1.
Nordenmark, Mikael
(author)
Unemployment, Employment Commitment and Well-being : The Psychosocial Meaning of (Un)employment among Women and Men
1999
Doctoral thesis (other academic/artistic) abstract
The general aim of this thesis is to study the psychosocial meaning of (un)employment among women and men. This is mainly done by analysing employment commitment, or non-financial employment motivation, and mental well-being among a random sample of 3 500 Swedes that were interviewed in the beginning of 1996, when all were unemployed, and then again in the end of 1997, when the labour market situation varied. In general, the results from this study support the unemployment studies that have emphasised the importance of employment for the possibility to create and maintain a satisfactory life situation.
2.
Jemberie, Wossenseged Birhane, 1985-
(author)
Alcohol and aging : a multimethod study on heterogeneity and multidimensionality
2023
Doctoral thesis (other academic/artistic) abstract
Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite growing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experiences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addiction services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol problems and recovery.Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related outcomes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons recruited from a specialist outpatient clinic for alcohol treatment. Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which respected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incorporating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by considering their heterogeneity in treatment goals, biopsychosocial functioning, and available resources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an integrated and person-centered care across the continuum.
3.
Meili, Kaspar Walter, 1989-
(author)
Capability for broader cost-effectiveness in public health and social welfare : developing, valuing, and applyingcapability-adjusted life years Sweden (CALY-SWE)
2024
Doctoral thesis (other academic/artistic) abstract
Spending in social welfare areas such as healthcare, wider public health, education, and social care consumes a major part of the public budget. Cost-effective resource allocation is a moral obligation towards both taxpayers and beneficiaries: tax money should be used efficiently, and it should be transparently accounted for. After all, economical management of resources is important for sustaining future prosperity and for addressing fundamental challenges such as climate change and demographic shift. In healthcare, cost‐effectiveness using quality-adjusted life years (QALYs) is a well-established tool to inform policymakers. Using cost per QALY implies that health-related quality of life (QoL), and not money, is an end on its own. Moreover, cost per QALY allows one to compare unrelated interventions by measuring the effects on the common QALY scale. However, for actors concerned with broader social welfare, such as the Swedish municipalities, QALYs may be less useful because their measurement focus is largely limited to health. Comparable outcome measures for broader social welfare are still sparsely available and employed, and a context-specific measure for Sweden is lacking. The aim of this thesis was to develop, value, and apply capability-adjusted life years Sweden (CALY‐SWE), a QoL outcome measure conceptually based on the capability approach, for broader social welfare and specific for Sweden.Within study 1, we organized a Delphi panel to select relevant capability attributes and then developed the phrasing for the questionnaire. The resulting questionnaire contains six attributes –health, social relations, financial situation & housing, security, occupation, and political & civil rights – each with three answer levels. The phrasing integrates an implicit threshold so that the sensitivity is focused on the lower range of the scale, thus incorporating equity considerations that relate to sufficientarianism and prioritarianism. In study 2, we developed a value set consisting of all quality weights for the 729 possible CALY-SWE states. We relied on health economic outcome methodology, namely hybrid modelling of discrete choice and time trade-off data that we collected in a cross-sectional web survey with representative sampling. This value set allows to aggregate the CALY-SWE answers into a single quality weight that can be used in cost‐effectiveness analysis to calculate CALYs. In study 3, we applied the CALY-SWE questionnaire and value set to describe the capability distribution in a cross-sectional representative sample of the Swedish population. In a framework of group comparisons, we estimated capability inequalities and shortfalls for different population groups. The results showed that there are capability inequalities for *disadvantage groups* as well as for groups with discriminative inequalities – *plurality groups*, for example between lower and higher education. For study 4, we applied CALY‐SWE in a cost‐effectiveness application to model the effects of a payroll tax reduction in Sweden from 2007 to 2016 (during the financial crisis) on young people not in employment, education, or training (NEET). The intervention was likely cost-effective from a societal perspective, but only with limited probability from a fiscal perspective, although definite statements regarding cost-effectiveness are challenging because a threshold value for a CALY is still lacking. The final chapter discusses the measure’s development, including normative choices, in relation to the Swedish social welfare and policy context, the capability framework as suggested by Amartya Sen, distributive justice, and other outcome measures in cost‐effectiveness evaluations. Important work remains – for example, assessing psychometric properties, developing the conceptualization of the 0 to 1 anchor scale for capability weights, and assessing a threshold value for a CALY. In conclusion, with the questionnaire development, value set elicitation, and demonstration of applications, important steps for CALY‐SWE were accomplished. Cost‐effectiveness evaluations in wider social welfare and public health using CALY-SWE are now possible.
4.
Nordin, Therese, 1980-
(author)
Harnessing togetherness : perceptions of loneliness and promotion of social participation in the home care context
2023
Doctoral thesis (other academic/artistic) abstract
Introduction: It is well known that older adults have a higher risk for loneliness, which is detrimental to health. Home care in Sweden has a responsibility to address social needs, but systematic approaches are lacking and there is a know–do gap. The overall aim of this thesis was to develop knowledge about older home care recipients’ and home care providers' perceptions of loneliness and social participation among older adults, and furthermore, to develop a work model for supporting social participation in home care and explore that process.Methods: Four studies were included. In the first study, care recipient interviews explored perceptions of social participation. In the second, a total population survey investigated the association between perceived care quality and loneliness. The third study used individual and group interviews with home care providers to explore discourses on loneliness and social support. The fourth applied a participatory action research(PAR) process with care workers to develop strategies to alleviate care recipients’ loneliness.Findings: Enjoying personally relevant occupations, both in solitude and with others, was found to be important for satisfactory social participation. Low perceived quality in home care quality was statistically associated with loneliness. Two discourses, one in which care recipients were described as valued but vulnerable “others”, and another in which they were described as competent peers, were identified. A work model facilitating social participation was created, and the process was applied to a “framework for occupational enablement for change in community practice”.Conclusion: The understanding of loneliness and social participation in the complex home care context has been nuanced, as have discourses that affect home care practice. The work model itself could become a first step towards systematically addressing loneliness and social needs, and the application of an occupational enablement framework onto the PAR process ties the methodologies together and facilitates participatory research for occupational therapy and science.
5.
Bergmark, Magnus, 1975-
(author)
Integrerade psykosociala insatser : Policy, implementering och praktik i ett komplext verksamhetsfält
2017
Doctoral thesis (other academic/artistic) abstract
InledningAlltsedan psykiatrins avinstitutionalisering tog fart under 1980- och 1990-talen har en utveckling av samhällsbaserade psykosociala insatser förespråkats för att erbjuda vård och stöd till personer med psykisk funktionsnedsättning. Insatserna förväntas bidra till att brukarna får tillgång till effektiv vård och stöd, samtidigt som de inkluderas i samhället. Vidare förutsätts insatserna baseras på kunskap och evidens, samt bygga på brukarens delaktighet och stödja dennes återhämtning. En annan målsättning är att vissa insatser ges i form av integrerade modeller, så att personer ur målgruppen får tillgång till sammanhållet stöd från inblandade myndigheter. Även om Sverige räknas som ett resursstarkt land som har kommit långt på området, så förekommer kritik mot utvecklingen. Kritiken har berört både planering och styrning på politisk nivå, men även utförandet av de insatser som erbjuds till brukarna. Kritiken har bland annat handlat om bristande samverkan mellan landsting och kommuner, och om stora lokala variationer i den erbjudna servicens kvalitet. I den här avhandlingen studeras dels utformningen av policy på området, dels implementering av specifika insatser. Syftet med avhandlingen är att undersöka hur svenska policymakare på nationell nivå har hanterat utvecklingen av psykosociala insatser för personer med psykisk funktionsnedsättning, samt att analysera möjligheter och svårigheter för organisationer och personal när det gäller att implementera de insatser som förespråkas av beslutsfattare. De frågeställningar som avhandlingen söker besvara är följande:Hur formuleras policy som syftar till att införa samhällsbaserade psykosociala insatser, och vad kan policyns egenskaper innebära för genomförandet av den?Vilka styrstrategier uttrycks i statliga policydokument?Vad hämmar respektive underlättar implementeringen av föreslagna integrerade psykosociala insatser?Hur kan vi förstå vad som påverkar möjligheten att erbjuda integrerade psykosociala insatser, i termer av lokala förutsättningar och strategier för implementering?MetodPolicy på området studerades genom en studie av tre av de övergripande dokument som beslutats på regeringsnivå de senaste 20 åren. Riktade kvalitativa innehållsanalyser baserade på relevant litteratur genomfördes. Implementering av insatser studerades genom att 15 program följdes under 3 års tid. 14 av dessa arbetade med att implementera arbetsrehabiliteringsprogram utifrån modellen Individual Placement and Support (IPS). Under samma tidsperiod följdes ett team som implementerade den intensiva samordnings-, vård- och stödmodellen Assertive Community Treatment (ACT). För att bedöma verksamheternas följsamhet till modellerna genomfördes programtrohetsskattningar av samtliga program. Data avseende programmens målgrupp samlades också in. Tre IPS-program deltog i en fördjupningsstudie där kvalitativa intervjuer genomfördes med ledare, personal och samverkanspartners. Implementeringen av dessa program analyserades utifrån implementeringsramverket the Consolidated Framework for Implementation Research. Implementeringen av samtliga 14 IPS-program studerades med hjälp av skattningsskalan the Sustainable Implementation Scale (SIS). När det gäller ACT-teamet genomfördes dels kvalitativa innehållsanalyser av djupintervjuer, och dels skattningar av implementeringskomponenter med hjälp av SIS.ResultatPolicy på området har innehållit stora mått av otydlighet och konflikt, både gällande de mål och medel som har formulerats. Regeringen har främst förespråkat så kallade mjuka styrstrategier, vanligen i form av statliga stimulansbidrag. Vissa förtydliganden och konkretioner har skett under tid, vilka ibland går i linje med de internationella rörelserna New Public Management och evidensbaserad praktik. Exempel på försök att strama upp styrningen är målformuleringar som förespråkar riktade och prestationsbaserade stimulansbidrag, samt nationella riktlinjer för att styra utvecklingen mot utvalda specificerade insatser. Trots detta är det fortfarande de berörda myndigheterna som är ansvariga för att välja ut, utforma och implementera psykosociala insatser. På verksamhetsnivå leder detta till att många otydligheter består, vilka ibland är relaterade till svårigheter att avgränsa ansvarsområden och att förändra hindrande regelverk och traditioner. Dessutom förekommer konflikter, exempelvis i form av konkurrerande målsättningar och ojämn resurstilldelning.Studierna av de integrerade modellerna IPS och ACT visar att implementering av dessa är möjlig, även i en sektoriserad välfärdskontext som den svenska. Det finns dock en rad faktorer på såväl organisationsnivå som teamnivå, som försvårar implementeringen. Exempel på dessa är de involverade organisationernas varierande målsättningar och traditioner, regelverkens utformning, samt svårigheter att erhålla långsiktig finansiering. I en del fall beskrivs de arbetssätt som modellerna förespråkar som försvårande, då de upplevs som annorlunda och utmanande för existerande rutiner och uppfattningar om stöd till målgruppen. Ett stort hinder för effektiv implementering är svårigheter att samverka, främst mellan, men även inom inblandade organisationer. De flesta program som lyckades genomföra en hållbar implementering hade personal som var duktiga på att navigera förbi de hinder som orsakades av ogynnsamma regler, och de lyckades även hitta vägar för att etablera samverkan, både horisontellt (med samarbetspartners på samma hierarkiska nivå) och vertikalt (mellan ledning och personal). En verksamhetsledare som har möjlighet att påverka samverkansrelationer i både horisontell och vertikal riktning är gynnande för implementeringen. Andra betydelsefulla komponenter som underlättar implementering är en noggrann planering innan ett program startas, medveten rekrytering av personal, formering av ändamålsenliga styrgrupper, samt att tidigt i processen arbeta strategiskt för att lösa finansieringsfrågan. Även programtrohetsskattningar var betydelsefulla, då de både fungerade som instrument för att identifiera förbättringsområden för programmen, men också hade en legitimerande funktion vid återkoppling till ledningen.SlutsatserDet råder en samstämmighet i övergripande målsättningar som syftar till att utveckla området integrerade psykosociala insatser. På en mer konkret nivå är läget betydligt oklarare, både gällande målsättningar i policy och av vem och hur insatserna ska implementeras. Även om vissa förändringar skett, står regeringen fortsatt för en mjuk styrning vilken lämnar ett stort ansvar till de myndigheter som ska implementera valda insatser. Detta innebär en rad svårigheter för frontlinjepersonalen, vilket leder till att de ofta behöver lägga mycket tid och energi på att hitta vägar för att överkomma dessa svårigheter.I många fall har ledare och personal goda möjligheter att uppnå en hög programtrohet på teamnivå, men för en hållbar implementering krävs det att ett program är väl förankrat både vertikalt och horisontellt. Därför finns ett behov av att forskare och beslutsfattare tar ett tydligare helhetsgrepp, både på området policy och implementering av specifika insatser. Skattningar av programtrohet och implementering kan vara ett stöd i att identifiera vad som fungerar samt vad som behöver förändras i och mellan organisationer. Men för att programmen ska lyckas med en effektiv implementering på organisationsnivå behöver deras legitimitet stärkas vertikalt, och planering för långsiktig lokal finansiering behöver göras i ett tidigt skede.
6.
Emsing, Mikael, 1980-
(author)
Conflict management & mental health among Swedish police officers & recruits
2022
Doctoral thesis (other academic/artistic) abstract
Introduction: An essential part of police work is handling people in distress, often related to some form of conflict that police officers are expected to handle in a professional manner. Thus, interpersonal and conflict management skills are essential for police officers. Further, police work has been hailed as one of the most complex and stressful jobs that one can have. While important progress has been made in relation to how the complex and stressful nature of police work affects the individual officers - less is known about the timing and onset of these effects. Similarly, while there is a growing body of research into police conflict management, more research is needed to deepen our understanding of police conflict management, not least in the Swedish context. The overall aim of the present thesis was to contribute to existing knowledge about police work by investigating conflict management and mental health among Swedish police recruits and officers.Materials and methods: The present thesis used a mixed-methods approach and is built on four sub-studies. Sub-study 1 examined the evidence base for current practices, methods, and training in conflict management by means of a scoping review. Sub-study 2 used semi-structured interviews to examine how police officers perceived conflict and conflict-management and their training within the subject. Results from sub-study 2 where also used increating items for the instrument developed in sub-study 4. Sub-study 3 used a quantitative design to examine the mental health status of Swedish police recruits using the SCL-90 questionnaire. Sub-study 4 documented the initial steps towards developing an instrument to measure conflict behaviors and attitudes to conflict management among police officers and evaluated the psychometric properties of this instrument.Results: A large proportion of the studies included in the scoping review were conducted in the US and manyfocused-on use of force. The results also indicate that a lack of available data, unified definitions and experimental as well as longitudinal research designs makes it difficult to draw causal conclusions regarding the effectiveness of training in conflict management. In the interviews, respondents described conflict largely in terms of interpersonal conflicts, and focused less on intrapersonal conflict. The complexity and importance of the role played by instructors during probationary training was also salient in their descriptions. As for mental health status, recruits overall reported scores that where similar to the general population. A small number of recruits (n = 15) reported scores that where above the patient mean of the Swedish general population in the corresponding age group. The intended factor structure of the instrument developed could not be operationalized in the instruments current form, but the instrument could still provide insights and provides a basis for further development of the instrument.Conclusions: To enhance our understanding on police conflict management, scholars and police departments should work together to agree upon unified definitions on key concepts related to this topic. More research using longitudinal and experimental designs are needed to further develop training interventions related to conflict management. While a small number of recruits reported scores above the Swedish patient mean, extant research has indicated that stigmas surrounding mental health among police could lead to unconstructive coping behaviors. Further research on mental health among not only Swedish police officers but also recruits, could focus on helpseeking-behaviors and stigmas related to mental health to provide valuable insights on the topic. The instrument developed within the present thesis needs further development but nonetheless represents a first step towards examining individual differences in relation to police conflict management behaviors and attitudes towards conflict.
7.
Rostami, Arian, 1973-
(author)
Police officers under pressure : sexual and gender-based harassment, stress, and job satisfaction in Sweden
2024
Doctoral thesis (other academic/artistic) abstract
Police officers encounter challenging and stressful situations at work, which negatively impact their health, job performance, and aspects of their lives. Regarding the gendered structure and competitive work environment of police organizations, women are under extra pressure from the pervasive gendered norms within the police organization. The aim of this dissertation is to study sexual and gender-based harassment and work-related stress as important work environment elements from a gender perspective, and to explore if and how these elements can affect police officers’ job satisfaction in the context of Swedish police work.This thesis is based on three studies: a scoping review, a quantitative study, and a qualitative study, resulting in four articles. In the scoping review study on sexual and gender-based harassment in police work in the European context 16 articles on sexual and gender-based harassment against police employees were studied. Thematic analysis was applied to obtain the main patterns across and within the included studies. In the qualitative study, data collection included one group interview and 12 individual interviews with male and female police officers. Thematic and content analysis were conducted to analyze the interviews. During the quantitative study, data were collected from 152 male and female police officers applying a set of questionnaires including sociodemographic questions, the Police Stress Identification Questionnaire (PSIQ), Sexual and gender-based harassment questions, and Job Descriptive Index (JDI). The scoping review showed that most of the European studies were focused on sexual harassment, while gender-based harassment was often overlooked or mixed with other types of harassment and discrimination. Six main themes were found in the studies; the existence of sexual and gender-based harassment, perpetrators, associated factors, consequences, individual response, and impact of organizational policies. In the mixed methods article, results from the quantitative and qualitative studies on sexual and gender-based harassment indicated that female police officers experienced a statistically significant higher percentage of gender-based harassment compared to male officers. However, there was not any significant gender difference in sexual harassment. “Sexual comments and jokes” and “mocking or telling jokes about the #MeToo campaign” by colleagues were reported as the most frequent sexual harassment and gender-based harassment items. Additionally, police officers identified the presence of toxic jargon and a culture of silence, along with ineffective or negative management styles, as organizational factors that can contribute to the perpetuation of such harassment. Also, the quantitative results on police work stress showed that police officers rated higher on the “impact on significant others” stress and “operational stress” subscales. In addition, female officers reported higher stress in these subscales compared to their male counterparts. The police officers who had experienced sexual harassment reported higher “self-image stress” and “operational stress”. Moreover, in studying job satisfaction among Swedish police officers, both male and female officers reported the highest satisfaction with “people on present job” and the lowest satisfaction with “opportunity for promotion” and then “pay”. No significant gender gap was found in job satisfaction subscales, nor was there a significant association between these subscales and experiences of harassment. However, organizational stress was negatively related to three domains of job satisfaction; “job in general”, “pay” and “supervision”. The research findings revealed that despite substantial changes in the Swedish police organization and work culture during recent decades, the issue of sexual and gender-based harassment remains persistent. This finding highlights the need for more attention to organizational factors (cultural and managerial issues) enabling sexual and gender-based harassment. The findings also underscore the higher levels of work pressure and challenges faced by female officers and the importance of challenging prevailing gender norms affecting both female and male police officers. Moreover, addressing organizational sources of stress can improve the working conditions and job satisfaction of police officers. Finally, the thesis highlights the importance of considering sexual and gender-based harassment along with work stress to create a safer and more productive police work environment.
