1.
Wickford, Jenny, 1979
(författare)
Physiotherapists in Afghanistan. Exploring, encouraging and experiencing professional development in the Afghan development context
2010
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Aim: The aim of the thesis is to analyze the matter of supporting professional development of physiotherapists in Afghanistan, and the issues involved in expatriate physiotherapists working with professional development cross-culturally and in development contexts. The thesis is based on two field studies, aspects of which are reported on in four papers. The first field study aimed at analyzing and describing the physiotherapy component of a disability programme. The aim of the second field study was to explore the process of a development project, in order to gain understanding of how such work can be done in a better way. Participant observation was used for the data production of both studies. The adult learning theories of transformative learning and situated learning were used as a theoretical framework in the thesis. Paper I describes the situation, needs and challenges for developing physiotherapy in Afghanistan. The therapists worked in isolation with little opportunity for further education or professional development. Their approach was mainly medical, where the work was dictated by the patients’ expectations and doctors’ recommendations. They used primarily passive methods of treatment, and their work was affected by cultural, religious and situational factors and they demonstrated a basic capacity of clinical reasoning. Paper II explores factors that impacted learning and professional development of the Afghan physiotherapists in the development project. Examples of these factors were: a pattern approach to treatment, linear thinking, and socially oriented decision-making that affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterized learning approaches; language barriers, different interpretations of meaning and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Paper III explores professional ethics for Afghan physiotherapists and identifies two ethical tensions for the professional practice of Afghan physiotherapists: between individualistic and communitarian ethical perspectives, and between normative ethics and local morals. Paper IV is a critical reflection over the expatriate development worker’s development process through, and impact on, the development project. The perspective of the development worker is transformed from an idealistic helper to an enterprising learner as a consequence of active participation in and a self-critical reflection of the process. Conclusion: Working with and researching professional development cross-culturally and in development contexts is complex and requires consideration of many different factors. Cultural competency is essential, where to understand others one needs to first understand oneself, and oneself in relation to others. This requires support when in the field. Physiotherapy theory and practice must be adapted to the local context. Actions taken towards promoting learning and professional development must be firmly rooted in the Afghan context, and investigated, planned and implemented together with Afghan physiotherapists. The professional development of Afghan supervisors and teachers should be a priority. To encourage reflection of both Afghan and expatriate physiotherapists a communicative learning approach could be taken, where ethical challenges and disorienting dilemmas can form the basis of a reflective discourse and lead to increased understanding.
2.
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.
3.
Nilsson, Kerstin
(författare)
To work or not to work in an extended working life? Factors in working and retirement decisions
2013
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
In most of the industrialised world, the proportion of older and retired people in the population is continuously increasing. This will have budgetary implications for maintaining the welfare state, because the active working section of the population must fund the non-active and old population. Aim: The overall aim of this thesis was to obtain knowledge about older workers’ work and life situation in association with their planning and decision to retire from working life. Method: The thesis includes one qualitative and three quantitative studies conducted in Sweden. Result: Self-rated health was found to be a better measure than diagnosed disease of whether older workers believed they could work until 65 years or beyond. Health seems not to be a general impediment to working in old age if older workers are satisfied with their work situation and have enough time and opportunities to recover from fatigue. In one of Sweden’s most hazardous work environments, older workers were not injured significantly more often than younger workers. Good mental and physical work environment, moderate working pace and working time, and the right competence and possibility for skills development were factors determining whether older workers believed they can extend their working life. Attitude to older workers in the organisation, motivation and work satisfaction were factors determining whether older workers want to extend working life. Health, personal economic incentives, family/leisure pursuits and attitude to pension in society affected both whether people believed they can and wanted to extend their working life. In their final retirement decision, older workers considered: i) their possibility to balance and adapt functional ageing and health to a sustainable work situation; ii) their economic situation; iii) possibilities for social inclusion and coherence; and iv) possibilities for meaningful activities. Whether these requirements were best fulfilled in or outside working life determined the decision to continue working or to retire. Conclusion: If it is desirable for society that people will to extend their working life, both the “can work” and the “want to work” factors need to be met. It is important to provide a good fit inside working life. This requires a focus not only on older workers, but also on organisations and managers in order to provide incentives that keep older workers in the work force.
4.
Petersson, Jesper, 1974
(författare)
Geographies of eHealth: Studies of Healthcare at a Distance
2014
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
This thesis examines the proliferation of healthcare services using information and communication technology to overcome spatial and temporal obstacles. These services are given such names as telemedicine and telecare, which are sometimes grouped together as telehealthcare under the umbrella term eHealth. My main argument is that a prevalent and overoptimistic rhetoric of how the possibilities of digitalization are expected to produce a homogenous and ubiquitous healthcare space conceals many of the spatiotemporal complexities involved in introducing telehealthcare and in the overall organizing of healthcare. To counteract such simplifications, I contend that we need a relational understanding of the technical and the geographical as always nested in the social and vice versa. With such an approach, it is arguably possible to begin to tease apart the many spatiotemporal entanglements of these innovations and to trace their political ramifications. This position is developed by integrating perspectives from science and technology studies with insights from human geography. The four constituent papers of this thesis pursue this argument in qualitatively grounded case studies of telehealthcare and its geographies. Paper I looks at various initiatives for fetal tele-ultrasonography, demonstrating that this practice cannot be reduced to a mere transparent relay for the speedy transmission of digital information across space and time. The paper investigates how its introduction could affect medical knowledge production, power hierarchies, and subject positions, for example, the status attributed to the fetal figure. Paper II traces Swedish transformations of telehealthcare. The use of telemedicine to reach those outside medicine’s range has arguably been accompanied by efforts to achieve intra-organizational streamlining via telemedicine. This process has continued with the emergence of telecare for personal use directed toward the overlapping groups of the elderly people and patients with chronic conditions. I contend that this shift can be understood through a geographical lens as attempts to save space and time by keeping as many patients as possible out of costly hospitalization and preventing them from engaging scarce specialist resources. Paper III compares four telemedicine projects in Sweden. In detailing how the purpose of practicing telemedicine differed between these projects in relation to, for example, the specifics of distance, care availability, and treated medical conditions, the paper demonstrates the existence of many versions of telemedicine. Whereas this fluidity could further the spread of telemedicine, it could also cause problems. To various actors wanting to use telemedicine in a homogenous and fixed way for national streamlining purposes, this diversity has generated confusion when they wished to align telemedicine in a preferred direction. The paper concludes that technology travels best when it can contain both fluid and fixed relationships. Paper IV argues that, whatever is claimed about creating a space- and time-independent healthcare by means of telehealthcare, the use of telecare to connect the standardized spaces of healthcare with the fluid everyday lives of elderly people and patients with chronic conditions actually works by unfolding new spaces of visibilities and establishing new temporalities as well. By investigating these spatiotemporalities, I demonstrate how these applications draw together discourses on individual freedom with medically derived algorithms and concerns about how to make best use of scarce healthcare resources.
5.
Vilhelmsson, Andreas
(författare)
A Pill for the Ill? : Depression, Medicalization and Public Health
2014
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. Critics argue, however, that the use of mental health surveys, underlying these descriptions, tends to overestimate the prevalence of mental disorders by not distinguishing everyday experiences of distress from pathological conditions. This medicalization of public health is believed to narrow the focus of public health practices. The aim of this thesis is twofold. The first objective is to describe and analyze experiences with antidepressant treatment for depression as expressed in adverse drug reaction (ADR) reports from patients, i.e. “consumers reports.” A second goal is to conduct a theoretical discussion, by looking at broad societal changes, and analyzing the consequences of mental ill health as a significant public health problem. Special attention will be given to medicalization. Reports of suspected adverse reactions regarding antidepressant mediations were submitted from 2002 to 2009 to an open Internet-based reporting system in Sweden. These were analyzed according to common psychiatric reactions and narrative experiences. Furthermore, a literature overview in a broad and general sense was performed to underpin a theoretical discussion on health, public health, mental ill health and medicalization. The main findings of this thesis were that patients reporting to an open Internet-based system in Sweden seemed, to a large extent, to experience psychiatric ADR symptoms of mental disturbances (sometimes severe), which affected them in many different ways, especially during discontinuation. These reports also suggested a negative doctor-patient interaction from the patient’s perspective. Risks leading to increased medicalization as a result of overdiagnoses of depression were found. Pharmaceuticalization resulting from overprescribed antidepressants was also deemed problematic. According to a theoretical discussion on public health and medicalization, increased medicalization as a result of excessive diagnosing risks individualizing mental problems and may divert the focus from the social and political context of public health. According to patient reports, there seems to be a potential problem as to how patients are diagnosed with depression and prescribed antidepressant medication in the medical encounter. Increased drug treatment risks lead to increased health care costs and potential harm from adverse drug reactions. Overdiagnosis and overtreatment may in turn lead to diminished trust in the health system. If depression is going to be viewed as a growing public health problem, it, therefore, calls for a distinction between ill health problems that are medical and those that are not. Arguments for increased medication must be related to a possible danger of medicalizing social problems and life crises.
6.
Grönberg Eskel, Marit, 1971-
(författare)
Från slutna institutioner till institutionaliserat omhändertagande
2012
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
In recent years, a number of reforms have been made regarding the provision of care to people experiencing psychiatric disabilities. The aim of these reforms was to enable these people to participate in society and to ”live as others”. This political ambition, as well as research on recovery, stands to a certain extent in contrast to the message conveyed in the media, where the mentally ill/disabled to a great extent are represented as dangerous and incurable. The aim of the thesis is to analyse if, and how a group of people experiencing psychiatric disabilities create a sense of being like others, and to relate the analysis to the historical emergence of the contemporary conception of mental illness/psychiatric disability. This thesis employs the method of interviews.I highlight the informants encounter with the historically based stereotype that defines the persons as unreasonable, irrational and incapable of taking care of themselves. When the informants face the stereotype, they act to reduce the negative consequences. The informants’ actions can be interpreted in terms of approaches and in this perspective the informants appear as strong actors, who, contrary to the stereotype, are capable of take care of themselves. Three approaches are described: expertise, adaptation, and distancing. In situations where the stereotype is not present, the informants can create a feeling of being like anyone else. Their stories show that the feeling of being like others is individual. The development taking place in the field is “path-dependent”, meaning that the initial activity, the differentiation of persons with mental illness and the subsequent events is a development following a pattern which could explain the failure of the good political intentions. It has progressed from closed institutions to an institutionalized care service.
7.
Jerlinder, Kajsa, 1976-
(författare)
Social rättvisa i inkluderande idrottsundervisning för elever med rörelsehinder : en utopi?
2010
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of this thesis is to contribute to the knowledgebase of inclusion and inclusive education and to outline possible consequences that may arise from an educational ideology of inclusion. The thesis describes a potential dilemma that is both theoretical and practical. The dilemma consists of, on the one hand, a need of identification and categorisation of specific groups in society in order to allocate and redistribute available resources, while, on the other hand, there is a need of social recognition of diversity in educational settings in order to achieve social justice and parity of participation. The inclusion of pupils with physical disabilities in the school subject of physical education (PE) is used as a particular example to illustrate a general dilemma. The specific aims were: i) to describe and apply a theoretical framework of ‘social status’ as a possible means of resolving the dilemma (study I); ii) to study PE teachers’ attitudes toward inclusive physical education (studies II and III); and iii) using a case study, to explore the experience of physical education through the eyes of a pupil with a physical impairment and his parents, classmates, PE teachers and personal assistant (study IV). Results show that Swedish PE teachers at primary school level are positive to inclusive PE for pupils with physical disabilities. Factors found to contribute to these positive attitudes were adequate training in inclusive education strategies, supportive school environments and personal resources. In a systematic review of international research PE teachers, in general, were found to have ambivalent attitudes to inclusive PE. This ambivalence was found over cultural borders among the 1200 respondents covered in the 15 articles reviewed and may indicate a latent awareness of the dilemma. Previous experience of having taught PE to pupils with physical disabilities, together with proper education in inclusion, mediated a more positive attitude. The case study of a 10-year-old boy with physical disabilities and significant others in his educational life proved to be a signal example of successful inclusion. Honneth’s three levels of social recognition were used in the analysis. Social recognition at individual, legal and value dimensions is a prerequisite for achieving social justice in inclusive PE settings. Finally, these findings, taken together, indicate a need to address social recognition and redistribution demands simultaneously in order to meet goals of equitable education for pupils with physical disabilities in inclusive PE teaching. Societal (external) and individual factors need to be combined when addressing the issue of social justice in inclusive education. A model of social status, developed by Fraser (2001; 2003), used in conjunction with the notion of plural identities is suggested as a possible resolution to the dilemma described in the thesis.
8.
Pietilä, Sirpa
(författare)
Tvillingskap genom livet : individualitet och relation i äldre tvillingars livsberättelser
2012
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Det övergripande syftet med avhandlingen var att utforska, beskriva och förstå upplevelser av tvillingskap utifrån äldre tvillingars livsberättelser. De 35 tvillingarna som ingår i denna avhandling var ett urval av deltagarna i två longitudinella studier av äldre tvillingar, SATSA (Swedish Adoption Twin Study of Aging) och Gender. Studiedesignen är kvalitativ och vid intervjuerna användes narrativ metod och berättelsematerialet analyserades med narrativ analys (studie I och II) och med kvalitativ, latent innehållsanalys (studie III och IV). Enligt tvillingarna i denna avhandling beskrevs tvillingskapet utifrån relationen med tvillingpartnern (I, III, IV) och ur ett identitetsperspektiv (II). Tvillingrelationer är unika men representerar också variationer. Tre slags relationsmönster identifierades, benämnda den närande, tärande och den ytliga relationen som baseras på kvalitativa aspekter (I). De olika typerna av relationer blev särskilt tydliga under viktiga skeden i livet, såsom vid ingående av äktenskap (III) och vid förlusten av tvillingpartnern (IV), vilket innebar att tvillingarna fick anpassa sig till ett mer individualiserat liv. I den närande och den ytliga tvillingrelationen upplevdes inte dessa livsförändringar som särskilt dramatiska, medan de för tvillingarna i den tärande relationen upplevdes som mer dramatiska. Från ett anknytningsteoriskt perspektiv förblev de äldre tvillingarna ankytningspersoner med oförändrade anknytningsmönster genom livet (I). Sammanbundet med den nära tvillingrelationen är hur tvillingar definerar sig själva, då tvillingskapet innebär att hantera både sin individuella identitet och tvillingidentiteten. Självbeskrivningarna med betoning av olikheter, ses mot bakgrund av hur tvillingarna upplevde att omgivningen uppfattade dem som en social enhet och tolkades som en vilja att betona sin individualitet i förhållande till tvillingpartnern och som ett budskap till omgivningen att vilja bli sedd som en egen individ (II). Sammanfattningsvis beskrevs tvillingskap av de flesta som en nära, berikande relation genom livet och för vissa mindre berikande beroende på vilken slags relation de hade till sin tvillingpartner. Parallellt pågick ett identitetsarbete att ta plats som en egen individ i tvillingrelationen och att hävda sin individualitet gentemot den övriga omgivningen i budskapet: ”Vi är inte så lika som ni tror”!
9.
Premberg, Åsa, 1955
(författare)
Förstagångsfäders upplevelser av föräldrautbildning, förlossning och första året som far
2011
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
In many western societies, fathers have traditionally assumed the role of breadwinner in the family, leaving responsibilities for parenting to the mother. It was not until the late 20th century that their role as participating and caring fathers evolved, and fathers began to be involved in childbirth and childbirth education. Childbirth education had previously been designed only for the mothers-to-be and was adapted to incorporate the needs of the fathers. The benefit of fathers in the delivery room is important; their participation enhances the future mothers’ well-being and the fathers’ attachment to the child. Recent studies have revealed that fathers experience their participation as positive and exciting, but demanding and requiring support. Since first-time fathers are known to be especially vulnerable, more research focusing on first-time fathers is needed to further investigate their experiences during childbirth education, labour and delivery, and during their first year as fathers, both to identify the fathers’ own needs of support as well as to identify fathers whose needs of support have not been met. The aim of the thesis was to explore first-time fathers’ experiences of childbirth education, childbirth and the first year as father. Studies I –III describe fathers’ experiences of childbirth education (I), childbirth (II) and the first year as a father (III). Study IV reports on the development and validation of an instrument for assessing fathers’ experiences and needs during labour and birth. Method: In studies I -III descriptive phenomenological interview studies with first-time fathers were carried out. In study IV a questionnaire was developed and validated with exploratory factor analysis, multitrait scaling analysis and known group’s analysis. Findings: Study I: The fathers’ experiences’ of childbirth education can be described as ‘childbirth education takes a secondary role while simultaneously creating preparedness for birth and fatherhood’. Study II: The first-time fathers’ experiences’ of childbirth was that it is an interwoven process pendulating between euphoria and agony. Study III: The fathers’ experiences of the first year as father is to place the baby in the centre without giving up one’s self. Study IV: Factor analysis yielded four factors comprising 22 items accounting 48.6% of the variance. The domains found were Worry, Information, Emotional support and Acceptance. Conclusion and implications: In order to provide support it is necessary to develop childbirth education so it better suits both parents. Designing groups for prospective fathers to strengthen their role in the transition to parenthood could be important. First-time fathers’ experience of the woman’s pain, fear of the unknown and the gendered preconceptions of masculine hegemony can be difficult to bear for the father-to-be. To maintain and strengthen childbirth as a mutually shared experience for the couple, the father needs to be recognised and supported both as supporter and as parent-to-be. Midwives and other caregivers have to acknowledge the father as a valued participant with exclusive knowledge of the woman’s needs, but also to be aware of fathers’ needs and the impact of gender aspects. Critical during the first year of fatherhood is that the fathers maintain his own integrity and develop an independent relationship with the child. The assessment instrument adequately taps important aspects of first-time fathers’ experiences of childbirth and may be a useful and sensitive tool for assessing their experiences and needs at labour wards and may be used to help identify fathers in need of extra support and counselling following negative birth experiences
