| 1. |
- Högberg, Karin
(författare)
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Web-based counselling to patients with haematological diseases
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with haematological diseases are entitled to supportive care. Considering organisational and technological development, support in the form of caring communication provided through the web is today a possible alternative. The aim of this thesis was to examine the usefulness and importance of a web-based counselling service to patients with haematological diseases. The basis for the thesis was a development project funded by the Swedish Cancer Society, which provided an opportunity to offer patients communication with a nurse through a web-based counselling service.Four studies were performed from a patient perspective. Study I had a cross-sectional design, measuring occurrence of anxiety and depression, and these variables’ associations to mastery, social support, and insomnia among patients with haematological diseases. Study II was a qualitative content analysis focusing on conditions for provision and use of the web-based counselling service. Study III used a qualitative hermeneutical approach to focus on patients’ experiences of using the counselling service. Study IV was a qualitative deductive analysis examining how communication within the web-based counselling service can be caring in accordance to caring theory.The results revealed that females of 30-49 years of age are vulnerable to experiencing anxiety. Low sense of mastery and support are associated with anxiety and/or depression. Being able to self-identify the need for support as well as appreciate the written medium are necessary conditions for the web-based counselling service to be used. The counselling service must also be part of a comprehensive range of supportive activities and web-based services to be useful. The main importance of the communication is that the patient’s influence on the communication is strengthened, and that the constant access to individual medical and caring assessment can imply a sense of safety. When patients share their innermost concerns and search for support, nursing compassion and competence can substantiate in explicit written responses.A conclusion is that there is a caring potential in communication within a web-based counselling service. To make this form of communication possible, nurses should take possession of and ensure that this medium for communication is offered to patients. Nurses should also increase their knowledge of caring communication in writing and how this possibly can impact patients.
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| 2. |
- Ahonen, Hanna
(författare)
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The multifaceted concept of oral health : Studies on a Swedish general population and perspectives of persons with experience of long-term CPAP-treated obstructive sleep apnea
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health.The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health.The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews.The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s component the core elements of oral health. In paper II, driving determinants and moderating factors were found to have direct effects on all core elements of oral health except aesthetic satisfaction. Three of the core elements of oral health (oral health-related quality of life, aesthetic satisfaction, and xerostomia) had direct effects on the latent variable overall health and well-being. Driving determinants and moderating factors had no direct effect on overall health and well-being, and no indirect effects were found. In paper III, the study participants’ views on oral health determinants were described and could be categorized into all the FDI framework dimensions. The component driving determinants could include a range of determinants affecting a person’s oral health such as CPAP treatment, age, the influence of family and social surroundings, interdental cleaning, willingness to change when needed, and relationship with oral healthcare professionals. In paper IV, the study participants described both negative and positive experiences occurring with or without their CPAP. The negative experiences included increased xerostomia, pain or discomfort, tooth wear, and negative feelings. The positive experiences included decreased xerostomia and improved oral health habits due to improved sleep. Many of the difficulties could be managed by easily accessible facilitators. The experiences the study participants described could be included in all the FDI framework components.In conclusion, the FDI’s framework can be applied in a general population to describe different components of oral health, and is also useful to describe a person’s views and experiences of oral health in a specific population. CPAP treatment could be considered an oral health determinant as it can affect a person’s oral health. Both positive and negative experiences can contribute to CPAP adherence as negative experiences often can be successfully managed.
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| 3. |
- Broström, Anders, 1978-
(författare)
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Strategists and Academics :
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis consists of five self-contained essays on interaction in R&D between university researchers and private firms. Together, these essays explore the conditions under which private firms benefit from spillovers from publicly funded and organised research. From the first essay, which sets out to empirically validate the theoretical arguments about the benefits of university-industry interaction for private firms, the thesis follows a line of pursuit that goes back and forth between exploration of the different benefits that firms enjoy from university interaction and the relationships between these benefits and the conditions of interaction. In essay II, a typology of rationales for establishing cooperative relations is presented. A considerable breadth of interaction rationales is documented, but on closer examination, a “core” set of rationales related to innovation in terms of invented or improved products or processes are found to be the main drivers of interaction. Developing this view, three critical issues previously studied within innovation economics are re-considered from the point of view of firm rationales for interaction; public co-funding of university-firm interaction (essay II), the role of geographic proximity for interaction on R&D (essay III) and the organisation of public sector research (public research institutes and universities) in relation to firm level competences (essay IV). In a fifth essay, four ideal types of strategy for localised interaction between R&D subsidiaries and universities are proposed. Through the framework developed in this essay, the rationales for interaction are related to the overall R&D strategy of multinational firms. Concluding the thesis, it is discussed how the research presented herein opens up for improved theorizing around the roles of academic research for industrial innovation.
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| 4. |
- Eriksson, Kerstin
(författare)
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Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.
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| 5. |
- Hjelm, Carina, 1964-
(författare)
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Cognitive function in elderly patients with chronic heart failure
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionApproximately 1-2% of the adult population in developed countries suffer from heart failure (HF), with the prevalence rising to more than 10% among patients 80 years of age or older. The HF syndrome is associated with elevated mortality and morbidity, and decreased quality of life. Cognitive dysfunction has been reported in patients suffering from a variety of cardiovascular disorders. However, few studies have systematically assessed cognitive performance in HF patients, its prevalence and other factors influencing cognition in HF patients. Further, it is of great interest to understand the relationship between self-care in HF and cognition. It may be important to screen for cognitive dysfunction as it may influence HF patients’ ability to perform self-care, e.g. make lifestyle changes, adhere to medical treatment and monitor, evaluate and treat symptoms of deterioration.AimThe overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care.Design and methodThis thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included.Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients.ResultsStudy I found that octogenarians with HF had significantly poorer spatial performance and episodic memory, and that the episodic memory declined more over time compared to a non-HF population of the same ages.Study II showed that octogenarians with HF had a significantly higher prevalence of vascular dementia, 16% vs. 6%, and all types of dementia, 40% vs. 30%, than those not diagnosed with HF. Factors related to dementia in individuals with HF were depression, hypertension and increased levels of homocysteine. Diabetes was associated with an increased risk for vascular dementia.In study III we found that HF patients with sleep disordered breathing (SDB) (apnoea-hypopnoea index >15) had significantly higher saturation time < 90%, more difficulties maintaining sleep and lower levels of daytime sleepiness compared to those in the non-SDB group. Cognitive function did not differ between the SDB and the non-SDB-group. Only insomnia was associated with a decreased global cognititive function measured with the Mini Mental State Examination instrument.Finally, in study IV, the relationship between self-care and different dimensions of cognitive function was explored. Psycho- and visuomotor function (speed and attention) was the only dimension of cognitive function associated with self-care.ConclusionOctogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems. Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care.
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| 6. |
- Saiedi, Ed, 1987-
(författare)
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Essays on Financial Technology and SME Finance : A Tale of Two Effects of the Global Financial Crisis: Financing SMEs and Innovative Financing
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The financial crisis of 2008-2009 took place exactly half a century after the publication of the seminal Modigliani and Miller (M&M) theorem, often called the capital structure irrelevance principle. This timing is curious since the crisis has highlighted the significance of deviations from assumptions of this theorem, i.e. the importance of corporate finance. A decade on, this thesis explores consequences of this unprecedented event by examining the determinants and effects of financiers’ and firms’ financing decisions, whose irrelevance is implied by the capital structure irrelevance principle.The financial crisis has not only expanded our knowledge frontier on corporate financing, it has altered financing itself. A host of financial innovations have arisen in its wake, enabled by digital technologies, which reshape or remove the role of traditional intermediaries. By tracing the adoption of these technologies to the crisis, this thesis frames the crisis not merely as a source of value destruction, but also as a source of creative destruction. Specifically, this thesis aims to empirically investigate two overarching research questions:(1) What are the determinants and real effects of financing decisions and outcomes for Small and Medium Enterprises (SMEs), in the face of crisis-era contractions in bank lending? (Papers IV and III)(2) What are the main drivers of the adoption of new financial technologies? (Papers I and II)Paper I empirically examines whether distrust in financial institutions, exacerbated by the financial crisis, has been a factor in the growth of peer-to-peer lending. The study argues that distrust in the intermediary (i.e. banks) will shift an individual’s asset allocation towards alternative assets (e.g. crowdfunding). By exploiting geographical variation in such distrust on lending on one of the largest P2P lending markets, Prospser.com, this research finds that higher distrust in banks is positively associated with the likelihood and level of participation in loans, and is negatively correlated with volumes of commercial banks’ deposits and reliance on deposit financing.Paper II empirically investigates drivers of the spread of infrastructure necessary to maintain and grow Bitcoin as a system (Bitcoin nodes) and infrastructure enabling the use of bitcoins for everyday economic transactions (Bitcoin merchants). Specifically, it investigates the role of legal, criminal, financial and social determinants. Findings offer some support for the view that the adoption of cryptocurrency infrastructure is driven by perceived failings of traditional financial systems, in that the spread of Bitcoin infrastructure is associated with low trust in banks and the financial system among inhabitants of a region, and with the occurrence of inflation crises. Active support for Bitcoins is higher in locations with well-developed banking services. Finally, it lends support to the view that bitcoin adoption is partly driven by cryptocurrencies’ usefulness in engaging in illicit trade.Paper III investigates effects of funding rejections on firm investments and performance, through matching successful and observably-similar unsuccessful capital-seeking SMEs. This approach to disentangling supply- from demand-side forces by exploiting application outcomes is novel and robust to substitution effects between sources of capital. The study finds evidence of firms’ investments being hampered due to inability to access capital in the crisis. Whereas liquidity helps absorb this supply shock, rejection makes firms less prone to use liquidity for investments in the post-crisis period. Reduced investment plans following rejection are a primary channel through which firm performance is lowered. Results imply that capital substitutions were not adequate to shield SMEs from crisis-era distress to creditor balance sheets.Paper IV exploits two novel datasets, unique in enabling observation of SME applications for, and use of, various debt and equity instruments, to study determinants of financing choices and outcomes of European SMEs. It tests applicability of extant research to business cycle contractions and bank-based financial systems, and finds similar results. During the crisis, SMEs largely behave in accordance with the pecking-order theory. Innovative firms seek debt more, but innovativeness is only associated with successful search if SMEs are old or market-oriented, and not tech-intensive. Young firms with high investment needs in the crisis had difficulties obtaining debt, but were more likely than average to succeed if applying for equity.
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| 7. |
- Stadin, Magdalena, 1987-
(författare)
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The digitalised work environment : Health, experiences and actions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aim of this thesis was to examine the association between technostress, operationalised as information and communication technology (ICT) demands, and indicators of work-related stress, as well as its association with self-rated health. Additional aims were to identify occupational groups at risk with regard to ICT demands, and to describe experiences of technostress and how it was handled by healthcare managers.Methods: The thesis includes four individual papers. Papers I–III have a quantitative (cross-sectional or prospective) study design and are based on data derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH) and collected between 2006 and 2016. Data was analysed by statistical methods, such as linear and logistic regression analysis. Paper IV has a qualitative study design and is based on data from 20 semi-structured interviews with healthcare managers. The data was analysed using the critical incident technique.Results: ICT demands were correlated with job strain and effort-reward imbalance, especially the demands and effort dimensions of these measures. High ICT demands were associated with suboptimal self-rated health in cross-sectional analyses and in prospective analyses including repeated measurement. Managers, and particularly ‘managers in healthcare and other community services’, followed by ‘managers in education’, had the highest odds ratio of ICT demands, in comparison with both ‘non-managers’ and ‘all other managers’. Healthcare managers’ experiences of technostress could be categorised into the main areas ‘negative aspects of digital communication’, ‘poor user experience of ICTs’ and ‘needs to improve organisational resources’. The actions they took to cope with technostress were categorised into the main areas ‘culture, norms and social support’, ‘individual resources’ and ‘organisational resources’.Conclusions: Technostress operationalised as ICT demands is associated with suboptimal self-rated health. Occupational groups differ in their exposure to ICT demands by industry and position. Organisational efforts to ensure a sustainable and healthy digital work environment are warranted. ICT demands should be assessed against ICT resources for a comprehensive understanding of their association with health.
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| 8. |
- Wikström, Lotta
(författare)
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The clinical utility of patients’ self-rated postoperative pain after major surgery – the perspective of healthcare professionals'
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Numeric Rating Scale (NRS) is suitable in postoperative settings, yet, the implementation has shown varying results. This has raised issues about the pain scales contribution to the identifying and understanding of pain. The aim of this thesis was to describe the clinical utility of patients’ self-rated postoperative pain after major surgery from a healthcare professional perspective.The aim of study I and II was to describe healthcare professionals’ perceptions of the use of pain scales, and to through considering critical incidents describe care experiences and actions taken by healthcare professionals’ when assessing pain. Participants in study I (N=25) and II (N=24) were enrolled- registered nurses and physicians with clinical experiences of pain scales. The aims of study III and IV were to determine the clinical applicability of NRS mode- and maximum- measures, and the NRS mode- and median measures at rest and during activity based on patients self-rated pain. The aim in study IV was additionally to determine the number of NRS ratings needed for the calculation of these measures. The number of surgical and orthopedic patients who completed study III were: n=157 and study IV: n=479.Study I and II confirmed earlier findings of patients’ self-reported pain scores as a facilitator in the understanding of their postoperative pain. Organizational routines, documentation devices, clinical competence, continuity in care, collaborative actions, time, and individual routines were healthcare related factors affecting the use of pain scales (I, II). Patient-related facilitating factors were patients’ ability and willingness to communicate pain, while disability and unwillingness to communicate or inconsistency in verbal communication with observed behaviors were barriers (II). Time and multidimensional communication approaches could bridge these barriers (I, II).Study III and IV showed acceptable reliability for the mode, median and maximum measures. Rank correlations for individual median scores, based on four ratings, versus patients’ retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. The Svensson method showed an individual variation within the expected outcome and a significant systematic group change towards a higher level of reported retrospective pain. The calculated pain measures, particularly concerning pain at rest, generally were lower than patients’ recall of pain.The findings described beneficial effects of patient self-reported pain, however present healthcare did not fully support the utilization of pain scales. Because of the simple measurement characteristics, the use of daily NRS average pain measures, patients’ pain can be followed until resolved. The measures could additionally become important patient reported outcome measures and thus constitute new motivators to increase the utilization of pain scales.
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| 9. |
- Wu, Eline
(författare)
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Enhanced external counterpulsation treatment in patients with refractory angina pectoris with emphasis on physical capacity, health-related quality of life and safety : An explorative and interventional study
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimised medical therapy. In addition, frequent angina symptoms are strongly associated with psychological distress. The challenging management of RAP and the severe limitations and symptomatology experienced by these patients underscore the need for further research in more novel treatment approaches. Enhanced external counterpulsation (EECP) is a potential non-invasive treatment that can decrease limiting symptoms in patients with RAP and is generally given as 35 one-hour sessions (i.e., one course) over seven weeks.Aim: The overall aim was to obtain a deeper understanding of patients’ experiences undergoing EECP treatment and to evaluate the effects of the treatment with focus on physical capacity, HRQoL and safety.Methods: An explorative and interventional study comprising both qualitative (paper I) and quantitative (papers II, III, and IV) study designs were performed. In paper I, semi-structured interviews took place with 15 strategically selected patients who had finished an EECP course at the two existing EECP clinics in Sweden. Data were analysed using inductive qualitative content analysis. In paper II, a quasi-experimental study with one-group pre-test/post-test design with a six-month follow-up was performed with 50 patients who had undergone one EECP course. The following pre- and post-treatment data were collected: medication use, six-minute walk test (6MWT), functional class according to the Canadian Cardiovascular Society (CCS), self-reported (i.e., questionnaire data) cardiac anxiety, and HRQoL. The questionnaires were also completed at a six-month follow-up. In paper III and IV, sociodemographic, medical, and clinical data related to EECP were collected by reviewing medical records of 119 patients with RAP who had undergone one EECP course and a 6MWT pre- and post-treatment. An increased walking distance by 10% post treatment, measured with 6MWT, was considered an adequate treatment response.Results: In paper I, the findings were divided into four content areas, each comprising three categories: (1) experiences before EECP was initiated comprised of uncharted territory, be given a new opportunity and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after one course of EECP treatment comprised improved physical well-being, improved mental well-being and maintaining angina in check. In paper II, patients used significantly less short-acting nitrates (p <. 001), walking distance increased on average by 46 m (p < .001), and CCS class improved after one EECP course (p < .001). In addition, all but one subscale of cardiac anxiety and all HRQoL components improved significantly, and the positive effects were maintained at the six-month follow-up (p < .05). In paper III, 49 (41.2%) of the 119 patients, were responders to EECP. CCS class ≥ 3, left ventricle ejection fraction < 50%, and previous revascularisation (i.e., ≤ one type of intervention) were predictors of response (p < .05). In paper IV, the treatment completion rate was high, and the occurrence of adverse events (AE) was low. Most device-related AE required nursing actions, while medical actions were needed more in the non-device-related AE. The AE distribution did not differ between responders and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders.Conclusions: The EECP treatment was perceived as an unknown option among these patients but also as be given a new opportunity to get better. The presence and care provided by the cardiac nurse contributed to a sense of security during treatment. The treatment resulted in reduced symptom burden, improved physical capacity and HRQoL, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with RAP. Moreover, the EECP should be considered preferentially for patients who have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularisation. The EECP treatment appears to be a safe and well-tolerated treatment option in patients with RAP.
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| 10. |
- Fagrell, Per, 1969-
(författare)
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Change and inertia in the development of Swedish engineering education : The industrial stakeholder perspective
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates higher education development in Sweden from an external stakeholder perspective, with a particular focus on engineering education. Industry has long been a major external stakeholder in the development of profession-oriented higher education, not least in the context of engineering education. Representatives of industry and other employers have continuously called for developments in the curriculum to prepare students for an evolving profession. Scholars of higher education have gone so far as to depict employers as the definitive stakeholder in higher education today. However, it has also been claimed that engineering education and its institutions are, and always have been, rather unresponsive to external calls for changes. These partly contrasting views call for a study of the role of industry vis-à-vis the different strategies that higher education institutions can draw upon to respond to external calls for change. Thus, the following overarching research question is posed: What kind of role does an external stakeholder such as industry have in the development of engineering education?The conceptual framework for the thesis is based on literature on organisational continuity and change, response strategies to external calls for change, university–business collaboration, and curriculum development and quality. The main theoretical concept presented in the thesis, however, is stakeholder theory and stakeholder analysis. A model for stakeholder analysis is chosen and presented in which the assessment of the attributes power, legitimacy and urgency form the basis for the analysis of the stakeholders’ salience.Empirically, the thesis is based on three studies, which have yielded four appended papers. The studies represent different situations in which external stakeholders have had the possibility of impacting higher education. All three studies have an interpretative and qualitative methodological approach, with semi-structured interviews as the main source for data collection, combined in the second study with historical document studies. In order to frame these studies in their historical context, an overview of the development of engineering education in Sweden is presented as a background. In this overview, the development of relationships between industry and engineering education institutions are depicted with reference to a series of milestone events.The results show that, from a historical perspective, industry has indeed been an influential stakeholder to engineering education. It is argued that while industry still is an important stakeholder, higher education institutions today have to attend to the interests of a broader range of stakeholders, including students, government and others. Claims in the international literature that employers are the definitive stakeholder in higher education does not seem to fit well with the Swedish context, as analysed in this thesis. This may be partly understood as a consequence of a shift away from national-level decision-making regarding higher education development, leaving previous structures for active stakeholder influence less potent.Important decisions about engineering education have in Sweden moved from a national and centralised level to an international level, exemplified by the Bologna Process and the global quality assurance and enhancement scheme called the CDIO[1] Initiative, and at the same time to a local level due to an ambitious autonomy scheme for higher education institutions in Sweden. This can be seen as a divergent trend compared to an international setting, specifically in Anglophone countries where the Washington Accord acts as the basis for curriculum development. This accreditation agreement is heavily influenced by the accreditation scheme for engineering education in the United States, the ABET criteria, in whose formulation employer representatives have a major impact. It may be questioned whether industry representatives have fully recognised this shift in the decision-making process in the engineering curriculum in Sweden. With regard to earlier claims that engineering education and its institutions are unresponsive to external calls for change, the thesis concludes that higher education institutions respond and act, but not always in the way external stakeholders expect or want. External stakeholders have to persist in their eternal quest for progress and development in engineering education, but they may have to adjust and divert their attention to both an international and local context at the same time.[1] CDIO: Conceive-Design-Implement-Operate
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