| 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. |
- Hayati, Elli Nur, 1966-
(författare)
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Domestic violence against women in rural Indonesia : searching for multilevel prevention
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Domestic violence has been recognized globally as one of the most important Public Health concerns with severe negative health consequences for the exposed women. Through UN bodies several international milestones have successfully pushed attention towards worldwide improvements in the life situations of women. Since the ratification of the Convention on Elimination of All Forms of Discrimination against Women (CEDAW) in 1984, significant positive changes towards equality between men and women in Indonesia have been initiated, one being the enactment of the Domestic Violence Act in 2004. However, there is still a need to improve the knowledge about what preventive measures that are feasible and work in different settings. This thesis aims to contribute to a better understanding of appropriate prevention strategies against domestic violence in rural Indonesia by exploring: i) risk factors for domestic violence; ii) women’s ways of coping with exposure to violence; iii) men’s views on masculinity and violence within marriage; and iv) challenges faced by local service agency in managing services for women survivors of domestic violence.Methods: Data from a cross sectional population based study was used to analyze risk factors for physical and sexual abuse among a cohort of pregnant women in Purworejo district. Further, a qualitative phenomenological interview study was conducted to reveal the dynamics of coping among women survivors of domestic violence in the same district. A Grounded Theory study based on focus group discussions with men formed the basis for a situational analysis of the linkage between masculinity and the use of violence within marriage. Finally, a qualitative case study was performed to explore the management practices of a local service agency in the district, to understand the challenges faced in their efforts to address domestic violence.Results: Sexual violence was associated with husbands’ demographic characteristics (age and low educated) and women’s economic independence. Exposure to physical violence among women was strongly associated with husbands’ personal characteristics. The attitudes and norms expressed by women confirmed unequal gender relationships. Experiencing violence led women to using an elastic band coping strategy, moving between actively opposing the violence and surrendering or tolerating the situation. The national gender equality policies were shown to have played a crucial role in transforming gender power relations among men and women (the gender order) in the Indonesian society. Three different positions of masculinity were identified, the traditionalist, the egalitarian, and the progressive, with different beliefs about men’s role within marriage and with various levels of accepting the use of violence. Long term structural preventive efforts and individual interventions targeted to the conflicting couples were preferred over reporting the abuser to the authorities. The major challenges faced by the local service agency were the low priority given by the authorities, mirrored also in low involvement in the daily service by the assigned volunteers. The local agency also stammered in translating the current law and policies into a society that held on to traditional and religious norms regulating the relationships between men and women.Conclusion: Overall, this thesis illustrates that sociocultural traditions and religious teaching still viscously influence people’s attitudes and beliefs about the use of violence within relationships. Domestic violence has not been accepted as a criminal act but is still to a large extent seen as a private family affair. Culturally sensitive programs aimed to bridging the gap between the current laws and policies and the socio-cultural traditions need to be further developed to protect women from domestic violence and increase gender equity in the Indonesian setting.
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| 3. |
- 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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| 4. |
- 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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| 5. |
- Lestari, Septi Kurnia, 1989-
(författare)
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Active and healthy ageing in Europe : significance of social relationships
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Social relationships have important roles in achieving active and healthy ageing. Social relationships are dynamic across the life course. A myriad of contextual and individual (e.g., sociodemographic and health-related) factors shape the levels of social relationship constructs (e.g., social contact, participation, and support) and how they change over time. This thesis aims to contribute to a better understanding of social relationships among the older European population, the impact of health on social relationships, the influence of social relationships on quality of life, and the impact of the COVID-19 pandemic on the levels of social relationships.Methods: The study subjects were community-dwelling Europeans aged 50 and over who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2020. In Sub-study 1, multilevel growth modelling was used to analyse the trajectories of seven social relationship constructs, i.e., provision and receipt of instrumental support, social contact, and participation in volunteer work, sport/social club, educational activity, and political/community organisation. Sub-study 2 used latent class analysis (LCA) to identify social relationship typologies based on the seven social relationship constructs and perceived emotional support. Next, the associations between frailty and social relationship typologies were analysed using LCA-with-covariates. Sub-study 3 evaluated the possible causal effect of social support provision, support receipt, and participation on quality of life using doubly robust estimation and sensitivity analysis for unobserved confounding. Sub-study 4 used multilevel logistic regression analysis to determine whether individuals’ exposure to COVID-19 and the country’s COVID-19 policies stringency index (S-Index) were associated with the initiation of provision and receipt of instrumental support and volunteering during the first phase of the COVID-19 pandemic. Results: In contrast to instrumental support receipt, the probability of instrumental support provision, social contact, and participation declined slightly over time (Sub-study 1). Four social relationship types were identified: 1) poor, 2) frequent and emotionally close, 3) frequent, emotionally close, and supportive, and 4) frequent, emotionally close, and active (Sub-study 2). Poor self-rated health limited instrumental support provision and increased instrumental support receipt from outside the household (Sub-study 1). Being pre-frail or frail was associated with less active social relationship types, i.e., Types 1, 2, and 3 (Sub-study 2). Social participation and instrumental support provision for people outside the household were correlated with a higher quality of life while receiving instrumental support was associated with a lower quality of life. None of these associations could be considered causal (Sub-study 3). During the COVID-19 pandemic, the level of volunteering and instrumental support provision was lower, but the level of instrumental support receipt was higher than before the pandemic. Being exposed to COVID-19 was positively associated with support receipt initiation. The close ones’ exposure to COVID-19 was positively associated with volunteering, support provision, and support receipt. S-Index was positively associated with instrumental support provision initiation but negatively associated with support receipt initiation (Sub-study 4).Conclusions: A significant share of older Europeans was socially active. Their engagement in social contact, support, and participation changed over time. The four social relationship types revealed the importance of having frequent contact in initiating instrumental support exchange and social participation. Health is a vital determinant of older adults’ social relationships. On the other hand, observed associations indicate that social relationships may influence older adults’ quality of life. The pandemic might lower social support provision and volunteering and increase support receipt levels in the population. However, the pandemic might also encourage older adults to provide help, likely to people within their neighbourhood. Overall, maintaining close social ties, especially with family and close friends, is important to stimulate active engagement in social support exchange and participation, which promotes healthy ageing.
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| 6. |
- 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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| 7. |
- Bolin, Malin, 1974-
(författare)
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The importance of organizational characteristics for psychosocial working conditions and health
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The importance of organizations for understanding differences in the working conditions and health of employees is often emphasized but rarely explored empirically. The general aim of this thesis is to describe organizational characteristics of workplaces, and to assess their impact on the psychosocial working conditions and health of employees. In modern working life, it is assumed that employees' working conditions and health are affected by a general transformation of workplaces from bureaucracy to post-bureaucracy. The organizational data used are based on structured interviews with managers at workplaces in different types of operations in mid-Sweden, whereas the individual data consist of a questionnaire to all employees working in the participating workplaces, resulting in a dataset of 90 workplaces and 4306 individuals. Descriptive analysis was carried out for comparison of organizational characteristics in different types of operations, while multilevel analysis was applied to investigate the magnitude of the organizational impact on psychosocial working conditions, and to analyze associations between organizational characteristics, psychosocial working conditions and health. The results showed that the workplaces were mainly displayed by a combination of bureaucratic and post-bureaucratic characteristics, and these were unequally distributed between types of operations. A systematic variation in the psychosocial working conditions and health of employees was found between workplaces, and the variation in psychosocial working conditions was attributed to several organizational levels. The variation between workplaces was explained by both organizational characteristics of the workplaces and individual characteristics of the employees. Formalization, centralization, job enrichment, individual responsibility, soft control systems, and performance control were associated with psychosocial working conditions when controlled for occupational class, gender and age of employees, and a high degree of customer adaptation was associated with increased sickness absence of employees. It is concluded that bureaucracy and post-bureaucracy should not be regarded as dichotomies. Organizational characteristics of workplaces have an impact on the psychosocial working conditions and health of employees beyond occupational class. This has implications for both the theory and the practice of occupational health research.
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| 8. |
- Eriksson, Malin, 1969-
(författare)
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Social capital, health and community action : implications for health promotion
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background; The overwhelming increase in studies about social capital and health occurring since 1995 indicates a renewed interest in the social determinants of health and a call for a more explicit use of theory in public health and epidemiology. The links between social capital and health are still not clear and the meanings of different forms of individual and collective social capital and their implications for health promotion needs further exploration. The overall aims of this thesis are to explore the relationship between social capital and health and to contribute to the theoretical framework of the role of social capital for health and health promotion.Methods; Data from a social capital survey were used to investigate the associations between individual social capital and self-rated health for men and women and different educational groups. Survey data were also analyzed to determine the association between collective social capital and self-rated health for men and women. A qualitative case study in a small community with observed high levels of civic engagement formed the basis for exploring the role of social capital for community action. Data from the same study were utilized for a grounded theory situational analysis of the social mechanisms leading to social capital mobilization.Main findings; Access to individual social capital increases the odds for good self-rated health equally for men and women and different educational groups. However, the likelihood of having access to social capital differs between groups. The results indicate a positive association between collective social capital and self-rated health for women but not for men. Results from the qualitative case study illustrate how social capital in local communities can facilitate collective actions for public good but may also increase social inequality. Mobilizing social capital in local communities requires identification of community issues that call for action, a fighting spirit from trusted local leaders, “know-how” from creative entrepreneurs, and broad legitimacy and support in the community.Conclusions; This thesis supports the idea that individual social capital is health-enhancing and that strengthening individual social capital can be considered one important health promotion strategy. Collective social capital may have a positive effect on self-rated health for women but not for men and therefore mobilizing collective social capital might be more health-enhancing for women. Collective social capital may have indirect positive effects on health for all by facilitating the ability of communities to solve collective health problems. However, mobilizing social capital in local communities requires an awareness of the risk for increased social inequality.
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| 9. |
- Eriksson, Olivia, 1985-
(författare)
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Gallery Experience : Viewers, Screens and the Space In-Between in Contemporary Installation Art
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation explores gallery experience as an embodied and site-specific occurrence. Using an interdisciplinary approach that bridges art historical research with film theoretical perspectives, it offers contextualized, in-depth analyses of a limited number of contemporary installation works exhibited in Scandinavia during 2014–2016. Focusing on how these case studies complicate the relationship between viewers and screens, the thesis examines how they actualize the notion of an in-between, both thematically and with regard to the specificities of the exhibition context. Drawing on film phenomenology on the one hand and art historical studies of relational art practices on the other, this study stakes out new paths for understanding embodied spectatorship in the social space of the gallery.Chapter one is concerned with how spatial arrangements structure the viewing experience and discusses the transitory nature of the gallery in relation to the five-channel film installation Intercourses (Jesper Just, Bonniers Konsthall, 2015). Reexamining the concept of relational aesthetics, it proposes that the gallery experience engenders provisional viewing collectives that are characterized by a sense of embodied displacement. This chapter also focuses on the viewer’s place vis-à-vis highly aestheticized images of war in the six-channel film installation The Enclave (Richard Mosse, Louisiana Museum of Modern Art, 2015), examining the blurring of boundaries between aesthetics and ethics at the site of projection.Chapter two explores archival art practices, focusing on institutional framing and how the gallery comes to function as a site for shared memory work. Discussing the two hybrid exhibitions Unfolding (Akram Zaatari, Moderna Museet, 2015) and Geography of Time (Fiona Tan, Museet for samtidskunst, 2015-2016), it considers the excavation of cultural memory and the formation of idiosyncratic image collections as a form of alternative historiography that is made possible by the animation of the archival document within the walls of the gallery.Chapter three deals more explicitly with participatory aspects through close analysis of a selection of works by installation artist Olafur Eliasson (Riverbed, Louisiana Museum of Modern Art, 2014 and Reality Machines, Moderna Museet, 2015-2016). It also considers the commercialized art sphere and the blockbuster exhibition in relation to the traditional function of the gallery or museum as a site for contemplation and demonstrates how Eliasson’s installations renegotiate the borders between the two.Chapter four considers the afterlife of installation through various documentation practices. Drawing on debates about the preservation of live art and the possible restructuring of aura brought on by these processes, it examines how the gallery experience is remembered and modified as a mediated event, as institutional memory, in alternative versions or in the form of embodied memory.The thesis concludes by reiterating how the case studies pose challenges to predominant models of aesthetic experience and require a double focus where thematic analysis and contextual considerations of the gallery as an institutional and social space form an undeniable whole. Arguing for the insights of a site-specific approach, the dissertation conceptualizes the gallery experience as a shared event where images, sculptural elements and viewer interaction come together to form new modes of embodied spectatorship.
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| 10. |
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