| 1. |
- Emsing, Mikael, 1980-
(författare)
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Conflict management & mental health among Swedish police officers & recruits
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: An essential part of police work is handling people in distress, often related to some form of conflict that police officers are expected to handle in a professional manner. Thus, interpersonal and conflict management skills are essential for police officers. Further, police work has been hailed as one of the most complex and stressful jobs that one can have. While important progress has been made in relation to how the complex and stressful nature of police work affects the individual officers - less is known about the timing and onset of these effects. Similarly, while there is a growing body of research into police conflict management, more research is needed to deepen our understanding of police conflict management, not least in the Swedish context. The overall aim of the present thesis was to contribute to existing knowledge about police work by investigating conflict management and mental health among Swedish police recruits and officers.Materials and methods: The present thesis used a mixed-methods approach and is built on four sub-studies. Sub-study 1 examined the evidence base for current practices, methods, and training in conflict management by means of a scoping review. Sub-study 2 used semi-structured interviews to examine how police officers perceived conflict and conflict-management and their training within the subject. Results from sub-study 2 where also used increating items for the instrument developed in sub-study 4. Sub-study 3 used a quantitative design to examine the mental health status of Swedish police recruits using the SCL-90 questionnaire. Sub-study 4 documented the initial steps towards developing an instrument to measure conflict behaviors and attitudes to conflict management among police officers and evaluated the psychometric properties of this instrument.Results: A large proportion of the studies included in the scoping review were conducted in the US and manyfocused-on use of force. The results also indicate that a lack of available data, unified definitions and experimental as well as longitudinal research designs makes it difficult to draw causal conclusions regarding the effectiveness of training in conflict management. In the interviews, respondents described conflict largely in terms of interpersonal conflicts, and focused less on intrapersonal conflict. The complexity and importance of the role played by instructors during probationary training was also salient in their descriptions. As for mental health status, recruits overall reported scores that where similar to the general population. A small number of recruits (n = 15) reported scores that where above the patient mean of the Swedish general population in the corresponding age group. The intended factor structure of the instrument developed could not be operationalized in the instruments current form, but the instrument could still provide insights and provides a basis for further development of the instrument.Conclusions: To enhance our understanding on police conflict management, scholars and police departments should work together to agree upon unified definitions on key concepts related to this topic. More research using longitudinal and experimental designs are needed to further develop training interventions related to conflict management. While a small number of recruits reported scores above the Swedish patient mean, extant research has indicated that stigmas surrounding mental health among police could lead to unconstructive coping behaviors. Further research on mental health among not only Swedish police officers but also recruits, could focus on helpseeking-behaviors and stigmas related to mental health to provide valuable insights on the topic. The instrument developed within the present thesis needs further development but nonetheless represents a first step towards examining individual differences in relation to police conflict management behaviors and attitudes towards conflict.
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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. |
- Nasseh Lotf Abadi, Mozhdeh, 1977-
(författare)
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Social support, coping, and self-esteem in relation to psychosocial factors : A study of health issues and birth weight in young mothers in Tehran, Iran
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Generally, pregnancy is considered to be a positive period in life in Iranian culture. For the parents, it is important to have a healthy pregnancy and, as a result, a healthy child. A sufficient birth weight of the infant represents one of the crucial conditions of a healthy development of a child during infancy as well as later in life. Ongoing research has been carried out regarding various medical factors related to birth weight, but there is a gap in knowledge about psychosocial factors such as social support, coping, self-esteem, stress and mother’s mental health, and various socio-demographic factors including domestic violence, which may lead to adverse pregnancy outcomes such as low birth weight. This thesis aims to provide knowledge to fill this gap.Methods: A cross-sectional survey was conducted in Tehran, Iran, including 600 young mothers who had delivered in Akbarabadi hospital, one of the main gynaecological hospitals affiliated with Tehran University of Medical Sciences. The investigation included a self-developed socio-demographic form, the Social Support Questionnaire, the Ways of Coping Checklist, Rosenberg’s Self-Esteem Scale, the General Health Questionnaire-12, and a Life Event Checklist.Results: We could not find a significant association between birth weight and mother’s level of education, and there was no substantial relationship between general mental health and birth weight. Verbal abuse was reported by 26.0% of the young mothers, 4.8% reported physical abuse, 5.5% reported sexual abuse, and 1.3% reported all three types of abuse. The abuse-index was significantly negatively associated with satisfaction with social support and with self-esteem.The higher the abuse-index, by trend, the lower was the infants’ birth weight. Weight before pregnancy, current weight, weight gain during pregnancy, and the number of prenatal care visits were significantly positively associated with the weight of the newborn. Mothers who reported having a history of a low birth-weight (LBW) child or were physically abused during pregnancy had infants with significant lower birth weight.The more the pregnant women were satisfied with their social support and the more often they used positive reappraisal as a way of coping, the higher was their infants’ birth weight. The higher the self-esteem, the less often they used escape avoidance and confrontive coping.Conclusion: The results suggest the importance of relationships between a healthy pregnancy and psychosocial as well as socio-demographic factors. Providing pregnant women with social support is a key component for a healthy pregnancy, especially when faced with stressful situations. The number of people available for support did not provide a significant buffering effect on domestic violence (DV), but the perceived quality of social support did. Higher education in the mother and husband, and women’s employment represented protective conditions against the occurrence of DV. Women who reported physical abuse during pregnancy had infants with lower birth weight. Satisfaction with social support and use of positive reappraisal were significantly associated with higher birth weight.
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| 4. |
- Rostami, Arian, 1973-
(författare)
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Police officers under pressure : sexual and gender-based harassment, stress, and job satisfaction in Sweden
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Police officers encounter challenging and stressful situations at work, which negatively impact their health, job performance, and aspects of their lives. Regarding the gendered structure and competitive work environment of police organizations, women are under extra pressure from the pervasive gendered norms within the police organization. The aim of this dissertation is to study sexual and gender-based harassment and work-related stress as important work environment elements from a gender perspective, and to explore if and how these elements can affect police officers’ job satisfaction in the context of Swedish police work.This thesis is based on three studies: a scoping review, a quantitative study, and a qualitative study, resulting in four articles. In the scoping review study on sexual and gender-based harassment in police work in the European context 16 articles on sexual and gender-based harassment against police employees were studied. Thematic analysis was applied to obtain the main patterns across and within the included studies. In the qualitative study, data collection included one group interview and 12 individual interviews with male and female police officers. Thematic and content analysis were conducted to analyze the interviews. During the quantitative study, data were collected from 152 male and female police officers applying a set of questionnaires including sociodemographic questions, the Police Stress Identification Questionnaire (PSIQ), Sexual and gender-based harassment questions, and Job Descriptive Index (JDI). The scoping review showed that most of the European studies were focused on sexual harassment, while gender-based harassment was often overlooked or mixed with other types of harassment and discrimination. Six main themes were found in the studies; the existence of sexual and gender-based harassment, perpetrators, associated factors, consequences, individual response, and impact of organizational policies. In the mixed methods article, results from the quantitative and qualitative studies on sexual and gender-based harassment indicated that female police officers experienced a statistically significant higher percentage of gender-based harassment compared to male officers. However, there was not any significant gender difference in sexual harassment. “Sexual comments and jokes” and “mocking or telling jokes about the #MeToo campaign” by colleagues were reported as the most frequent sexual harassment and gender-based harassment items. Additionally, police officers identified the presence of toxic jargon and a culture of silence, along with ineffective or negative management styles, as organizational factors that can contribute to the perpetuation of such harassment. Also, the quantitative results on police work stress showed that police officers rated higher on the “impact on significant others” stress and “operational stress” subscales. In addition, female officers reported higher stress in these subscales compared to their male counterparts. The police officers who had experienced sexual harassment reported higher “self-image stress” and “operational stress”. Moreover, in studying job satisfaction among Swedish police officers, both male and female officers reported the highest satisfaction with “people on present job” and the lowest satisfaction with “opportunity for promotion” and then “pay”. No significant gender gap was found in job satisfaction subscales, nor was there a significant association between these subscales and experiences of harassment. However, organizational stress was negatively related to three domains of job satisfaction; “job in general”, “pay” and “supervision”. The research findings revealed that despite substantial changes in the Swedish police organization and work culture during recent decades, the issue of sexual and gender-based harassment remains persistent. This finding highlights the need for more attention to organizational factors (cultural and managerial issues) enabling sexual and gender-based harassment. The findings also underscore the higher levels of work pressure and challenges faced by female officers and the importance of challenging prevailing gender norms affecting both female and male police officers. Moreover, addressing organizational sources of stress can improve the working conditions and job satisfaction of police officers. Finally, the thesis highlights the importance of considering sexual and gender-based harassment along with work stress to create a safer and more productive police work environment.
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| 5. |
- Bäck, Thomas, 1956-
(författare)
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från polisutbildning till polispraktik : polisstudenters och polisers värderingar av yrkesrelaterade kompetenser
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to build knowledge about the transition from an educational to an occupational context. More specifically, the dissertation focuses on the transition from police education to police practice by studying the way police students and police officers perceive the importance of a number of professional competences related to their future occupations. The aim is also to study whether the importance of these competences has changed between the time of their police education and their work as police officers and to what extent the respondents perceive that police education contributed to the development of these competences.Methodologically, this dissertation is in some parts based on cross-sectional data. In other parts, it is based on longitudinal data and uses a combination of both quantitative and qualitative data. The quantitative data are based on questionnaires given to police students at the beginning and end of their police education and to police officers after a few years of police practice. The questionnaire used in sub studies B, C and D is part of the European cooperation project called Recruitment, Education, and Career in the Police (RECPOL). The qualitative data are based on interviews. Theoretically, a frame factor perspective is used to analyse and understand the dissertation’s empirical data.The results show a change in the way the respondents perceive the importance of the studied competences over time. The police students generally valued theprofessional competences higher at the beginning of their education and significantly lower at the end of their education. As police officers, however, they valued the importance of these competences almost as high as they did at the beginning of their education. The results show small differences between how male and female police students and police officers valued these competences. When the respondents reflected on the reasons why the significance of the competences changed over time, different themes emerged. The results also show that police education’s contribution to the development of these competences is clearly lower than the extent to which they are perceived as important for work as police officers. In the interviews, reflections on the reasons for this indicated a discrepancy between the educational and occupational contexts.One conclusion is that police students at the end of their education need to better understand that they have not fully learnt everything they need to know and that they are becoming police officers with the capacity to continue developing professionally and contributing to the police as a learning organization.
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| 6. |
- Granholm Valmari, Elin, 1983-
(författare)
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Beyond the badge : police officers’ lifestyles and health
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Being a frontline police officer is regarded to be one of the most high-strain professions in the world, encompassing physical, emotional and cognitive stressors. These stressors may cause ill health, physically, mentally and socially, impacting both professional and private life roles and everyday activities. Despite this, there has been limited consideration of the broader complexities of police officers’ lifestyles. Thus, the primary aim of this thesis was to identify health promoters and health challenges within the lifestyles of frontline police officers using a transactional perspective. The secondary aim was to translate these findings into the initial developmental stages of an instrument targeting critical areas of police officers’ lifestyles to foster health sustainability.Method: The thesis includes four studies. In Study I, a method for scoping reviews was used when gathering data from previously conducted studies within Europe. Studies II and III were qualitative studies using in-depth interviews. In Study II a reflexive thematic analysis was used, whereas in Study III qualitative content analysis was utilized. Study IV builds on data from the other studies. During the early development process of the instrument focus groups, cognitive interviewing methods and a content validity approach were undertaken.Findings: Altogether, the findings offer insights into how police officers’ lifecontexts, roles and everyday activities transact to become their unique lifestyles. In Study I the life contexts affecting police officers’ lives and health were mapped. It was concluded that research on police officers’ private lives is limited in Europe, despite contextual and environmental influences on their lives and health. In Studies II and III it was found that balancing work with private-life activities and roles included health challenges and resources. The findings relate to balancing risk and violence with vigilance in private life, societal attitudes with the police identity, work with healthy routines and habits, and unpredictability with stability. Study IV took initial steps towards crafting a self-reflection instrument targeting the essential conditions for living a sustainable and healthy lifestyle asa police officer.Conclusion: This thesis illuminates the complex interplay of factors that definethe unique lifestyles of police officers, influenced by their life contexts, roles, and everyday activities. It highlights the importance of both organizational strategies and police officers utilizing health-promoting strategies in maintaining asustainable lifestyle essential for fostering health sustainability. In the context of societal challenges and the need for a strong police force, maintaining police officers’ health sustainability is crucial for the benefit of both the Police Authority and society.
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| 7. |
- Hansson, Jonas, 1971-
(författare)
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Mind the blues : Swedish police officers' mental health and forced deportation of unaccompanied refugee children
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Policing is a public health issue. The police often encounter vulnerable populations. Police officers have wide discretionary powers, which could impact on how they support vulnerable populations. In encountering vulnerable populations the police officers are required to be professional; maintaining mental health in the face of challenges is part of professionalism. Their encounters with vulnerable populations might influence their mental health which in turn might influence the way they use their discretion when making decisions.Background/context: Sweden receives more unaccompanied, asylum-seeking refugee children than any other country in Europe. The number of asylum applications for such children increased from 400 in 2004 to 7000 in 2014 to over 35,000 in 2015. These children come to Sweden and apply for asylum without being under the care of their parents or other legal guardian. Some are denied asylum. If they do not return to their country of origin voluntarily the police are responsible for their deportation. The Swedish government wants an increasing number of deportations and wants them carried out with dignity. This thesis is about the police officers’ perceptions of how to interpret the seemingly contradictory demands for more deportations, that is, efficiency; and concerns for human rights during the deportation process, that is, dignity. This is conceptualized using three theoretical frameworks: a) street-level bureaucracy, b) job demand-control-social support model and c) coping. These theoretical frameworks indicate the complexity of the issue and function as constructions by means of which understanding can be brought to the police officers’ perceptions of deportation work involving unaccompanied, asylum-seeking refugee children and how such work is associated to their mental health.Aim: The current research aims to investigate and analyse Swedish police officers’ mental health in the context of deportations of unaccompanied, asylum-seeking refugee children.Methods: This thesis uses both qualitative and quantitative methodology. The qualitative approach comprised interviews conducted to achieve a deeper understanding of the phenomenon of police officers’ perceptions of deportations of unaccompanied, asylum-seeking refugee children. The quantitative method involved the use of validated questionnaires to investigate the association between police officers’ mental health and psychosocial job characteristics and coping. This approach made it possible to study a complex issue in a complex environment and to present relevant recommendations. A total of 14 border police officers were interviewed and 714 police officers responded to a survey.Results: The police officers utilize their wide discretionary powers and perceive that they are doing what is best in the situation, trying to listen to the child and to be aware of the child’s needs. Police officers with experience of deportations of unaccompanied, asylum-seeking refugee children were not found to have poorer mental health than police officers with no such experience. Furthermore, high job demand, low decision latitude, low levels of work-related social support, shift work and being single are associated with poor mental health. Coping moderates the association between mental health and the experience of carrying out deportations of unaccompanied, asylum-seeking, refugee children, and the police officers seem to utilize both emotional and problem-solving coping during the same complex deportation process.Implications / conclusions: The general conclusion reached in this thesis is that if police officers are subject to reasonable demands, have high decision latitude, access to work-related social support, and utilize adaptable coping, the deportation work does not seem to affect their mental health. When police officers meet vulnerable people, they utilize their discretionary powers to deal with seemingly contradictory demands, that is, efficiency and dignity. The executive role in the deportations of unaccompanied, asylum-seeking refugee children and the awareness of dealing with a child threatened with deportation might give rise to activation of a sense of protection, safety and security. Discretion might make it possible to act on this sense of protection, safety and security and to combine efficiency and dignity. Further studies, which integrate cognitive and emotional discretion with coping, need to be undertaken.
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| 8. |
- Holmquist, Sofie, 1987-
(författare)
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Analyzing self-report data : assessing basic psychological needs in education and at work
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aims of this thesis were 1) to investigate how to measure and model basic psychological needs in higher education and work contexts, specifically in Swedish-speaking populations, and 2) to analyze the psychometric properties of basic psychological needs self-report instruments.The thesis consists of four studies and a summary. The main concepts studied were the basic psychological needs for autonomy, competence, and relatedness, as conceptualized in the Self- Determination Theory (SDT).The first study identified subgroups of early career psychologists characterized by their ratings on self- efficacy, psychological flexibility, and basic psychological need satisfaction. The results show that the groups differed in self-rated health, well-being, and intention to leave their profession. Higher basic psychological need satisfaction, self-efficacy, and psychological flexibility were associated with better self-rated health and well-being.The second study was an extensive psychometric evaluation of the need satisfaction and frustration scale (NSFS) in a large sample of Swedish workers. The analyses supported measurement invariance longitudinally and for gender, as well as the nomological validity of the scale. The dimensionality analyses supported a six-dimensional structure of the NSFS that takes small cross-loadings into account in an exploratory structural equation modeling representation. However, poor discrimination between need satisfaction and need frustration was present for some items.The third study translated a revised Swedish version of the NSFS, adapted to the educational domain, and validated it in a sample of Swedish university students. Dimensionality analyses supported using the NSFS as a three-dimensional measure of students' need for autonomy, need for competence, and need for relatedness. In support of nomological validity, each need uniquely contributed to predicting perceived stress and academic burnout. However, unexpectedly, autonomy did not provide incremental value beyond competence and relatedness in predicting life satisfaction and academic engagement.The fourth study translated and adapted the basic psychological need satisfaction and frustration scale (BPNSFS) to Swedish and the educational domain (BPNSFS-ED). This study also investigated the coherence between the BPNSFS-ED and the NSFS. Factor analyses showed support for using the scale as a six- dimensional measure of students' needs satisfaction and need frustration. The coherence between the BPNSFS-ED and the NSFS was moderate, and the BPNSFS-ED appears to be a more SDT coherent measure of students’ basic psychological needs.The main contribution of this thesis was providing researchers with a validated self-report instrument to assess basic psychological needs in Swedish education. The results also highlight challenges with measuring and modeling basic psychological needs and question whether items from well-used basic needs self-rating scales properly tap into the concept of need frustration. Finally, the results show that the need for autonomy seems to differ between basic psychological needs instruments which calls for mindfulness when choosing an instrument to measure basic psychological needs, and when comparing results across studies. Based on the results of this thesis, the BPNSFS-ED self-report instrument appears to be a good choice for researchers interested in assessing basic psychological needs in Swedish education.
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| 9. |
- Sundqvist, Johanna, 1978-
(författare)
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Forced repatriation of unaccompanied asylum-seeking refugee children : towards an interagency model
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Not all children seeking asylum without parents or other relatives are entitled to residence permits. In the last few years, more than one in four unaccompanied asylum-seeking refugee children have been forced to repatriate, either to their home country or to a transit country. Mostly the children refuse to leave the country voluntarily, and it becomes a forced repatriation. Five actors collaborate in the Swedish child forced repatriation process: social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. When a child is forced to repatriate, the Swedish workers involved must consider two different demands. The first demand requires dignified repatriation, which is incorporated from the European Union’s (EU’s) Return Directive into Swedish Aliens Act. The second demand requires that the repatriation process be conducted efficiently, which means that a higher number of repatriation cases must be processed. The fact that the same professionals have different and seemingly contradictory requirements places high demands on the involved collaborators. Two professionals have a legal responsibility for the children until the last minute before they leave Sweden: social workers and police officers. That makes them key actors in forced repatriation, as they carry most of the responsibility in the process. Further, they often work with children who are afraid what will happen when they return to their home country and often express their fear through powerful emotions. Being responsible and obliged to carry out the government’s decision, despite forcing children to leave a safe country, may evoke negative emotional and mental stress for the professionals involved in forced repatriation. Aim The overall aim of this study is to explore and analyse forced repatriation workers’ collaboration and perceived mental health, with special focus on social workers and police officers in the Swedish context.Materials and methods The study combines a qualitative and quantitative research design in order to shed light at both a deep and general level on forced repatriation. In qualitative substudy I, a qualitative case study methodology was used in one municipality in a middle-sized city in Sweden. The municipality had a contract regarding the reception of unaccompanied asylum-seeking refugee children iv with the Swedish Migration Board. The municipality in focus has a population of more than 100,000 inhabitants. The city in which the data were collected has developed a refugee reception system where unaccompanied asylumseeking refugee children are resettled and await a final decision regarding their permit applications. This situation made it possible to recruit participants who had worked with unaccompanied refugee children without a permit. Semi-structured interviews were conducted with a total of 20 social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. A thematic approach was used to analyse the data. In quantitative substudies II, III and IV, a national survey of social workers (n = 380) and police officers (n = 714), with and without experience of forced repatriation, was conducted. The questionnaires included sociodemographic characteristics, the Swedish Demand-Control Questionnaire, Interview Schedule for Social Interaction, Ways of Coping Questionnaire and the 12- item General Mental Health Questionnaire. Factor analysis, correlational analysis, and univariate and multivariable regression models were used to analyse the data.Results The qualitative results in substudy I showed low levels of collaboration among the actors (social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians) and the use of different strategies to manage their work tasks. Some of them used a teamwork pattern, showing an understanding of the different roles in forced repatriation, and were willing to compromise for the sake of collaboration. Others tended to isolate themselves from interaction and acted on the basis of personal preference, and some tended to behave sensitively, withdraw and become passive observers rather than active partners in the forced repatriation. The quantitative results in substudy II showed that poorer mental health was associated with working with unaccompanied asylum-seeking refugee children among social workers but not among police officers. Psychological job demand was a significant predictor for mental health among social workers, while psychological job demand, decision latitude and marital status were predictors among police officers. Substudy III showed that both social workers and police officers reported relatively high access to social support. Furthermore, police officers working in forced repatriation with low levels of satisfaction with social interaction and close emotional support increased the odds of psychological disturbances. In substudy IV, social workers used more escape avoidance, distancing and positive-reappraisal coping, whereas police officers used more planful problem solving and self-controlling coping. Additionally, social workers with experience in forced repatriation used more planful problem solving than those without experience.Conclusions In order to create the most dignified forced repatriation, based on human dignity, for unaccompanied asylum-seeking refugee children and with healthy actors, a forced repatriation system needs: overall statutory national guidance, interagency collaboration, actors working within a teamworking pattern, forced repatriation workers with reasonable job demands and decision latitude, with a high level of social support and adaptive coping strategies. The point of departure for an interagency model is that it is impossible to change the circumstances of the asylum process, but it is possible to make the system more functional and better adapted to both the children’s needs and those of the professionals who are set to handle the children. A centre for unaccompanied asylum-seeking refugee children, consisting of all actors involved in the children’s asylum process sitting under the same roof, at the governmental level (Swedish Migration Board, the police authority) and municipality level (social services, board of legal guardians), can meet all requirements.
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| 10. |
- Forouzan, Ameneh Setareh, 1967-
(författare)
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Assessing responsiveness in the mental health care system : the case of Tehran
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Understanding health service user perceptions of the quality of care is critical to developing measures to increase the utilisation of healthcare services. To relate patient experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This measures what happens during user’s interactions with the system, using a common scale, and requires that the user has had a specified encounter, which they evaluate. The concept of responsiveness has only been used in a very few studies previously to evaluate healthcare sub-systems, such as mental healthcare. Since the concept of responsiveness had not been previously applied to a middle income country, such as Iran, there is a need to investigate its applicability and to develop a valid instrument for evaluating health system performance. The aim of this study is to assess the responsiveness of the mental healthcare system in Tehran, the capital of Iran, in accordance with the WHO responsiveness concept.Methods: This thesis is a health system research, based on qualitative and quantitative methods. During the qualitative phase of the study, six focus group discussions were carried out in Tehran, from June to August 2010. In total, 74 participants, comprising 21 health providers and 53 users of the mental healthcare system, were interviewed. Interviews were analysed through content analysis. The coding was synchronised between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility. Responses were examined in relation to the eight domains of the WHO’s responsiveness model.In accordance with the WHO health system responsiveness questionnaire and the findings of the qualitative studies, a Farsi version of the Mental Health System Responsiveness Questionnaire (MHSRQ) was tailored to suit the mental healthcare system in Iran. This version was tested in a cross-sectional study at nine public mental health clinics in Tehran. A sample of 500 mental health services patients was recruited and subsequently completed the questionnaire. The item missing rate was used to check the feasibility, while the reliability of the scale was determined by assessing the Cronbach’s alpha and item total correlations. The factor structure of the questionnaire was investigated by performing confirmatory factor analysis (CFA).To assess how the domains of responsiveness were performing in the mental healthcare system, I used the data collected during the second phase of the study. Utilising the same method used by the WHO for its responsiveness survey, we evaluated the responsiveness of outpatient mental healthcare, using a validated Farsi questionnaire.Results: There were many commonalities between the findings of my study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from my findings. In addition, the domain of prompt attention was included in two newly labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity, and confidentiality were considered important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however.The results of the qualitative study were used to tailor a Farsi version of the MHSRQ. A satisfactory feasibility, as the item missing value was lower than 5.2%, was found. With the exception of the access domain, the reliability of the different domains in the questionnaire was within a desirable range. The factor loading showed an acceptable uni-dimensionality of the scale, despite the fact that the three items related to access did not perform well. The CFA also indicated good fit indices for the model (CFI = 0.99, GFI = 0.97, IFI = 0.99, AGFI = 0.97).The results of the mental healthcare system responsiveness survey showed that, on average, 47% of participants reported experiencing poor responsiveness. Among the responsiveness domains, confidentiality and dignity were the best performing factors, while autonomy, access to care and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Autonomy, quality of basic amenities and clear communication were dimensions that performed poorly but were considered to be highly important by the study participants.Conclusion and implications: This is the first time that mental healthcare system responsiveness has been measured in Iran. Our results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in this country. Dignity and confidentiality were domains which performed well, while the domains of autonomy, quality of basic amenities and access performed poorly. Any improvement in these poorly performing domains is dependent on resources. In addition, attention and access to care, which were rated high in importance and poor in performance, should be priority areas for intervention and the reengineering of referral systems and admission processes. The role of subjective social status in responsiveness should be further studied. These findings might help policymakers to better understand what is required for the improvement of mental health services.
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