| 1. |
- Addelyan Rasi, Hamideh, 1975-
(författare)
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Empowering Women in the Middle East by Psychosocial Interventions : Can provision of learning spaces in individual and group sessions and teaching of coping strategies improve women’s quality of life?
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This study set out to construct a conceptual framework that can be used in social work with women in the Middle East and other settings where women have limited access to resources, which, as a result, limits their decision-making capacity. The framework has both an empirical and a theoretical base. The empirical base comprises data from two intervention projects among Iranian women: single mothers and newly married women. The theoretical base is drawn from relevant psychological and social work theories and is harmonized with the empirical data. Psychosocial intervention projects, based on learning spaces for coping strategies, were organized to assess if Iranian women could use a problemsolving model (i.e. focused on cognition and emotion simultaneously) to effectively and independently meet challenges in their own lives and improve their quality of life.Methods: Descriptive qualitative and quasi-experimental quantitative methods were used for data collection and analysis. Forty-four single mothers and newly married women from social welfare services were allocated to nonrandomized intervention and comparison groups. The intervention groups were invited to participate in a 7-month psychosocial intervention; the comparison groups were provided with treatment as usual by the social welfare services. The WHOQOL-BREF instrument was used to measure quality of life, comparing each intervention groups’ scores before and after the intervention and with respective comparison groups. In addition, content analysis and constant comparative analysis were performed on the qualitative data collected from the participants before, during and after the intervention.Results: The results of the quasi-experimental study show significant and large effect sizes among the women exposed to the intervention. Small and not statistically significant effect sizes were observed in the women provided with traditional social welfare services. Accordingly, teaching coping strategies can be a means to improve the quality of life of women in societies where gender discrimination is prevalent. The qualitative findings from the Iranian projects illustrate a process of change —socio-cognitive empowerment— with regard to thinking, feeling and acting among women during and after the intervention. The women developed a number of mental capacities essential to coping and life management. All women used the model effectively, and consequently, made more deliberate decisions to improve their life situations.Conclusion: The practical lessons from the Iranian projects highlight the possibilities of empowering women through fostering mindfulness and deliberate decision making as well as achieving consciousness. This study provides provisional evidence that psychosocial intervention projects, based on learning spaces for coping strategies, can help many clients to achieve their goals and improve their quality of life, and that this psychosocial intervention project can be a useful model for social work practice with women in the Middle East. The conceptual framework can help social workers to bridge the gap between theory and practice: that is, to draw from existing social work theories and, through the psychosocial intervention model, better apply this knowledge in their practical work with women in challenging social environments.
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| 2. |
- Kullberg, Agneta, 1955-
(författare)
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My Home is my Castle : Residential Well being and Perceived Safety in Different Types of Housing Areas in Sweden
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the perspective of the residents are limited in the literature. Although historically public health research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditions influence residential well-being.Aim: The overall aim of this thesis was to examine factors and conditions associated with residential well-being and perceived safety in different types of housing areas and to compare safety promotion intervention designs based on residents self-expressed safety needs with corresponding designs developed by local government professionals.Materials and methods: A postal survey (response rate 56%, n=2476) and 11 focus groups (57 participants) were conducted among the residents in 3 small-scale housing areas with detached houses and 3 housing areas with blocks of flats in a Swedish municipality. The areas were geographically contiguous as each of the small-scale areas bordered on an area with blocks of flats. The study municipality is a designated member of WHO Safe Community network that have signed up to work in line with the indicators developed by WHO Collaborating Centre on Community Safety Promotion. Narrative data from a postal questionnaire were used to analyze the lay perspective and identify features perceived to be necessary to feel safe by residents in areas with blocks of flats and small-scale housing areas. Quantitative data were used to examine correlates of local safety-related concerns through a factor analysis. Logistic regression analysis examined associations between high-level scores of the safetyrelated dimensions found and area-level crime rate and being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. To examine how self-assessed area reputation is associated with social trust and residential well-being, a multilevel logistic regression analysis was performed using quantitative data, controlling for the random effect of neighbourhood- and individual-level socio-demographic factors. Data from focus group interviews were analyzed to identify mechanisms of how neighbourhood reputation was established. The quality function deployment (QFD) technique was used in a case study to integrate residents’ demands into the design of safety promotion interventions in housing areas. The resulting design was then compared with the safety intervention programme designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community programme.Results: The residents’ narratives showed that a stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in small-scale housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. The crime rates were lower and safety-related concerns were less in small-scale housing areas. Three composite dimensions (CD) of perceived residential safety were identified: structural indicators of social disorder (CD 1); contact with disorderly behaviour (CD 2); and existential insecurity (CD 3). Area-level crime rates and individual-level variables were associated with dimensions (CD 1) and (CD 3), but only individuallevel variables were associated with dimension (CD 2). The level of residential well-being and social trust was higher in small-scale areas. The housing area reputation was found to be strongly associated with safety-related concerns, residential well-being and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order. The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups. The Safe Community programme designed by professionals did not address the social integrative processes, but did cover the vulnerable groups.Conclusions: Area reputation is an important and probably underestimated dimension in the development of residential well-being and perceived safety. The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particular suitable for providing a quality orientation from the lay perspective on safety promotion in local residential areas. The current Safe Homes concept in the Safe Community programme would benefit from being widened to Safe Housing.
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| 3. |
- Lindqvist, Kent, 1948-
(författare)
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Towards community-based injury prevention : the Motala model
- 1993
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the Swedish County of Östergötland a comprehensive health policyprogramme including accidents was decided by the health authorities in 1988. An accident prevention programme (the "Motala Accident Prevention Study") had already started with an epidemiological analysis of accidents in the community. The Motala study is based on Bracht and Kingsbury's five-stage model of community development: community analysis, design and initiation, implementation, maintenance, and reassessment.The scientific reporting of the Motala study in this thesis is based on selected parts of the five-stage model and is grouped into reports from the community analysis (the main study) and an intervention study. The aim was to describe the panorama of accidents, their causes and effects in a defined community, and to account for the economic consequences of these accidents. A secondary aim was to provide an epidemiological basis for a sports accident prevention programme and out of that design such a programme, and to evaluate the effects of loan programmes on infant car restraints. In forthcoming papers other parts of the different stages of the model will be presented.Total population injury surveillance was performed in an area with apopulation of over 41,000. All accidents (N= 4,926) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 118.9 per 1,000. They consisted of accidents in the home (35.0%), sports accidents (18.9%), accidents at work (13.7%), traffic accidents (12.8%), and "other" accidents (19.5%). Half of the victims covered by health insurance were put on sick leave in connection with the accident, and 12.6% of these were admitted to hospital. The age-group 13-19 years, and men between 20-29 years of age, showed the highest accident rate. The total cost to society for people in the labour force, including treatment cost and production loss, was 103.4 million SEK (15.7 million USD). The cost to society of uninsured people for time lost from "normal activities" because of an accident was estimated at 43.1 million SEK (6.5 million USD). There are three important conclusions with regard to the economic consequences of accidents. Firstly, it appears important to assess not only the productive working time of the injured people, but also other time, in which normal activities are restricted. Secondly, the findings reveal the conflict between the utilitarian and the dutybased ethical basis of health care activities. Thirdly, the results show the need for well-controlled studies with alternatives to show the effects of different actions.
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| 4. |
- Nilsen, Per, 1960-
(författare)
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Opening the Black Box of Community-Based Injury Prevention Programmes : Towards Improved Understanding of Factors that Influence Programme Effectiveness
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite wide application of community-based programmes to prevent injuries and promote health over the last 25 years, there is a paucity of evaluations from which to obtain evidence regarding the effectiveness and critical factors contributing to achieving effectiveness of these programmes. Research on community-based injury prevention programmes thus far has been driven by the question “does it work?” However, merely establishing whether a programme works or not provides insufficient information to generate new knowledge about these programmes. Many programme evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the programme and its effects. Opening the black box is essential to developing the best evidence in relation to community-based programmes.Keeping the question “does it work?” in mind as a departure point, the seven studies of this thesis address different aspects of the questions “why does it work?” and “how does it work?” The aim is to aid in the understanding of factors that influence the operation and effectiveness of community-based injury prevention programmes.The findings from the studies support a number of conclusions with regard to the three research questions posed. There is limited evidence for the effectiveness of communitybased injury prevention programmes. Some of the problems of providing convincing evidence are due to the methodological difficulties of evaluating these programs.Contextual conditions and the amount of financial resources available to a programme are key factors associated with the effectiveness of community-based injury prevention programmes. There is inconclusive evidence regarding the importance of some of the socalled success factors described in the scientific literature for achieving effectiveness. While many programmes have access to locally collected injury data, they devote limited time to the analysis of this ssembled data. When selecting interventions, many programmes rely upon tuitive and subjective methods, e.g. discussions in networks, feedback from the general public, and experiences gained in their own work. This style of decision making is “experience-based” rather than evidence-based.The theoretical underpinning of the community-based approach has certain shortcomings, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programmes. Programmes overwhelmingly define geographical units as communities. However, these entities can be highly heterogeneous and characterised by a weak sense of community, which can yield insufficient community member participation and intersectoral collaboration, as well as inadequate reach for many programmes. At the same time, none of the most plausible assumptions of the community-based approach appears to be fully or widely applied in programme practice. The implication is that many community-based programmes do not function at an optimum level.
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| 5. |
- Nolén, Sixten, 1962-
(författare)
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Increased bicycle helmet use in Sweden : needs and possibilities
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: From the perspective of what is called "vision zero" in Sweden, fatalities and injuries among bicyclists are unacceptable. Despite that, bicyclists constitutes approximately one third of all road user inpatients in Swedish hospitals, which is about the same proportion seen for drivers and passengers of motor vehicles. There are too many bicycle-related head injuries, but the risk of such traumas could be reduced considerably by the use of helmets. Bicycle helmet wearing can be increased by voluntary means, for instance by long-term community-based helmet promotion programs. However, the best effect has been achieved by combining promotion with a compulsory helmet law for all bicyclists, as has been done in Australia, New Zealand, and North AmericaAim: The general aim of the research underlying this dissertation was to provide further information about the need for increased bicycle helmet use in Sweden, and to determine what measures can lead to more widespread helmet wearing. The four papers included addressed two main questions: (1) What is the need for increased helmet wearing among different categories of bicyclists in Sweden? (2) Is a non-compulsory local bicycle helmet law a realistic alternative to a mandatory helmet law for all bicyclists?Materials and methods: Observational studies of helmet use by bicyclists in Sweden were conducted once a year (average n = 37,031/year) during the period 1988-2002 (paper I). The general trend in observed helmet wearing in different categories of bicyclists was analyzed by linear regression, and the results were used to predict future trends in helmet wearing. Three studies (papers II-IV) were also performed to evaluate a non-compulsory local bicycle helmet "law" in Motala municipality during the study period 1995 to 1998 (papers II-IV). This law was introduced in 1996 and applies specifically to school children (ages 6-12 years), although the intention is to increase helmet use among all bicyclists. Adoption of the law was accompanied by helmet promotion activities. In one of the studies in the evaluation, written material and in-depth interviews (n=8) were analyzed qualitatively to describe the process and structure of development of the Motala helmet law. The other two studies used a quasi-experimental design to assess the impact of the helmet law: one comprised annual observations of helmet wearing among bicyclists in Motala (average n=2,458/year) and control areas (average n=17,818/year); and the other included questionnaire data on attitudes, beliefs, and self-reported behavior of school children in Motala (n=1,277) and control areas (n=2,198). The average response rate was 72.8%.Results and discussion: There was a significant upward trend in helmet use in all categories of bicyclists from 1988 to 2002. Helmet wearing increased from 20% to 35% among children(≤ 10 years) riding bikes in their leisure time, from 5% to 33% among school children, and from 2% to 14% in adults. Total average helmet use rose from 4% to 17%. However, during the last five years of the study period (1998-2002), there was no upward trend in helmet wearing for any of the categories of bicyclists. If the historic trend in helmet use continues, the average wearing rate will be about 30% by the year 2010. The Motala helmet law was dogged by several problems, mainly during the initiation phase, and some of them led to poor rooting of the law in the schools and indistinct roles and responsibilities of the municipal actors. Despite that, the law initially led to a significant increase in helmet wearing among the primary target group (school children), from a pre-law level of 65% to about 76% six months post-law, whereas thereafter the wearing rate gradually decreased and was at the pre-law level 2 ½ years after the law was adopted. Nonetheless, a weak but significant effect on adult bicyclists remained: the pre-law level of about 2% rose to about 8% at the end of the study period. Only about 10% of bicyclists on bike paths in Motala wore helmets 2 ½ years post-law. The questionnaire study showed one significant effect on school children in Motala two years post-law, namely, a stronger intention to ride bicycles if a national compulsory helmet law was introduced. There was, however, no significant long-term influence on children's attitudes or beliefs about helmet wearing, which agrees with the results of the observational study.General conclusions: It is indeed necessary to increase bicycle helmet wearing in Sweden. Both the current average rate of helmet use and the rate predicted for the near future are far from the goal of 80% that was officially proposed by several years ago. Previous research has shown that, to achieve substantial and sustained bicycle helmet use, it is necessary to use helmet promotion in combination with a national helmet law that is compulsory and applies to all bicyclists. The present evaluation of the non-compulsory local helmet law in Motala indicated that this type of initiative is not a powerful alternative to a mandatory national helmet law. Nevertheless, much has been learned from the initiation and implementation of this local action.
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| 6. |
- Nordqvist, Cecilila, 1962-
(författare)
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Alcohol screening and simple advice in emergency care : staffs’ attitudes and injured patients’ drinking pattern
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: About 800,000 people are risky drinkers in Sweden and the alcohol consumption has increased around 30% during the last 6 years. In order to counteract the negative effects of drinking there is a need to implement preventive measures at various levels in society. One place where risky drinkers could be identified is the healthcare setting. More than 10% of the visits at emergency departments and 20% of the injuries have been found to be alcohol‐related. So far, very few risky drinkers attending emergency departments receive advice about sensible drinking although there is good research evidence of the efficacy of such advice. Aim: The main aim was to explore the effects of a simple alcohol preventive routine in emergency care on staffs´ attitudes towards alcohol prevention and injury patients´ drinking pattern. Material and methods: A screening and simple advice routine was introduced at the emergency department of Motala County hospital. The staffs´ attitudes were explored by interviews with 12 staff members before the introduction and in 6 follow‐up interviews after a year. All the triage staffs´ attitudes were also measured by a questionnaire before the start of the routine and after 6 months. During the first 6 months of the routine 878 injury patients between 16 and 70 completed an alcohol screening questionnaire. During the next 6 months 647 patients received written advice about sensible drinking after having completed the screening questionnaire. A total of 619 patients included in the 12 months study period were followed‐up by telephone interview and changes in drinking pattern were analyzed. After a further 6 months of intervention a total of 2151 patients had been completing the questionnaire during the total study period of 18 months. The association between drinking pattern and different injury variables was analyzed in order to identify special risk groups and situations. Results: The staff was generally positive to alcohol prevention before the routine started and it was completed as intended. After 6 months of screening the staffs´ role legitimacy and perceived skills had increased. Despite of a further positive change in attitudes towards alcohol prevention the staff was uncertain after the study period whether emergency departments are appropriate settings for alcohol prevention. A total of 9% of the women and 31% of the men attending the emergency department for an injury were defined as risky drinkers. One single item in the questionnaire, concerning frequency of heavy episodic drinking, identified the majority of risky drinkers. In the cohort of patients,who was only screened, 34% was no longer engaged in heavy episodic drinking after 6 months and in the cohort that received written advice in addition to the screening the proportion was 25%. The latter group also increased readiness to change by 14%. The proportion of risky drinkers was higher among injury patients, 21% compared to 15% in the general population in the cathment area. This was mostly explained by a higher proportion of young men in the study group. When drinking pattern was compared, both risky and non‐risky drinkers proved to be significantly more likely than abstainers to be injured in amusement locations, parks, lakes or seas and during play or other recreational activities, when controlling for age and sex. Nine percent of the injury patients reported that they believed that their injury was related to alcohol. Half of this group was non risky‐drinkers. Conclusions: The triage staff performed the intervention as agreed, and in some aspects, which could facilitate further development of alcohol preventive measures, their attitudes changed positively. However, it appears difficult to expect alcohol preventive measures to involve more of the staff’s time than the routine tried, and other practical solutions have to be evaluated. A question about frequency of heavy episodic drinking identified the majority of risky drinkers and could be used as a single screening question. There was a reasonable reduction in heavy episodic drinking among the injury patients. The lack of a control group makes it difficult to fully explain whether this change is a result of the injury per se, the screening and the written advice procedure or a natural fluctuation in the patients´ drinking pattern. More studies are needed in order to establish the minimal levels of intervention in routine care that is accepted by the staff, and has a reasonable effect on risky drinkers’ alcohol consumption.
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| 7. |
- Olofsson, Niclas
(författare)
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Violence through the life cycle : A public health problem
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution , declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course — deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse — but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society.Methods: Three different data sources were used in the four articles, three cross-sectional studies (“Life and Health in Norrland” and “Health on Equal Terms 2004 and 2006”) and one longitudinal (“Level-of-Living Survey”).Results: We present an important picture of the strong association between exposure to violence and ill health through the life cycle. A population-based study showed an increased risk of poorer physical and psychological health among boys and girls aged 0-18, as reported by their mothers exposed to violence. Further, a strong association between those exposed to violence and physical and mental ill health was demonstrated in young adults aged 18-25, also after adjusting for possible confounders, specifically for women. Even in an elder group aged 65-84, representative results showed an extensive negative health outcome panorama caused by fear of crime and exposure to abuse both in elderly men and women. Lastly, in trying to provide additional empirical support for the association between exposure to violence and ill health the prospective study demonstrated that violence exposure in adolescence and young adulthood presented a negative association to severe illness burden in adulthood for women but not men.Conclusion: Exposure to violence among both men and women is an important risk factor for ill health and should receive greater attention in public health work. A strong association between violence and various health outcomes was demonstrated in different time periods through the life cycle.
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