| 1. |
- Almgren White, Anette, 1960-
(författare)
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Intermedial narration i den fotolyriska bilderboken : Jean Claude Arnault, Katarina Frostenson och Rut Hillarp
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This bipartite thesis presents and implements an intermedial model for co-reading poems and photographs in paper books, a genre I call photo poetry. A survey of the genre in Sweden was carried out and presented in a selected bibliography in my licentiate thesis.Two well-established poets, Katarina Frostenson and Rut Hillarp, made their debut in the genre in the 1980s and have since produced three books each. Frostenson cooperates with photographer Jean Claude Arnault and Hillarp created the poems as well as the pictures herself. Scholarly studies up to now have focused on the poems, however, and have therefore neglected the impact of the photographic pictures.The first part of the thesis elaborates a model based on the framework of the picture book and adapted to the text genre of poetry and the epistemology of the photographic picture. Two different narrative reading strategies are developed and applied to the material: the metonymical and the metaphorical linking. The metonymical linking implies that the diegesis on the spread is perceived to be part of a larger diegesis and that that diegesis has direct virtual contact with the diegesis on the next spread. The metaphorical linking implies that the diegesis on the single spread is perceived to be part of a larger diegesis, but that that diegesis has no direct virtual spatial contact with the next spread.Whether or not a diegesis is perceived to have direct virtual spatial contact with spreads depends on the story’s display of the contingency of characters, time and place.The model is based on the relations tied to the book’s construction: the schematic, the synchronic and the diachronic relation. The schematic relation concerns meaning created on all spreads, the synchronic relation meaning on a single spread, and the diachronic relation meanings on spreads in a row. The schematic and the diachronic may appear to overlap somewhat but in the schematic relation the focus is on tracing different story schemes, and in the diachronic relation the focus is on how the narration progresses and alternates between different schemes.The findings show that with the co-reading model the impact of the photographs gives a deeper understanding of not only the narrative interplay of word and image but also of semiotic, intermedial and intertextual connections. The reading strategies applied show that Frostenson’s and Arnault’s works gain from a metonymically linked interpretation whereasHillarp’s mainly gain from a metaphorically linked interpretation. The study also discusses the impact of the photographic picture and connects it to the semiotic theory of C. S. Peirce as well as to Western picture practices.
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| 2. |
- Barenfeld, Emmelie, 1981, et al.
(författare)
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Promoting aging migrants' capabilities: A randomized controlled trial concerning activities of daily living and self-rated health
- 2018
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Ingår i: Aims Public Health. - : American Institute of Mathematical Sciences (AIMS). - 2327-8994. ; 5:2, s. 173-188
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.
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| 3. |
- Barenfeld, Emmelie, 1981, et al.
(författare)
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Supporting decision-making by a health promotion programme : Experiences of persons ageing in the context of migration
- 2017
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- This study is part of the Promoting Aging Migrants’ Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants’ everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70- 83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.
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| 4. |
- Barenfeld, Emmelie, 1981, et al.
(författare)
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Understanding the "black box" of a health-promotion program : Keys to enable health among older persons aging in the context of migration
- 2015
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researchercommunity partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.
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| 5. |
- Fritz, Johanna, et al.
(författare)
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Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods
- 2019
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.
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| 6. |
- Fritz, Johanna, et al.
(författare)
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Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour.
- 2021
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Ingår i: Archives of physiotherapy. - : Springer Science and Business Media LLC. - 2057-0082. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.METHODS: An explorative and comparative pre-/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.RESULTS: There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.CONCLUSION: It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients' outcomes in this study. Most of the patients' health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.TRIAL REGISTRATION: The study protocol was retrospectively registered in ClinicalTrials.gov . ID NCT03118453 , March 20, 2017.
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| 7. |
- Lind, Susanne, et al.
(författare)
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Implementation of evidence-based palliative care in acute care hospitals : Obstacles and opportunities as described by politicians, hospital managers and health care professionals
- 2016
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Ingår i: Palliative Medicine. - 0269-2163 .- 1477-030X. ; 30:6, s. NP300-
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Tidskriftsartikel (refereegranskat)abstract
- Background: In high income countries, such as Sweden, a large proportion of all deaths occur at hospitals which is commonly not consistent with the desire of the patient and next-of-kin. A common way to translate knowledge into clinical practice is to create practice guidelines for different levels of the health care organization. During the last years, national clinical guidelines for palliative care and guidance from the NBHW have been published for the first time in Sweden. Hence, the aim of this study was to identify perceptions of obstacles and opportunities for implementation of evidence-based palliative care in acute care hospitals, as described by local politicians, chief medical officers and health care professionals.Method: Interviews were conducted with local politicians, chief medical officers and health care professionals and analysed through a directed qualitative content method, guided by The Consolidated Framework for Implementation Research.Results: Palliative care was commonly mentioned as a comprehensive way for alleviation of patients’ suffering with the overall goal for maintaining quality of life, especially in end of life care. Palliative care at the hospital was described by the staff as characterized by sudden disease, rapid changes back and forth between life and death and difficulties to predict the outcome. The environment, the culture, poor communication and poor cooperation in the work team were described as obstacles for implementation. The informants mentioned the newly published documents as important but the knowledge about the content varied a lot. A newly formed internal group with the assignment to develop the palliative care at the clinic was emphasized by all health care professionals as a good opportunity to get support and local guidelines.Conclusion: An active process at different levels in the health care organization is important for a successful implementation of evidence-based palliative care in acute care hospitals.
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| 8. |
- Lind, Susanne, et al.
(författare)
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Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders’ perceptions
- 2017
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:11, s. 1194-1201
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Tidskriftsartikel (refereegranskat)abstract
- In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. © 2017 Elsevier B.V.
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| 9. |
- Lind, Susanne, et al.
(författare)
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Implementation of the integrated palliative care outcome scale in acute care settings - a feasibility study
- 2018
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Ingår i: Palliative & Supportive Care. - : Cambridge University Press. - 1478-9515 .- 1478-9523. ; 16:6, s. 698-705
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Although hospitals have been described as inadequate place for end-of-life care, many deaths still occur in hospital settings. Although patient-reported outcome measures have shown positive effects for patients in need of palliative care, little is known about how to implement them. We aimed to explore the feasibility of a pilot version of an implementation strategy for the Integrated Palliative care Outcome Scale (IPOS) in acute care settings.Method: A strategy, including information, training, and facilitation to support the use of IPOS, was developed and carried out at three acute care units. For an even broader understanding of the strategy, it was also tested at a palliative care unit. A process evaluation was conducted including collecting quantitative data and performing interviews with healthcare professionals.Result: Factors related to the design and performance of the strategy and the context contributed to the results. The prevalence of completed IPOS in the patient's records varied from 6% to 44% in the acute care settings. At the palliative care unit, the prevalence in the inpatient unit was 53% and the specialized home care team 35%. The qualitative results showed opposing perspectives concerning the training provided: Related to everyday work at the acute care units and Nothing in it for us at the palliative care unit. In the acute care settings, A need for an improved culture regarding palliative care was identified. A context characterized by A constantly increasing workload, a feeling of Constantly on-going changes, and a feeling of Change fatigue were found at all units. Furthermore, the internal facilitators and the nurse managers' involvement in the implementation differed between the units.Significance of the results: The feasibility of the strategy in our study is considered to be questionable and the components need to be further explored to enhance the impact of the strategy and thereby improve the use of IPOS.
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| 10. |
- Wallin, Tina
(författare)
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Firm renewal in the regional economy
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists four independent papers. In each paper the purpose is to analyse firm renewal, with special consideration to regional characteristics. Highlighted here are the knowledge available in the region where a firm is located as well as the local supply of financial intermediaries.The first paper analyses how the interaction of firms’ internal and external knowledge, in terms of knowledge intensive business services (KIBS), is related to the intensive and extensive margins of export flows. The second paper can be considered a continuation of the first, as the focus is solely on the export of new products. Also here, the interaction of internal and external knowledge is the main focus, analysed through education types. The results of these papers suggest that the regional contexts are indeed relevant for firm renewal, as firms that benefit from being located in areas with high external knowledge already have high internal knowledge.The third paper shifts focus to the innovation process itself by analysing how the access to the local supply of banks is related to firms’ perceived obstacles for innovation activities. The results indicate that lower access to banks increases the probability to experience problems obtaining external capital, which could be detrimental for firms’ renewal possibilities in the long run. The fourth paper focus on the creation of firms and analyses whether individuals are more or less likely to be self-employed after having children in a context where an extensive welfare system exists. The results show that individuals are less likely to be self-employed after having children than before, thus lowering the rate of firm renewal in the economy.
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