| 1. |
- Ahlborg, Mikael, 1985-
(författare)
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Social capital and inequalities in mental health among young adolescents in Sweden
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore social capital and inequalities in mental health among young adolescents in Sweden. This is a compilation thesis comprising four studies. Studies I and II are quantitative studies of crosssectional data from the Swedish Health Behaviour in School-aged Children survey. The aim of Study I was to investigate socioeconomic inequalities in health using both a subjective and an objective measure of socioeconomic status among Swedish adolescents. The findings showed that subjective socioeconomic status robustly and independently predicted mental health problems, poor life satisfaction and poor general health perception. The association between objective socioeconomic status and mental health was weakened, and even reversed, when subjective socioeconomic status was accounted for in regression models. A Latent Profile Analysis was applied in Study II with the aim of identifying distinct profiles of family, school and peer social capital in a nationally representative sample of adolescents and to explore health outcomes in those profiles. The findings showed that five distinct profiles best represented the data for 11 and 15-year olds, while a four-profile model was optimal for 13-year olds. Significant inequalities were identified between profiles when these were examined in terms of mental health problems and life satisfaction. The design of Study III was a qualitative semi-structured interview study. The aim was to explore social capital from the perspective of adolescents in relation to mental health. Adolescents spoke of having access to a safe space, feeling connected to others and predictability as important aspects of social relationships and networks in relation to mental health. The aim of Study IV was to identify and evaluate the design and psychometric properties of instruments for assessing social capital specifically developed and validated for self-reporting among adolescents (10-19 years). The design was a systematic review, in which 20 instruments were identified. The results revealed a lack of instruments that covered both the multidimensionality of social capital and contextual relevance in relation to adolescents. The conclusion from this thesis is that social capital may be useful for identifying vulnerable individuals and for differentiating between the natural imbalance of adolescence and what may lead to serious illness. Longitudinal research and refinement of the operationalization of the concept are, however, needed to enhance the understanding of these findings.
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| 2. |
- Karhina, Kateryna, 1982-
(författare)
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Social capital and well-being in the transitional setting of Ukraine
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The military conflict in Ukraine that started in 2014 was accompanied with many changes in the political, economic and social spheres. It brought informal volunteering activities (i.e. one form of social capital) to emerge, function and later to be formalized, in order to support soldiers and their families. This situation is unique given the transitional setting of Ukraine, which has led to comparably low levels of social capital and negative indicators of health and well-being. This thesis aims to explore social capital during military conflict in contemporary Ukraine and to analyze the associations between social capital and well-being, as well as the distribution of social capital among Ukrainian women and men.Methods: The study combines a qualitative and quantitative research design. A case study was conducted using qualitative methodology. Eighteen in-depth interviews were collected with providers and utilizers of volunteering services. Grounded Theory and social action ideal types methodology of Weber were used for the analysis. The quantitative research utilized two secondary datasets. The World Health Survey was utilized to analyze the association between social capital and physical and mental well-being for women (n=1723) and men (n=910) by means of multivariate logistic regression. The European Social Survey (wave 6) was used in order to investigate access to social capital and the determinants of gender inequalities in the access with a sample of 1377 women and 797 men. Multivariate logistic regression and postregression Fairlie’s decomposition analysis were used to analyze the determinants of the inequalities.Results: The key findings of this thesis show that social capital transforms during military conflict and takes particular forms in transitional settings. There are positive and negative effects on well-being connected to crisisrelated volunteering. The associations between social capital and well-being vary for women and men in favour of women. Social capital is unequally distributed between different social groups. Some forms of social capital may have stronger buffering effect on women than men in Ukraine. Access to social capital can be viewed as an indicator for social well-being, and thus social capital can be used both as a determinant and an outcome in social capital and health research.Conclusion: Informal social participation, i.e. volunteering might play an important role in societal crises and needs to be considered in social capital measurements and interventions. Social capital measurements utilized in stable societies do not evidently capture these forms, i.e. it is not taken into account. The associations between social capital and well-being depend on the measurements that are used. Since social capital has both positive and negative effects on well-being, this should be considered in research, policies and practices in order to prevent negative and promote positive outcomes. In Ukraine, as well as in other settings, social capital is an unequal resource for different societal groups. Reducing gender and income inequalities would probably influence the distribution of social capital within the society.
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| 3. |
- Kien, Vu Duy, 1977-
(författare)
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Inequalities in non-communicable diseases in urban Hanoi, Vietnam : health care utilization, expenditure and responsiveness of commune health stations
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality among adults in Vietnam. Little is known about the magnitude of socioeconomic inequalities in NCDs and other NCD-related factors in urban areas, in particular among the poor living in slum areas. Understanding these disparities are essential in contributing to the knowledge, needed to reduce inequalities and close the related health gaps burdening the disadvantaged populations in urban areas. Objective: To examine the burden and health system responsiveness to NCDs in Hanoi, Vietnam and investigate the role of socioeconomic inequalities in their prevalence, subsequent healthcare utilization and related impoverishment due to health expenditures. Methods: A cross-sectional study was conducted among 3,736 individuals aged 15 years and over who lived in 1211 randomly selected households in 2013 in urban Hanoi, Vietnam. The study collected information on household’s characteristics, household expenditures, and household member information. A qualitative approach was implemented to explore the responsiveness of commune health stations to the increasing burden of NCDs in urban Hanoi. In-depth interview approach was conducted among health staff involved in NCD tasks at four commune health stations in urban Hanoi. Furthermore, NCD managers at relevance district, provincial and national levels were interviewed. Results: The prevalence of self-reported NCDs was significantly higher among individuals in non-slum areas (11.6%) than those in slum areas (7.9%). However, the prevalence of self-reported NCDs concentrated among the poor in both slum and non-slum areas. In slum areas, the poor needed more health care services, but the rich consumed more health care services. Among households with at least one household member reporting diagnosis of NCDs, the proportion of household facing catastrophic health expenditure and impoverishment were the greater in slum areas than in non-slum areas. Poor households in slum areas were more likely to face catastrophic health expenditure and impoverishment. The poor in non-slum areas were also more likely to face impoverishment if their household members experienced NCDs. Health system responses to NCDs at commune health stations in urban Hanoi were weak, characterized by the lack of health information, inadequate human resources, poor financing, inadequate quality and quantity of services, lack of essential medicines. The commune health stations were not prepared to respond to the rising prevalence of NCDs in urban Hanoi. Conclusion: This thesis shows the existence of socioeconomic inequalities in the prevalence of self-reported NCDs in both non-slum and slum areas in urban Hanoi. NCDs associated with the inequalities in health care utilization, catastrophic health expenditure and impoverishment, particular in slum areas. Appropriate interventions should focus more on specific population groups to reduce the socioeconomic inequalities in the NCD prevalence and health care utilization related to NCDs to prevent catastrophic health expenditure and impoverishment among the households of NCD patients. The functions of commune health stations in the urban setting should be strengthened through the development of NCDs service packages covered by the health insurance.
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| 4. |
- Vaezghasemi, Masoud, 1978-
(författare)
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Nutrition transition and the double burden of malnutrition in Indonesia : a mixed method approach exploring social and contextual determinants of malnutrition
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionNutrition transition concerns the broad changes in the human diet that have occurred over time and space. In low- to middle-income countries such as Indonesia, nutrient transition describes shifts from traditional diets high in cereal and fibre towards Western pattern diets high in sugars, fat, and animal-source foods. This causes a swift increase in the prevalence of overweight and obesity while undernutrition remains a great public health concern. Thus a double burden of malnutrition occurs in the population. The main aim of this investigation was to explore social and contextual determinants of malnutrition in Indonesia. The specific objectives were: (i) to examine body mass index (BMI) changes at the population level, and between and within socioeconomic groups; (ii) to estimate which context (i.e., household or district) has a greater effect on the variation of BMI; (iii) to assess the prevalence of double burden households (defined as the coexistence of underweight and overweight individuals residing in the same household) and its variation among communities as well as its determining factors; and (iv) to explore and understand what contributes to a double burden of malnutrition within a household by focusing on gender relations.MethodsA mixed method approach was adopted in this study. For the quantitative analyses, nationally representative repeated cross-sectional survey data from four Indonesian Family Life Surveys (IFLS; 1993, 1997, 2000, 2007) were used. The IFLS contains information about individual-level, household-level and area-level characteristics. The analyses covered single and multilevel regressions. Data for the qualitative component were collected from sixteen focus group discussions conducted in Central Java and in the capital city Jakarta among 123 rural and urban men and women. Connell’s relational theory of gender and Charmaz’s constructive grounded theory were used to analyse the qualitative data.ResultsGreater increases in BMI were observed at higher percentiles compared to the segment of the population at lower percentiles. While inequalities in mean BMI decreased between socioeconomic groups, within group dispersion increased over time. Households were identified as an important social context in which the variation of BMI increased over time. Ignoring the household level did not change the relative variance contribution of districts on BMI in the contextual analysis. Approximately one-fifth of all households exhibited a double burden of malnutrition. Living in households with a higher socioeconomic status resulted in higher odds of double burden of malnutrition with the exception of women-headed households and communities with high social capital. The qualitative analysis resulted in the construction of three categories: capturing the significance of gendered power relations, the emerging obesogenic environment, and generational relations for child malnutrition.ConclusionAt the population level, greater increases in within-group inequalities imply that growing inequalities in BMI were not merely driven by socioeconomic factors. This suggests that other under-recognised social and contextual factors may have a greater effect on the variation in BMI. At the contextual level, recognition of increased variation among households is important for creating strategies that respond to the differential needs of individuals within the same household. At the household level, women’s empowerment and community social capital should be promoted to reduce inequalities in the double burden of malnutrition across different socioeconomic groups. Ultimately community health and nutrition programmes will need to address gender empowerment and engage men in the fight against the emerging obesogenic environment and increased malnutrition that is evident within households, especially overweight and obesity among children.
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| 5. |
- Jordal, Malin, et al.
(författare)
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Escorting Students into Responsibility and Autonomy (ESRA) : A Model for Supervising Degree Project
- 2021
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Ingår i: Advances in Medical Education and Practice. - : Dovepress. - 1179-7258. ; 12, s. 1165-1173
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several models for how to support students and provide them with the skills needed to write their degree projects have been proposed. However, few attempts have been made to present a general model for students’ academic work based on reasoning and communication skills rather than memorizing and mimicking their supervisors during their independent degree project.Objective: In the present paper, we propose a well-structured model that assists supervisors in promoting students’ responsibility and autonomy, while at the same time maintaining a high level of support.Presentation: We present a step-by-step protocol based on a partnership model with a contractual style that focuses on students’ academic work with their own texts through a process of alternating between abstract and concrete writing. This protocol, which is called the ESRA (Escorting the Students into Responsibility and Autonomy) model, can be utilized regardless of the content, specific aim and scope of the individual student’s degree project.Discussion and Conclusions: We argue that this model promotes high levels of engagement and assumption of responsibility among students, while also offering a feasible structure for ensuring the steps to empowerment and autonomy. Use of the ESRA model is suitable when a constructive interaction between students and supervisors is desirable as a tool to achieve the learning outcomes of the degree project. Thus, the proposed model is one step toward giving a new generation of nurses the skills and ability they need to adapt in the changing world of the 21st century and to make promoting health a core mission of their profession.
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