1.
Grim, Katarina, 1971-
(författare)
Legitimizing the knowledge of mental health service users in shared decision making : Promoting participation through a web-based decision support tool
2019
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Aim: The overall aim of this thesis was to explore the manner in which user knowledge and user perspectives can be included and supported in shared decision making (SDM) in mental health services.The thesis consists of four studies. Study I explored what needs service users identify to participate in deliberative processes and decision making in their care. Study II examined how a decision support tool (DST) for SDM can be designed to enhance service users’ ability to have active and meaningful roles in SDM. Study III investigated barriers and facilitators associated with the implementation of a web-based DST designed to provide a concrete structure to support SDM. In study IV, a theoretical analysis was performed to elucidate the barriers associated with user knowledge being expressed and legitimized in decision-making processes.Methods: A key feature of the project involved a process of exploring decisional and informational needs and of developing, testing and implementing a DST for SDM. Qualitative data have been collected through focus group and individual interviews with service users and service providers, usability testing with service users and checklists.Findings: The findings show a number of characteristics specific to the mental health service context that need to be considered when developing support for SDM. Decisions were often complex and found to encompass a number of life domains. Issues related to social context and individual recovery highlighted the necessity to include the knowledge perspectives of service users throughout decision processes. In response, phases for preparation and follow-up was emphasized in the DST. The results indicate that supportive structures are required for service users to express their knowledge perspectives and for providers to include them in their decision-making. Moreover, existing barriers related to organizational structures and to power differentials need to be addressed. Conclusions and implications: A DST specifically designed for the mental health context, that methodically invites service users to participate in each phase of the decision-making process might function as a guiding structure to validate service users as knowledgeable agents.
2.
Fjellfeldt, Maria, 1976-
(författare)
Choice as governance in community mental health services
2017
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
In 2009, the Act on Freedom of Choice Systems (SFS 2008:962) wasestablished in Sweden, and this enabled municipalities to organise services aschoice models. This thesis describes and analyses the implementation of afreedom of choice system within community mental health services. Daycentre services were in focus, and a case study was conducted of a majormunicipality that sought to be a “world-class city” in regard to citizens’ choice.The experiences of policy makers, managers, professionals, and participantswere explored in interviews, and documents on a national, municipal, and citydistrict level, as well as homepages of providers of community mental healthservices, were all part of the study and were analysed using content-analysismethods.The results showed that the freedom of choice system aimed for two objectives– improvements at the individual level and financial efficiency. In practice,financial efficiency was experienced as the main objective. Increased varietyof services was aimed for by the competitive model, but such variety was notobserved. Instead, services tended to be more similar than specialised.Concerning new providers, they were characterised as committedprofessionals running companies with strained economies. Participantsaffected by the reform expressed anxiety and worries due to theunpredictability and uncertainty embedded in the competitive choice model.Choice within the system concerned where to go, whereas participantsemphasised a wish to be able to influence the choice aspects of who carriedout the service and how much time to attend the services.The conclusion was that the freedom of choice system was implemented as atechnology of governance to increase financial efficiency of services.Individual choice was not experienced as increased in any aspect except forthe choice of where to go. Instead, freedom of choice actually appeared todecrease due to standardisation and hierarchical structures. Aspects that werefound to be relevant when designing freedom of choice systems aiming toincrease individual freedom of choice were to address predictability andcontinuity, to address sustainable financial premises, to analyse the predictedimpact of administrative systems that are to be used, and to avoid the use of“hidden goals” in the policy-making process.
3.
Hämberg, Eva, 1958-
(författare)
Tillsyn i teori och praktik : om statlig styrning och kontroll av socialtjänstens individ- och familjeomsorg
2017
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of this thesis is to deepen the understanding about the function of control in the inspection process and to increase the knowledge about the legitimacy and impact from inspection on different types of social and welfare services. In the thesis the form and legitimacy of the inspection process are studied in two types of social services in Sweden: a less complex service where the task to investigate and make decisions about social care dominates (IAD), and a more complex service where the task to provide treatment interventions dominates (TI). The data consists of policy documents, inspection reports, casefile documentation, and interviews with inspectors, politicians, managers and social workers. The inspection process is discussed in relation to theories about control systems and legitimacy processes. Inspection is a policy instrument whose standards are derived from legislations and where those subject to the inspection are obliged to meet the demands made by the inspectorates. This form of disciplinary control has been questioned given that its complexity makes it hard to regulate the practice of social work through detailed rules. By including a less disciplinary form of control the instrument’s ability to impact on more complex aspects of social services are expected to increase. The results show a difference in how the inspection process is set up in the two types of services. In the IAD services the process takes the form of a disciplinary control system, whereas the process in TI services initially takes the form of a non-disciplinary system. In spite of the differences observed in the initial stages of the process, the results show that the judgments of inspectors in both types of services are almost exclusively based on information about concrete and detailed aspects. This entails that the judgements of inspectors in both types of services mostly take the form of statements on simple observable and concrete conditions, whereas judgments about more complex aspects are rarely made. The study also shows that although the propriety and relevance of the inspectors’ judgements are questioned more in TI organisations inspections seem to have greater validity and impact on TI than on IAD organisations. The results of the thesis point to two explanations. One explanation is that the costs of dealing with the problems underlying the identified deficiencies are lower for TI than IAD organisations. This in turn leads to greater acceptance of carrying out the proposed measures in TI than in IAD organisations. Another possible explanation is that the potential sanctions are greater for TI than IAD organisations.
4.
Saar, Maarja
(författare)
The answers you seek will never be found at home : Reflexivity, biographical narratives and lifestyle migration among highly-skilled Estonians
2017
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Det övergripande syftet med denna avhandling är att undersöka förhållandet mellan migration, reflexivitet och social klass. I fokus för den empiriska analysen står högt kvalificerade estniska emigranter. Reflexivitet har hittills inte varit ett viktigt begrepp i migrationsstudier. Även om vissa studier använt ordet reflexivitet, har det i huvudsak fungerat som bakgrundsbegrepp. Det finns en påtaglig brist på empiriskt orienterade studier av reflexivitet i migrationsstudier.Avhandlingen består av fyra artiklar med något olika inriktning. Den första undersöker det empiriska fallet i sin helhet utifrån en survey-undersökning om estniska migranter. Den andra artikeln diskuterar den brittiske sociologen Margaret Archers sätt att analysera migration och argumenterar i hennes efterföljd för ett socialpsykologiskt synsätt på de skiftande motiven att migrera. Den tredje artikeln utmanar tanken på att migranters återvändande i huvudsak kan förstås som saknad efter sociala relationer och känslor av hemlängtan. I den fjärde artikeln föreslås ett sätt för livsstilsorienterade migrationsstudier att hantera frågan om reflexivitet. Här positioneras livsstilsmigranter teoretiskt till andra typer av migranter och hur variationer ilivsstilsmigration kan analyseras. Trots inbördes variation har samtliga artiklar en gemensam nämnare.
5.
Jansson, Peter M., 1965-
(författare)
Våldets onda cirklar : En explorativ undersökning av mäns barndomsupplevelser, maskuliniteter, känslor, våld samt terapeutiska interventioner mot våld
2016
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Avhandlingens överordnade syfte är att utforska möjligheterna för ett integrerat forskningsperspektiv på mäns våld samt exemplifiera hur sådan forskning kan bedrivas. Det konkreta syftet är att öka kunskapen om hur våldsamma mäns barndomsupplevelser, socialisation, maskulinitetskonstruktion och emotioner kan relateras till deras våld mot andra män, mot sig själva och mot kvinnor samt till hur terapeutiska interventioner mot våld kan analyseras och utvecklas i korrespondens med denna kunskap. Med vetenskapsteoretiska utgångspunkter hämtade från den kritiska realismen och ekologiska metoder relaterar studien forskning från olika skolbildningar till varandra; - psykologisk: om barndomserfarenheter och socialisation, socialpsykologisk: om emotioner och interaktion samt sociologisk: om social klass, könsmaktsstrukturer och hegemonisk maskulinitet. Detta genomförs för att kunna få tillgång till kunskap om hur olika faktorer samverkar vid mäns våld.I studie I och II studerades möjligheterna att undersöka de sociala banden mellan terapeut/terapi och klient inom terapeutiska behandlingar mot våld. I studie I operationaliserades indikatorer på emotionerna stolthet och skam och i studie II testades dessa på terapeuter inom en KBT-orienterad terapi. I studie IIIundersöktes män i olika maskulinitetspositioner, där urvalet för den ena gruppen hämtades ur populationen män dömda till terapi för våld och missbruk och den andra ur populationen män som organiserat arbetade för jämlikhet och mot våld mot kvinnor. I studien jämfördes de båda gruppernas förhållningssätt till faktorer som i tidigare forskning relaterats till våld och våld mot kvinnor. I studie IVundersöktes våldsdömda mäns karriärer fram till deras nuvarande position som våldsbejakande kriminella i avsikt att öka kunskapen om det samspel mellan faktorer som i olika situationer leder fram till deras våld mot andra män, sig själva och kvinnor. Samtliga empiriska studier använde kvalitativa metoder för datainsamling och analys. I studie IV användes individuella intervjuer och biografisk analys, I studie II ochIII användes gruppintervjuer samt deduktiv innehållsanalys. I studie I, den teoretiska reviewartikeln, utgjorde sociologisk, socialpsykologisk och psykologisk teoribildning empiri.Avhandlingen visar att det finns fler fördelar är nackdelar med ett nivåövergripande perspektiv. Nivåintegrerande studier försvåras av att de kräver en komplex metodologi för att kunna hantera samverkan mellan faktorer bakom våld på olika nivåer men ger å andra sidan en mer holistisk förståelse av fenomenet i fråga. Resultaten visar att integrerande perspektiv kan minska risken för ekologiska felslut och ökar förståelsen av komplex samverkan mellan faktorer bakom mäns våld, något som kan komma att bidra till kunskapsutvecklingen inom våldsterapiområdet. Den teoretiska reviewartikeln (studie I) exemplifierade hur teoretiskt och metodologiskt driven forskning om sociala band kan göras pragmatiskt tillämpbar av terapeuter inom våldbehandlingar. Den tillämpade studien av en KBT-terapi (studie II) gav exempel på hur operationaliserade indikatorer på stolthet och skam kan användas praktiskt för att bestämma kvalitén på det sociala bandet mellan terapeut och klient. Den studerade KBT-terapin innehöll som förväntat både skam- och stolthetskapande moment vilket utgör värdefulla utgångspunkter för vidare forskning. Jämförelsen mellan män i idealtypiskt motsatta maskulinitetspositioner (studie III) visade att både gruppen av män som arbetar mot våld mot kvinnor och männen dömda till behandling mot våld, bär på ambivalenta attityder gentemot våld och våld mot kvinnor. Jämförelsen visade vidare att gruppernas maskulinitetskonstruktioner och attityder till våld korresponderar med grupperingarnas olika tillgång till ekonomiska, sociala och kulturella resurser. Den biografiskt fokuserade kvalitativa studien av män i våldsbehandling (studie IV) undersökte explorativt hur karriären fram till våldskriminell kan se ut och hur barndomsupplevelser, socialisation, maskulinitet och emotioner hos enskilda våldsverkande män kan tänkas ha samverkat med varandra när våld äger rum. Resultaten visade att de män som vittnar om utsatthet för allvarligt våld i barndomen är mer skambenägna och vid kränkningar från andra tenderar att omedvetet och utan föregående känslor av skam direkt reagera med aggressioner och våld mot båda könen. Övriga män var visserligen skambenägna men beskrev en mer kontrollerad våldsreaktion. Två män som blivit brutalt fysiskt mobbade i grundskolan, berättade om ett mer kontrollerat våld. En preliminär hypotes är att männen kan ha lärt sig att kognitivt, för att undslippa fortsatt mobbing, ta kontrollen över processen där skamkänslor ersätts med aggressioner. Föräldrarnas personliga problem tillsammans med deras bristande sociala kontroll och omsorg antogs ha ett samband med flera av männens skolproblem, deras umgänge med avvikande ungdomar, deras senare svårigheter med att kunna försörja sig med konventionella medel samt deras våldskarriärer.
6.
Ewertzon, Mats, 1956-
(författare)
Familjemedlem till person med psykossjukdom : bemötande och utanförskap i psykiatrisk vård
2012
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation.A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV).The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV).Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.
7.
Kania-Lundholm, Magdalena, 1980-
(författare)
Re-Branding A Nation Online : Discourses on Polish Nationalism and Patriotism
2012
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of this dissertation is two-fold. First, the discussion seeks to understand the concepts of nationalism and patriotism and how they relate to one another. In respect to the more critical literature concerning nationalism, it asks whether these two concepts are as different as is sometimes assumed. Furthermore, by problematizing nation-branding as an “updated” form of nationalism, it seeks to understand whether we are facing the possible emergence of a new type of nationalism. Second, the study endeavors to discursively analyze the ”bottom-up” processes of national reproduction and re-definition in an online, post-socialist context through an empirical examination of the online debate and polemic about the new Polish patriotism.The dissertation argues that approaching nationalism as a broad phenomenon and ideology which operates discursively is helpful for understanding patriotism as an element of the nationalist rhetoric that can be employed to study national unity, sameness, and difference. Emphasizing patriotism within the Central European context as neither an alternative to nor as a type of nationalism may make it possible to explain the popularity and continuous endurance of nationalism and of practices of national identification in different and changing contexts. Instead of facing a new type of nationalism, we can then speak of new forms of engagement which take place in cyberspace that contribute to the process of reproduction of nationalism. The growing field of nation-branding, with both its practical and political implications, is presented as one of the ways in which nationalism is reproduced and maintained as a form of “soft” rather than “hard” power within the global context. The concept of nation re-branding is introduced in order to account for the role that citizens play in the process of nation branding, which has often been neglected in the literature. This concept is utilized to critically examine, understand, and explain the dynamics of nation brand construction and re-definition, with a particular focus on the discursive practices of citizens in cyberspace. It is argued that citizens in the post-socialist countries, including Poland, can engage in the process of nation re-branding online. It is also argued that this process of online nation re-branding may legitimately be regarded as a type of civic practice through which citizens connect with each other and reproduce a form of cultural national intimacy.The results of the analysis of the online empirical material illustrate that nation re-branding is a complex, dynamic, and ambivalent phenomenon. It involves a process of discursive negotiation of nation and of national identity, but also challenges, dismantles, and transforms the national image as it is communicated both internally and externally. This reveals nation re-branding as an element in the post-socialist transformation from a ”nation” to a ”Western,” ”modern,” and ”normal” country in which dealing with an ”old” nation brand is as equally important as the introduction of the new brand. Nationalism does not disappear in the digital age, but rather becomes part of the new way of doing politics online, whereby citizens are potentially granted a form of agency in the democratic process.
8.
Mjöberg, Jessica, 1977-
(författare)
Innerlighetens tid : En sociologisk undersökning av intimitet och senmodernitet
2011
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Due to a recent increase in usage of the concept of intimacy within social scientific research, the overarching aim of this work is to investigate its meaning and significance in contemporary social life. The first part of the thesis reviews research on intimacy. Intimacy is perceived as being vaguely defined as a concept, leading to insufficient discussions concerning the significance of intimacy both as a social concept and as a social phenomenon in contemporary western society. In order to become more clearly defined as a social concept to use in future research, intimacy needs to be investigated as a social phenomenon. The second part explores and analyses intimacy as a social phenomenon by way of three partly phenomenological and partly theoretical analyses: the phenomenology of intimacy, the arithmetic of intimacy and the dark sides of intimacy. The three analyses result in a definition of intimacy understood as a kind of sociality, or mode of social being, characterized by an oceanic experience, mutual and complete directedness between the ones being in relation, an experience of mental as well as physical closeness, and an experience of time as “durée”. The third part discusses the proposed definition of intimacy as sociality in relation to contemporary social theory. In relation to an understanding of contemporary western society as late modern or radicalized modern, intimacy as sociality is discussed as a radicalization of a rational sociality, characteristic for modern society. The discussion takes the form of a dialectic critique of modern dualistic theories, proposing a triadic (dialectic) alternative for understanding basic forms of sociality and social relations. The vague notion of intimacy as a concept suited to characterize social life in contemporary western society is supported by this proposition.
9.
Forsberg Kankkunen, Tina, 1969-
(författare)
Två kommunala rum : Ledningsarbete i genusmärkta tekniska respektive omsorgs- och utbildningsverksamheter
2009
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of this study is to describe and partially explain how management is shaped in female-dominated social care and education services and male-dominated technical services, and how this contributes to creating and reproducing a gender system in municipal organizations. This was achieved by interviewing male and female operative managers in social care and education services and technical services. The managerial work of operative managers was also problematized in relation to activities at other organizational levels – the operational versus the strategic. The theoretical fields used in the study are primarily those having to do with organization and gender. I describe how power structures like sex and gender influence the construction of management; for example, genderized environments generate managerial action patterns, resources, and organizational prerequisites. The analytical results show that managerial work in social care and education services differs in practice from managerial work in technical services. Social care and education services have poorer organizational prerequisites for social interaction among organization levels than do technical services. The discrete prerequisites for managerial work make it more difficult for operative managers in social care and education services to support and interact with staff at the operative level than it is for operative managers in technical services. Operative managers in social care and education services also find it more difficult to actively influence the decision processes than do operative managers in technical services. When operative managers in social care and education services are cut off from strategic decisions and prevented from showing and explaining their needs and activities, the gender system in municipal organizations can be reproduced in the shadows.
10.
Schön, Ulla-Karin, 1970-
(författare)
Kvinnors och mäns återhämtning från psykisk ohälsa
2009
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder. Four studies have been carried. Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness. The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.
