| 1. |
- Ahlgren, Christina, et al.
(författare)
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Engagement in New Dietary Habits : Obese Women's Experiences from Participating in a 2-Year Diet Intervention
- 2016
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Ingår i: International Journal of Behavioral Medicine. - : Springer. - 1070-5503 .- 1532-7558. ; 23:1, s. 84-93
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.
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| 2. |
- Axelsson, Sarianne Wiklund
(författare)
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Prerequisites for sustainable life style changes among older persons with obesity and for ICT support
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The experiences from persons in the third age of lifestyle changes due to obesity are rarely described in research. Interventions regarding lifestyle changes and obesity show weak evidence for long-term effects. Information and communication technology (ICT) may add an important potential in interventions, but readiness among older persons and the actual needs for support must be explored. Therefore the overall aim for the thesis was to explore the prerequisites for sustainable lifestyle changes among older persons with obesity; and how this could be supported by ICT.Both qualitative and quantitative approaches were used. In paper I, 10 participants were individually interviewed about their experiences of lifestyle changes and in a multistage focus group study (paper IV), 6 participants expressed the support needed for sustainable lifestyle changes in relation to obesity. Qualitative content analysis was used. In a randomly selected population survey, 154 participants responded to an enquiry about general and health related ICT usage (paper II). They also rated scenarios for expected psychosocial impact on web based e-health services and mobile health applications (paper III).An integration of the results identified four main findings: The first finding, A never-ending process of vigilance and vulnerability, showed constant attempts of weight loss and pre-occupation on not to fail in an un-supportive environment. The second finding; Need for psychosocial support marked that the process of lifestyle changes was influenced by factors as sensibility to moods, social support and others’ attitudes. It was therefore essential for the persons to achieve emotional balance. The third finding, ICT as a possible support for adaptability, presented that older Swedes expected a positive psychosocial impact by ICT, especially in a future perspective. ICT was most valued in the domain of adaptability. The degree of usage of health related ICT, however, was low, although persons with overweight had more experience of this usage. Finally, the fourth finding; Reconstructions from weight to health expresses the needs of reconstructing focus towards health, rather than being pre-occupied with weight loss. Physical activity that was associated to joy and to have a functioning body, a body that would serve them as before, were motives to lose weight.In conclusion, this thesis illustrates that a lifestyle change due to obesity in third age is lined with vigilance not to fail and requires a great deal of endurance and effort. The potential of ICT to support lifestyle changes is likely to be substantiated by the positive expectations on ICT from a psychosocial impact perspective, especially in views of the future. Findings indicate a need for moving focus from weight towards health and to see opportunities, and that psychosocial support and enjoyable physical activity are important prerequisites for sustainable change.
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| 3. |
- Einarsson, Sandra, 1981-, et al.
(författare)
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Thinking and re-thinking : a qualitative study of university teachers' perspectives on the development process for a new online interprofessional education curriculum in a Swedish higher education institution
- 2023
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Ingår i: Nordic Studies in Education. - : Cappelen Damm Akademisk. - 1891-5914 .- 1891-5949. ; 43:3, s. 225-240
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to reflect on the experience of working collaboratively across education programmes, departments, and faculties from the perspective of university teachers at a higher education institution. Nine teachers from five programmes working together to develop a new curriculum for interprofessional education (IPE) participated in a focus group discussion. Data were analysed using thematic analysis. Findings suggest that teacher experiences can be understood in terms of teamwork processes valued from both professional and IPE experiential variations within the group. Since findings illustrate pedagogical collaboration across department and faculty boundaries, they can inspire teachers who are planning a similar process.
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| 4. |
- Hammarström, Anne, et al.
(författare)
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Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients : A Study of Pain Rehabilitation
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.METHODS: In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.RESULTS: The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.IMPLICATIONS: The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.CONCLUSIONS: Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.
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| 5. |
- Hammarström, Anne, et al.
(författare)
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Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education. Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS). Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high-and low-educated men. Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.
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| 6. |
- Lehti, Arja, et al.
(författare)
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Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic : patient and professional perceptions of inequity in rehabilitation of chronic pain
- 2017
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:1, s. 45-53
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.SETTING AND METHODS: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.RESULTS: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.CONCLUSION: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.
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| 7. |
- Stenberg, Gunilla, Med dr, 1968-, et al.
(författare)
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Gender matters in physiotherapy
- 2022
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 38:13, s. 2316-2329
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Tidskriftsartikel (refereegranskat)abstract
- The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.
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| 8. |
- Stålnacke, Britt-Marie, et al.
(författare)
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Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?
- 2015
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation of Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 47:4, s. 365-371
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment. Methods: The population consisted of consecutive patients (n=589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record. Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker. Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.
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| 9. |
- Wiklund, Maria, et al.
(författare)
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Access to rehabilitation : patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective
- 2016
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.
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| 10. |
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