| 1. |
- Alfonsson, Johan, 1985
(författare)
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Alienation och Arbete. Unga behovsanställdas villkor i den flexibla kapitalismen
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to investigate how flexible capitalism, drawing from the case of on-call employees, influences the ability to control life and work and affects relationships with other people, both inside and outside work; and to investigate how this can be understood in terms of alienation. A subsidiary aim that emerges from this investigation is to develop existing alienation theories in a way that enables them to be used to understand human existence under flexible capitalism. Alienation is understood as a process in which something that should be connected has lost its connection: it is a relation of relationlessness. This raises three questions: How can we decide what a relation “ought” to be? What relations are being alienated and what is causing these relations to become relationless? In the thesis I use an immanent perspective to identify the “ought” in the studied context: the capitalist mode of production. For value to exist it is required that man is, as Marx puts it in Capital, “the free proprietor of his own labour-capacity, hence of his own person”. Thus, there is a premise of self-determination in capitalism. A premise which, because of man’s need to create value and the fact that her activity must be subordinated to the value logic, cannot be realized. This applies to everyone in our society, capitalists and labourers alike, and alienates man from her activity, herself, others and her product. This is understood as abstract alienation. On a concrete and specific level the control of how to reach this value-goal and to what extent this affects the individual’s life may differ depending on how value production takes place and the individual’s position in production. I call this concrete alienation and it can be understood as the concrete expression of the abstract alienation. In this way, alienation is neither a purely structural nor a purely subjective phenomenon. It can be both. Following changes in the accumulation regime the concrete alienation has transformed during the last decades, which is expressed in the on-call employees’ situation. Based on an analysis of 17 in-depth interviews I conclude that that their subjective motifs of being in the employment differ and their employment is objectively shaped differently. The objective and subjective dimensions are the basis for understanding on-call employees’ alienation at a concrete level. Drawing from Jaeggi’s qualified subjectivism I argue that since a premise of capitalism is self-determination, the individual must have a say in their situation and experience. If an individual feels that she can’t control her life she is thus alienated from the premise of self-determination. If she feels that she can control her life but this feeling is not realised, meaning that there is no objective possibility to control or steer her life, there is no self-determination and thus alienation persists even though it is not perceived. The result tells us that on-call employment can be used both as a way to increase the freedom and self-determination over one’s life and hinder it, it can instrumentalise life and work in a specific way, and it can hinder the control over social relations, both in and outside of work. As a result, even though they all experience abstract alienation, their level of concrete alienation differs.
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| 2. |
- Blomqvist, Marjut, 1966-
(författare)
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Health among people with psychotic disorders and effects of an individualized lifestyle intervention to promote health
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to increase knowledge of health among people with psychotic disorders such as schizophrenia and other long-term psychotic conditions. The aim was also to investigate health effects, in terms of clinical health outcomes and self-reported questionnaires, of atwo-year individualized lifestyle intervention implemented in psychiatric outpatient services involving cooperation with the municipal social psychiatry services. The motivation for the study was to generate new knowledge in order to be able to promote health in people with psychotic disorders and to improve the care and support provided for this target group. The thesis consists of four studies. A quantitative study (Study I), was conducted using a cross-sectional design to investigate the prevalence of overweight, obesity, risk of cardiovascular disease (CVD) and the relationships between self-rated salutogenic health, sense of coherence, CVD risk, and body mass index among people with psychoticdisorders (n=57). The study was conducted in four psychiatric outpatient services; questionnaires were completed by the participants and clinical health measurements were collected by the participant’s contact nurse at the psychiatric outpatient services. The participants showed a moderate/high risk of CVD, the mean for BMI was 31.9 (59.6% were obese) and 31.6% were overweight. The results did not reveal any relationships between the subjective and objective measuresof health indicating the need for both subjective and objective assessments of health in psychiatric care. In a qualitative study (Study II), data were collected with semi-structured interviews (n=16) andanalyzed with qualitative content analysis. The interviews resulted in an overall theme “Being regarded as a whole human being by self and others”, which showed the multidimensional nature of health and the issues that enable healthy living among people with severe mental illness. Three categories emerged: (i) everyday structure (ii), motivating life events and (iii) support from significant others. The results indicate that a person with severe mental illness needs to be encountered as a wholeperson if healthy living is to be enabled. In a quasi-experimental study (Study III), the potential effects of participation in the two-year lifestyle intervention (intervention group n=54 and control group (n=13) were investigated. The data were collected at baseline, after 12 months and after 24 months using the self-reported questionnaire the Salutogenic Health Indicator Scale (SHIS), the Hopkins Symptom Checklist (HSCL-25) and the National Public Health Survey. Measures of clinical healthoutcomes were conducted by the participant’s contact nurse at the psychiatric outpatient services. Multilevel modeling was used to test differences in changes over time. Significant changes were foundin physical activity, HbA1c and waist circumference after participation in individualized lifestyle intervention. The relationship between changes in physical activity, levels of salutogenic health and glycated hemoglobin (Hb1Ac) were investigated (n=54) in Study IV. The data were collected atbaseline, after 12 months and after 24 months using the self-reported questionnaires Salutogenic Health Indicator Scale (SHIS) and National Public Health Survey. Within-person changes in physical activity between baseline and at the end of the twenty-four-month intervention were calculated. Selfreported increased physical activity was positively associated with self-rated salutogenic health and negatively associated with level of HbA1c after participation in the intervention. The thesis shows that a well-founded assessment of general health needs must consider both the individual's subjective experiences and objective measurements in order to form a solid foundation for dialogue and shareddecision-making about essential care services. The results also show that it is possible to stimulate healthy behavioral changes with a two-year individualized lifestyle intervention and bring both subjectively and objectively measured health benefits for people with psychotic disorders. The importance of nurses in psychiatric care applying a holistic approach and integrating lifestyle interventions into daily person-centered psychiatric care in collaboration with other healthcare providers to facilitate changes towards a healthy lifestyle in persons with psychotic illness is emphasized in the thesis.
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| 3. |
- Cederholm Björklund, Jennie, Doktorand, 1973-
(författare)
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Value creation for sustainable rural development – perspectives of entrepreneurship in agriculture
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Entrepreneurship and innovation are regarded as key factors in the development of society - not least in the development of sustainable rural areas, where they are emphasised by both authorities and research. This thesis is situated in this field of inquiry and studies entrepreneurship in agriculture. It explores how we can further develop both agriculture and sustainable rural areas. Farmers have traditionally played a significant role in rural areas and rural development, and still do. However in pace with societal development and the reduced number of farms and farm production, their role has changed. Today, they are considered as raw material producers, being the first link in a food chain, and active in landscape conservation in the countryside. However, agriculture plays a significant role in rural development and in Sweden, authorities strive for development of sustainable rural areas by encouraging economic growth and innovation within and between companies (business models, value chains etc.). They work with economic growth strategies, but both their management and results are criticised (OECD, 2019).This thesis states that greater contextualized knowledge is required to facilitate sustainable rural and agricultural development. Against this background, the purpose of this thesis is to explore entrepreneurship in agriculture from different perspectives, to find mechanisms affecting value creation for sustainable rural development.To meet the research purpose, Swedish agricultural entrepreneurship was studied from different perspectives and data was collected with different methods enabling significant triangulation of data. Studies of challenges in entrepreneurship and sustainable rural development were conducted from individual farmer and business perspectives as well as from the individual and organisational levels of actors within the support system, actors such as advisors, authorities, policy makers and officials. Thus, it was possible to explore perspectives on entrepreneurship in agriculture and identify mechanisms and structures affecting value creation for sustainable rural development. Mechanisms can be explained as underlying, invisible and sometimes unconscious and non-rational factors, feelings, norms, values or attitudes that affect behaviour in various ways.The key theories and literature covered included the concept of entrepreneurship with the intertwined sub-concepts of innovation and management at individual, business, organisational and societal levels.The thesis probed under the surface of rural development, exploring agricultural development at business level by using the concepts of Sustainable Entrepreneurship, Business Model Innovation and Barriers to Sustainable Business Model Innovation when exploring the challenges farmers face. The concepts of Self-leadership, Emotional Intelligence and Entrepreneurial Orientation helped to explore how challenges are approached, by for example understanding mechanisms concerned with feelings and mind-set. Further, the thesis also studied how entrepreneurship was encouraged and supported by the agricultural support system, and, with help from the Complexity Leadership Theory, established the urgent need of adaption to environmental changes and the creation of innovation within the system. The concepts of Agricultural and Rural Entrepreneurship and Embeddedness helped in understanding and shed light on the importance of considering the mutual influence and interplay between farmers, actors within the support system, embeddedness in context and rural entrepreneurship.This thesis makes several contributions. It extends knowledge about entrepreneurship in agriculture by highlighting the importance of understanding embeddedness and the concept of agricultural sustainability, and by this providing evidence of the importance of including agriculture in entrepreneurship research. Consequently, this thesis has another viewpoint than previous research which states that farmers are not entrepreneurial and has overlooked agriculture in entrepreneurship research.Firstly, it shows that farmers, to a very considerable degree, contribute to sustainable rural development and also play the role of enabler for rural entrepreneurship. Second, by exploring the support system, and thereby providing insights into the challenges within the system, in the organisations and betweenthe organisations, this thesis shows transparency and improved understanding of challenges in for example communication, trust, management and culture. Further, a model contributes suggestions for how to improve the system and create innovation to enable encouragement of entrepreneurship in agriculture. Third, this thesis contributes to business model research by illustrating the importance of including and reflecting on embeddedness in context and the understanding of agricultural sustainabilityin business model innovation. Hence, this thesis extends previous business model research which mainly considered agriculture as the first step in a food production chain, exposed to the same challenges as other non-agricultural companies further up the value chain. By providing insights about challenges to farmers’ entrepreneurship, and how these challenges can be approached as well as how entrepreneurship can be encouraged and supported in agriculture, this thesis can contribute to policies and strategies shifting focus from primarily trying to transform farmers into traditional entrepreneurs to taking advantage of the enabling role played by farmers. This thesis contributes to show the diversity in entrepreneurship, by providing understanding of entrepreneurship in agriculture, where value creation extends far beyond individual companies and competitive advantages, and hence impacts sustainable rural development.
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| 4. |
- Collberg, Philippe
(författare)
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Meningar i text : Satsradning i teoretisk och empirisk belysning
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The topic of this thesis is the construction labelled satsradning in Swedish, which typically corresponds to the English term comma splice. They signify a case of two syntactically independent (main) clauses which are joined in the same orthographic sentence, without a coordinating conjunction. The two clauses can either be separated by a comma or joined together with no punctuation mark at all.The thesis focuses on comma splice constructions in texts written by Swedish students in upper secondary school, and the construction is addressed both theoretically and empirically. The aim is twofold. Firstly, based on previous research, the ambition is to build a theoretical model for analysis of clause relationships. Secondly, this model is applied on students’ texts in general and occurring cases of comma splice in the texts. Consequently, the students’ use of the comma splice is related to theoretical aspects of clause linking and meaning in text as well as related aspects on clausal and sentential level of the texts in question.The theoretical framework used is Segmented Discourse Representation Theory (SDRT), which is a theoretic approach to coherence and discourse interpretation drawing on a combination of dynamic semantics, common-sense reasoning, and speech act theory. A crucial observation in SDRT is that discourse is structured hierarchically by coordinating and subordinating discourse relations. Coordinating relations are claimed to link two propositions on the same level, whereas subordinating relations are claimed to change the granularity in the interpretation, e.g. when one proposition elaborates on another. The model for analysis on clause relationships presented discusses how the interpretation of coordinating and subordinating relations in clause linking relates to a syntactic dichotomy between coordinated and subordinated clauses. In addition, the model presents six categories of lexical markers that tie main clauses together.The empirical material consists of 96 student texts written within the course Svenska 1 in a first-year class in Swedish upper secondary school. In these texts 207 comma splices were observed and analysed. The results show, among other things, that comma splices often can be reformulated with subordinated clauses, since most of the cases in argumentative and referring texts have a hierarchy on discourse level. Moreover, the students’ use of comma splice differs in different types of texts.
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| 5. |
- Ekengren, Johan, 1979-
(författare)
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Careers of Swedish Professional Handball Players : From an Empirical Model to Career-Long Psychological Support Services
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This PhD Project with a specialization in sport psychology is inspired by the cultural praxis of athletes’ careers paradigm. This implies that the Project blends theory, research, and practice within the context of Swedish handball, by investigating career pathways of professional players providing empirically based, and context specific, implications. The overarching aim of the Project is twofold: (a) to examine the career experiences of Swedish professional handball players and consolidate them into the empirical career model of Swedish professional handball players (ECM-H), and (b) based on the ECM-H, to develop, validate, and test an applied framework promoting career-long psychological support services in Swedish handball (CPS-H). The first aim is covered by Study I and II, and the second aim is met in Study III and IV. The dissertation is designed as a collection of four articles with one article per study. Study I focused on a qualitative exploration of career experiences from 18 Swedish professional handball players including major career stages and transitions in their athletic and non-athletic development. The players’ accounts were consolidated into the ECM-H describing the context-specific features and pathways throughout the handball career. When developing the ECM-H, gender-specific issues appeared of interest for further investigation. Gender issues were addressed in Study II by re-analyzing the data from Study I. Two composite vignettes were created describing the career pathways of nine male and nine female players. Study III initiated a move from research to practice. Based on the ECM-H, applied sport psychology literature and experiences of the research team led by the first author, the applied framework CPS-H was heuristically developed and validated in three focus groups with end users; professional players, coaches, and sport psychology practitioners. The validated version of the CPS-H is presented with general and career stage-specific recommendations for its implementation among support providers (i.e., where, when, what, who, why, and how of psychological support service). Study IV was designed as an instrumental case study for testing a part of the CPS-H framework. More specifically, the mastery career stage. A career assistance program (CAP) named Life as a professional handball player was developed for, implemented with, and evaluated by Swedish League team. The program included eight workshops dealing with various aspects of the players’ athletic and non-athletic life (e.g., performance, training, lifestyle, recovery, future planning), together with crisis-related issues (e.g., coping with uncertainty). These workshops were delivered by the first author during 12 weeks of a competitive season. The mixed-methods evaluation revealed a perceived improvement in players’ personal coping resources (e.g., increased awareness) and a decrease in their fatigue and stress. This Project contributes to the athlete career sport psychology discourse and the emerging athlete mental health discourse by presenting the ECM-H and CPS-H frameworks, and the CAP Life as a professional handball player, grounded in the cultural context of Swedish handball. The frameworks and CAP can serve as inspiration for future research and practice, informed by a cultural praxis. The Project shows the usefulness of working as a scientist-practitioner and establishing theory-researchpractice-context links for the promotion of culturally informed implications, and supports the work of facilitating a holistic understanding of athletes’ striving for healthy, successful, and long-lasting careers in sport and life.
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| 6. |
- Fan, Yuantao, 1989-
(författare)
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Wisdom of the Crowd for Fault Detection and Prognosis
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Monitoring and maintaining the equipment to ensure its reliability and availability is vital to industrial operations. With the rapid development and growth of interconnected devices, the Internet of Things promotes digitization of industrial assets, to be sensed and controlled across existing networks, enabling access to a vast amount of sensor data that can be used for condition monitoring. However, the traditional way of gaining knowledge and wisdom, by the expert, for designing condition monitoring methods is unfeasible for fully utilizing and digesting this enormous amount of information. It does not scale well to complex systems with a huge amount of components and subsystems. Therefore, a more automated approach that relies on human experts to a lesser degree, being capable of discovering interesting patterns, generating models for estimating the health status of the equipment, supporting maintenance scheduling, and can scale up to many equipment and its subsystems, will provide great benefits for the industry. This thesis demonstrates how to utilize the concept of "Wisdom of the Crowd", i.e. a group of similar individuals, for fault detection and prognosis. The approach is built based on an unsupervised deviation detection method, Consensus Self-Organizing Models (COSMO). The method assumes that the majority of a crowd is healthy; individual deviates from the majority are considered as potentially faulty. The COSMO method encodes sensor data into models, and the distances between individual samples and the crowd are measured in the model space. This information, regarding how different an individual performs compared to its peers, is utilized as an indicator for estimating the health status of the equipment. The generality of the COSMO method is demonstrated with three condition monitoring case studies: i) fault detection and failure prediction for a commercial fleet of city buses, ii) prognosis for a fleet of turbofan engines and iii) finding cracks in metallic material. In addition, the flexibility of the COSMO method is demonstrated with: i) being capable of incorporating domain knowledge on specializing relevant expert features; ii) able to detect multiple types of faults with a generic data- representation, i.e. Echo State Network; iii) incorporating expert feedback on adapting reference group candidate under an active learning setting. Last but not least, this thesis demonstrated that the remaining useful life of the equipment can be estimated from the distance to a crowd of peers.
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| 7. |
- Gilljam, Britt-Mari, 1957-
(författare)
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Barns delaktighet i pediatrisk vård – perspektiv, erfarenheter och möjligheter till förändring utifrån barn med långvarig sjukdom
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Det senaste decenniet har patientens delaktighet fått en allt större uppmärksamhet i forskning, riktlinjer, lagar och klinisk vård. Men många barn känner sig inte delaktiga i sin vård. Vårdpersonal och föräldrar talar ofta över huvudet på barn och ofta förstår barnen inte vad de vuxna pratar om. Barn har också svårt att själva uttrycka sig verbalt i vårdsituationer. Det saknas studier som undersöker långvarigt sjuka barns perspektiv på främjande faktorer för barns delaktighet i vården. Det saknas också användarvänliga svenska validerade verktyg och frågeformulär där barn självständigt kan uttrycka sig och interagera med vårdpersonal, för att mäta barns delaktighet och för att tillämpa delaktighet praktiskt i vården. Både patientlagen och lagen om Förenta nationernas barnkonvention deklarerar att alla barn har rätt att vara delaktiga i sin vård. Denna rättighet behöver överföras till praktisk handling och både vårdpersonal och hälso- och sjukvården som organisation behöver utvecklas.Syfte: Det övergripande syftet med avhandlingen var att utforska barns perspektiv på delaktighet i sin vård, hos barn med långvarig sjukdom och att utveckla och validera verktyg och instrument för att stödja pediatriska verksamheter i tillämpning av barns delaktighet.Metod: I delstudie I användes en konstruktivistisk grundad teori för att utforska barns perspektiv, erfarenheter och önskemål om delaktighet samt främjande faktorer för att öka barns delaktighet. Datainsamlingen skedde genom intervjuer och fokusgrupper med barn med reumatisk sjukdom. I delstudie II användes en konvergent parallell mixad metod för att undersöka om det digitala kommunikationsverktyg Sisom påverkade delaktigheten hos barn med cancer under läkarbesök. I delstudie III användes en participatorisk design där det digitala kommunikationsverktyg Sisom vidareutvecklades och validerades i en svensk kontext. Metoden som användes var iterativ utvärdering genom low- and high-fidelity med friska barn och barn med cancer som deltagare. I delstudie IV användes en instrumentutvecklings design för att utveckla, validera och psykometriskt testa ett frågeformulär om barns delaktighet i vården. I studien deltog friska barn och barn med olika långvariga sjukdomar i utvecklingsarbetet.Resultat: I delstudie I framkom kärnkategorin Att släppa rädsla och osäkerhet öppnar för tillit och delaktighet med Att omges av trygga relationer och miljöer och Att bli stärkt och att få stöd för att kunna vara delaktig som tillhörande koder från den fokuserade kodningen. Dessa koder framkom från med barn med långvarig sjukdom som främjande faktorer för barns delaktighet i vården. Det kvalitativa resultatet i delstudie II visade att barns delaktighet ökade vid användning av det digitala kommunikationsverktyget Sisom. Det kvantitativa resultatet visade att läkarna tilltalade barnen oftare och att barnen talade något mer. I delstudie III utvecklades Sisom, tillsammans med barn, till ett användarvänligt digitalt verktyg på svenska. Verktyget utvecklades från problem fokuserat till salutogenetiskt och påståenden ändrades till frågor. Frågeformuläret (ChiPaC) som utvecklades i delstudie IV resulterade i ett frågeformulär där barn själva kan uttrycka sin uppfattning av delaktighet. Statistiska beräkningar resulterade i en faktoranalys med en fyra-faktorlösning, där 12 frågor inkluderades som förklarade 59,47 % av variansen. De fyra faktorerna benämndes: Att få vara med, Att lita på personalen, Att ta kontroll och Att förstå information. Intra Class Correlation visade stark och måttlig samstämmighet mellan sex av frågorna, svag samstämmighet mellan fem frågor och otillräcklig på en. Chronbach´s alpha beräknades till 0,76. Konklusion: Främjande faktorer för barns delaktighet i sin egen vård vid långvarig sjukdom är trygga relationer och miljöer samt att få stöd i att kunna vara delaktiga. Det digitala kommunikationsverktyget Sisom möjliggör för barn 6–12 år med långvarig sjukdom att självständigt uttrycka sina uppfattningar om hur de mår och sina upplevelser kring sin situation. Sisom främjar också barns delaktighet i form av att de blir lyssnade till, får uttrycka sina åsikter och synpunkter samt får dessa beaktade i samtal med vårdpersonal. Frågeformuläret ChiPaC visade tillfredställande psykometriska egenskaper för att kunna användas vid utvärdering av barns delaktighet i vården. Sisom och ChiPaC utvecklades från barns perspektiv med barn med långvarig sjukdom och friska barn som medaktörer. Denna avhandling bidrar även till kunskap om hur barn med långvarig sjukdom kan engageras som medaktörer i forskning.
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| 8. |
- Jeppsson, Cecilia, 1967-
(författare)
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”Rörlig och stabil, bred och spetsig”. Kulturell reproduktion och strategier för breddat deltagande i den svenska kulturskolan
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One point of departure of this study is the intensified national interest at the policy level in Swedish kulturskolor (Community Schools of Music and Arts) as an inclusive and accessible institution. Yet, the field can be described as torn between tradition and change. The field’s tra- ditional features can be understood as associated with the music field’s institutional discourses.The aim of the study is to deepen our understanding of Swedish kulturskolor as a field in relation to the political mission to strive for widening participation. The theoretical perspective of Bourdieu is applied at an overarching level, supplemented with discourse theo- retical perspectives. Discourses are understood as resources in actors’ positioning in the field.This mixed-methods study is based on a survey of 2413 sixth-graders, focus group conversations with 18 teachers, and interviews with five principals of seven kulturskolor. The results of article I identify the typical student as a Swedish-born girl with well-educated parents, in line with Bourdieu’s theory of cultural reproduction. It is suggested that a “kultur skola-appropriate habitus” contributes to children’s satisfaction in their studies.In article II–IV, teachers’ and principals’ strategies for widening participation incor- porated various measures from inclusion in existing tradition to inclusion through a wide range of flexible and short-term courses. The strategies and positions are interpreted as orthodox versus heterodox strategies to legitimize the programmes.The theoretically informed conclusions describe the field as heteronomous and affected by media, politics, and economics – a phenomenon interpreted as comprising cross-field effects. Despite the field’s diminishing autonomy, teachers and principals are seen as power- ful actors who are encouraged to take action in shaping conditions for participation in the kulturskolor of the future.
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| 9. |
- Lundström, Sofie, 1971-
(författare)
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Hälsa, levnadsvanor och erfarenheter av förändring av levnadsvanor hos personer med psykossjukdom – hälsofrämjande aspekter inom psykiatrisk omvårdnad
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Personer med psykossjukdom har ofta sämre fysisk hälsa jämfört med befolkningen i övrigt, delvis relaterat till ohälsosamma levnadsvanor såsom låg fysisk aktivitet, ohälsosam kost, tobaksbruk och riskfull alkoholkonsumtion. Trots att hälsofrämjande insatser har framhållits som betydelsefullt för att minska ojämlikheten i hälsa har inte det hälsofrämjande arbetet fått en given plats inom psykiatrisk vård. Ökad kunskap behövs dels om vilka levnadsvanor som påverkar hälsan, dels om vilka aspekter som påverkar möjligheten till förändring av levnadsvanor för personer med psykossjukdom.Syfte: Det övergripande syftet med avhandlingen var att utforska hälsorelaterade levnadsvanor och upplevd hälsa, samt erfarenheter av förändring av levnadsvanor och främjande aspekter för förändring, hos personer med psykossjukdom.Metod: Avhandlingen består av fyra delstudier. Delstudie I var en kvantitativ tvärsnittsstudie med syftet att kartlägga hälsorelaterade levnadsvanor och upplevd hälsa hos personer med psykossjukdom samt att undersöka könsskillnader och skillnader utifrån känsla av sammanhang (SOC). Data samlades in från personer med psykossjukdom som deltog i en hälsofrämjande levnadvaneintervention (n = 65). Beskrivande och jämförande analyser genomfördes på data, insamlad före interventionens start för att kartlägga självskattad hälsa, livskvalitet, BMI och levnadsvanor. För delstudie II som hade en kvalitativ design genomfördes narrativa intervjuer med personer med psykossjukdom som deltagit i en hälsofrämjande levnadsvaneintervention (n = 10). Syftet var att belysa innebörden av den levda erfarenheten av förändring av levnadsvanor hos personer med psykossjukdom. En fenomenologisk hermeneutisk metod användes för att analysera intervjutexterna. Deltagare i delstudie III bestod av sjuksköterskor som arbetade på olika psykiatriska öppenvårdsmottagningar (n = 15). Semistrukturerade intervjuer genomfördes för att beskriva deras erfarenheter av aspekter som främjar fysisk hälsa och stödjer hälsosamma levnadsvanor för personer med psykossjukdom. Intervjutexterna analyserades med kvalitativ innehållsanalys. Delstudie IV var en kvantitativ uppföljningsstudie och bestod av insamlad data från personer med psykossjukdom som deltagit i en hälsofrämjande levnadsvaneintervention (n = 54). Data, som bestod av självskattningar, kliniska mått och blodprover, samlades in före interventionens start, efter 12 månader och efter 24 månader. Flernivåanalys användes som metod för att undersöka hälsorelaterade förändringar efter deltagande i en hälsofrämjande levnadsvaneintervention.Resultat: Resultatet i delstudie I visade att personer med psykossjukdom hade högre BMI, lägre självskattad hälsa och livskvalitet, var mer stillasittande och rökte mer jämfört med befolkningen i övrigt. Personer med stark SOC skattade sin livskvalitet bättre och rökte mindre jämfört med de med svag SOC. Kvinnor konsumerade mer frukt och grönsaker än män. I delstudie II beskrevs innebörden av levnadsvaneförändringar, av personer med psykossjukdom: som en kamp med inre och yttre begränsningar, att det var något som måste göras på egen hand men tillsammans med andra och att längtan efter ett liv i harmoni kan motivera till förändringar. I resultatet av delstudie III framhöll sjuksköterskor aspekter som kan främja hälsa och hälsosamma levnadsvanor för personer med psykossjukdom. Sjuksköterskornas erfarenheter var: att ha ett hälsofrämjande fokus i varje möte, att stödja med varje persons förutsättningar i åtanke och att ta ansvar för hälsofrämjande insatser på varje nivå inom organisationen. Resultatet i delstudie IV visade en positiv förändring av fysisk aktivitet. Förändringen var associerad med antal tillfällen personen hade deltagit i hälsogrupp. Förändring av självskattad hälsa var positivt associerad med känslan av sammanhang. Således kan det antas att hälsofrämjande insatser som genomförs i grupp kan förbättra fysisk aktivitet, och att känslan av sammanhang bör stärkas för en bättre upplevd hälsa hos personer med psykossjukdom. Konklusion: Det finns såväl individuella aspekter som relationella, organisatoriska och samhälleliga aspekter som påverkar möjligheten till förändring av levnadsvanor. Inre styrka, en positiv självbild och positiva erfarenheter är individuella aspekter som tillsammans med relationella aspekter såsom stöd och att få ingå i en gemenskap, kan främja förändringar hos personer med psykossjukdom. På en organisatorisk och samhällelig nivå är samverkan, ansvarsfördelning samt kunskap och kompetens viktiga ingredienser för att främja det hälsofrämjande arbetet inom psykiatrisk vård. Det hälsofrämjande arbetet bör, tillsammans med insatser såsom utbildning och praktiskt stöd, fokusera på insatser som kan öka personens känsla av sammanhang och stärka resurser. Sjuksköterskan inom psykiatrisk vård har en nyckelposition för att utveckla den hälsofrämjande omvårdnaden, där fysisk och psykisk hälsa integreras, och där personens egen förmåga till förändring främjas. Ett salutogent och personcentrerat förhållningssätt, kan bidra till en hälsofrämjande omvårdnad, men för att kunna utveckla det hälsofrämjande arbetet inom psykiatrisk vård behöver individuella, relationella samt organisatoriska och samhälleliga aspekter beaktas. Således behöver det i samverkan tas ett gemensamt ansvar för hälsa och hälsosamma levnadsvanor, och organisatoriska strukturer behöver utvecklas för att möjliggöra en personcentrerad vård och för att utveckla de hälsofrämjande insatserna för personer med psykossjukdom.
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- Luthra, Renee, 1985-
(författare)
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Falling through the cracks. A study on young adults with intellectual disability not involved in employment, education or daily activity
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The time after finishing secondary school is marked by changes and milestones of adulthood. There is increased attention and knowledge that for some individuals in the general population, the time after secondary school consists of not participating in an occupation. However, there is limited knowledge and research on young adults with intellectual disability who after special upper secondary school find themselves in this situation. In this thesis, these individuals are referred to as Not in Employment, Education, or Daily activity(NEED). The general aim of the thesis is to increase knowledge about young adults with intellectual disability who after upper secondary school are NEED, by providing deeper understanding and analysis of the target group’s characteristics and associations with NEED status, as well as to study the subjective experiences of becoming and being NEED. This is a compilation thesis consisting of two studies that have led to four articles, as well as an introductory comprehensive summary. The four articles have different focuses but together provide a nuanced understanding of the target group.The first study is a register study, which is the basis for article I and II. The register study used the national Halmstad University Register for Pupils with Intellectual Disability (HURPID) and two other Swedish registers to conduct statistical analyses. Article I explored the situation after USSID for the NEED group in terms of background factors, financial support and the use of disability services. The findings showed the heterogeneity of the group. Many had financial supports, but few used disability services. Moreover, background factors, financial support and use of disability services had various significant associations with not having an occupation. Article II described and analyzed the group’s family situation and how this relates to not participating in an occupation as opposed to being in an occupation of employment, education or daily activity. Family situation in the target group varied depending on sex, age, and immigrant background. Regression analyses illustrated the significance of family situation to occupational status; however the results differed between men and women. Factors of partnerships and having children were found to be associated with not participating in an occupation for women, but not for men. The second study is an interview study that is the basis for article III and IV. Interviews were conducted with 10 participants from the target group and these were analyzed with thematic analyses. Article III analyzed first-hand experiences of becoming and being NEED, and encounters with agencies and institutions. The results indicated that the experience of not having an occupation is influenced by individual and environmental factors. It was common to experience limited post-school occupations, face challenges with finding an occupation, and difficulties with navigating and attaining appropriate formal support. The experiences of not being involved in an occupation is discussed as a form of social exclusion. Article IV examined the group’s social relationships, networks and experiences of belonging. The results found that individuals had social relationships and networks in informal domains (family, friends, partners), but also in organized settings (the support and service system, recreational activities). These relationships provided feelings of acceptance, support, and care which all related to a sense of belonging. However, within their experiences of belonging these individuals were simultaneously striving for increased independence. This duality between belonging and independence at times clashed, as well as was influenced and amplified by dimensions surrounding having an intellectual disability.The overall empirical findings are analyzed through the use of ecological systems theory, and theories of social exclusion and belonging. An ecological approach allows for organizing and identifying different aspects of the environment, characteristics of the individual as well as interactions occurring between them, that help in understanding becoming and being NEED. Social exclusion and belonging more closely examine different perspectives of not having an occupation. These concepts are regarded as existing on a continuum where individuals in the target group can experience varying degrees of both, depending on context and situation. Within both social exclusion and belonging, some people with intellectual disability are displaying an active choice. These individuals are resisting categorization by choosing to not partake in the supports and settings associated with an intellectual disability. The conclusion of this thesis is that young adults with intellectual disability who are not participating in an occupation is a complex phenomenon. To understand this more in-depth many different factors, interactions and experiences have to be considered. There is a great need to develop resources and services that have a holistic approach that also fit with individual needs and desires, in order to better promote participation and prevent individuals from falling through the cracks.
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