiding principles of the Ottawa Charter such as intersectorial and community action.

  • 10.
    Jansson, Elisabeth VG
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Fosse, Elisabeth
    University of Bergen, Norway.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare.
    National public health policy in a local context: implementation in two Swedish municipalities2010In: How to transfer public health research into practice: Challenges in implementation research, 2010Conference paper (Refereed)
    Abstract [en]

    Background: In 2003 the Swedish parliament adopted a wide-ranging national objective for public health, focusing specifically on health determinants. It is envisaged that the overall objective will be achieved through the efforts of different bodies, including agencies, county councils and municipalities. Responsibility for implementation is located at regional and local level, without any specified guidelines or, for example, economic incentives for how the work should be performed.

    This study’s intention is, from a bottom-up perspective, to investigate public-health policy in two municipalities, and to see whether municipal policies can be related to the national objective.  The bottom-up perspective focuses on the actors, the people responsible for implementation, and on the process as seen from their own perspective. The implementers play a key role, as mediators of empirical knowledge and bases for decisions to the national decision-makers. Thus, in the implementation of national policy at local level, decision-makers are dependent on the decisions made and priorities set by the municipalities in their own local settings, as these are related to competing or similar laws, policies, stakeholders and needs. Local and committed actors have an important function in the implementation process. Serious commitment and occupying a position of power are important aspects of success, but so too is professional expertise. At the same time, local actors’ opportunities to act and implement national targets within their own organization is restricted by surrounding structures, e.g. the party-political (partisan) composition of the municipality and its administrative organization, and also the presence or not of formal or informal support networks.

    Methods: Scrutiny of documents and interviews provided a foundation for a qualitative case study.

    Results: The results reveal a loose fit between policy implementation and the national public health policy. The local level does not regard the national objective as implementable; instead, it has, to varying degrees, chosen to redefine its goals according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local public-health promotion.

    Discussion /Conclusions: Problems that accompany major, ambitious and non-specific goals, like those in the Swedish public health policy, are that they risk being integrated into a solely symbolic structure, entailing formal adoption but with only a superficial finish.  Below the surface, the informal, original organization remains in the administrations, which hinders implementation.

    Swedish municipal self-governance, with its enhanced scope for local action, offers an opportunity for communities to shape their own politics and policies. But, at the same time, this acts as a barrier to opportunities for decision-makers at national-government level to influence and guide the municipalities towards the national objective of more organized and structured health promotion focusing on the determinants of healthInc reased knowledge of the policy, and of its specific focus on health determinants, is needed to increase understanding/motivation to implement the national policy locally.

  • 11.
    Jansson, Elisabeth
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Zetterquist, Susanne
    Karlsson Vestman, Ove
    Mälardalen University, School of Education, Culture and Communication.
    Tillgren, Per
    Evaluating the implementation of a county council policy in two municipalities - methodological strategies and tools.2009Conference paper (Refereed)
    Abstract [en]

     

    Background: In year 2004 the Stockholm County Council (CC) approved a policy to reduce overweight and obesity. The implementation at local level started in two pilot municipalities during a two years period and resulted in several subprojects. Program theory (PT) is a methodology used to understand and identify key components in complex programs.

     

    Objectives: To highlight strategies and tools applied in planning and conducting an implementation evaluation of a CC policy in two municipalities.

     

    Methods: A descriptive process analysis of identified obstacles and solutions in all phases of the evaluation. Work notes, minutes from the steering group and the evaluating group meetings where analyzed to recapture the evaluation process.

     

    Result: PT was used to get an understanding of the components of the policy, the projects and their interrelations. Three separate PT where developed, one for the CC policy and one for the project in each municipality. To get a general idea of the projects and to organise the vast amount of documentation a form was developed for the project managers to fill in. To identify stakeholders and actors, organisational charts (OC) were developed for the project’s organisations including CC representatives. The evaluation’s data collection was based on principles for triangulation (documents, survey and interviews). The PT and OC where used in the purposeful sample of respondents. The PT and OC also worked as a component when reporting the results.

     

    Conclusion: PT is a useful tool to clarify the intentions and relations between levels of implementation when evaluating complex, multilevel programs. Using multiple means for data collection is a helpful strategy to generate both general and in depth understanding of a policy’s implementation. PT and OC are useful tools to make sure everyone has the same understanding of the policy’s components and organisation when communicating with stakeholders and respondents in all phases of the evaluation process.

  • 12.
    Wallin, Emmie
    et al.
    Mälardalen University, Department of Caring and Public Health Sciences.
    Jansson, Elisabeth
    Mälardalen University, Department of Caring and Public Health Sciences.
    Tillgren, Per
    Mälardalen University, Department of Caring and Public Health Sciences.
    Sustainable Development and Public Health – Could it be combined?2007Conference paper (Refereed)
    Abstract [en]

    Background: The WHO policy framework - Health for all in the 21st century – in the European region provides Health Promotion and thereby Public Health practitioners with an agenda that includes and highlights equity (health as a resource for all humans regardless of background), environmental aspects (influences peoples health and possibilities of being healthy) and economic aspects (the ability and possibility of making healthy choices). These dimensions are also the pillars of sustainable development. Besides these similarities the two concepts seems to cohere on several key points in their fundamental visions and strategies; long-term view, interdisciplinary collaboration, holistic approach including system thinking, democracy and participation etc. Although, are the concepts really coherent in their definitions and explanations of these visions and strategies?

    The objective is to study similarities and differences between the concepts of health promotion and sustainable development in Swedish national documents for public health and sustainable development between 1992 and 2006.

    Method: A systematic review of a strategically sample of governmental public health and sustainable development documents including a manifest content analysis to get an understanding of how health promotion and sustainable development as concepts are described.

    Expected results: Preliminary results indicate that the concepts have different approaches to a few of the similar key points, especially participation and democracy. The final results will help to clarify the relationship between the concepts of health promotion and sustainable development and will be presented at the conference.

  • 13.
    Zetterquist, Susanne
    et al.
    Folkhälsovetenskap, Social Medicine.
    Jansson, Elisabeth
    Mälardalen University, School of Health, Care and Social Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare.
    Karlsson Westman, Ove
    Mälardalen University, School of Health, Care and Social Welfare.
    Utvärdering av implementeringsprocessen för ”Ung & Sund i Sigtuna kommun” och folkhälsoprojektet i ”Ett gott liv för alla i Upplands Väsby kommun" en delutvärdering av Stockholms läns landstings Handlingsprogram övervikt och fetma 2004.2008Report (Other academic)
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