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- Haraldsson, Johanna, et al.
(författare)
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Confidentiality matters! Adolescent males’ views of primary care in relation to psychosocial health : a structural equation modelling approach
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 40:4, s. 438-449
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters.Design: Cross-sectional.Setting: School-based census on life, health and primary care in Region Sörmland, Sweden.Subjects: 2,358 males aged 15–17 years (response rate 84%).Main outcome measures: The impact of poor mental health and HCBs on adolescent males’ valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling.Results: Almost all respondents valued confidentiality regardless of their mental health or whetherthey engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receivinga secrecy explanation. Among those who had visited a GP in the past year (n¼1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26;p¼0.005) and to be comfortable asking about sex than their peers (appOR 1.22;p¼0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25–1.54;p0.010).Conclusion: Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offerprivate time and explain professional secrecy.KEY POINTSConfidentiality for adolescent males has been scantily studied in relation to mental healthand health-compromising behaviours.In this study, most adolescent males valued confidentiality, regardless of their mental healthand health-compromising behaviours.Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care.When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions.
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| 4. |
- Johnsson, Linus, 1978-, et al.
(författare)
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Autonomy is a Right, Not a Feat : How Theoretical Misconceptions have Muddled the Debate on Dynamic Consent to Biobank Research
- 2016
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Ingår i: Bioethics. - : Wiley. - 0269-9702 .- 1467-8519. ; 30:7, s. 471-478
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Tidskriftsartikel (refereegranskat)abstract
- Should people be involved as active participants in longitudinal medical research, as opposed to remaining passive providers of data and material? We argue in this article that misconceptions of 'autonomy' as a kind of feat rather than a right are to blame for much of the confusion surrounding the debate of dynamic versus broad consent. Keeping in mind two foundational facts of human life, freedom and dignity, we elaborate three moral principles - those of autonomy, integrity and authority - to better see what is at stake. Respect for autonomy is to recognize the other's right to decide in matters that are important to them. Respect for integrity is to meet, in one's relationship with the other, their need to navigate the intersection between private and social life. Respect for authority is to empower the other - to help them to cultivate their responsibility as citizens. On our account, to force information onto someone who does not want it is not to respect that person's autonomy, but to violate integrity in the name of empowerment. Empowerment, not respect for autonomy, is the aim that sets patient-centred initiatives employing a dynamic consent model apart from other consent models. Whether this is ultimately morally justified depends on whether empowerment ought to be a goal of medical research, which is questionable.
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| 5. |
- Johnsson, Linus, 1978-, et al.
(författare)
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How general practitioners decide on maxims of action in response to demands from conflicting sets of norms : a grounded theory study
- 2019
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Ingår i: BMC Medical Ethics. - : Springer Science and Business Media LLC. - 1472-6939. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: The work of general practitioners (GPs) is infused by norms from several movements, of which evidence based medicine, patient-centredness, and virtue ethics are some of the most influential. Their precepts are not clearly reconcilable, and structural factors may limit their application. In this paper, we develop a conceptual framework that explains how GPs respond, across different fields of interaction in their daily work, to the pressure exerted by divergent norms.Methods: Data was generated from unstructured interviews with and observations of sixteen Swedish GPs (who have by definition more than five years of experience after license to practice) and family medicine residents (with less than five years of experience) between 2015 and 2017. Straussian Grounded Theory was used for analysis.Results: We found that GPs’ maxims of action can be characterised in terms of dichotomous responses to demands from four distinct sets of norms, or “voices”: the situation, the self, the system, and the profession. From the interactions between these voices emerge sixteen clusters of maxims of action. Based on the common features of the maxims in each cluster, we have developed a conceptual framework that appears to be rich enough to capture the meaning of the ethical decisions that GPs make in their daily work, yet has a high enough level of abstraction to be helpful when discussing the factors that influence those decisions.Conclusions: Our four-dimensional model of GPs' responses to norms is a first step toward a middle-range theory of quality from GPs' perspective. It brings out the complexity of their practice, reveals tensions that easily remain invisible in more concrete accounts of their actions, and aids the transferability of substantive theories on GPs' ethical decision making. By explaining the nature of the ethical conflicts that they experience, we provide some clues as to why efforts to improve quality by imposing additional norms on GPs may meet with varying degrees of success.
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| 6. |
- Johnsson, Linus, 1978-, et al.
(författare)
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Hypothetical and factual willingness to participate in biobank research
- 2010
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Ingår i: European Journal of Human Genetics. - : Nature Publishing Group. - 1018-4813 .- 1476-5438. ; 18, s. 1261-1264
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Tidskriftsartikel (refereegranskat)abstract
- In the debate on biobank regulation, arguments often draw upon findings in surveys on public attitudes. However, surveys on willingness to participate in research may not always predict actual participation rates. We compared hypothetical willingness as estimated in 11 surveys conducted in Sweden, Iceland, United Kingdom, Ireland, United States and Singapore to factual participation rates in 12 biobank studies. Studies were matched by country and approximate time frame. Of 22 pairwise comparisons, 12 suggest that factual willingness to participate in biobank research is greater than hypothetical, six indicate the converse relationship, and four are inconclusive. Factual donors, in particular when recruited in health care or otherwise face-to-face with the researcher, are possibly motivated by factors that are less influential in a hypothetical context, such as altruism, trust, and sense of duty. The value of surveys in assessing factual willingness may thus be limited.
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- JOHNSSON, LINUS, 1978-, et al.
(författare)
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Making researchers moral : Why institutionalised distrust might not work
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Research ethics, once a platform for declaring intent, discussing moral issues and providing advice and guidance to researchers, has developed over time into an extra-legal regulatory system, complete with steering documents, overseeing bodies, and formal procedures. The process of institutionalising distrust is usually motivated by reference to past atrocities committed in the name of research and the need to secure public trust. This paper examines some limitations of this approach. First, past atrocities cannot provide the necessary justification unless institutionalised distrust is a necessary or efficient means to prevent future ones; and there are several reasons to doubt that this is the case. Second, the efficacy of ethics review in safeguarding morally acceptable research depends on the moral competence and integrity of individual researchers—the kinds of qualities that institutionalised distrust calls into question. Third, ethics guidelines cannot, as it is sometimes assumed, educate or guide researchers to moral behaviour unless they already have considerable capacity for moral judgment. Fourth, institutionalised distrust is a potential threat to the moral competence and integrity of researchers by encouraging a blinkered view of ethical issues, inducing moral heteronomy through incentives, and alienating them to research ethics as a pursuable activity. We conclude that the moral problem posed by inappropriate short-term behaviour on behalf of researchers is dwarfed by the potential long-term consequences of allowing their moral competence to deteriorate. Measures must therefore be taken to ensure that researchers are equipped to take their individual responsibility and not obstructed from doing so.
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| 8. |
- Johnsson, Linus, 1978-, et al.
(författare)
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Making researchers moral : Why trustworthiness requires more than ethics guidelines and review
- 2014
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Ingår i: Research Ethics. - : SAGE Publications. - 1747-0161 .- 2047-6094. ; 10:1, s. 29-46
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Tidskriftsartikel (refereegranskat)abstract
- Research ethics, once a platform for declaring intent, discussing moral issues and providing advice and guidance to researchers, has developed over time into an extra-legal regulatory system, complete with steering documents (ethics guidelines), overseeing bodies (research ethics committees) and formal procedures (informed consent). The process of institutionalizing distrust is usually motivated by reference to past atrocities committed in the name of research and the need to secure the trustworthiness of the research system. This article examines some limitations of this approach. First, past atrocities cannot provide the necessary justification unless institutionalized distrust is a necessary or efficient means to prevent future ones – and there are several reasons to doubt this. Second, the efficacy of ethics review in safeguarding morally acceptable research depends on the moral competence and integrity of individual researchers – the very qualities that institutionalized distrust calls into question. Third, ethics guidelines cannot, as is sometimes assumed, educate or guide researchers in moral behaviour unless they already possess considerable capacity for moral judgment. Fourth, institutionalized distrust is a potential threat to the moral competence and integrity of researchers by encouraging a blinkered view of ethical issues, inducing moral heteronomy through incentives, and alienating them to research ethics. We conclude that the moral problem posed by inappropriate short-term behaviour on behalf of researchers is dwarfed by the potential long-term consequences if their moral competence is allowed to deteriorate. Measures must therefore be taken to ensure that researchers are equipped to take their individual responsibility and are not obstructed from so doing.
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| 9. |
- Johnsson, Linus, 1978-
(författare)
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Multidimensional Property Supplementation : A Method for Discovering and Describing Emergent Qualities of Concepts in Grounded Theory Research
- 2021
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 31:1, s. 184-200
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Tidskriftsartikel (refereegranskat)abstract
- Multidimensional property supplementation is a grounded theory method for analysis that conceives of concepts as multidimensional spaces of possibilities. It is applied in an iterative process comprising four steps: expansion, whereby vague codes are split and contraries postulated; abstraction of practically significant differences in terms of properties and dimensions; geometrization of properties to create conceptual subspaces that supplant subcategories and have additional, emergent qualities; and unification of the concept by validating it against data and relieving it of properties that do not tie in sufficiently with other concepts. Multidimensional conceptual models encourage the researcher to elaborate properties that explain, predict, or guide action. Fully developed, they can be easily connected to others in a process and function, by virtue of their emergent qualities, as falsifiable hypotheses in their own right. For these reasons, multidimensional property supplementation is open to epistemological justification without presuming acceptance of techniques specific to grounded theory.
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| 10. |
- Johnsson, Linus, 1978-, et al.
(författare)
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The voice of the profession : how the ethical demand is professionally refracted in the work of general practitioners
- 2023
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Ingår i: BMC Medical Ethics. - : BioMed Central (BMC). - 1472-6939. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Among the myriad voices advocating diverging ideas of what general practice ought to be, none seem to adequately capture its ethical core. There is a paucity of attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we present an empirically grounded model of the professional morality of GPs, and discuss its implications in relation to ethical theories to see whether it might be sustainable as a general practice ethic.METHODS: We observed and interviewed sixteen GPs and GP residents working in health care centres in four Swedish regions between 2015-2017. In keeping with Straussian Grounded Theory, sampling was initially purposeful and later theoretically guided, and data generation, analysis and theoretical integration proceeded in parallel. The focal concept of this article was refined through multidimensional property supplementation.RESULTS: The voice of the profession is one of four concepts in our emerging theory that attempt to capture various motives that affect GPs' everyday moral decisionmaking. It reflects how GPs appreciate the situation by passing three professional-moral judgments: Shall I see what is before me, or take a bird's-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? By thus framing the problem, the GP narrows down the range of considerations, allowing them to focus on its morally most pertinent aspects. This process is best understood as a way of heeding Løgstrup's ethical demand. Refracted through the lens of the GP's professional understanding of life, the ethical demand gives rise to specific moral imperatives that may stand in opposition to the express wishes of the other, social norms, or the GP's self-interest.CONCLUSIONS: The voice of the profession makes sense of how GPs frame problematic situations in moral terms. It is coherent enough to be sustainable as a general practice ethic, and might be helpful in explaining why ethical decisions that GPs intuitively understand as justified, but for which social support is lacking, can nevertheless be legitimate.
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