| 1. |
- Backteman-Erlanson, Susann, 1958-
(författare)
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Burnout, work, stress of conscience and coping among female and male patrolling police officers
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. Police work is a stressful occupation with frequent exposure to traumatic events and psychological strain from work might increase the risk of burnout. This thesis focuses on patrolling police officers (PPO), who work most of their time in the community and have daily contact with the public. Since police work traditionally is a male coded occupation we assume that there are differences between women and men in burnout as well as experiences from psychosocial work environment.Aim. The overall aim of this thesis is to explore burnout, psychosocial and physical work environment, coping strategies, and stress of conscience when taking gender into consideration among patrolling police officers.Methods. This thesis employs both qualitative and quantitative methods. In Paper I a qualitative approach with narrative interviews was used where male PPO described experiences of traumatic situations when caring for victims of traffic accidents. A convenience sample of nine male PPO from a mid-sized police authority was recruited. Interviews were analyzed using qualitative content analysis. Papers II, III, and IV were based on a cross-sectional survey from a randomly selected sample stratified for gender from all 21 local police authorities in Sweden. In the final sample, 1554 PPOs were invited (778 women, 776 men), response rate was 55% (n=856) in total, 56% for women (n=437) and 53% for men (n=419). The survey included a self-administered questionnaire based on instruments measuring burnout, stress of conscience, psychosocial and physical work environment, and coping.Results. Findings from Paper I were presented in three themes; “being secure with the support system,” “being confident about prior successful actions,” and “being burdened with uncertainty.” Results from Paper II showed high levels of emotional exhaustion (EE), 30% for female PPOs and 26% for male PPOs. High levels of depersonalization (DP) were reported for 52 % of female PPO, corresponding proportions for male were 60%. Multiple logistic regression showed that stress of conscience (SCQ-A), high demand, and organizational climate increased the risk of EE for female PPO. For male PPO stress of conscience (SCQ-A), low control and high demand increased the risk of EE. Independent of gender, stress of conscience (SCQ-A) increased the risk of DP. Psychometric properties of the WOCQ were investigated with exploratory factor analysis and confirmatory factor analysis, a six-factor solution was confirmed. DIF analysis was detected for a third of the items in relation to gender. In Paper IV a block wise hierarchical multiple regression analysis was performed investigating the predictive impact of psychological demand, decision latitude, social support, coping strategies, and stress of conscience on EE as well as DP. Findings revealed that, regardless of gender, risk of EE and DP increased with a troubled conscience amongst the PPO.Conclusion. “Being burdened with uncertainty” in this male-dominated context indicate that the PPO did not feel confident talking about traumatic situations, which might influence their coping strategies when arriving to a similar situation. This finding can be related to Paper II and IV showing that stress of conscience increased the risk of both EE and DP. The associations between troubled conscience and the risk of experiencing both emotional exhaustion and depersonalization indicate that stress of conscience should be considered when studying the influence of the psychosocial work environment on burnout. Results from this study show that the psychosocial work environment is not satisfying and needs improvement for patrolling police officers in Sweden. Further studies including both qualitative and quantitative (longitudinal) methods should be used to improve knowledge in this area to increase conditions for preventive and rehabilitative actions.
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| 2. |
- Stenberg, Gunilla, 1968-
(författare)
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Genusperspektiv på rehabilitering för patienter med rygg- och nackbesvär i primärvård
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Gender as a social and cultural construction has an impact on physiotherapist and patient beliefs, understanding, and behaviour and could affect physiotherapy encounters. Gender studies in early rehabilitation are scarce. The aim of this thesis was to study gender during different parts of the rehabilitation process for primary health care patients with neck and back pain. Method The analyses are based on data from three different samples. One sample is composed of physiotherapists and two samples consist of patients consulting primary health care providers because of neck and back pain. All data were gathered from primary health care provided in Västerbotten County. Baseline data on 73 physiotherapists and 586 of their patients with neck and back pain were collected by questionnaire during three consecutive days in 2006. Patient data included affected pain site and treatment procedures used by the physiotherapist (Study I). Differences in treatment procedures used by female and male physiotherapists and differences in use for female or male patients were analysed using Chi square-test, Fisher’s exact tests, Mann-Whitney U tests and logistic regressions with cluster analysis. Thematised interviews with 12 patients were made before the patient’s first appointment with a physiotherapist or doctor and repeated after three months. Data were analysed according to grounded theory (Study II) and qualitative content analysis (Study III). A comprehensive questionnaire was answered at the first appointment when patients sought a physiotherapist in primary health care. The questionnaires included questions about pain intensity, self-rated health, function, psychological stress reactions, domestic work, work environment, self-efficacy and kinesiophobia. Response patterns were linked to the International Classification of Functioning Disability and Health (ICF) and analysed using principal component analysis (PCA) and partial least squares projections to latent structures (PLS). Result Patients were given the same treatment procedures irrespective of gender. The treatment procedures most often used were training of joint motion (48%), training of muscle functions and strength training (31%), massage (31%), physical treatment (28%), information about health/ill health (24%), and acupuncture (18%). Female and male physiotherapists used the same treatment procedures with a few exceptions. Female physiotherapists used treatment for mental functions and acupuncture more often than male physiotherapists. The women gave their patients a unique mixture of treatment procedures more frequently (43%) compared to their male colleagues (25%). Male physiotherapists used more training of joint motion. "To be confirmed" emerged as the core category when analysing interviews that considered expectations or experiences. Five categories were extracted: "To be taken seriously", "To get an explanation", "To be individually assessed and treated", "To be invited to participate", and "To be taken care of in a trustworthy environment". These were factors leading to confirmation. Two ideal types were identified: "confident" and "ambiguous". The "confident" did not doubt their right to health care and blamed their work for causing the pain. They related to a positive identity of strong or hard working. The "ambiguous" were afraid of being regarded as old, whining women and not being taken seriously. They were ashamed of having neck or back pain and blamed themselves; they thought they were not fit enough. The ideal types were not completely defined by gender, but more men were among the "confident" ideal type and more women were among the "ambiguous" type. Patients reacted differently to feelings of being confirmed or not, and this depended on whether they were the "confident" or "ambiguous" ideal type. The "confident" were satisfied and reacted with reorientation when they felt confirmed, even if they were not totally cured. When not confirmed, the "confident" reacted with anger, frustration, and feelings of shame or remained proud and blamed the health care personnel for being incompetent. The "ambiguous" also were satisfied and felt reoriented when they were confirmed. They then moved from being an "ambiguous" type to a more "confident" type. When the "ambiguous" were not confirmed in healthcare, they became dissatisfied and unhappy. They doubted the assessment, felt forlorn, and felt increased shame. Not being confirmed was experienced more negatively by women than by men irrespective of ideal type. Interesting information was found about how patients view their body in relation to pain during analysis of expectations and experiences in study II interviews. This led to Study III. In study III, "Fear of hurting the fragile body" emerged as an interview theme. Five categories supported or undermined beliefs about pain and physical activity: "The mechanical body", "Messages about activity", "Earlier experiences of pain and activity", "To be a good citizen", and "Support to be active". Patients thought their pain was due to tissue damage and viewed their bodies in a mechanical way. Clear messages from health care personnel about activity led to less fear of physical activity. Vague and contradictory messages led to more fear. Gender-stereotyped messages were given to patients. "The take it carefully" was such a message, and was more often to women when women were thought to be weak and in need of training. Another message was "Pain goes with heavy work". This message was more often given to men when men were thought to be strong and not in need of training. Earlier experiences of pain and activity could have been positive or negative. If positive, the experiences led to less fear of engaging in physical activity. A wish to be a good citizen, such as being a good parent, led to patients being more engaged in child care and playing more than they thought was good for their pain. Women, more than men, expressed avoidance of sick leave because they did not want to be a burden to society or to their work colleagues. Patients were anxious about how to do the "correct" exercises to avoid further injury. Practical support and a follow up to adjust the training program were important to reduce the fear of engaging in physical activity and to maintain motivation. One hundred and eighteen patients (84 women and 34 men) completed the questionnaire. PCA of all questions identified five significant components. The model explained 37% of the variance. The predictive power was 17%. PC1 explained 17% of the variance and the predictive power was 0.13%. PC1 was mainly explained by questions classified in ICF as Activity and Participation. These included questions about physical function and self-efficacy (classified as Content of Thought). Questions about support (classified as Environmental Factors) and stress reactions (classified as Body Function (Emotional Functions)) mainly explained PC2. PC3 was mainly explained by reported pain and symptoms from muscles (classified as Body Functions) and domestic work and leisure time activities (classified as Activity and Participation). There were differences in t-scores between women and men in PC2 (p=0.045) and PC3 (p=0.003). Variables that discriminated between women and men were questions about stress reactions and support at work in PC2, and questions about pain intensity and domestic work in PC3. Conclusion As a physiotherapist working with neck and back pain rehabilitation patients, it is important to be aware of both one’s own and the patient’s preconceptions about women and men. It is also important to be aware of the impact of gender on the professional role when choosing treatment procedures in order to ensure that choices will be based on evidence of effectiveness and not from stereotypes. Awareness of the patient’s individual needs and subsequent adaptation of treatments is also important. Some patients display a negative self-assessment and shame. They need more support to be able to reorient. Unless these patients are confirmed, they are at risk of prolonged disability. Gender stereotypes can hinder rehabilitation of neck and back pain if women are seen as weak and in need of protection and men are seen as strong and not in need of preventive muscle training. When assessing neck and back pain patients with questionnaires, gender has less significance than when asking questions about physical function and self-efficacy. Questions about emotions of stress reactions, support at work, and pain intensity contribute to gender differences for women. Questions on the level of domestic work contribute to gender differences for men.
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| 3. |
- Strömbäck, Maria, 1965-
(författare)
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Skapa rum. Ung femininitet, kroppslighet och psykisk ohälsa : genusmedveten hälsofrämjande intervention.
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental health problems among young people, girls and young women in particular, are a serious public health problem. Gendered patterns of mental illness are seen in conjunction with stress-related problems such as anxiety, depression, and psychosomatic complaints. Intervention models tailored to the health care situation are therefore in need of development and evaluation. The overall aim of this thesis is to develop knowledge and understanding for young women’s mental health, stress-related, and bodily problems from a psychosomatic and gender theory perspective, and to evaluate a gender sensitive physiotherapeutic intervention model consisting of a stress management course for young women with stress-related problems.The thesis consists of four studies. The overall research design combines qualitative and quantitative methods in which questionnaires and interviews were used to explore participant experiences and symptoms linked to perceived stress before and after the intervention. Data consisted of a cumulative sample of 65 young women, 16 to 25 years of age, who attended the youth-friendly health center because of stress-related problems. In paper I, multiple symptom areas of mental health and somatic problems, self-image and aspects of body perception were measured before the course. Participants were 47 of the young women. The results were compared with published normative and clinical reference groups. In paper II, the young women’s experiences of living stressful femininity were analysed with a qualitative content analysis using gender theoretical and phenomenological perspectives as an interpretative frame. The study was based on interviews with 25 of the women. In paper III, follow-up interviews were done with 32 of the women after completion of the course. Data was using qualitative content analysis to illuminate experiences of participating in the course. In paper IV, the course was evaluated by measuring changes in multiple symptom areas using the Adult Self Report (ASR), Social Analysis of Social Behaviour (SASB), and Body Perception Questionnaire (BPQ). Participants were 54 of the women who completed measurements finishing the course.Young women present complex symptomatology of stress-related problems. The total burden of symptoms plus the narrated experiences highlight how renegotiations of gender constructions and handling of normative and stressful femininity constrain access to bodily resources. After the stress management course, their measured and narrated experiences show positive changes and release of mental health and stress problems, including a more positive self-image and sense of enhanced confidence in their bodies. Experiences of the course as a safe and explorative space for gendered collective understanding and embodied empowerment indicate the need to develop gender-sensitive interventions. The thesis contributes to youth and gender theoretical perspectives with integration of psychosomatic and psychiatric physiotherapy. A broader awareness of how gender constructions and sociocultural aspects are significant in the understanding of psychosomatic expressions of mental ill health and young femininity is valuable in development of theory and interventions in physiotherapy, as well as into other fields.
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