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  • 251.
    Ekermo, Mats
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Svensson, Roland
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hur har de mobila omvårdnadsteamen påverkat användningen av psykiatrisk slutenvård?: Rapport från ett utvecklingsarbete i Landstinget Sörmland. Delrapport 3.2016Rapport (Annet vitenskapelig)
    Abstract [sv]

    Detta är den tredje delrapporten i projektet "Utvärdering av mobila omvårdnadsteam  inom psykiatrin i södra och västra Sörmland".  I rapporten redovisas i vilken utsträckning omvårdnadsteamen mål om minskad psykiatrisk slutenvård har uppnåtts, vad som går att utläsa efter två års verksamhet. 

    Rapporten bygger på patientstatistik hämtad från patientdatabasen och på information från ärendeblad som upprättats av omvårdnadsteamen när patienter anslutits. Rapporten riktar sig i första hand till de som direkt berörs av det pågående utvecklingsarbetet med mobila omvårdnadsteam inom psykiatrin i Landstinget Sörmland.

  • 252.
    Ekermo, Mats
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Svensson, Roland
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Mobila omvårdnadsteam inom psykiatrin: Rapport från ett utvecklingsarbete i Landstinget Sörmland. Delrapport 1.2015Rapport (Annet vitenskapelig)
    Abstract [sv]

    Detta är den första delrapporten i projektet ”Utvärdering av mobila omvårdnadsteam inom psykiatrin i södra och västra Sörmland”. I rapporten redovisas data som belyser utvecklingen av de mobila omvårdnadsteamen under det första verksamhetsåret, 2014.

    Huvudsakligen bygger rapporten på intervjuer med omvårdnadsteamens personal och patientstatistik hämtad från patientdatabasen och från journalhandlingar. Rapporten riktar sig i första hand till de som direkt berörs av det pågående utvecklingsarbetet med mobila omvårdnadsteam inom psykiatrin i Landstinget Sörmland.

  • 253.
    Ekermo, Mats
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Svensson, Roland
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Patienters och närståendes erfarenheter av de psykiatriska omvårdnadsteamen: Rapport från ett utvecklingsarbete i Landstinget Sörmland. Delrapport 4.2016Rapport (Annet vitenskapelig)
    Abstract [sv]

    Detta är den fjärde delrapporten i projektet "Utvärdering av mobila omvårdnadsteam inom psykiatrin i södra och västra Sörmland". I rapporten redovisas patienters och närståendes erfarenheter av omvårdnadsteamen och syn på verksamhetsidén med psykiatrisk vård och stöd i hemmet som alternativ till inläggning i slutenvården. 

    Rapporten bygger på intervjuer med 18 patienter som varit anslutna till omvårdnadsteamen och sju närstående. Rapporten riktar sig i första hand till de som direkt berörs av det pågående utvecklingsarbetet med mobila omvårdnadsteam inom psykiatrin i Landstinget Sörmland.

  • 254.
    Ekermo, Mats
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Svensson, Roland
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Psykiatrisk vård i hemmet.: Ett tredje vårdalternativ under framväxt?2017Rapport (Annet vitenskapelig)
    Abstract [sv]

    Sedan år 2014 bedriver psykiatrin i Landstinget Sörmland en verksamhet med mobila psykiatriska omvårdnadsteam i länets södra och västra delar. Genom omvårdnadsteamen vill man erbjuda patienter psykiatrisk vård i hemmet som alternativ till inläggning och förkorta vårdtiden inom slutenvården. Forskare vid Mälardalens högskola har under åren 2014-2016 följt utvecklingsarbetet och i fyra forskningsrapporter utvärderat arbetssättet utifrån medarbetarnas, vårdgrannars, patienters och anhörigas perspektiv samt vilka effekter omvårdnadsteamen har på den psykiatriska slutenvårdskonsumtionen. Kvalitativ och kvantitativ metod har använts.

    I denna slutrapport presenteras utvärderingsresultatet i sin helhet och vad arbetsmodellen med psykiatrisk vård i hemmet innebär enligt sörmlandsmodellen. En näraliggande arbetsmodell som utvecklats inom psykiatrin i Motala-Mjölby sedan 1990-talet redovisas. Internationella erfarenheter och forskning redovisas avseende arbetsmodellen Crisis Resolution Team (CRT) (Home Treatment) som implementerats på nationell nivå inom den engelska psykiatriska vården.

    Den psykiatriska specialistvården i Sverige bedrivs idag huvudsakligen i två former, genom öppenvårdsmottagningar och genom heldygnsvård i psykiatrisk slutenvård. Återkommande kritik som framförs handlar om slutenvårdens begränsningar och om ett alltför stort glapp mellan öppenvården och slutenvården. I denna rapport väcks frågan om psykiatrisk vård i hemmet utgör ett tredje vårdalternativ under framväxt.

  • 255.
    Ekermo, Mats
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Svensson, Roland
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Vårdgrannarnas perspektiv på de psykiatriska omvårdnadsteamen: Rapport från ett utvecklingsarbete i Landstinget Sörmland. Delrapport 2.2016Rapport (Annet vitenskapelig)
    Abstract [sv]

    Detta är den andra delrapporten i projektet "Utvärdering av mobila omvårdnadsteam inom psykiatrin i södra och västra Sörmland". I rapporten redovisas vårdgrannarnas; de psykiatriska öppenvårdsmottagningarna, akut- och  slutenvården inom landstinget samt den kommunala socialpsykiatrins erfarenheter av omvårdnadsteamens arbete.

    Utvärderingen bygger på enkäter och intervjuer med olika personalgrupper. Rapporten riktar sig i första hand till de som direkt berörs av det pågående utvecklingsarbetet med mobila omvårdnadsteam inom psykiatrin i Landstinget Sörmland. 

  • 256.
    Eklund, Caroline
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Development and evaluation of a web application for stress management: Supporting behaviour change in persons with work related stress2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Stress is the most common reason for sick leave in Sweden. Stress can lead to health-related problems such as burnout syndrome, depression, sleep disorders, cardiovascular disease and pain. It is important to handle stress at an early stage before it could lead to health-related problems. The web enables to reach many persons at a low cost. Web-applications have proven to be effective regarding several health-related problems. However, adherence is often low and many of the available stress management-programs have not been based on evidence. The overall aim of the thesis was to develop and evaluate a fully automated, evidence-based web-application for stress management for persons experiencing work related stress. The thesis compiles of four studies. Study I contained the systematic development of the program in three phases. Phase one included the development of the program's theoretical framework and content, and phase two consisted of structuring the content and developing the platform to deliver the content from. The third phase consisted of coding the behaviour change supporting content, validation of the program among experts and testing it with one possible end-user. The result was an interactive web-application tailored to the individual's need for stress management supporting behaviour change in several ways; My Stress Control (MSC). In study I, MSC was also tested regarding how to proceed through the program. The results showed that the participants had trouble to reach the program’s end. In study II the feasibility of the coming RCT study procedure was investigated as well as how feasible MSC, the web-application, was to be applied in a larger study. 14 persons participated in study II. The findings proved the scientific study procedure feasible with minor changes, but some changes were required for the web-application to increase the chance for success in a larger, more costly study. In study III nine of the 14 persons that participated in study II were interviewed. The interviews aimed for a better understanding of how the participants experienced the program to further develop it. One theme was identified: Struggling with what I need when stress management is about me. It described an understanding for that stress management takes time and is complex but that it was difficult to find the time for working with it. In study IV, a randomized controlled trial, MSC was evaluated regarding its effect on stress. One group with access to MSC was compared to a wait-list group. 92 persons participated in study IV. The results showed that there were no significant between- or within group differences on perceived stress. A small effect size of MSC on perceived stress was shown between intervention- and wait-list groups, but adherence to the program was low.

    These studies support that a web-application based on the evidence within multiple fields may have effect on perceived stress. However, to handle stress on one’s own is complex and the paradox in having one more thing to do when already stressed contribute to a conflict on how to handle the task. How to facilitate adherence to the fully automated program should be further investigated in future studies.

  • 257.
    Eklund, Caroline
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Elfström, Magnus
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Yvonne
    Mälardalens högskola, Akademin för innovation, design och teknik, Innovation och produktrealisering.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Development of the web application My Stress Control—Integrating theories and existing evidence2018Inngår i: Cogent Psychology, Vol. 5, nr 1, s. 1-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To describe the systematic development of an evidence-based, tailored, interactive web application for self-management of work-related stress, and to test usability issues regarding how to proceed through the programme. Methods: Evidence from the fields of stress management, behaviour change and web-based interventions was the foundation for the theoretical framework and content. The next step was the development process of the web application and validation among experts and one possible end user. Last, a usability test with 14 possible end users was conducted. Results: The web-application, My Stress Control (MSC), was built on a solid theoretical framework. It consists of 12 modules including: introduction, psychoeducation, ambivalence, stress management strategies, lifestyle change, and maintenance. Self-monitoring, goal-setting, re-evaluating goals, feedback, and prompting formulation of intention to change are central techniques supporting behaviour change. The usability test revealed difficulties in understanding how to proceed through the programme. Conclusion: The development contributes to filling a gap in the literature regarding development of complex web-based interventions. MSC is dissimilar to existing programs in the field, considering the tailoring and multi-tracked opportunities. Although developed from the evidence in multiple fields, the web application would benefit from further development to support users in reaching the end module.

  • 258.
    Eklund, Caroline
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Elfström, Magnus
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Yvonne
    Mälardalens högskola, Akademin för innovation, design och teknik, Innovation och produktrealisering.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Evaluation of a Web-Based Stress Management Application: A Feasibility Study2018Inngår i: Journal of Technology in Behavioral Science, ISSN 2366-5963, Vol. 3, nr 3, s. 150-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the current study was to investigate the feasibility of a Web-based program that promotes behavior change for stress-related problems in terms of the program’s acceptability, practicability, and any possible effects. In addition, the aim was also to study how appropriate and realistic the study’s process and resource management would be for conducting a randomized controlled trial. A convenience sample consisting of 14 individuals was recruited from a university in Sweden. The participants had access to the program for a duration of 9 weeks. Questionnaires were answered before accessing, during use of, and after completing the program. Both qualitative and quantitative data were collected and analyzed. The program was considered acceptable and practically feasible, though small adjustments have to be made. The program was considered time-consuming, extensive, and in need of some clarifications. Regarding process and resource management, the study participants required minimum support. It was difficult to identify the time point when to send out the process measures because the participants worked at their own pace. Also, one of the process measurements, the motivation to change, remained stable. With some adjustments to the instructions to the study participants and minor changes in the program, the intervention and study’s procedure were considered as feasible and can be carried out in a randomized controlled trial.

  • 259.
    Eklund, Caroline
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Elfström, Magnus
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Yvonne
    Mälardalens högskola, Akademin för innovation, design och teknik, Innovation och produktrealisering.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    User experiences from a web-based, self-management programme: struggling with what I need when stress management is about me2019Inngår i: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, s. 39-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To explore users’ experiences of a tailored, interactive web application that supports behaviour change in stress management and to identify if and in that case what in the web-based programme that needed further development or adjustment to be feasible in a randomised controlled trial.

    Method: The design of this study was explorative with a qualitative approach. Nine individuals were recruited among the staff at a university. Semi-structured individual interviews were conducted and analysed using qualitative content analysis, after the participants had completed the web-based stress management programme.

    Results: One theme was identified, Struggling with what I need when stress management is about me, describing the paradox in having a programme that is perceived as supporting stress management while also being perceived as extensive and time consuming. The theme was divided in two categories: Defining the needs, where the users expressed what they needed from the programme and their everyday environment, to be able to use the programme, and It is about me, where the programme was described as helping the users understand their own stress.

    Conclusion: The participants expressed acceptance of using a web-based programme for stress related problems. The perceived extensiveness of the programme must be considered in further development.

  • 260.
    Eklund, Caroline
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Elfström, Magnus
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Evaluation of the web application My Stress Control, a stress management program for persons experiencing work related stress: A randomized controlled trialInngår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558Artikkel i tidsskrift (Fagfellevurdert)
  • 261.
    Elfström, Magnus
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Wulff Hamrin, Cornelia
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Correlates of desire to work in persons visiting psychiatric outpatient clinics2019Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Persons with mental health problems often express a clear desire to work, although whatfactors that contribute to this healthy aspiration are less clear. The purpose of this study thuswas to explore person, healthcare, and work-related factors in relation to desire to work inpersons visiting psychiatric outpatient clinics. The sample consisted of 272 persons visitingone of four psychiatric outpatient centres from two county councils in the south of Sweden.The possible participants were asked if they wanted to participate in research while waitingfor their scheduled appointments. A comprehensive questionnaire consisting of factors inthe research literature as well as factors advocated by patient organisations was used. Theparticipants’ ratings were analysed using non-parametric group comparisons and logisticregressions. Free-text answers were analysed by content. Higher education, better mentalhealth self-efficacy, and more experiences of demands and conflicts at the workplace wereall significantly related to desire to work in bivariate analyses. However, fighting spirit andsocial support at work had the strongest associations with desire to work in the multivariatelogistic analyses. The Nagelkerke R2 was .34. Free text answers indicated the importanceof managers’ role for the psychosocial work climate, and for receiving help with structuringthe workday to allow recovery after sickness absence. In contrast to the traditional prevocationalrehabilitation approach, and in line with a supportive work environment approach,the results points to the possibility to influence a further improved desire to work throughsupportive leadership and an open and communicative psychosocial climate.

  • 262.
    Elfström, Magnus
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Östlund, Gunnel
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Anbäcken, Els-Marie
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Zander, Viktoria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Gustafsson, Lena-Karin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Reablement for older persons by an interprofessional home rehabilitation team: An ongoing RCT2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    The aim is to evaluate the effects of intensive home rehabilitation regarding multidimensional health perceptions and other quality of life domains, physical ability and capacity among older people (65+). The design is a randomized controlled study of a reablement intervention with controls receiving traditional home care. The intervention is goal- and user oriented, home-based, time limited (3 months), and organized by an interprofessional team consisting of the professions nurse, enrolled nurses, physiotherapists, social worker, and occupational therapists. The effects of the intervention are measured by self-reported health and quality of life (EQ-5D-5L, HACT) including psychological well-being (GP-CORE), physical capacity (SPPB, hand dynamometer test), activity performance (COPM), and home care hours needed. Data are collected at inclusion (T1; applying for home care), after the three months intervention (T2), and at six months (T3). Primary outcome analyses will be performed according to intention to treat; 2 x 3 mixed design (group x time) ANCOVA with each dependent variable at T1 as covariate. Based on a medium effect size in favour of the intervention in the pilot study, and a dropout of 20%, the power calculation indicated that 240 persons should be included. The project will contribute with evidence of the effects of interprofessional home rehabilitation for reablement, and consequences for older persons’ bio-psycho-social health. The project is ongoing with more than 120 persons included. The intervention may result in reduced costs for care, but especially individual gains in relation to reduced care needs, maintained independence and good health.

  • 263.
    elin, elin csaszar
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Empatigraden hos försäkringskassans handläggare: Utifrån handläggarens kön, kundernas kön, situation och ersättningsnivå2016Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Empati är förmågan att känna känslor och reaktioner på en intellektuell och emotionell nivå som en annan individ upplever. Det upplevs genom medkänsla, sympati och ömhet. Syftet var att mäta om graden av empati hos handläggare på försäkringskassan skiljer sig åt. 58 deltagarna läste en fiktiv berättelse där en kund ringer in och ber om en tidigare utbetalning. Enkäten bestod av fyra versioner där kön, behov av mat/medicin, har barn/har inte barn, sjuk/separerad och inkomstbaserad/garantibelopp varierade. Deltagarna skattade känslor utifrån Batsons empatiskala. Resultatet visade högst nivå av empati hos kvinnor. Känslan av hög förståelse och  meningsfullt dömde rätten till en tidigare utbetalning. Brister i studien var att det inte blev en full faktoriell design och att få män deltog. Förslag på framtida forskning vore en studie med en jämnare könsfördelning där handläggare och kunder med samma kön jämförs med varandra.

  • 264.
    Ellingsen, Sidsel
    et al.
    University College of Haraldsplass, Norway.
    Roxberg, Åsa
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Kristoffersen, Kjell
    Agder University, Kristiansand, Norway.
    Rosland, Jan-Henrik
    Bergen University, Sunniva, Clinic for Palliative Care, Norway.
    Alvsvåg, Herdis
    University College of Haraldsplass, Bergen, Norway.
    Being in transit and in transition: The experience of time at the place, when living with severe incurable disease - a phenomenological study2014Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 28, nr 3, s. 458-468Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open-ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.

  • 265.
    El-Natour, Caroline
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Ohlsson, Stephanie
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    “KÄNNER DU DIG KRÄNKT, SÅ HAR DU BLIVIT KRÄNKT”: En kvalitativ studie om skolkuratorers upplevelse av arbetet med unga som blivit utsatta för sexuella trakasserier2019Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Syftet med studien var att undersöka hur skolkuratorer på grundskolan arbetar mot kränkande behandling i form av sexuella trakasserier. Vidare undersöktes om det förekommer skillnader i kuratorers bemötande, värderingar och bedömningar ur ett genusperspektiv med utgångspunkt från ett fiktivt fall. Metoden baserades på ett kvalitativt tillvägagångssätt med semistrukturerade intervjuer kopplade till en vinjett. Fyra deltagare utgick under intervjutillfällena från en vinjett och två tog ställning till en annan. Vinjetterna innehöll samma fiktiva berättelse förutom att elevens könstillhörighet var utbytt. Studiens vetenskapliga ramverk bestod av genusteori. Genomsökandet av tidigare forskning inom området visade att professionella vanligtvis gör en viss skillnad i bemötandet av klienter baserat på klientens könstillhörighet. Resultatet från den här studiens intervjuer synliggör dock inga utmärkande skillnader i bemötande beroende på elevens kön. Dock kunde vissa skillnader urskiljas i intervjupersonernas fria berättande i vilket intervjupersonernas förståelse av vissa typer av beteenden hos elever kunde härledas till stereotypa föreställningar om kön. Avslutningsvis diskuteras utifrån skribenternas perspektivhuruvida skolorna borde utveckla sina utbildningsstrategier avseende makt, sexualitet och samtycke.

  • 266.
    Elvén, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Clinical reasoning focused on clients’ behaviour change in physiotherapy: Development and evaluation of the Reasoning 4 Change instrument2019Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    With the recognition of the impact of lifestyle behaviours on health and the evidence of incorporating behavioural considerations in physiotherapy, there is a need to advance the clinical reasoning of physiotherapists. Clinical reasoning encompasses the thinking and decision-making processes guiding client management and is a core competency of physiotherapists. Enabling clinical reasoning advancements requires investigations in practice and education, which in turn require robust assessments. The overall aim of this thesis was to develop and evaluate an instrument to study physiotherapy students’ clinical reasoning focused on clients’ activity-related behaviour and behaviour change.

    In study I, a conceptual model was developed based on exploration of existing research, theory and views of physiotherapists and students. The data resulted in the clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists (CRBC-PT). Studies II and III included instrument development and evaluation in four phases. Phase 1 included determination of the instrument structure and item generation based on the CRBC-PT model, evidence in clinical reasoning assessment and existing measures. Phase 2 included cognitive interviews with students to assess item understanding and resulted in revisions of item problems and approval of feasibility. Phase 3 included a Delphi study with physiotherapists with expertise in behavioural medicine to evaluate item relevance. The findings demonstrated a high level of consensus regarding content relevance. The final version of the Reasoning 4 Change (R4C) instrument included four domains, namely, Physiotherapist, Input from client, Functional behavioural analysis, and Strategies for behaviour change. In phase 4, the reliability and validity of the instrument were evaluated. Physiotherapists with expertise in behavioural medicine and students responded to the web-based R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. The analyses showed excellent inter-rater reliability, satisfactory construct validity, internal consistency and test-retest reliability. In study IV, final-semester students (n=151) from all physiotherapy programmes in Sweden completed the R4C instrument. Hierarchical multiple regression analyses were conducted with three dependent variables, namely, input from client, functional behavioural analysis, and strategies for behaviour change. All included independent variables explained 37% of the variance in input from client. Cognitive and metacognitive skills explained 22%, attitudes 15% and curriculum with behavioural medicine competencies 3%. Only the variable curriculum with behavioural medicine competencies explained the variance in functional behavioural analysis (4%) and strategies for behaviour change (5%).

    In conclusion, the in-depth description of clinical reasoning focused on clients’ behaviour change may contribute to expanded understanding of the complexity and multidimensionality in reasoning processes that incorporate factors related to human behaviours, analyses of what factors motivate or hinder behaviours, and interventions to support behaviour change. Such knowledge is valuable for the teaching of and learning clinical reasoning. The R4C instrument helps fill the need for well-tested instruments and can support investigations and evaluations in physiotherapy education and research. To develop students’ clinical reasoning competence, cognitive and metacognitive skills, positive attitudes and the incorporation of behavioural medicine competencies into physiotherapy curricula should be targeted. Further attention to complex reasoning, including analysis and intervention, is warranted.

  • 267.
    Elvén, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Reflections on qualitative meta-synthesis studies: 'getting the search strategy right'2017Inngår i: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 22, nr 5-6, s. 219-220Artikkel i tidsskrift (Annet vitenskapelig)
  • 268.
    Elvén, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Students’ clinical reasoning focused on client behaviour change assessed with the web-based Reasoning 4 Change instrument.2019Inngår i: AMEE2019, 24-28 Aug, Vienna, Austria. / [ed] International Association for Medical Education, 2019, s. 883-883Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background;

    With the recognition of the impact of lifestyle-related behaviours on health and illness there is a need to advance the clinical reasoning of health professionals in general and physiotherapy students in specific. Enabling such advancements requires robust assessments and knowledge regarding factors associated with physiotherapy students’ clinical reasoning outcomes. The aim of this project was to develop a web-based clinical reasoning instrument to assess physiotherapy students’ clinical reasoning and investigate individual- and curriculum level predictors of their clinical reasoning outcomes.

     

    Summary of work;

    A new clinical reasoning instrument was developed based on theory, evidence and expert opinions. Reliability and validity of the instrument were evaluated including physiotherapy students and physiotherapists. 151 physiotherapy students in their final semester at the eight entry-level programmes in Sweden responded the instrument and data were analysed with multiple regression analysis.

     

    Summary of results;

    The web-based instrument, named Reasoning 4 Change (R4C), comprise four domains related to 1) physiotherapists’ capabilities, skills, attitudes and beliefs 2) history-taking and examination, 3) analysis and 4) treatment strategies to support behaviour change. The instrument is built up of several case scenarios and incorporates a holistic, client-centred and behavioural focused clinical reasoning process. The instrument demonstrated satisfactory reliability and validity. Cognitions, attitudes and curricula content were significantly associated with students’ clinical reasoning outcomes in the end of their education.  

     

    Discussion and Conclusions; The R4C instrument fills a gap in education and can support investigations and evaluations of students’ clinical reasoning focused on clients’ behaviour change. To develop students’ clinical reasoning competence, cognitive, metacognitive capabilities and skills, positive attitudes, and behavioural medicine content in curricula need to be targeted.

     

    Take-home Messages: The web-based R4C instrument is ready to be used in physiotherapy education evaluation. With some modifications the instrument may be used in other health professional educations as well. To improve physiotherapy students’ clinical reasoning for the benefit of clients’ health-related behaviour change, education interventions should focus on developing students’ analytical and reflective capabilities and skills. Also, a learning environment that support positive attitudes towards the integration of biopsychosocial and behavioural considerations in clinical reasoning should be encouraged.

  • 269.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    Univ British Columbia, Canada.
    Factors influencing physical therapists' clinical reasoning: qualitative systematic review and meta-synthesis2017Inngår i: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 22, nr 1-2, s. 60-75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The capacity of physical therapists to reason effectively in patient management is essential to maximizing outcomes. Although conceptual frameworks of clinical reasoning exist, their theoretical foundations are insufficiently validated to establish those factors that are paramount in guiding physical therapists' clinical reasoning. Studies on how physical therapists clinically reason constitute important means of identifying constructs of such reasoning. Objective: This systematic review aimed to synthesize and interpret the findings of qualitative studies designed to examine factors that are inherent in physical therapists' clinical reasoning with respect to their knowledge, experiences, and practices. Methods: Searches of studies were carried out in four databases, gray literature, and reference lists. Two reviewers independently assessed methodological quality of the studies using the Critical Appraisal Skills Program (CASP) and performed the analysis: extraction and comparative appraisal of findings, identification of themes, reciprocal translation synthesis, and identification of categories and subcategories. Results: Ten studies were included. Four themes of factors influencing physical therapists' clinical reasoning emerged, namely, Physical therapist as a source, Patient as a source, Elements of the reasoning process, and Context. Conclusions: The identified themes validated some constructs underlying existing clinical reasoning frameworks. Most influencing factors were related to the physical therapist, which highlights opportunities to improve effective reasoning at this level. The notion that this process is recurrent, multifaceted, and contextual lends itself to changing in accordance with the needs of the patient, consistent with a biopsychosocial perspective. How clinicians weigh biomedical and psychosocial elements in their reasoning however warrants further study.

  • 270.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Factors influencing physiotherapists' clinical reasoning: a meta-synthesis2015Inngår i: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 101, s. e360-e361Artikkel i tidsskrift (Fagfellevurdert)
  • 271.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Factors influencing physiotherapists' clinical reasoning: A meta-synthesis.2015Inngår i: Physiotherapy 2015, Stockholm, Sweden., 2015Konferansepaper (Fagfellevurdert)
  • 272.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för ekonomi, samhälle och teknik. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elisabeth
    Department of Physical Therapy, Faculty ofMedicine, University of British Columbia, Vancouver, BC, Canada.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    A clinical reasoning model focused on clients' behaviour change with reference to physiotherapists: Its multiphase development and validation2015Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, nr 4, s. 231-243Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose: A biopsychosocial approach and behaviour change strategies have long been proposed to serve as a basis for addressing current multifaceted health problems. This emphasis has implications for clinical reasoning of health professionals. This study's aim was to develop and validate a conceptual model to guide physiotherapists' clinical reasoning focused on clients' behaviour change. Methods: Phase 1 consisted of the exploration of existing research and the research team's experiences and knowledge. Phases 2a and 2b consisted of validation and refinement of the model based on input from physiotherapy students in two focus groups (n=5 per group) and from experts in behavioural medicine (n=9). Results: Phase 1 generated theoretical and evidence bases for the first version of a model. Phases 2a and 2b established the validity and value of the model. The final model described clinical reasoning focused on clients' behaviour change as a cognitive, reflective, collaborative and iterative process with multiple interrelated levels that included input from the client and physiotherapist, a functional behavioural analysis of the activity-related target behaviour and the selection of strategies for behaviour change. Conclusions: This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.

  • 273.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för ekonomi, samhälle och teknik. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elisabeth
    Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change2018Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 34, nr 5, s. 367-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 274.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Dean, Elizabeth
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Dept Phys Therapy, Vancouver, BC, Canada..
    Hällman, Olle
    Uppsala Univ, Dept Informat Technol, Uppsala, Sweden..
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'2018Inngår i: AIMS PUBLIC HEALTH, ISSN 2327-8994, Vol. 5, nr 3, s. 235-259Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 275.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    A clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists: Its multiphase development and validation2014Inngår i: Abstract book. The International Conference on Health and Social Welfare and Coproduction. Mälardalen University, Eskilstuna, Sweden. 9-10 sept 2014, 2014Konferansepaper (Fagfellevurdert)
  • 276.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    An innovative instrument to assess physiotherapists’ clinical reasoning focused on clients’ behaviour change: Its development and validation.2016Inngår i: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 102, nr s1, s. e155-e155Artikkel i tidsskrift (Fagfellevurdert)
  • 277.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Development of a model of Clinical Reasoning with focus on patients’ Activity-related Behaviour and Behaviour change.2013Inngår i: Abstrakt bok. Sjukgymnastdagarna 2-4 oktober 2013, 2013, s. 110-111Konferansepaper (Fagfellevurdert)
  • 278.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Development of a tool for assessing physiotherapy students’ clinical reasoning with focus on patients’ behavioural change2013Inngår i: Nordic Advances in Health Care Sciences Research. November 13-14 2013 in Lund. Abstract book, 2013, s. 13-13Konferansepaper (Fagfellevurdert)
  • 279.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Predictors of clinical reasoning focused on clients’ behavior change among physical therapy students2018Inngår i: Raisonnement Clinique 2018: Textes del la 4e Conférence Internationale de Montréal sur le Raisonnment Clinique. / [ed] Dyer, Joseph-Omer, 2018Konferansepaper (Fagfellevurdert)
    Abstract [en]

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

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

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

  • 280.
    Elvén, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hochwälder, Jacek
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    University of British Columbia, Canada .
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students2019Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, nr 8, s. 964-976Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 281.
    Emilson, C.
    et al.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Asenlof, P.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Pettersson, S.
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Karolinska Univ Hosp, Dept Rheumatol, Stockholm, Sweden..
    Bergman, S.
    Res & Dev Ctr Spenshult, Halmstad, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Sandborgh, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Martin, C.
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Demmelmaier, I
    Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    PHYSICAL THERAPISTS' ASSESSMENTS, ANALYSES AND USE OF BEHAVIORAL CHANGE TECHNIQUES IN INITIAL CONSULTATIONS ON MUSCULOSKELETAL PAIN: DIRECT OBSERVATIONS IN PRIMARY HEALTH CARE2016Inngår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, s. S187-S187Artikkel i tidsskrift (Annet vitenskapelig)
  • 282.
    Emilson, C.
    et al.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Demmelmaier, I.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Bergman, S.
    Research and Development Center Spenshult, Halmstad, Sweden.
    Lindberg, P.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Denison, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Åsenlöf, P.
    Department of Public Health, and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain2017Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 2, s. 186-196Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting. Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants. Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes. Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03). Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

  • 283.
    Emilson, C.
    et al.
    Uppsala University, Uppsala, Sweden.
    Åsenlöf, P.
    Uppsala University, Uppsala, Sweden.
    Pettersson, S.
    Karolinska University, Sweden.
    Bergman, S.
    University of Gothenburg, Gothenburg, Sweden .
    Sandborgh, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Martin, C.
    Uppsala University, Uppsala, Sweden.
    Demmelmaier, I.
    Uppsala University, Uppsala, Sweden.
    Physical therapists' assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: Direct observations in primary health care2016Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, nr 1, artikkel-id 316Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain. Methods: A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice. Results: Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings. Conclusion: Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy. 

  • 284.
    Engquist, M.
    et al.
    Department of Orthopaedics, Ryhov Hospital, S-551 85 Jönköping.
    Löfgren, H.
    Neuro-orthopedic Center, Ryhov Hospital, Jönköping.
    Öberg, B.
    Linköping University.
    Holtz, A.
    ala University Hospital,.
    Peolsson, A.
    Linköping University.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Vavruch, L.
    Neuro-orthopedic Center, Ryhov Hospital.
    Lind, B.
    Department of Orthopaedics, Ryhov Hospital.
    Surgery versus nonsurgical treatment of cervical radiculopathy: A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up2013Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, nr 20, s. 1715-1722Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN.: Prospective randomized controlled trial. OBJECTIVE.: To study the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program compared with the same physiotherapy program alone for patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA.: Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. METHODS.: Sixty-three patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with anterior cervical decompression and fusion. The physiotherapy program included general/specific exercises and pain-coping strategies. The outcome measures were disability (Neck Disability Index), neck and arm pain intensity (visual analogue scale), and the patient's global assessment. Patients were followed for 24 months. RESULTS.: The result from the repeated-measures analysis of variance showed no significant between-group difference for Neck Disability Index (P = 0.23). For neck pain intensity, the repeated-measures analysis of variance showed a significant between-group difference during the study period in favor of the surgical group (P = 0.039). For arm pain intensity, no significant between-group differences were found according to the repeated-measures analysis of variance (P = 0.580). Eighty-seven percent of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up compared with 62% in the nonsurgical group (P < 0.05). At 24 months, the corresponding figures were 81% and 69% (P = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group. Significant reduction in Neck Disability Index, neck pain, and arm pain compared with baseline was seen in both groups (P < 0.001). CONCLUSION.: In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years. Structured physiotherapy should be tried before surgery is chosen. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

  • 285.
    Engquist, Markus
    et al.
    Ryhov Hosp, Jönköping, Sweden..
    Lofgren, Hakan
    Ryhov Hosp, Jönköping, Sweden..
    Oberg, Birgitta
    Linköping Univ, Linköping, Sweden..
    Holtz, Anders
    Univ Uppsala Hosp, Uppsala, Sweden..
    Peolsson, Anneli
    Linköping Univ, Linköping, Sweden..
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Vavruch, Ludek
    Ryhov Hosp, Jönköping, Sweden..
    Lind, Bengt
    Univ Gothenburg, Gothenburg, Sweden..
    A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone2017Inngår i: JOURNAL OF NEUROSURGERY-SPINE, ISSN 1547-5654, Vol. 26, nr 1, s. 19-27Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.

  • 286.
    Engquist, Markus
    et al.
    Ryhov Hospital, Jönköping, Sweden.
    Löfgren, Håkan
    Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linkoping University, Linköping, Sweden.
    Holtz, Anders
    Uppsala University Hospital, Uppsala, Sweden.
    Peolsson, Anneli
    Linkoping University, Linköping, Sweden.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Vavruch, Ludek
    Spine Center Goteborg, Gothenburg, Sweden.
    Lind, Bengt
    Spine Center Goteborg, Gothenburg, Sweden.
    Factors affecting the outcome of surgical versus nonsurgical treatment of cervical radiculopathy: A randomized, controlled study2015Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 20, s. 1553-1563Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Prospective randomized controlled trial.

    OBJECTIVE: To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy.

    SUMMARY OF BACKGROUND DATA: An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out.

    METHODS: Sixty patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at one year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress And Risk Assessment Method, DRAM), self efficacy (Self Efficacy Scale, SES) health status (EQ-5D) and MRI findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/ neck pain intensity and NDI.

    RESULTS: Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain < 12 months (p = 0.007), duration of arm pain < 12 months (p = 0.01) and female sex (p = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, p = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, p = 0.02 and NDI, p = 0.02), low SES score (p = 0.05) and high DRAM score (p = 0.04). (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone.

    CONCLUSIONS: In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self efficacy and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.

  • 287.
    Eriksson, H.
    et al.
    The Red Cross University College, Stockholm, Sweden.
    Christiansen, M.
    Karolinska Institutet, Stockholm, Sweden.
    Holmgren, Jessica
    Karolinska Institutet, Stockholm, Sweden.
    Engström, Annica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Salzmann-Erikson, M.
    University of Gävle, Gävle, Sweden.
    Nursing under the skin: A netnographic study of metaphors and meanings in nursing tattoos2014Inngår i: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 21, nr 4, s. 318-326Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aims of this study were to present themes in nursing motifs as depicted in tattoos and to describe how it reflects upon nursing in popular culture as well as within professional nursing culture. An archival and cross-sectional observational study was conducted online to search for images of nursing tattoos that were freely available, by utilizing the netnographic methodology. The 400 images were analyzed in a process that consisted of four analytical steps focusing on metaphors and meanings in the tattoos. The findings present four themes: angels of mercy and domination; hegemonic nursing technology; embodying the corps; and nurses within the belly of the monster. The tattoos serve as a mirror of popular culture and the professional culture of nurses and nursing practice within the context of body art. Body art policy statements have been included in nursing personnel dress code policies. Usually these policies prohibit tattoos that are sexist, symbolize sex or could contribute and reproduce racial oppression. The results show that the tattoos can be interpreted according to several layers of meanings in relation to such policies. We therefore stress that this is an area highly relevant for further analyses in nursing research.

  • 288.
    Eriksson, Henrik
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Salzmann-Erikson, M.
    Dalarna University.
    Cyber nursing-Health 'experts' approaches in the post-modern era of virtual performances: A nethnography study2013Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, nr 3, s. 335-344Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The imperative to gather information online and to become an 'expert' by locating effective advice for oneself and others is a fairly new support phenomenon in relation to health advice. The creation of new positions for health 'experts' within the space of the Internet has been addressed as a cybernursing activity. A focused analysis of communication in health forums might give insight into the new roles that are available for health experts in cyberspace. Aim: The aim of this study is to describe approaches to being an 'expert' in lifestyle health choice forums on the Internet and to elaborate on the communicative performances that take place in the forums. Method: An archival and cross-sectional observational forum study was undertaken using principles for conducting ethnographic research online. 2640 pages of data from two health Internet forums were gathered and analyzed. Findings: The results reveal three distinctive types of experts that emerge in the forums: (1) those that build their expertise by creating a presence in the forum based on lengthy and frequent postings, (2) those who build a presence through reciprocal exchanges with individual posters with questions or concerns, and (3) those who build expertise around a " life long learning" perspective based on logic and reason. Discussion: The results suggest that experts not only co-exist in the forums, but more importantly they reinforce each others' positions. This effect is central; alongside one another, the posts of the three types of experts we identify constitute a whole for those seeking the forum for advice and support. Users are provided with strong opinions and advice, support and Socratic reasoning, and a problem-oriented approach. The Internet is now an integral part of everyday living, not least of which among those who seek and offer support in cyberspace. As such, cyber nursing has become an important activity to monitor, and formal health care professionals and nursing researchers must stay abreast of developments. © 2012 Elsevier Ltd.

  • 289.
    Eriksson, Henrik
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Salzmann-Erikson, Martin
    Oslo Univ Hosp.
    Supporting a caring fatherhood in cyberspace - an analysis of communication about caring within an online forum for fathers2013Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 1, s. 63-69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Supporting a caring fatherhood in cyberspace an analysis of communication about caring within an online forum for fathers Background: Today's parents seek out social support on the Internet. A key motivation behind the choice to go online is the need for more experience based information. In recent years, new fathers have increasingly taken on an active parental role. Men's support for their caring activities for infants on the Internet needs attention. Aim: The aim was to describe communication about caring activities for infants among men who visited an Internet-based forum for fathers and elaborate on the dimensions of support available in the forum. Method: An archival and cross-sectional observational forum study was undertaken using principles for conducting ethnographic research online: nethnography. A total of 1203 pages of data from an Internet forum for fathers were gathered and analysed. Result: Support for a caring fatherhood in cyberspace can be understood as fathers' communicating encouragement, confirmation and advice. The findings show that important ways of providing support through the forum included a reciprocal sharing of concerns how to be a better father in relation to caring for an infant. Concerns for their child's well-being and shared feelings of joy and distress in everyday life were recurrent supportive themes in the communication. Information gained from contacting others in similar situations is one important reason for the fathers' use of the Internet. Discussion: Support offered in this kind of forum can be considered as a complement to formal support. Professionals can use it to provide choices for fathers who are developing themselves as caregivers without downplaying the parental support offered by formal health care regimes. Further research: Online support will probably be one of the main supporting strategies for fathers in Scandinavia. Caring and nursing researchers need to closely monitor support activities that develop, and over time, as these ill likely become an important source of support for people.

  • 290.
    Eriksson, Henrik
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Sandberg, Jonas
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Hellström, Ingrid
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Experiences of long-term home care as an informal caregiver to a spouse: Gendered meanings in everyday life for female carers2013Inngår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 8, nr 2, s. 159-165Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. One of the most common circumstances in which a woman gradually steps into a long-term caregiver role at home involves caring for a spouse suffering from dementia. Little attention has been paid to examining the experiences and motivations of such caregivers from a feminist perspective. Methods. Twelve women, all of whom were informal caregivers to a partner suffering from dementia, were interviewed on the following themes: the home, their partner's disease, everyday life, their relationship and autonomy. The results of these interviews were analysed in relation to gender identity and social power structures using a feminist perspective. Results. The findings of this study show that the informants frequently reflected on their caregiving activities in terms of both general and heteronormative expectations. The results suggest that the process of heteropolarisation in these cases can be an understood as a consequence of both the spouse's illness and the resulting caring duties. Also, the results suggest that the act of caring leads to introspections concerning perceived 'shortcomings' as a caregiver. Finally, the results indicate that it is important to recognise when the need for support in day-to-day caring is downplayed. Conclusions. Women view their caregiving role and responsibilities as paramount; their other duties, including caring for themselves, are deemed less important. We stress that the intense commitment and responsibilities that women experience in their day-to-day caring must be acknowledged and that it is important for healthcare professionals to find mechanisms for providing choices for female caregivers without neglecting their moral concerns. Implications for practice. Female carers face difficulties in always living up to gendered standards and this need to be considered when evaluating policies and practices for family carers.

  • 291.
    Eriksson, Henrik
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Sandberg, Jonas
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmgren, Jessica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Pringle, Keith
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    His Helping hands: Adult daughters’ perceptions of fathers with a caregiving responsibility2013Inngår i: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 16, nr 2, s. 235-248Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Women's position as informal carers has been taken for granted in social policy and social professions, while relatively few discussions have elaborated on caring as a later life activity for men and the impact on family care. This study explores the processes connected to informal caregiving in later life through the position of adult daughters of older fathers engaged with long-term caregiving responsibilities for a partner. A sample of eight daughters, with fathers having primary caregiving responsibility for their ill partners was recruited and in-depth interviews were carried out and analysed according to qualitative procedures. The daughters' descriptions of their relationships with their fathers show that being an older man who engages in caring can have a positive outcome on relations. Even if some of the daughters have doubts about their fathers “masculine authenticity”, all of them appear to cherish “his helping hands” as a carer and closer more intimate relationships with their fathers. Caring for an old and frail spouse may potentially present alternative ways of being a man beyond traditional ‘male activities’ and that caring might also sometimes involve a re-construction of gender identities. It is suggested that social work professionals may use a gendered understanding to assess and work strategically with daughters and other family members who support caring fathers.

  • 292.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Användning av BRA - Barns rätt som anhöriga2018Rapport (Annet vitenskapelig)
  • 293.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Barn som upplever våld2014Inngår i: I arbete med våldsutsatta kvinnor: Handbok för yrkesverksamma / [ed] Josefin Grände, Lisa Lundberg, Maria Eriksson, Stockholm: Gothia Fortbildning , 2014, 3, s. 112-131Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 294.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Barns rätt som anhöriga BRA: Utvärdering av ett utvecklingsarbete2014Rapport (Annet vitenskapelig)
    Abstract [sv]

    Rapporten redovisar iakttagelser och slutsatser om Allmänna Barnhusets utvecklingsarbete med namnet BRA – Barns Rätt som Anhöriga, och den modell för information, råd och stöd till anhöriga barn som arbetet resulterade i: BRA-modellen. Utvärderingsuppdragets fokus har legat på att skaffa en så bred bild som möjligt av BRA modellen, och att ta vara på synpunkter, tankar och förändringsförslag som kan bidra till att tydliggöra och förbättra modellen. Det empiriska underlaget består av basuppgifter om 46 av de 56 barn och unga som deltagit i BRA-samtal och läger, intervjuer med 8 av de deltagande barnen, intervjuer och samtal med 11 personer från de 3 pilotverksamheter som ingick i projektet, och samtal med de 2 projektledarna från Barnhuset.

    Utvecklingsarbetet prövade en modell med följande komponenter: barn och föräldrar får vid ett första samtal tillsammans information om de rättigheter som barnets anhörigskap medför. Barnet erbjuds sen 1-2 enskilda samtal. Om barnet önskar genomförs därefter ytterligare ett samtal tillsammans med föräldern. Efter de enskilda samtalen erbjuds barnet att träffa andra barn med liknande erfarenhet under ett läger en helg eller ett skollov.

    Utifrån uppgifter om deltagande barn och de insatser som genomförts kan man dra slutsatsen att det är två olika versioner av BRA som prövats i praktiken: ”fullständig-BRA” där modellen har i relativt hög grad prövats utifrån samtliga komponenter och ”mini-BRA” där BRA-insatsen framförallt har bestått av ett inledande informationssamtal och i vissa fall ytterligare ett individuellt samtal. Vidare har de olika versionerna av BRA riktats till delvis olika målgrupper, vilket betyder att BRA-modellen i sin helhet framförallt har prövats på tonårstjejer med erfarenhet av föräldrars psykiska ohälsa, medan yngre flickor och pojkar vars föräldrar har någon typ av somatisk problematik endast tagit del av mini-BRA. Det är endast barn från de verksamheter som åtminstone i några fall prövat fullständig-BRA som kommer till tals i intervjuerna. Sammantaget betyder detta att slutsatserna om hur modellen fungerar för yngre barn och barn till föräldrar med somatiska sjukdomar blir ganska osäkra.

    Såväl de intervjuade barnens utsagor som det samtalsledarna säger tyder på att när det gäller individdelen av BRA har målsättningarna uppfyllts i hög grad vad gäller att barnen har fått kunskap om sina rättigheter med anledning av förälderns fysiska sjukdom/psykiska störning/missbruk, att de har fått den information de behöver om sin förälders sjukdom/psykiska störning/missbruk, och att de har fått hjälp att uttrycka eventuellt behov av råd och stöd. Både barn och samtalsledare kommenterar också det pedagogiska redskap som används i samtalen och menar att det har varit viktigt och till stor hjälp. Det är dock inte lika tydligt att barnets behov av råd och stöd blivit synliggjort för föräldrar/närstående vuxna, eller att barnet eller familjen vid behov har länkats till personer/verksamheter som kan ge hjälp; råd, stöd, behandling, och så vidare. I synnerhet dessa frågor kan alltså behöva stå i fokus i fortsatt utvecklingsarbete. I och med de begränsningar som finns i materialet om och från de deltagande barnen går det inte att utifrån barnen uttala sig om det är några grupper barn som individdelen av BRA inte fungerar lika bra för. Piloternas tankar om eventuella begränsningar handlar framförallt om att BRA-modellen skulle behöva anpassas till barn med olika former av funktionsnedsättningar och kommunikationssvårigheter. Sammantaget framstår individdelen av modellen som mycket lovande och utifrån de intervjuer som rapporten bygger på kan man tolka det som att BRA-samtal kan stärka barns känsla av sammanhang.

    Målsättningarna för lägret verkar de ha uppfyllts i mycket hög grad när det gäller att stärka barnen genom att de får träffa andra i samma situation, uppleva gemenskap och dela erfarenheter, bli hörda och få uttrycka sina åsikter, samt att ha kul och lära sig mer om sina rättigheter. Det är mer oklart i vilken lägret bidragit till att barnen fått fler strategier att hantera vardagen som anhörig. De barn som deltagit i ett läger talar alla mycket positivt om den erfarenheten. Mer kritiska synpunkter från barnen handlar - vid sidan om att lägret varit lite för komprimerat tidsmässigt - framförallt om att lägerledarna behöver vara observanta på att det kan vara påfrestande känslomässigt för deltagarna att vara på läger. Ett inslag i lägerprogrammet är inspirerat av norska Forandringsfabrikkens deltagandemodell höringar och i den här delen får barnen möjlighet att som grupp förmedla erfarenheter, goda råd och förslag på förbättringar för anhöriga barn till politiker och beslutsfattare. Att döma av de barn som kommit till tals i intervjuerna var relationen till och utbytet med de andra barnen betydligt viktigare än detta mer barnpolitiska inslag. Barns rätt till att komma till tals också i ett vidare perspektiv verkar inte ha stått högst på agendan för de barn som deltog i lägret. Det kan bland annat ha att göra med att de inte träffat varandra tidigare utan etablerade sina relationer där och då.

    BRA är en modell som sätter barnets rättigheter i fokus. Arbetet bygger på barns delaktighet och förutsätter de vuxnas lyssnande. De barn som intervjuats bekräftar att det är viktigt att BRA-modellen har barnets rättigheter som utgångspunkt, och man kan tolka barnintervjuerna som att samtalsledarna i hög grad lyckats bidra till att barnen fått mer kunskap om sina rättigheter. Det som för många av pilotverksamhetens medlemmar har varit nytt med BRA-modellen är dels att insatsen riktar sig direkt till barnet och sedan just detta att arbetet utgår från barns rättigheter och delaktighet. Piloterna betonar att det är ett nytt perspektiv de har lärt sig att arbeta utifrån, som ifrågasätter vuxnas tolkningsföreträde. Även utgångspunkten i rätten till information ger ett annat arbetssätt och en mer lyssnande inställning, medan det ”vanliga” sättet att arbeta framstår som tydligare styrt av de professionella. Det kan dock vara en utmaning att arbeta utifrån barns delaktighet och egenmakt inom ramen för relationer som inte är jämlika utan i stället präglas av vuxnas överordning och barns beroende och underordning. En annan utmaning med att arbeta på det här sättet är att rättigheter kan framstå som något ganska abstrakt och att det kan vara svårt att ”översätta” så att det blir möjligt för barn att ta till sig kunskap om sina rättigheter. Ytterligare en utmaning är förknippad med ansatsen att lära barn något. En erfarenhet från pilotomgången är att medan det första individuella samtalet väldigt tydligt har fokus på det enskilda barnet, kan det vid det andra samtalet vara lätt att börja ”undervisa” om rättigheter, så att samtalets innehåll inte kommer lika mycket från barnen själva, och barnen får en lägre grad av delaktighet. Ytterligare en utmaning som piloterna lyfter fram är att det inte är givet att BRA-tanken om barns rättigheter och barns delaktighet också i ett vidare perspektiv får gehör i den egna organisationen eller hos andra samhällsinstanser.

    En analys av hinder och möjligheter när det gäller tillämpningen av modellen bekräftar väl känd kunskap om betydelsen av såväl organisatorisk förankring och beredskap som ledningsstöd vid implementeringen av nya metoder eller arbetssätt. Det blir också tydligt det kanske ställs särskilda krav på organisatorisk förberedelse om BRA-modellen ska implementeras inom verksamheter med vuxna som primär målgrupp. Det behöver också finnas en grundläggande kunskap i hela organisationen om anhöriga barn och deras rättigheter för att det ska bli möjligt att rekrytera barn till BRA-insatsen. Under utvecklingsarbetet var en utgångspunkt att BRA-modellen ska vara så grundläggande att även av personal som inte är särskilt inriktade på barn ska kunna använda den. Piloterna menar dock att även om modellen är tydlig och enkel ställer exempelvis BRA-samtal krav på den som leder samtalen, och den förutsätter viss vana och erfarenhet att luta sig mot. Den utbildning i modellen piloterna genomgått får genomgående högt betyg, liksom stödet i förberedelse och genomförande av lägren. Kritiska kommentarer handlar mer om olika besked under projektet gång om exempelvis rekrytering till lägret. Det faktum att BRA framställs som en modell kan också vara något av en utmaning för dem som ska omsätta den i praktik, och det ställer krav på handledning från Barnhusets sida. Detta eftersom en del professionella, inte minst inom socialtjänsten, är ovana vid att arbeta manualbaserat. En del piloter uttrycker exempelvis en osäkerhet om de måste följa anvisningarna ”till punkt och pricka” för att de ska genomföra ”riktiga” BRA-samtal. En fråga för det vidare arbetet med BRA är att tydliggöra instruktionen till BRA-samtal och diskutera hur strikt denna måste följas för att det ska vara fråga om just ”BRA: Barns Rätt som Anhöriga”.

    Helhetsbedömningen blir att detta är ett i många avseenden framgångsrikt utvecklingsarbete. Det material som ligger till grund för analysen tyder på att arbetet med BRA-samtal och läger lyckats uppfylla målsättningarna. Vidare har utvecklingsarbetet resulterat i en modell som framstår som lovande inte bara när det handlar om att informera anhöriga barn om deras rättigheter och kartlägga behov av vidare stöd, utan som även tycks kunna stärka barns känsla av sammanhang. När nu modellen är utvecklad blir det därför angeläget att på allvar pröva den i olika verksamheter, och att studera hur BRA modellen fungerar i jämförelse med andra metoder eller modeller för information och stöd till barn som anhöriga.

  • 295.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Children's perspectives: On violence and interventions to protect and support them2013Konferansepaper (Annet vitenskapelig)
  • 296.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Children’s voices, children’s agency and the development of knowledge about children exposed to intimate partner violence2016Inngår i: Interpersonal Violence: Differences and Connections / [ed] Marita Husso, Tuija Virkki, Marianne Notko, Helena Hirvonen, Jari Eilola, London: Routledge, 2016, 1, s. 140-152Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    In this chapter, I argue that children’s voices and perspectives constitute a very fruitful point of departure in knowledge development in the field of intimate partner violence (IPV). Furthermore, that research and practice need to draw on a “double view” on these children as both objects for adults’ care, protection and support, and as social actors with their own perspectives, preferences and agendas.

    First, I review the extent to which it is possible to identify current research on intimate partner violence focusing on children’s voices and children’s agency, and outline a typology of different kinds of research on children exposed to intimate partner violence, as well as the “double view” on children exposed to intimate partner violence.

    Second, I discuss three different empirical areas to illustrate the point about possible knowledge gains. The first area is children’s exposure to intimate partner violence, specifically children’s ways of tackling their situation and experiences. This part of the discussion includes elaborations of the concept of “witnessing” or exposure to IPV, the relationship between the effects of exposure and children’s creation of meaning, and children’s agency. The second area is risk assessment and it is argued that such assessments must include not just immediate danger (or perpetrator dangerousness) but also the long-term risk associated with emotional violence, retraumatization or undermining of recovery, as well as the child’s sense of security. The third area is the critical assessment of support and treatment interventions, including perspectives on children exposed to IPV as services users, and to what extent their service user perspectives are included in the development and evaluations of interventions.

  • 297.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Delmål 4: Mäns våld mot kvinnor ska upphöra2015Inngår i: Forskarrapporter till Jämställdhetsutredningen: SOU 2015:86 Betänkande av Jämställdhetsutredningen, Stockholm: Fritzes, 2015, s. 235-337Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 298.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Deltagarnas röster om BRA modellen2014Inngår i: Barns rätt som anhöriga: Om att göra barn delaktiga / [ed] Åsa Lundström Mattsson, Stockholm: Allmänna Barnhuset , 2014, 1, s. 17-35Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 299.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Domestic violence, family law proceedings, and children’s victimization at school2015Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aim

    The paper   discusses what the practices of family law social workers and school staff   mean for children’s vulnerability and victimization at school (including   preschool).

    Background  

    While   there has been considerable discussion of issues about child protection and   the cooperation between school and social services in that context, studies   on the intersection between school and family law proceedings seem virtually   non-existent. This is also the case when it comes to family law proceedings,   school and different forms of childhood adversity.

    Methods

    The   analysis draws on a survey to 110 preschool managers and 110 school head   teachers in two counties in Sweden, as well as qualitative interviews with   school staff, individually or in groups (22 interviewees).

    Findings

    Victimizing practices range from staff   neglect of children’s possible fear due to previous exposure to violence, and   the invalidation of experiences of violence, to outright dangerousness as   when staff exposing children and their abused mothers to risks for further   violence. Not just the children who are the objects of a family law dispute   are subjected to victimising practices at school, but other children as well.   A key example is when children with disputing parents are subjected institutional   violence by social workers trying to enforce contact, and this is witnessed   by other children.

    Conclusion

    The pattern of victimizing practices can   be linked to institutional and professional hierarchies, as well as dominating   discourses in the domain of education constructing domestic violence as a   problem of order affecting the collective, rather than as a threat to the   rights of individual children.

     

  • 300.
    Eriksson, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Family law proceedings, intimate partner violence, and children’s victimizationat school2015Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives

    What do practices of family law professionals and school staff mean for children’s vulnerability and victimization at school? While there has been considerable discussion of issues about child protection and the cooperation between school and social services in that context, studies on the intersection between school and family law proceedings seem virtually non-existent. This is also the case when it comes to family law proceedings, school and different forms of childhood adversity. The paper explores how family law proceedings in cases involving intimate partner violence impact on school and how school staff tackle the issue of violence and family law.

    Methods

    The empirical material consists of qualitative interviews with a sample of pre-school/school staff, individually or in groups, and a questionnaire to school head teachers and pre-school managers. In total 12 interviews were carried out with 22 interviewees from different staff categories. The questionnaire was sent out to 110 pre-schools and 110 schools in two Swedish counties (response rate 51 and 65 percent respectively). The analysis both concerns the children exposed to violence who are the objects of family law disputes, and the vulnerability of other children at school.

    Results

    The analysis shows that children’s victimization at school can be due to actions by court staff, family law social workers and school staff, in addition to actions by parents. The problematic practices range from actions with victimizing effects, such as the neglect of children’s possible fear due to previous experiences of violence, or the invalidation experiences of violence, to outright dangerousness as when leaving children and their mothers without protection. In the worst case scenario, these practices enable further violence, possibly even lethal violence. Further violence may also be witnessed by other children present at school.

    Conclusion

    The examples found in the data sets make it clear that it is not just the children who are the objects of a family law dispute that are subjected to victimizing practices at school, but other children as well. An issue raised by the analysis presented here is the question as to whether the concept of children “witnessing” violence as crime victims in their own right – well established in Swedish policy today - should be expanded to include also children who witness violence against their peers or their peers’ parents at school.

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