| 1. |
- Guldbrandsson, Karin, et al.
(författare)
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An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena
- 2009
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Ingår i: Health Promotion International. - : Oxford University Press (OUP). - 1460-2245 .- 0957-4824. ; 24:4, s. 434-44
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Tidskriftsartikel (refereegranskat)abstract
- In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three 'streams', the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts 'policy windows' and 'policy entrepreneurs' could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers' ability to detect actors possessing policy entrepreneur resources.
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| 2. |
- Guldbrandsson, Karin
(författare)
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Child health promotion : analyses of activities and policy processes in 25 Swedish municipalities
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish municipalities are important actors that offer appropriate environments for healthpromoting activities directed at children and adolescents. Enhanced understanding on how such activities develop is needed to improve local public health action. The overall objective of this thesis was to describe potential explanatory factors in municipal health-promoting measures directed at children and adolescents, in order to facilitate for national actors to support healthpromoting action in the municipalities. In the first three papers of this thesis the intentions of 25 Swedish municipalities to promote children and adolescents' health are described. Safety promotion (Study I), health promotion in preschools (Study II) and health promotion in schools (Study III) were of primary interest. In the next step policy processes and factors that might explain municipal public health action were analysed (Study IV). Finally, data from Study 1 were used to test correlations between municipal safety-promoting activities and health outcome (Study V). Although intentions to promote children's health were in general quite well developed, there were some exceptions and variations among the municipalities. Significant correlations between municipal healthpromoting activities and outcome variables were revealed on injuries (Study V) but not on youth behaviour (Study III). Municipal socio-economic status, measured as proportion adults with more than 12 years of education, did not predict the level of healthpromoting measures, whereas municipal growth seemed to have a hampering effect. These results were consistently observed in Studies I-III. Faster growing municipalities reported fewer safety-promoting measures, a lower fraction of preschool staff with a university degree and a lower fraction of full-time employed teachers with a university degree than slower growing municipalities. Five potential explanatory factors for policy process development were identified in Study IV: financial problems, perceived local needs, external funding, national and international policy documents and presence of a local public health sector. Politicians, public officials and nongovernmental organisations were important actors in different phases of the policy process, with strong commitment, professional skills and powerful position in the organisation as main characteristics. The health sector in general, epidemiological statistics and evidence-based methods were seldom mentioned in Study IV. Potential policy implications based on the results presented in this thesis are that disseminating public health-related knowledge through international and national policy documents and supporting institutionalisation of a local public health sector might be useful methods to stimulate and support municipal public health action. Further, means to introduce and distribute epidemiological statistics and evidence-based methods to the municipalities ought to be considered. Increased and improved cooperation between public health sciences and political sciences (e.g., by integrated courses and shared research projects) could be helpful in developing public health research within the municipal arena.
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| 3. |
- Guldbrandsson, Karin, et al.
(författare)
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Reply to the Letter to the Editor
- 2010
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Ingår i: Health Promotion International. - : Oxford University Press (OUP). - 0957-4824 .- 1460-2245. ; 25:1, s. 136-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Guldbrandsson, Karin, et al.
(författare)
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The DECIDE evidence to recommendation framework adapted to the public health field in Sweden
- 2015
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Ingår i: Health Promotion International. - Oxford University Press : Oxford University Press (OUP). - 0957-4824 .- 1460-2245. ; :June 16
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Tidskriftsartikel (refereegranskat)abstract
- Organizations worldwide compile results from scientific studies, and grade the evidence of interventions, in order to assist policy makers. However, quality of evidence alone is seldom sufficient to make a recommendation. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) framework aims to facilitate decision making and to improve dissemination and implementation of recommendations in the healthcare and public health sector. The aim of this study was to investigate whether the DECIDE framework is applicable in the public health field in Sweden. The DECIDE framework was presented and discussed in interviews with stakeholders and governmental organizations and tested in panels. Content analyses were performed. In general, the informants were positive to the DECIDE framework. However, two questions, the first regarding individual autonomy and the second regarding method sustainability, were by the stakeholders felt to be missing in the framework. The importance of the composition of the DECIDE stakeholder panel was lifted by the informants, as was the significant role of the chair. Further, the informants raised concerns about the general lack of research evidence based on RCT design regarding universal methods in the public health sector. Finally, the local, regional and national levels’ responsibility for dissemination and implementation of recommendations were lifted by the informants. The DECIDE framework might be useful as a tool for dissemination and implementation of recommendations in the public health field in Sweden. Important questions for further research are whether these findings are suitable for other public health topics and in other public health settings.
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| 5. |
- Guldbrandsson, Karin, et al.
(författare)
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The significance of policy documents in municipal child health promotion
- 2008
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 36:3, s. 228-234
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To investigate municipal utilization of policy documents in child health-promoting activities with reference to document types, substance in the documents and timing in the policy process. Methods: Fifty semi-structured interviews were performed using the snowball method, and content analyses of written documentation were made. Data were categorized by means of a policy process matrix, and nine case studies were written. Triangulation was used as a validating method, and the coding reliability was assessed. Statements related to various policy documents were categorized according to document types, substance in the documents, and timing in the policy process. Results: Various policy documents were spontaneously mentioned by 33 of 50 interviewees, in eight of nine case studies, and in all stages of the policy process. Well-defined statements concerning which content in the policy documents that actually impacted on the policy process development were uncommon. Conclusions: This study shows that policy documents are present in policy processes related to child health-promoting activities in Swedish municipalities. As Swedish municipalities are autonomous and not forced to pursue governmental recommendations, this probably demonstrates that policy documents are significant in the development of such processes.
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| 6. |
- Guldbrandsson, Karin, 1956, et al.
(författare)
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What makes things happen? : An analysis of the development of nine health-promoting measures aimed at children and adolescents in three Swedish municipalities
- 2005
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Ingår i: Social Science & Medicine. - 0277-9536. ; 61:11, dec, s. 2331-2344
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish municipalities offer important environments for health promotion. However, national actors need increased knowledge on how to support the development of public health measures in the municipalities. The aims of this study were to describe the development of municipal health-promoting measures directed at children and adolescents and to identify factors that might explain the development of such measures. Fifty semi-structured interviews and written documentation gathered from three municipalities in Stockholm County resulted in nine case studies. A policy process matrix, based on the actor-structural approach, was constructed to categorise the data. Five aspects contributing to the trajectory of municipal health-promoting measures aimed at children and adolescents were often mentioned in the data set. These are financial problems, perceived local needs, access to external funding, statements in national and international policy documents and the presence of a local public health sector. Politicians, public officials, and non-governmental organisations were the most mentioned actors, with heavy commitment, professional skills, and powerful position referred to as prevalent characteristics. Public health core concepts such as epidemiological statistics and evidence-based measures were rarely mentioned. The health care sector did not seem to have had any direct influence on municipal health-promoting measures. The dissemination of knowledge about public health related international and national policy documents and support for the institutionalisation of a local public health sector might be useful ways to support municipal public health measures.
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| 7. |
- Ingemarson, Maria, et al.
(författare)
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Implementation of a school-wide prevention programme-teachers' and headmasters' perceptions of organizational capacity.
- 2014
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Ingår i: Evaluation and Program Planning. - : Elsevier BV. - 0149-7189 .- 1873-7870. ; 43, s. 48-54
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Tidskriftsartikel (refereegranskat)abstract
- This study focuses on schools' organizational capacity to implement a Swedish school-wide programme, Prevention in School (PS). It is based on semi-structured interviews with seven headmasters and 13 teachers from seven Swedish schools. The interviews were analyzed by the use of qualitative content analysis. The findings show that the adoption of a comprehensive intervention like PS challenges the school organization as the staff encountered a variety of organizational barriers when implementing the programme. Factors connected to lack of consensus, collaboration and insufficient programme management were the main barriers that were identified. Teachers wanted a more extensive support from their headmasters in terms of participation in different programme activities. It was emphasized that peer coaches need to be prepared for their task, although the headmasters found it difficult to be able to choose those teachers who they perceived as the most suitable. It is concluded that leadership, coaching and staff selection need particular attention when implementing a programme like PS, since those factors have been defined as important implementation drivers, both in this study and previously.
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| 8. |
- Ingemarson, Maria
(författare)
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PS – a school-wide prevention programme : effects, core components and implementation.
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- PS is multi-component intervention at the primary prevention level and aims at creating a positive learning environment and decreasing problem behaviours among students in the school years 4-9. During 2009-2012 the programme was both implemented and studied for the first time in a Swedish context. The present thesis comprises four studies of PS and applies a mixed methods approach. The thesis aims to study: 1) If the programme is effective in enhancing the classroom climate, and decreasing problem behaviours among students (Study I), 2) teachers and school staff’s perceptions of programme and implementation (study II and III) and 3) if teacher’s use of praise and clarity of school rules, regardless of programme use, are useful as classroom management techniques, and if there are any differences between classes in terms of disruption (study IV). A quasi-randomized trial was conducted in study I, comprising 3207 students in school grades 5-7 and 188 teachers in 23 schools in the wider area of Stockholm. The participating children and their head teachers answered self-report questionnaires on three occasions: At baseline and one and two years after programme initiation. Degree of implementation in the schools was also measured. Further, a qualitative design with semi-structured interviews and thematic content analysis was used in study II and III. The interviews were conducted in seven PS schools with seven school leaders and 13 school teachers during 2010 and 2011. In study IV, students (n=2266) and classes were divided into two groups, based on teacher ratings of disruptive students in class. Baseline and 12-month follow-up responses were used to perform multiple regression analysis, to compare groups and to investigate possible longitudinal associations. Study I showed no significant effects on students’ problem behaviours and classroom climate at last follow-up. The findings from study II indicated barriers to programme commitment in terms of lack of consensus, collaboration barriers and insufficient process management. It was concluded that leadership, coaching and staff selection need particular attention when implementing a programme like PS, since those factors have been defined as important implementation drivers, both in this study and previously. Study III showed that teachers’ professional identity, programme understanding and experience of change were factors affecting implementation. Ambiguities regarding the boundaries of the social assignment, opposition against the theoretical underpinnings and an unclear core component were identified as implementation barriers. In study IVit was shown that clarity of school rules did not substantially contribute to classroom climate, whereas teacher’s use of praise to some extent did. The hypothesis on weaker associations in the low disruption group could not be confirmed. This thesis cannot provide an answer to the question whether PS is effective or not, since findings indicate that the implementation did not succeed. However, findings in the last study indicate that teacher’s use of praise may contribute to improve the classroom climate. If the PS programme is to be used again there is a need for revisions, and sufficient time for schools to consider programme adoption will be crucial. Aspects of programme implementation are further discussed.
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| 9. |
- Ingemarson, Maria, et al.
(författare)
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The implementation of a behavioural support programme Teachers' perceptions of the programme and themselves as providers
- 2016
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Ingår i: Health Education. - : EMERALD GROUP PUBLISHING LTD. - 0965-4283 .- 1758-714X. ; 116:6, s. 526-540
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - The purpose of this paper is to investigate how teachers received and perceived the school programme Prevention in School (PS), a positive behavioural support programme; how did the teachers perceive the programme characteristics and themselves as providers; and how did this affect programme implementation? Design/methodology/approach - Qualitative methods with semi-structured interviews with 13 teachers and thematic content analysis were used. Findings - The teachers were heterogeneous in their views, with professional identity, programme understanding and experiencing change being important factors for the implementation. Ambiguities regarding the boundaries of the social assignment, opposition against the theoretical underpinnings and an unclear nomenclature in a core component affected the implementation negatively. Among the perceived benefits were instant rewards in the form of aha moments and increased self-awareness. The nature of the implementation barriers indicates that PS is in need of further development. Practical implications - Compatibility with teachers' ideologies, clarification of the social assignment and enough time to consider programme adoption are vital when implementing a programme like PS. Originality/value - The study provides context-specific understanding of teachers' perceptions of a behavioural support programme and of their role when trying to implement it. It is known that providers' perceptions affect the implementation and this study contributes to the field of implementation research, with particular respect to the school setting and comprehensive programmes like PS.
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| 10. |
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