1.
Pasquini, Mirko, 1991
(författare)
The Negotiation of Urgency: Economies of Attention in an Italian Emergency Room
2021
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Urgency in a hospital Emergency Room (ER) is not a self-evident state. Urgency is made, by establishing priorities, distributing attention and material resources, and deciding who and what needs to be attended to first – and, simultaneously, who and what has to wait. The process of determining urgency is known as “triage” (from the French verb, trier, “to choose”). This thesis is about the vicissitudes of triage in an Italian ER. Based on one year of ethnographic fieldwork, the thesis explores what happens when urgency is at stake; when it is contested and caught up between different, and frequently conflicting, perspectives. It explores how urgency is determined in practice, and shows how triage always is a vulnerable process of negotiation guided by economies of attention. How is urgency actually shaped in interactions between patients, their families and friends, and the ER staff? The different chapters explore how time in the ER is created through shifting registers of attention, and how attention in the ER is affected by widespread economic and social precarity, and neoliberal national policies of governance. It discusses how triage increasingly is structured by attitudes of mistrust; and also by potential or real outbreaks of violence. Addressing the particular positioning of the ER as a thick space of conjunction between neoliberal state politics and people's increasing need for care and recognition, the thesis aims to contribute to medical anthropology literature by analyzing triage not as a neutral medical way of sorting, but as a practice that actively creates difference. It explores both the limits of triage, and how those limits can spark improvisation and creative reinvention.
2.
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.
3.
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.
4.
Nordenmark, Mikael
(författare)
Unemployment, Employment Commitment and Well-being : The Psychosocial Meaning of (Un)employment among Women and Men
1999
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) 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.
5.
Hasselgren, Caroline, 1987
(författare)
Inequity in mind. On the Social and Genetic Risk Factors of Dementia and Their Interactions
2019
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The present thesis seeks to further explain the occurrence of Alzheimer’s disease and other dementias by studying the long-term impact of class- and gender-based inequities as well as the extent to which they potentially moderate genetic risk. Central to this endeavour is the recognition of social inequity as multifaceted, and of potential intersections between different drivers of structural (dis)advantage in relation to individual health prospects. The main point of departure is that even though the causes of dementia are heterogeneous and cannot be reduced to either genetic or environmental factors, dementia is, just like many of its potential risk/protective factors, unevenly distributed in the population. Nevertheless, our knowledge of whether and how systems of structural inequity intersect and interact with individual genetic endowments in the development of disease is still scarce. The thesis encompasses four empirical studies, all of which should be considered examples of interdisciplinary efforts to incorporate theory and expertise from different fields in order to create a more holistic understanding of dementia aetiology. The analyses are based on data derived from the longitudinal Gothenburg H70 Birth Cohort Study (H70) and the Prospective Populations Study on Women (PPSW) from Gothenburg, Sweden. The baseline sample (N =1019) was first examined in 2000 and followed up in 2005 and 2009. Study I lays the foundation upon which the other studies rest. It does so by asking whether socio- economic status (SES) could in fact moderate the increased risk of dementia that carrying one or more copies of the APOE (apolipoprotein E) ε4 allele implies. Having identified that high SES seems to buffer the effect of APOE ε4 among men but not among women, Study II and III set out to explore two mechanisms that could possibly shed further light on the link between socio-economic (dis)advantage and dementia risk as well as on the previously identified sex difference: work environment exposures and access to social networks. The findings of Study II suggest that work control is the most influential aspect of the work environment, with respect to moderation of genetic endowments, but that it is only protective among men. While no significant gene-social network interactions were revealed in Study III, the results indicate that there might be important differences between men and women in the impact of social networks on dementia risk. Finally, Study IV tests the assumption that the higher lifetime risk of dementia among women could, at least in part, be the result of differences in educational attainment and/or in experiences of general psychological distress. The results confirm that education ought to be considered a ‘gendered’ dementia risk factor and propose that psychological distress constitutes a potential, and hitherto rarely acknowledged, pathway between dementia and female sex, on the one hand, and dementia and low educational attainment, on the other. In light of the findings presented in this thesis, it is evident that dementia is an emergent phenomenon that must not be reduced to the sum of its parts, especially considering the results suggesting that genetic endowments can actually be moderated by externally imposed factors. Additionally, all four studies underline that the risk/protective factors that are more proximate to the individual, such as work environment exposures, social networks or distress, must not be studied as if they were distinct from the social structures that ‘put people at risk of risks’. Consequently, I argue, class and sex/gender must be attended to as fundamental, and intersecting, causes of dementia if we are to better understand why some individuals develop the disease, while others do not.
6.
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.
7.
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.
8.
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.
9.
Andréasson, Frida
(författare)
Doing informal care : Identity, couplehood, social health and information and communication technologies in older people’s everyday lives
2021
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of the thesis has been a) to analyse how informal care influences the identity of carers and care recipients, their sense of couplehood and social health, and b) to explore the use of Information and Communication Technology (ICT) in the context of informal care and the everyday lives of older people. Study I focused on how older carers conceptualised their identity as carers on a Swedish online social forum, using a netnographic methodology. The findings indicated a change in self-perception as the carer role was acquired. Carers’ capacities were filtered through the needs of the care recipient, making their carer identities into invisible selves. The findings revealed that online communication had the potential to create a virtual space of social recognition. Study II aimed to reflect on carers’ experiences of participation in a co-design process consisting of user group sessions with carers and researchers. The goal was to develop a web-based support programme for carers. The findings emphasised a need to consider carers’ lifeworlds and to develop flexible human-centred design methodologies, that are able to balance carers’ needs and ideas with proposed research outcomes. Studies III and IV utilised an ethnographic methodology. In study III, the notion of couplehood in informal care was analysed. The findings showed that in the process of becoming a carer and a care recipient previous (often gendered) responsibilities were re- negotiated and new practicalities emerged. Although these changes were understood as a natural part of family life, they nevertheless led to changes in the (power) balance between spouses, expressed in terms of a professionalised relationship and a sense of social isolation. ICT was used as a means to get a respite from caring and uphold a social connection with others. In study IV, the social implications and consequences of spousal informal care and carers and care recipients’ experiences of illness and the ill body was explored. The findings showed that the participants experienced barriers to living life as before. Thoughts about or the presence of ill and “leaking” bodies thus lead to “self-chosen” social isolation or social distancing by others. The thesis highlights that informal care needs to be understood as an identity forming practice, having a significant impact on involved parties’ sense of couplehood, their social health and that ICT can contribute to ease carers’ and care recipients’ daily life.
10.
Hovhannisyan, Karen
(författare)
Very Integrated Program (VIP): health promotion for patients with alcohol and drug use disorders
2019
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Treatment of patients with alcohol or drug use disorders is a complex multistage process addressing the substance addiction and co-morbidities. The risky lifestyles, including tobacco smoking, insufficient physical activity and unhealthy diet, which can aggravate health condition as well as addiction treatment itself, are very common among these patients. The complex health promotion (Very Integrated Program, VIP), addressing both the risky lifestyle and educating about the chronic diseases, can be promising for achieving better outcomes foraddiction treatment.This thesis aims to explore the health status and lifestyle risk factors in patients with alcohol or drug use disorders in Sweden (study 1), to investigate the effect of the VIP in patients with alcohol or drug use disorders (study 2). In addition, the thesis aims to explore the factors of interest associated with this intervention, such as the compliance of these patients to the VIP (study 3) and the characteristics of the patients that were successful in changing their lifestyle (study 4). The thesis consists of a comprehensive survey (study 1), two quantitative studies (studies 2 and 4), and a mix methods study (study 3).The screening of the patients with alcohol or drug use disorders revealed that most of them had at least one lifestyle risk factor (93%) and suffer from at least one chronic disease (70%). The VIP intervention garnered no significant effect on harm reduction among these patients, their health status or quality of life (QoL), as well as on the addiction treatment outcomes, such as days in treatment or time to relapse. Surprisingly, the patients that did not receive the program had significantly more substance-free days after 12 months. The patients with highereducation, better QoL, and several lifestyle risk factors had higher chances of changing their lifestyle. The patients’ higher self-efficacy was positively associated with their compliance with the health promotion program. The patients displayed willingness for a change but also showed strong emotions associated with the process of change.
