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This thesis gives an insight about the impact of hearing loss on young adults as they function in daily life. Young adults with hearing loss included in the thesis can convey a very central perspective that can have an impact on a change in interventions and treatment in school life, working life and even in their leisure time. The overall aim of the thesis is to study the living conditions and life experiences of young men and women who are deaf or hard of hearing (DHH). Despite the increased proportion of people with hearing loss, there still seem to be challenges in the face of inclusive environments for people with hearing loss. This thesis hopes to shed some light on the experiences of people with hearing loss and also to explain the link between hearing loss, social inclusion and social exclusion.

The thesis is based on four different sub-studies. In Studies I and IV, a survey study with material collected from the web-based survey Liv och Hälsa Ung (Life and Health of Young People) was used. Pupils attending grades 7 and 9 in compulsory schools and year 2 in upper-secondary schools in all municipalities of the county of Örebro in Sweden. Life and Health of Young People survey examines young people's living conditions, lifestyles and health. The results of Study I showed that people with (DHH) experienced lower levels of well-being than those who had no disability. The results also showed that those who went to special school felt that they had more friends and were more socially included than those who went to mainstream schools. The results of Study IV showed that adolescents without disabilities rate their well-being higher, have lower mental ill-health and have fewer somatic problems than adolescents with DHH. The results also showed that boys rate their well-being, lower mental ill-health and somatic problems higher than girls. These patterns were the same regardless of whether the adolescents had a disability and regardless of their year in school.

In Studies II and III, interviews were conducted with 16 participants (10 male, 6 female), aged 24 to 31 years, and all had severe-to-profound hearing loss. The results of that analysis in Study II showed that they longed to be included, to be accepted, to create an inclusive social environment, to find friends and partners, and to communicate effectively so that they could be understood. In other words, they desired to feel a sense of belonging. Study III showed that most HH people experience communication barriers in higher education, at work and in leisure time. These barriers lead to feelings of loneliness and make it difficult to achieve social inclusion. Another result in study III revealed how important technology is for social interactions and social relationships. The technology has helped reduce several barriers when it comes to communicating with others. Both Assistant Technology (AT) and Information and Communication Technology (ICT) are important tools for facilitate social interaction and maintaining social activities with friends and partner and creating inclusive arenas.

This study examines the question of which school environment - special or mainstream school - is more favourable for deaf and hard-of-hearing students in Sweden, when it comes to their well-being, and their social and academic inclusion. The aim is threefold: first to compare the well-being of adolescents who are deaf or hard-of-hearing, who are deaf or hard-of-hearing and have additional disabilities, and who have no disabilities; second to compare the adolescents from the two deaf and hard-of-hearing groups and their experiences of inclusion and exclusion in school; and third to ascertain if any gender differences exist between the two groups of deaf and hard-of-hearing students concerning their experiences of inclusion and exclusion. A total of 7865 adolescents (13-18 years of age) answered a total survey about the life and health of young people in a county in Sweden. The results show that both boys and girls in the hard-of-hearing groups rated their well-being lower and were less satisfied with their lives than pupils without disabilities. They also show that the hard-of-hearing boys and girls attending special school were more satisfied with their lives and to a greater extent felt included both socially and academically than students in mainstream school.

Globally, there is limited research on how deaf and hard of hearing adults experience higher education and work. The purpose of the present study is to examine hard of hearing (HH) adults’ experiences of social interactions and social relationships in higher education, the workplace and leisure time. Data were obtained from semistructured interviews with 16 individuals (aged 24–31 years) from diverse cultural backgrounds (10 males and 6 females) with severe-to-profound hearing loss. Participants were selected based on previous expressed interest in participating in further studies after having been involved in an earlier study. The interviews were subjected to a qualitative thematic data analysis. According to the results, people with a hearing loss experience communication barrier in higher education, at work and in leisure time. These communication barriers lead to difficulties achieving social inclusion, and in some circumstances to social exclusion. Assistive technology (AT) and information and communication technologies (ICT) were important facilitators of moving from social exclusion towards social inclusion.

Background: The value of support, service, and care in intellectual disability (ID) practice is linked to the competence of the professionalcaregivers. The quality of work is affected by the level of education of healthcare employees involved.Specific Aims: This study aimed to collect data on how employees perceive their education and training in ID practice and howeducational programs prepare them for their working environment.Methods: We used a quantitative approach to investigate how employees reflect on their knowledge about ID and other disabilitiesand the sources of such knowledge. A total of 262 employees engaged in ID practice completed an online survey.Findings: The results indicated that education significantly influenced the participants’ knowledge level, and highly specific education(i.e., workplace training) can substitute for work experience in ID practice. The authors conclude that all workplaces shouldexamine their employees’ skills regularly from the viewpoint of fulfilling the needs of people with ID.Discussion: Based on the results, it can be concluded that employees in ID practice need specific knowledge through workplacetraining (i.e., through hands-on practice at the workplace). Competence development in the form of workplace training is neededto upskill the staff and possibly increases employees’ participation at work.

Studies on hard of hearing (HH) individuals have focused mostly on children´s experinces in school. Howerver, their lives as young adults have not received much attention. The present study therefore examined HH young adults´experiences of social identity and group membership. Semi-structured interviews were counducted with 16 individuals (10 males, 6 females) with servere-to-profound hearing loss. They were from diverse cultural backgrounds. A qualitative content analysis was performed with a manifest analysis. Two categories emerged: belonging to a social enviroment and engaging in important communication. The results indicate that the HH individuals, either deliberately or unconsciously, chose to be with other HH individuals because of their longing for group membership and desire to avoid being misunderstood. The participants longed for inclusion, acceptance, and opportunities to create an inclusive social environment and to communicate with others.

In Sweden, as in many other industrialised countries, the official stance is an inclusive school promotes an integrated society and creates supportive local communities. Lack of attention to mental well-being of adolescents may lead to mental ill-health that may endure for the rest of an individual´s life. Many deaf and hard-of-hearing (DHH) adolescents in mainstream schools become depresses, have more illness and often have poorer health and develop a negative self-image. This self reported survey study, which used a cross-sectional, quantitative approach, is one of the first studies to address these issues. The sample for this study consisted of 5798 adolescents (235 DHH, 221 DHH with additional disabilites, 5342 hearing) attending compulsory and upper-secondary schools in Sweden. The results showed that adolescents without DHH have higher well-being, fewer somatic problems and lower mental ill-health than adolescents with DHH.

Denna rapport redovisar en utvärdering av en utbildning i Pedagogiskt förhållnings- och arbetssätt, (PFA) vilken innebär att man utgår från varje persons färdigheter och svårigheter, för att skapa förutsättningar till en tillvaro där personens färdigheter används och svårigheter kompenseras. Utbildningsinsatserna görs i två varianter, antingen (1) fysiskt i grupp på en bestämd plats eller (2) digitalt individuellt och platsoberoende. Målet med projektet är att utvärdera kursdeltagarnas kunskapsinhämtning samt yrkesrelaterad tilltro till sin förmåga.  

Deltagarna i utbildningarna var personal inom LSS-verksamhet som antingen gick en fysisk eller digital utbildning i Pedagogiskt förhållnings- och arbetssätt (PFA). För att utvärdera PFA-utbildningen samlades totalt 338 enkäter in fördelade på två mättillfällen; före utbildningen startade och direkt efter den var avslutad. Förutom bakgrundsfrågor om deltagarnas kännedom om PFA, KASAM, kognition samt kognitiva funktionsnedsättningar så utarbetades ett nytt frågeformulär med totalt 16 frågor för att mäta anställdas tilltro till sin förmåga att arbeta stödjande och omsorgsrelaterat.

Sammanfattningsvis visade resultaten av utvärderingen att både den fysiska och digitala formen av PFA-utbildning bidrog till kunskapsutveckling inom PFA, KASAM (känsla av sammanhang), kognition och kognitiva funktionsnedsättningar. Resultaten indikerar att den fysiska formen av utbildning hade en mer positiv effekt på studerandes kunskapsnivå om PFA, KASAM, kognition samt kognitiva funktionsnedsättingar efter utbildningens slut jämfört med de deltagare som deltog i den digitala utbildningen. Dock var kunskapsnivån i den fysiska gruppen, speciellt gällande PFA, något högre redan innan de startade utbildningen jämfört med de som gick kursen digitalt. Det är möjligt att den personliga interaktionen och den fysiska närvaron i klassrummet bidrog till en starkare inlärningsupplevelse. Viktigt att påpeka är att resultaten av denna utvärdering behöver tolkas och förstås utifrån de andra skillnader som fanns mellan den fysiska utbildningen och den digitala lärmiljön. Exempelvis så pågick den fysiska utbildningen under en vecka på plats tillsammans med andra kursdeltagare, lärare och handledare med två dagars praktik medan den digitala utbildningen i PFA var individuell, innehöll filmer och egna övningar och tog cirka 5 timmar att fullfölja.

När det gäller frågan om hur den fysiska och digitala PFA-utbildningen påverkar tilltron till yrkesförmågan, visar utvärderingen att det inte finns entydiga bevis för att den ena utbildningsformen är bättre än den andra. Det fanns väsentliga skillnader i hur de två utbildningarna genomfördes, som inte bara handlar om ifall utbildningen är fysisk eller digital. Därför bör slutsatserna vara försiktiga. Utvärderingen ger dock stöd för att tre av de fyra faktorer som tidigare studier har identifierat för att höja self-efficacy (självförtroende) enligt Banduras teori (1997) verkar vara betydelsefulla även i PFA-utbildningen. Att skapa positiva erfarenheter, få stöd (social persuasion) från signifikanta andra och att identifiera sig med andra jämförbara personer (ställföreträdande erfarenheter) har betydelse för att öka tilltron till den egna yrkesförmågan.

Rapporten i sin helhet inleds med en kort bakgrund, syfte, ett metodavsnitt och en teoretisk referensram utifrån det salutogena perspektivet, KASAM och self-efficacy (tilltro till den egna förmågan). Därefter följer en redovisning av resultatet och några avlutande reflektioner.