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- Hansson, Anna
(författare)
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Subjective Well-being in an Adult Swedish Population : Findings from a Population-based Study
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis examines various factors associated with subjective well-being (SWB) in an adult Swedish population, aged 20-64 years, using cross-sectional and longitudinal data. The thesis includes four studies based on the PART study, a current population-based study on mental health, work, and relations in Stockholm County, Sweden. Research has shown that there is a relationship between mental health problems such as depression and low well-being. It is therefore of great interest to investigate various factors associated with SWB in order to promote or increase mental health. We also examined if the well-being scale used in all studies could be used as a screening instrument for depression.The specific aim of Study I was to examine if age, gender, foreign background (i.e. not born in Sweden), cohabitation, education, financial strain, social support, childhood conditions and negative life events and their associations with SWB could be replicated in our data. In Study II we investigated strategies people chose to employ in order to improve or maintain their well-being and whether these were associated with SWB. Study III examined if changes in cohabiting, social support or the financial situation influenced SWB, after controlling for neuroticism at a 3-year follow-up. The change in the study sample’s SWB was also studied during the same time period. In Study IV the aim was to investigate whether the well-being scale, the (WHO) Ten Well-being index, could be used as a screening instrument for depression.Results from Study I showed that men had higher SWB than women, and that positive childhood conditions, cohabiting, greater age, sound financial situation, absence of negative life events, and support from friends were all positively associated with SWB. Social support had the strongest relationship. Together, these factors explained 20 % of the variance in SWB and the findings replicated earlier research. The strategies reported in Study II were physical exercise, physical health,engaging in pleasurable activities, relaxation, plan/set limits, social support, professional contacts, positive thinking, and work. Of these, social support, relaxation, physical exercise and physical health were associated with higher SWB. Social support showed the strongest association. In Study III changes in financial situation, social support, or cohabiting influenced SWB after controlling for neuroticism. The results also suggested that SWB was relatively stable over a period of three years. Preliminary findings from Study IV indicate that the (WHO) Ten Well-being index can work as a screening instrument for depression in populationbased samples.In summary, the findings suggest that demographics and psychosocial factors explain only a small part of the variance in SWB, replicating previous data. Certain self-care strategies are positively associated with SWB. In addition, changes in life circumstances influence SWB, even after controlling for neuroticism over a period of three years despite the stability of SWB. Furthermore, the preliminary findings indicate that the well-being scale can work as a screening instrument for depression in a population-based sample. The overall conclusion from the results of this thesis suggests that it is important for the health care services to be aware that negative life events/circumstances may affect people’s SWB over several years. Furthermore, selfhelp interventions might be important in order to maintain or increase SWB.
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| 2. |
- Göransson, Carina, 1967-
(författare)
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Developing and evaluating an interactive app to support self-care among older persons receiving home care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The proportion of older persons worldwide is growing. With older age, complex health problems may occur and the need for home care increases. To support older persons to maintain health and self-care, innovative ways need to be developed. The aim of the project was to develop and evaluate an interactive app among older persons receiving home care. The project had several phases: i) to define and understand the problem ii) develop the intervention iii) develop and optimise evaluation. Qualitative and quantitative methods were employed. Data were collected through a scoping review, interviews with healthcare experts, older persons and nursing assistants (study I); interviews with older persons (studies II, III); focus groups with homecare nurses (study II). Questionnaires at baseline, end of intervention and 6-month follow-up; with instruments to assess aspects of health, health literacy, self-care, and a study specific question regarding sense of security were used (studies III-IV). Logged data from reported health concerns, alerts, and notes were collected (study IV). Data were analysed using qualitative content analysis (study I), thematic analysis (study II), qualitative content analysis with directed approach (study III) and descriptive and inferential statistics (studies III, IV). Results: Important aspects for health and self-care from the older persons’ perspectives were described as: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care (I). These results were included in the app as questions with self-care advice, graphs and alerts to homecare nurses. The app use was described as an enabler for learning (II). The older persons showed improved communicative and critical health literacy at the 6- month follow-up (IV). They described an increased sense of security (II and III), which decreased at the 6-month follow-up (III). They expressed increased self-confidence (II) and support in self-care, but reported a decrease in self-care ability at the 6-month follow-up (III). App usage was high, with the health concern pain triggering the most alerts (IV). Their aspects of health were unchanged at the three assessments points (IV). In this context using an app may increase older persons’ participation in their care. The results show that for some older persons, an app can be implemented as a tool for support in conventional home care.
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| 3. |
- Johansson-Pajala, Rose-Marie
(författare)
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Pharmacovigilance in municipal elderly care : From a nursing perspective
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Medication management constitutes a large part of registered nurses' (RNs) daily work in municipal elderly care. They are responsible for monitoring multimorbid older persons with extensive treatments, and they often work alone, without daily access to physicians. RNs’ drug monitoring is, in this thesis, based on the concept of pharmacovigilance. Pharmacovigilance is about the science and the activities that aim to improve patient care and safety in drug use, that is, to detect, assess, understand and prevent drug-related problems.The overall aim was to explore conditions for pharmacovigilance from a nursing perspective, focusing on implications of RNs’ competence and use of a computerized decision support system (CDSS). Both quantitative and qualitative research methods were used, including a questionnaire (I), focus group discussions (II), individual interviews (III) and an intervention study (IV). In total 216 RNs and 54 older persons participated from 13 special accommodations, located in three different regions.RNs who had completed further training in pharmacovigilance rated their medication competence higher than those who had not. However, there was no difference between groups in the number of pharmacovigilant activities they performed in clinical practice (I). The RNs appeared to act as “vigilant intermediaries” in drug treatment. They depended on the nursing staff's observations of drug-related problems. The RNs continuously controlled the work of staff and physicians, and attempted to compensate for shortcomings in competence, accessibility and continuity (II). RNs’ use of a CDSS was found to affect drug monitoring, including aspects of time, responsibility, standardization of the work, as well as access to knowledge and opportunities for evidence-based care (III). The CDSS detected significantly more drug-related problems when conducting medication reviews, than the RNs did. Nevertheless, this did not result in any significant improvement in the quality of drug use in the follow up, three and six months later (IV).This thesis contributes to the recognition of pharmacovigilance from a nursing perspective. Increased medication competence seems to be insufficient to generate pharmacovigilant activities. RNs depend on other health care professionals and organizational conditions in order to perform their work. A CDSS has the potential to support RNs, both in structured medication reviews and in daily clinical practice. Inter-professional collaboration is crucial, with or without a CDSS, and the entire team needs to be aware of and take responsibility. Other important conditions is the existence of well-functioning communication channels, competence across the team, and established procedures based on current guidelines.
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| 4. |
- Westerbotn, Margareta
(författare)
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Drug Use Among the Very Old Living in Ordinary Households : Aspects on Well-being, Cognitive and Functional Ability
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Sweden today a major proportion of the population survive to old ages. To a large extent, the oldest old are capable of living longer in their own households; some of them are very healthy while others have multiple diagnoses or ailments caused by a normal ageing process. This means that many elderly persons receive their health care needs in their own home, and in the future this will be even more common. Drug use of the elderly is a complex field, and many drugs have side effects complicating the medical treatment and decreasing the quality of life. Aim: This thesis aims to explore and describe the medicine use and the medical situation of very old persons (¡Ý84 years) living in ordinary households, and to obtain knowledge of their views on the use of drugs.Methods: This thesis combines quantitative and qualitative research methods. The quantitative studies (Study I, II and III) were based on data from the Kungsholmen Project, a population based study of elderly people living in a district of the inner city of Stockholm, Sweden. Data collection of the present studies was carried out from the third follow-up 1997-1998. The qualitative data (Study IV) was obtained 2005 through in-depth interviews with 25 elderly men and women, aged 85-97 years, living in ordinary households in Stockholm, Sweden. A pre-tested semi-structured questionnaire was used for the interviews.Results: The findings in Study I demonstrated that cardiovascular diseases are very frequent in this population (62%). Heart failure (47%) and hypertension (37%) were the most common conditions; and diuretics (69%), nitrates (31%) and cardiac glycosides (30%) were the most commonly prescribed drugs. Multivariate regression analyses showed that while being affected by a CV disease did not affect the emotional well-being of the participants (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of cardiac glycosides (p=0.006) and nitrates (p=0.008) was associated with increased negative feelings. Study II revealed that 88% of the population took medicines on a regular basis, and only 23% of them received help with the handling of their medicines. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female gender (OR: 2.8; 95% CI: 1.2-6.5) was the only variable associated with regular use of medicines. The results also showed that older age and functional disability as measured by ADL, increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. Using multiple regression models, we found that the only factor related to not receiving help from a family member was that of living alone (OR:0.05; 95% CI: 0.006-0.4). Study III showed that the prevalence of pain among very old persons was 46%, and the prevalence of pain treatment was 71%. Results from logistic regression analysis using all variables in the model indicated that pain reporting was not associated with age, gender or living conditions, but decreased with decreasing cognitive status and with increasing functional disability. Furthermore, pain treatment was not associated with age, gender, living conditions, cognitive and functional status. The qualitative data in Study IV indicated that most of the participants managed their medicines by themselves and were very content with this. Those elderly who received help with their medicines were also very pleased with this help. The findings also revealed that the most important components for the elderly to be able to remain living in their homes and to handle their medicines by themselves, were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back-up.Conclusions: This study revealed that a large proportion of very old people (¡Ý84 years) were living in ordinary households and used medicines regularly. Being a woman and living alone were associated with receiving help with medicines from the community help services. Cognitive and functional ability were revealed to be significant factors in the management of medicines, but also to affect the pain reporting, and type of received pain treatment. Most of the older participants managed to handle their medicines by themselves, and were very pleased by doing this. However, most of them were concerned about the risk of losing their memory, as they are getting older, because they knew that they would not be able to manage themselves any more and therefore would have to move to an institution.
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