| 1. |
- Emilsson, Maria, 1966-
(author)
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Betydelsen av personlighet och uppfattning om läkemedel för följsamhet till astmamedicinering
- 2010
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Licentiate thesis (other academic/artistic)abstract
- En okontrollerad astma kan leda till komplikationer i lungor och luftvägar. Astma kan kontrolleras med läkemedelsbehandling men fullständig astmakontroll uppnås inte alltid. Den vanligaste orsaken till att astmakontrollen inte uppnås är brister i följsamheten till astmamedicinering. Syfte: 1) Att undersöka om personlighetsdrag hos unga vuxna med astma var relaterad till astmakon-troll och hälsorelaterad livskvalitet, samt belysa samband mellan personlighetsdrag och följsamhet till regelbunden a... merstmamedicinering. 2) Att belysa samband mellan personlighetsdrag, uppfattning om läkemedel och följsamhet till astmamedicinering. Material och metod: I Studie I ingick 268 individer (165 kvinnor och 103 män) i åldern 22 år (±1år). I Studie II ingick 35 patienter (25 kvinnor och 10 män) med en medelålder av 52.8 år. I studierna an-vändes frågeformulär för att samla in data om personlighet, följsamhet, astmakontroll, hälsorelaterad livskvalitet och uppfattning om läkemedel. Resultat: Personlighet hade samband med följsamhet till astmamedicinering, uppfattningar om läke-medel, astmakontroll och hälsorelaterad livskvalitet. I Studie I framkom att de som skattade sig mer impulsiva rapporterade lägre följsamhet. Ett negativt samband fanns mellan höga värden i personlig-hetsdraget alexitymi (bristande intresse att förstå och prata om känslor) och följsamhet till astmamedi-cinering hos unga vuxna män. Likaledes framkom ett negativt samband mellan personlighetsdraget antagonism och följsamhet hos unga vuxna män. Hos båda könen var personlighetsdraget negativ af-fektivitet relaterat till dåligt kontrollerad astma. Det indikerades att personlighet kan påverka den men-tala hälsan hos både unga kvinnor och män, medan den fysiska hälsan hade samband med astmakon-troll och fysisk aktivitet. I Studie II framkom att fyra av fem personlighetsdrag hade samband i olika riktningar med uppfattningar om läkemedel. Högt värde i Specefikt-nödvändighetsskalan (uppfattning om nödvändigheten av förskrivna läkemedel) var relaterat till hög grad av följsamhet. Personlighets-draget målmedvetenhet var relaterat till hög följsamhet hos män. Känslomässig instabilitet hade sam-band med lägre värden i följsamhet också hos män. Konklusion: Kunskapen om personlighetens betydelse behöver fördjupas, men uppsatsens resultat indikerar behovet av att identifiera individuella skillnader i personlighet för att öka patienternas följ-samhetsbeteende, stärka deras uppfattning om nödvändigheten av läkemedelsbehandling och minska deras oro för läkemedelsbehandling, vilket har betydelse för både astmakontroll och hälsorelaterad livskvalitet.
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| 2. |
- Hedman, Lisa
(author)
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Mellan sakfrågorna, det är där man hittar mervärdet : Politikers och tjänstemäns lärande i arbetet med barns och ungas inflytande
- 2024
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Licentiate thesis (other academic/artistic)abstract
- IntroductionHow we can increase children’s opportunities to participate and influence society is a highly topical issue. Against the background of a reduced commitment to political participation and a reduced trust in politicians (see e.g. Amnå & Ekman, 2013; Öhrnvall, 2023), it becomes more important to work on promoting dialogues between decision-makers and citizens. These dialogues can contribute to deepening and strengthening democracy (Bornemark, 2017). The UN Convention on the Rights of the Child (SFS 2018:1197) describes the child’s right to form and express his or her views and to have these considered. Swedish youth policy describes the goal as "all young people should have good living conditions, the power to shape their lives and have influence over the development of society" (Prop. 2013/14:191). In addition to the statutory requirements for children’s and young people’s opportunities for participation and influence, there are positive individual and societal benefits. The work with children’s and young people’s participation strengthens social capital and reduces social exclusion (Andersson & Sandgren, 2015; Wennerholm, Juslin & Bremberg, 2004). Municipalities must ground their efforts in the UN Convention on the Rights of the Child, which is incorporated into Swedish law and stated in political objectives. However, in several municipalities, politicians and civil servants find it difficult to put their knowledge of the Convention into practical work (see e.g. Barnombudsmannen, 2022; Stern & Jörnlund, 2011). Children and young people have been the main focus in previous studies regarding the work with children’s and young people’s influence. These studies have examined children’s and young people’s political interest and commitment (see e.g. Amnå & Ekman, 2013; Amnå, Ekström & Stattin, 2016; Tukkannen, Kankaaranta & Wilska, 2012) and the significance of forums for the future of democracy such as youth councils (Kassman & Vamstad, 2019; 2022). Other studies have shed light on forums for children’s and young people’s opportunities for participation and influence and how children and young people are given the opportunity to develop by participating in these forums (Andersson, 2018a; Harada, 2023; Kassman & Vamstad, 2019). Informal learning focuses mainly on how children and young people learn to cooperate (Harada, 2023), develop their thoughts by listening to others (Kassman & Vamstad, 2019), and develop their democratic skills (Andersson, 2018a; Harada 2023; Kassman & Vamstad, 2019). There are also studies that have emphasized pedagogical perspectives on adults’ attitudes and the consequences for the way they approach children and young people (Andersson, 2015, 2018a, 2018b, 2022). Viewing young people as future citizens rather than current citizens has been described as a risk that limits their opportunities for participation (Taft & Gordon, 2013). While these previous studies have focused to a greater extent on children and young people, they lack in focus regarding adults and their learning (politicians and civil servants), meaning what skills, abilities, and knowledge adults develop (see e.g. Andersson, 2015, 2018a; Harada, 2023; Kassman & Vamstad 2019; Svensson, 2006; Waara et al., 2010).This study focuses on the adults by highlighting the conditions and expressions of politicians’ and civil servants’ learning in their work on increasing children’s and young people’s influence. A large proportion of the decisions concerning children and young people are made at the municipal level. Local civil servants and politicians deal with a wide range of issues relating to schools, social services, leisure, and community planning, a complex task that requires both education and acquired knowledge in these areas. In a changing world with various demands on the organization, knowledge development and learning processes become central to meeting the challenges they face (see e.g. Argote, 2011; Tjulin & Klockmo, 2023; Sunnemark et al., 2023). The point of departure for this study is that politicians and civil servants have both individual and collective experiences as well as knowledge that can be made visible when they work with children’s and young people’s influence. The learning that takes place within organizations thus becomes central to adapting, developing, and managing the changes in the work that politicians and civil servants are faced with (see e.g. Argote & Miron-Spektor, 2011). Aim and research questionIn this study, the focus is on conditions for and expressions of politicians’ and civil servants’ learning in their work on children’s and young people’s influence. Conditions are understood as what enables and hinders learning, which reflects the premises for what kind of learning is made possible in their work. Central to their work on increasing children’s and young people’s influence is dialogue, which makes it possible to share experiences and knowledge. The purpose of this study is to examine the conditions and expressions of politicians’ and civil servants’ learning in their work with children's and young people's influence. The following research questions guided the study: x How do politicians and civil servants describe the experiences they bring with them from their work with children and young people? x What conditions enable and hinder the learning processes of politicians and civil servants in their work with children’s and young people’s influence? MethodThis study emanates from data produced between October 2020 and June 2022, primarily through observations of meetings in which nine politicians and 16 civil servants participated. The study is designed as a case, where the case is framed by the model that the municipality has designed for their work on children’s and young people’s influence. The study’s empirical data has been collected through observations and dialogue sessions. Through these observations of their work, it became possible to see how their understanding is expressed (see e.g. Lalander, 2015; Kawulich, 2005). In doing so, the observations have been a prerequisite for studying conditions and expressions that emerge while they work and how these can enable or hinder politicians’ and civil servants’ learning. The study’s dialogue sessions were inspired by unstructured focus groups (Wibeck, 2010) and reflexive participant collaboration (Motulsky, 2021). Prior to the dialogue session, participants viewed a stimulus material based on the observations. These meetings allowed politicians and civil servants to develop their thoughts about the work previously observed (see e.g. Motulsky 2021; Wibeck, 2010).The empirical material that forms the basis of the analysis consists of three parts, (1) observation notes, (2) transcripts from dialogue sessions and (3) written documents. In the current study, data triangulation has been used. By collecting data in such a way, it’s possible to see what commonly occurs on different occasions and what becomes visible in situated contexts (Fusch, Fusch & Ness, 2018). It can be described by the way observations relate to different activities between people and groups where the context becomes central. Triangulation has been used in this study to deepen knowledge about how these different factors complement each other in the municipality’s work. All data was analysed through a thematic analysis based on the work of Braun and Clarke (2006). The analysis aimed to identify and investigate patterns in the material in relation to the purpose of the study and resulted in five themes with subthemes.ResultsThe study’s material shows how politicians’ and civil servants’ experience external demands and internal expectations become prerequisites for the shaping of their learning processes. The external and internal contexts create conditions for what knowledge both individuals, groups, and the organization obtain (see e.g. Argote 2013; Argote & Miron-Spector, 2011). The study shows how their work is shaped by external requirements which contain overall goals based on the UN Convention on the Rights of the Child and the national goals for youth policy (SFS 2018:1197; Prop. 2013/14:191). The external context is also shaped by existing norms, such as norms about age, and the way politicians formulate policies that are institutionalized in their work (see e.g. Butler, 1980). Norms regarding children and childhood shape their work including policies and politics. In the external contexts of the work, there is also a contradiction that can be exemplified by nationally prevalent political expressions such as "being the adult in the room" which comes into conflict with the point of view regarding children as competent actors, stated in the UN Convention on the Rights of the Child (SFS 2018:1197). The different demands formulated by the external context also have an impact on how the local goals and efforts are shaped. This study shows how commitment and motivation are prerequisite for sharing experiences and knowledge at work. Politicians and civil servants participate in various knowledge-raising activities related to work with children’s and young people’s influence and then bring these experiences to their smaller working groups. The discussions that take place at work can be understood as a way of assimilating knowledge, i.e. how they try to make sense of others' experiences and knowledge in their own context (see e.g. Cohen & Levinthal, 1990; Vaghefi, Lapointe & Shahbaznehad, 2018). However, the results reveal challenges in transferring the information to new situations and making use of it. The results show that the new forms of work largely resemble their previous structures. An explanation could be seen in terms of how their experiences affect the knowled
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| 3. |
- Sjöström, Thomas
(author)
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Platsens betydelse för lärande i primärvård på landsbygden : Digital vård och sociala rum
- 2023
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Licentiate thesis (other academic/artistic)abstract
- IntroductionE-health, defined as digital healthcare services enabling remote contact between patient and caregiver, has gained increased attention in scientific research during the recent decades. Given the rapid pace of technological progress and the ever-changing nature of work, health care professionals constantly need to learn new technologies (Agrawal & Prabakaran, 2020; Carlander, 2021; Samuelson et al., 2022). Such learning can take place in different ways. Over the past thirty years, theories of work-integrated learning (WIL) have emerged, initially focusing on individual practitioners formal learning as an organized activity in educational settings, only to later widen the scope to include informal learning – learning as a dimension of everyday practice – at individual, group and organizational level. In this thesis, health care professionals’ informal learning is studied.E-health, at times conceptualized as a place-independent technology liberating health care from its spatial limitations, is analysed from a place perspective, thus contemplating on the importance of place when presumably place-independent technologies are implemented in everyday practice. While the general conditions for primary care in urban and rural areas have been researched to some extent (e.g. Ekman et al., 2019; Kullberg et al., 2018; Lindberg & Carlsson, 2018; Lindberg et al., 2021; Myndigheten för vård och omsorgsanalys, 2021) it remains to explore in what ways these conditions can affect professional learning in an e-health context, thus affecting how technology is used. A perspective that describes the technology as place-independent could suggest that the technology works in a similar way everywhere, a one-size fits all, regardless of where practice is conducted. But with few exceptions (e.g. Currie et al., 2015; Lindberg et al., 2021; Lindberg & Carlsson, 2018; Salemink et al., 2017), e-health in primary care from a place perspective has rarely been studied and problematized. Although the relevance of e-health for rural areas has been identified, there is still a lack of research and knowledge regarding e-health in rural areas (Lindberg & Carlsson, 2018) and the spatial shift that occurs when care moves from a physical to a digital space. In health research, calls for research with place perspectives have been voiced, as health is linked to the social, and the social to a place (Wiles et al., 2009); in this case, what takes place while learning digital health in a social space.The setting of this study is a rural primary health care center located in Sweden. In the area of the health care center, geographical distances are longer, the population older, and the digital infrastructure to some extent deficient, compared to the national average. The study describes and analyzes healthcare professionals’ learning, use of e-health services and their experience of the potential and limitations of e-health in their rural context. In addition, patients 65 years and older are interviewed, as they form a central part of the care environment described and thus the health care professionals’ everyday learning environment.Aim and research questionsThe overarching purpose of the study is to contribute with an increased understanding of how health care professionals in primary care come to learning and e-health services to use in a health care environment with physical geographical distances, an aging population, and to some extent insufficient digital infrastructure. The following research questions guided the work:- How can health care professionals’ learning and use of e-health technologies be understood from a place perspective?- Which opportunities and limitations do e-health pose in rural primary care?- How are older people's experiences taken into account when e-health services are used and how does the elderly patient (65 years and older) experience an increasingly digital primary care environment?MethodThis study emanates from data produced january 2021 to may 2022 through interviews with health care professionals (N=14) and patients aged 65 years and older (N=14). Health care professionals were recruited from a primary health care center in a rural area in Sweden. Patients were recruited from the same area. The health care professionals comprised of doctors, nurses, assistant nurses, medical secretaries and a health care center manager. Semi-structured interview guides were used during the interviews. The health care professionals were asked questions about individual use of digital health technologies, motivation to use digital health technologies, professional learning and development and experience of digital health in a rural setting. Patients were in a similar fashion asked about individual use of digital health technologies, motivation to use these technologies and their personal relationship to the health care center. All data were analyzed in accordance with constructive grounded theory as described by Charmaz (2017, 2014, 2012, 2005, 2000). This variant of grounded theory has gained influence in recent years and has also become popular in the health sciences (Albert, 2019; Mills et al., 2006). The difference between classical grounded theory and the constructivist-based grounded theory can be seen as a difference in ontology and epistemology. In the constructivist-based theory, unlike the classical grounded theory, the researcher is seen as a co-creator of the empirical material. Through his/her interpretations, the researcher becomes part of what is being studied, which means that the empirical material is subsequent to change. Charmaz (2014) describes constructivist grounded theory as a method that can lead to creative interpretations as the analytical process can contribute with an understanding of both social processes and general events.ResultsDuring interviews, health care professionals and patients assigns the health care center connotations that are also used to describe the wider setting of the health care practice, the “countryside”; a place with geographical distance but also social proximity, often contrasted and compared with a notion of a more impersonal care in the city. The “personal care” described at the local health care center is made possible due to spatial continuity, in part created by relationships and networks built up over time, in part due to the emotional connections to the health care center as a physical place. For patients, recognition creates a knowledge-based continuity, which in turn provides security and emotional ties between patient and professional. Health care professionals view these relationships as an integral part of creating good care. The emphasis of personal relationships and the importance of the social in care – i.e. informal, spontaneous meetings between patient and nurses – shows how the health care have established a social role in local society. Both professionals and patients describes the health care center as a meeting place, a place with no boundaries for access to health care. However, e-health technologies, for example digital care meetings via videolink, is to a large extent viewed as creating new boundaries. Health care professionals describe how the elderly patient lacks knowledge or is too unaccustomed to use digital tools, why elderly patients opt out of digital care meetings in favor of a physical visit. Interviewed patients, however, describe that they – with variations but to a large extent – are digitally savvy. Instead, opting out of digital care is an expression of active choice. The health care center is an appreciated meeting place that delivers a social, informal and spontaneous dimension of care, dimensions the digital care meeting cannot offer. vii Together with this empirical data, theoretical data of social health, affordances and the importance of third places in local society, shows the relation between place and learning. Gibson's (1979) concept of affordance encompasses the conditions that emanate from a particular place, a place-related action-borne knowledge based on the resources offered in the surrounding environment, thus providing answers to what the environment can offer in regard to its possibilities and limitations. On the superficial level, a coverage map showing the digital infrastructure in the health care centers’ immediate area – showing whether a digital care meeting is at all possible – describes one of the affordances that exist when the health care professionals are faced with the decision to schedule a digital care meeting. On the other hand, there are also more abstract affordances at play: the view of the patient's relationship with the health care center and its professionals, the local role of the health care center, the patient's readiness – i.e. digital literacy – to conduct a digital care meeting and the question of the nature of a “good” care meeting.Discussion and conclusionThe study highlights the importance of viewing learning from a sociocultural perspective. Although Gibson's (1979) affordances previously have been used in research on learning, it could be argued that this has been done with a narrow interpretation of what constitute an affordance. For example, workplace affordances have been limited to which learning opportunities are easily accessible to workers, the employee's ability to create learning opportunities for themselves, and access to teachers (e.g. Berkhout et al. 2017). But since a workplace cannot be seen as a solitary unit, more studies need to shed light on e-health from a place perspective where health care activities, such as e-health, are seen together with their cultural and social context. To understand what learning is possible, an understanding of place is required. Following a socio-material perspective the affordance cannot be limited to the characteristics of an actor or technology – what it enables – but also something that
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| 4. |
- Viking, Tuija
(author)
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En studie om interprofessionellt lärande i teamarbete : Fallet med en 'best practice´ för tvångsvård
- 2019
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Licentiate thesis (other academic/artistic)abstract
- Det interprofessionella lärandet, IPL, i team har blivit ett populärt medel för att öka samarbete och kvalité i den sociala sektorn och hälso- och sjukvård. En alltmer specialiserad och fragmentiserad vård, som ofta genomförs i team, har lett till stor spridning av interprofessionell utbildning, IPE. Studerande och/eller medlemmar från olika professioner lär sig därmed, med, från och om varandra. Sådant lärande antas ske vid utbyte av och reflektion över varandras olika erfarenheter, perspektiv och kunskaper, d.v.s. professionella skillnader, och leda till förbättrad effektivitet och kvalitet i vården.Inom hälso- och sjukvårdsområdet har man dock bara i mindre skala undersökt vad IPL i etablerade team innebär och hur professionella skillnader påverkar lärandet. Denna licentiatuppsats hade som övergripande syfte att bidra med ökad kunskap inom detta område. Här studerades ett arbete, med kliniska riktlinjer för psykiatrisk tvångsvård, som skulle genomföras av ett interprofessionellt team. Huvudfrågan var hur teamet arbetade med riktlinjerna och hur professionella skillnader kom till uttryck och gav implikationer för IPL. Licentiatuppsatsen är en fallstudie. Undersökningen baseras dels på material (mötesprotokoll, mejlkommunikation, dokument och mediarapporter) från teamets tre-åriga arbete, dels nio intervjuer och en observation av seminariet där teammedlemmar presenterade de färdiga riktlinjerna. Studie 1 syftade till att undersöka hur teamet hanterade en kontrovers och hur de strategier som användes gav konsekvenser för interprofessionellt lärande. Studie 2 syftade till att studera hur teamet granskade kön/genus i arbetet med riktlinjerna och vilka implikationer det blev för riktlinjerna och för interprofessionellt lärande. Fokus här är därmed på ett lärande i ett "färdigt" team. Resultaten i studierna baseras på fallbeskrivning och narrativ analys. Fynden i studierna tolkades huvudsakligen utifrån sociokulturell teori och idéer och insikter från kontroversstudier (studie 1) och det genusvetenskapliga fältet (studie 2).Resultatet i studie 1 visade att kontroversen hanterades främst genom en kompromiss. Resultatet visar också hur lärandestrategier nyttjades vid användning av texter. Lärandet utmanades dock när maktstrategier användes genom hävdande av auktoritet snarare än utforskande av kunskapsläget.Resultatet i studie 2 visade hur kön/genus aktualiserades i en diskussion om könsskillnader i användning av tvångsbälten. I diskussionen användes professionsspecifika erfarenheter och kunskaper om kön/genus, vilket kan antas främjade IPL. Teamets lärande om komplexiteten kring kön/genus resulterade i riktlinjer som betonar makt och med fokus på den individuella patienten. Därmed ledde teamets analys och lärande relaterat till kön/genus paradoxalt till könsneutrala riktlinjer. Slutsatsen är att studierna, på olika sätt, visade förekomst av IPL och hur detta påverkades både positivt och negativt av professionella skillnader.
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