| 1. |
- Edin, Kerstin E, 1952-
(författare)
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Perspectives on intimate partner violence, focusing on the period of pregnancy
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Målet med denna avhandling var att undersöka partnerrelaterat våld mot kvinnor i Sverige från olika perspektiv och med ett särskilt fokus på graviditetsperioden. Syftet var: 1) att ta reda på barnmorskors erfarenheter, attityder och rutiner angående partnerrelaterat våld mot gravida kvinnor inom mödravården; 2) att utforska hur personer som arbetar inom olika program för våldsbenägna män (inom och utom kriminalvården) talar om manligt och kvinnligt och om partnerrelaterat våld, speciellt i förhållande till graviditet; och 3) att belysa kvinnors erfarenheter av att bli och vara gravid samtidigt som de var utsatta för våld i relationen, samt deras möten med barnmorskorna på mödravårdscentralen. Data för tre studier samlades in under åren 1998-2003 med kvantitativa och kvalitativa metoder. En enkät skickades till alla yrkesverksamma mödravårdsbarnmorskor i Västerbotten och analyserades statistiskt och med innehållsanalys. Forskningsintervjuerna utfördes och analyserades enligt ’grundad teori’ (för att skapa teoretiska förklaringsmodeller), ’diskursanalys’ (för att visa hur ett gemensamt språkbruk konstruerar ’sanning’) och ’narrativ metod’ (för att tolka och återberätta innebörden i personliga berättelser). Resultaten från de studier som lade grunden till denna avhandling visar på problemets komplexitet, både från de professionellas och från kvinnornas perspektiv. Barnmorskorna (artikel I) var yrkeskunniga men också kunniga om partnerrelaterat våld mot kvinnor, men utan PM eller andra riktlinjer, så blev de osäkra och ställde sällan direkta frågor eftersom ämnet ansågs vara känsligt och tabubelagt. De professionella (artikel II-III) som arbetade med våldsbenägna män i olika program (inom eller utanför kriminalvården) krävde att män skulle ta ansvar för sitt våld. De ansåg att våldsamma män var tämligen vanliga män men avvikande i särskilda avseenden såsom i samspel, kommunikation, nära relationer och i deras kvinnosyn. De professionella beskrev stereotyper om könsskillnader och hur aggressivitet kan starta på olika sätt hos olika typer av män och ansåg också att graviditet kan utlösa konflikter och våld. Likväl så ingick i programmen vanligtvis inte känsliga frågor, om t.ex. graviditet och samlevnad, och trots en god vilja och avsikt att skapa en ’ny maskulinitet’, så tycktes deras strategier och tankegångar rent av kunna motverka deras egna goda syften. De nio intervjuade kvinnorna (artikel IV) som hade varit utsatta för våld beskrev hur deras liv hade varit komplicerade och blivit till en mardröm då deras hjärtevän hade förvandlats till en förövare. Två kvinnor bröt upp från sina relationer under graviditeten på grund av livshotande våld medan de andra för det mesta höll uppe en fasad och dolde det pågående våldet inför barnmorskan och andra alltmedan de gick balansgång mellan hopp och förtvivlan eller väntade på rätt tidpunkt att ge sig av. Förutom kvinnornas berättelser om partnerrelaterat våld under graviditet (artikel IV) så presenterades två professionella grupper och deras gemensamma svårigheter gällande tabun och känsliga frågor utanför det man vanligtvis sysslade med i sin profession (artikel I-III). Barnmorskorna var yrkeskunniga men hade ingen handlingsplan för att kunna bemöta och identifiera komplexiteten i våldsutsatta gravida kvinnors situation som ofta består i att dölja och balansera. De professionella i program för män konfronterade tydligt mäns våld och hade ambitionen att utmana deras maskulinitet, men då de i samtalen exempelvis förbisåg att ta upp vissa känsliga frågor kan utfallet ifrågasättas.
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| 2. |
- Nyström, Sofia, 1977-
(författare)
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Becoming a professional : A longitudinal study of graduates' professional trajectories from higher education to working life
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The study has a longitudinal design where Political Science and Psychology graduates’ have been interviewed on three consecutive occasions; the last semester before graduation, the first year and then, in the third year of professional work. The theoretical frame of reference comprises a situated and social learning theory and a gender perspective. These theories were chosen since they elaborate on concepts such as identity, practice, participation and learning.The results indicate that becoming a professional is not an isolated phenomenon merely learned and nurtured in higher education and/or in working life. It is emphasised as a dynamic learning process between a reflective individual, the interaction with a professional practice as well as a relationship between other spheres of life, e.g. the personal and the private. The graduates’ professional trajectories can be characterised by a movement from appropriating new knowledge to a need to change direction, e.g. new work tasks or professional fields. This is also a process of professional identity formation. The graduates’ professional identity is emphasised as being both closely related to a gender identity and influenced by the individuals’ belonging to and participation in other practices. The results thus indicate that professional identity formation is an interplay between different spheres of life that changes over time. By using a longitudinal design, it can be claimed that becoming a professional requires balancing one’s whole life situation.
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| 3. |
- Omer-Salim, Amal, 1964-
(författare)
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Mothers’ Agency in Managing Breastfeeding and Other Work in Dar es Salaam, Tanzania and New Delhi, India
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Combining breastfeeding and other forms of work is desirable from both public health and labour productivity perspectives. This is often challenging, especially in low- or middle-income fast-growing urban settings. The aim of this thesis was to gain a deeper understanding of mothers’ perspectives on combining breastfeeding and other work in the urban contexts of Dar es Salaam, Tanzania, and New Delhi, India. Individual semi-structured interviews were conducted with community mothers (n=8) and health worker mothers (n=12) in Dar es Salaam, and mothers working in the health (n=10) and education sectors (n=10) in New Delhi. The methods of analysis were: qualitative content analysis, grounded theory approach, and directed and general inductive content analyses. Mothers’ agency manifested in several ways. Striving to integrate or segment the competing domains of home and work was a goal of these mothers to reduce conflicts in managing breastfeeding and other work. Spatial and time constraints led mothers to engage in an array of carefully planned actions and troubleshooting tactics that included ways of ensuring proximity between them and their baby and efficient time managing. The timing of these strategic actions spanned from pregnancy, over maternity leave, to the return to employment. Managing breastfeeding and work triggered emotions such as stress, frustration and guilt, but also satisfaction and joy. Mothers negotiated with family, employers, colleagues and informal networks to gain support for their strategies, displaying both individual, collective and proxy agency. Changing family structures and roles highlight the potentially greater supportive role of the partner/husband. Work/Family Border Theory and Bandura’s agency constructs provided frameworks for a deeper understanding of mothers’ perspectives, but using existing family relationship constructs would better diffentiate between various modes of agency. Workplaces and maternity protection conditions were generally inadequate. Interventions are required: to strengthen the breastfeeding mother’s own agential capacity using an individual approach; to provide information to families and communities; to improve regulatory, structural and attitudinal conditions at workplaces, and to strengthen health and social services to adequately support mothers in managing breastfeeding and other work.
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| 4. |
- Stolpe, Karin
(författare)
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Att uppmärksamma det väsentliga : Lärares ämnesdidaktiska förmågor ur ett interaktionskognitivt perspektiv
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Den här avhandlingen syftar till att belysa lärares ämnesdidaktiska förmågor i naturvetenskap. Jag fokuserar på tre olika förmågor som är centrala för lärare, nämligen lärares professionella seende, deras automatiska agerande samt deras förmåga att berätta narrativ. Den teoretiska utgångspunkten för avhandlingen är det som jag kallar för det interaktionskognitiva perspektivet. Tre olika aspekter av interaktion behandlas, interaktion mellan individen och hennes omgivning, interaktion mellan individen och andra individer samt interaktion mellan två olika kunskapsformer – den deklarerbara och den intuitiva kunskapen – som bearbetas i det explicita respektive det implicita minnessystemet. Modellen om de två minnessystemen är således central i den här avhandlingen och jag behandlar hur dessa båda minnessystem samverkar så att deklarerbara och intuitiva kunskaper tar sig i uttryck i form av förmågor. Informanterna i de ingående studierna utgörs av såväl lärarstudenter som erfarna lärare som undervisar om, berättar om eller löser problem med ett naturvetenskapligt innehåll, med särskild tyngdpunkt på ekologi. Datainsamlingen har främst bestått i intervjuer, såväl semistrukturerade som stimulated recall-intervjuer. Dessutom har data samlats in genom att undervisning har videofilmats och att informanter har beskrivit sin undervisning i loggböcker. Resultaten visar att vi kan urskilja tre olika aspekter av lärares professionella seende: uppmärksamma, identifiera och känna igen. Förmågan att uppmärksamma det väsentliga i en komplex miljö, exempelvis att finna en viss typ av gräs bland andra gräs, är starkt förknippad med förmågan att känna igen. Dessa förmågor bygger på intuitiv kunskap och är därmed en långlivad förmåga. Att identifiera, dvs. att kunna sätta ett namn på gräset, är däremot en deklarerbar kunskap som är snabbt avklingande relativt lärtillfället. Vidare visar resultaten att förmågan att agera automatiskt är starkt situerad och därmed sammanlänkad med lärandemiljön, elevgruppen och det specifika innehållet. Automatiskt agerande bygger på erfarenhet (igenkänning) av en specifik situation vartill ett beteende är kopplat. En lärare behöver inte själv vara medveten om sitt agerande eftersom detta är en intuitiv kunskap. Den intuitiva kunskapen verkar dessutom vara en viktig del av berättelser. Studenterna kunde upp till ett år efter lärtillfället återberätta grunddragen i en historia. Däremot visade det sig att de exakta vetenskapliga termerna, dvs. den deklarerbara kunskapen, till stor del hade bytts ut mot mer vanligt förekommande termer. Jag vill poängtera värdet av både intuitiv och deklarerbar kunskap i lärarutbildningen.
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| 5. |
- Bjerneld, Magdalena
(författare)
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Images, Motives, and Challenges for Western Health Workers in Humanitarian Aid
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis presents how humanitarian aid workers were attracted, motivated, recruited, and prepared for fieldwork, and how they reported their work experience directly from the field and when they returned home. Data were derived from interviews with experienced aid workers, focus group discussions with presumptive aid workers, analysis of letters from aid workers in the field on MSFs homepages in Europe, and from interviews with recruitment officers at some of the main humanitarian organisations. Health professionals were attracted by the positive images of humanitarian action. They wished to work in teams with like-minded people, and to make a difference in the world. However, this image was not supported by the recruitment officers, or experienced aid workers, who described a complex reality in humanitarian action. The experienced aid workers instead had realised they learned more than they contributed. The recruitment system for relief workers would benefit from a more holistic approach, where personalities of the aid workers are more in focus. More time must be spent with the applicants, both recruited and returning aid workers, in order to improve the system. A socialisation approach could help identify the right personnel and to motivate current personnel to continue.
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| 6. |
- Daerga, Laila, 1965-
(författare)
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Att leva i två världar : hälsoaspekter bland renskötande samer
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: There is a gap of knowledge of the health situation among the reindeer herding Sami in Sweden. The Swedish government has also got criticism for not taking responsibility for the Sami health. The aim of this thesis was to get more knowledge to understand the health situation of the reindeer herding Sami in Sweden. Furthermore, gender specific risk factors in the working environment among reindeer herders and their perception of healthcare and social services were investigated.Method: Cross–sectional questionnaires covering different aspects of health such as musculoskeletal disorders, trust for different healthcare providers and work related psychosocial factors was distributed to reindeer herding Sami and non-Sami populations. Interviews with nine reindeer herding Sami about trust in healthcare and social services were carried out and analyzed with thematic analysis. Sixteen discussion meetings with 80 reindeer herders focusing on psychosocial perspectives of working conditions in Sami communities were performed.Result: The prevalence of musculoskeletal symptoms from elbow, hand/wrist and lower back from male reindeer herders were higher compared to blue-collar worker. Psychosocial risk factors for health were identified such as high workload on a few herders, difficulties to get relief and support as well as to get appreciation in work and lack of participation in decisionmaking among women were common in the organization of reindeer husbandry. The trust in healthcare and social services was lower among reindeer herding Sami compared to non-Sami majority population. A hypothesis is that healthcare professionals do not know that the "Reindeer cloud" (metaphor to iCloud) affects all parts in the reindeer herders life. The distrust are influenced by historically traumas, reindeer herding Sami experiences from healthcare professionals and healthcare organization and culturally generated norms.Conclusio: The thesis hypothesized that health disorders, attitude towards healthcare and psychosocial environment are important aspects when trying to understand the health situation among the reindeer herding Sami. There is a need to introduce long-term public health work for all Sami people, to establish ethical guidelines for Sami health research and develop healthcare services that provides access to healthcare for the reindeer herding Sami, on equal terms.
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| 7. |
- Eriksson, Elisabet
(författare)
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Christian Communities and Prevention of HIV among Youth in KwaZulu-Natal, South Africa
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Young people in South Africa, particularly females, are at great risk of acquiring HIV, and heterosexual sex is the predominant mode of HIV transmission. In order to curb the epidemic the Department of Health encourages all sectors in the society, including religious institutions, to respond effectively. The present thesis seeks to increase the understanding of the role of Christian communities in prevention of HIV for young people. Three denominations in KwaZulu-Natal were selected to reflect the diversity of Christian churches in South Africa: the Roman Catholic Church, the Evangelical Lutheran Church in Southern Africa, and the Assemblies of God. Using qualitative interviews the first paper explores how religious leaders (n=16) deal with the conflict between the values of the church and young people’s sexuality. Study II reports on attitudes to HIV prevention for young people among religious leaders (n=215) using questionnaire survey data. Study III investigates how young people (n=62) reflect on messages received from their churches regarding premarital sex by analysing nine focus group discussions. In the fourth paper, based on questionnaire survey data, we report on young people’s (n=811) experiences of relationships with the opposite sex and their perceived risk of HIV infection. The view that young people in churches are sexually active before marriage was common among religious leadership. The majority of religious leaders also reported that they are responsible for educating young people about HIV prevention. Religious leaders who had received training on HIV were more likely to run a life skills programme for young people, however they were ambivalent about prevention messages. Young people reported premarital sexual abstinence as the main HIV prevention message from their churches. The majority responded that they had received information about HIV in church. To be in a relationship was common, more so for males for whom multiple relationships also were viewed more acceptable. To perceive themselves at risk of HIV infection was common. Further training for religious leaders is needed to enable them to manage the conflict between the doctrine of the church and their willingness to assist young people in the transition into adulthood.
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| 8. |
- Eriksson, Malin, 1969-
(författare)
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Social capital, health and community action : implications for health promotion
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background; The overwhelming increase in studies about social capital and health occurring since 1995 indicates a renewed interest in the social determinants of health and a call for a more explicit use of theory in public health and epidemiology. The links between social capital and health are still not clear and the meanings of different forms of individual and collective social capital and their implications for health promotion needs further exploration. The overall aims of this thesis are to explore the relationship between social capital and health and to contribute to the theoretical framework of the role of social capital for health and health promotion.Methods; Data from a social capital survey were used to investigate the associations between individual social capital and self-rated health for men and women and different educational groups. Survey data were also analyzed to determine the association between collective social capital and self-rated health for men and women. A qualitative case study in a small community with observed high levels of civic engagement formed the basis for exploring the role of social capital for community action. Data from the same study were utilized for a grounded theory situational analysis of the social mechanisms leading to social capital mobilization.Main findings; Access to individual social capital increases the odds for good self-rated health equally for men and women and different educational groups. However, the likelihood of having access to social capital differs between groups. The results indicate a positive association between collective social capital and self-rated health for women but not for men. Results from the qualitative case study illustrate how social capital in local communities can facilitate collective actions for public good but may also increase social inequality. Mobilizing social capital in local communities requires identification of community issues that call for action, a fighting spirit from trusted local leaders, “know-how” from creative entrepreneurs, and broad legitimacy and support in the community.Conclusions; This thesis supports the idea that individual social capital is health-enhancing and that strengthening individual social capital can be considered one important health promotion strategy. Collective social capital may have a positive effect on self-rated health for women but not for men and therefore mobilizing collective social capital might be more health-enhancing for women. Collective social capital may have indirect positive effects on health for all by facilitating the ability of communities to solve collective health problems. However, mobilizing social capital in local communities requires an awareness of the risk for increased social inequality.
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| 9. |
- Sahlén, Klas-Göran, 1957-
(författare)
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An ounce of prevention is worth a pound of cure : preventive home visits among healthy seniors
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers. An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over. The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results. Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling. Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked. Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.
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| 10. |
- Wilhelmsson, Margaretha, 1948-
(författare)
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Developing Interprofessional Competence : Theoretical and Empirical Contributions
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Different professions meet and work together in teams every day in health and social care. In order to idenUiy and deliver the best quality of care for the patient, the teamworkers need to be both professionally and interprofessionally competent. How can higher education prepare teamworkers to be both professionillly and interprofcssionally competent? This thesis seeks to contribute theoretically and empirically to this issuc. A starting point for interprofessional education (WE) worldwide was when WHO presented a document entitled "Leaming Together to Work Together for Bdter Health". The basic idea in this strateg)' was that it is favourable for undergraduilte students and the development of their own professionill identity to experience other professions in health and sodal sectors as earlyas during their undcrgraduate studies. Inherent in this scheme is that the various professions will work together in practice. Thc overall winner in this new thinking about education and professionai prLlctice would be the patient. One of the Hrst systematic attempts to organize IPE academically was initiated in 1986 at the Faculty of Health Sciences (FHS) at Linköping University in Sweden. The "Linköping Model" has now yielded 25 yeilrs of practical experience and development of IPE curricula.Aims: The overall aims of this thesis we.re to define, describe and measure effects and outcomes of interprofessional education/learning.Methods: In the research papers theoretical, aualitative and quantitative methods have been used.Results: The newly registered medical doctors educated at the FHS at Linköping University and exposed to WE and PBL reported more confidence (p < 0.0001) that their lIndergraduate studies had given them interprofessional skilIs and abilities to collaborate with other professions than medical students from all other medical faculties in Sweden. Nurses who hild been exposed to interprofessional curricula during their undergraduate education ilt FHS reported to greater extent (p = 0.003) that they were prepared to work as a nurse. Furthermore, they also reported to a greater extent (p < 0.0001) that their undergraduate education hild prepared them to work with other healt care professions. Other findings in this thesis wcre that female tudents in generill and nursing students had a more positive view of interprofessional learning and were more open-minded about collaboration with other professions. Only to a minor extent did exposure to a more extensive interprofessional curriculum promote a positive attitude towards teamwork.Conclusions: A major challenge to modern health care is the need for more interprofessional teamwork to improve the safety and quality of patient-centred care. This thesis indicates some directions for more successful interprofessional education.
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