| 1. |
- Johansson, Yvonne A., 1956-
(författare)
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Delirium hos äldre patienter som vårdas på sjukhus : identifiering av symtom, tecken och riskfaktorer samt journalförda vårdåtgärder
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I samband med sjukhusvård kan äldre patienter riskera försämrad hälsa, inklusive delirium. Delirium, som är vanligt hos äldre patienter på sjukhus, är ett akut och allvarligt tillstånd med svåra konsekvenser för såväl patienten som för närstående, vårdpersonal och hälso- och sjukvård. Det är viktigt att delirium förebyggs, identifieras och behandlas. Forskning visar dock på brister i vården, vilket kan påverka patienternas hälsa och välbefinnande negativt. Det övergripande syftet med avhandlingen var att identifiera och beskriva symtom, tecken, riskfaktorer och vårdåtgärder vid delirium hos äldre patienter som vårdas på sjukhus samt att utvärdera tillämpbarheten av ett bedömningsinstrument för att identifiera delirium. Alla deltagande patienter var 65 år och äldre och rekryterades från ett länssjukhus (I-IV) och ett universitetssjukhus (III, IV). Dessutom ingick de bedömare som bedömt delirium med bedömningsinstrumentet 4AT i delarbete IV. Delarbetena bestod av en kvantitativ subgruppsanalys (n=25) av en punktprevalensstudie (n=210), en retrospektiv journalgranskning (n=78) med kvalitativ analys och två tvärsnittsstudier baserade på samma urval (n=200) med kvantitativa (III, IV) och kvalitativa analyser (IV). Data samlades in genom strukturerade intervjuer, validerade instrument, patientjournaler, frågeformulär och en öppen intervjufråga.Patienterna rapporterade svåra och besvärande symtom vilka hade journalförts i begränsad omfattning (14%). Även kognitiv funktionsnedsättning och patienternas beskrivningar av sitt välbefinnande hade journalförts i liten utsträckning. Patienternas tecken på delirium ledde till nedsatt förmåga att såväl delta i sin egen vård som att undvika skada. Vårdpersonalen svarade delvis på patienternas tecken på delirium då åtgärderna kunde vara både anpassade, bristfälliga och utöver vanlig vård. Skörhet var den starkaste riskfaktorn för delirium. Andelen patienter med delirium ökade med svårighetsgraden av skörhet. Den svenska versionen av bedömningsinstrumentet 4AT för att identifiera delirium hade diagnostisk precision och klinisk användbarhet med hög interbedömarreliabilitet. Bedömningsinstrumentet 4AT tolererades väl av patienterna, var lätt att använda och tog några minuter att genomföra. Detta innebär att det nu finns ett enkelt bedömningsinstrument för delirium på svenska som kan användas för att bedöma delirium hos äldre patienter som vårdas på sjukhus.Endast en mindre del av den studerade vården kan ses som personcentrerad och patientsäker. Struktur, systematik och ett helhetsperspektiv tycktes saknas, liksom ett personcentrerat förhållnings- och arbetssätt. För att minska incidensen av delirium, lidande och kostnader behöver vården förbättras. Det finns behov av att öka kunskapen om delirium och att se delirium som en vårdskada inom all vård. Vidare finns behov av att utveckla vården genom att tydligt integrera ett personcentrerat och patientsäkert förhållnings- och arbetssätt för att nå en helhetssyn på patienten. Målet är att främja hälsa och välbefinnande genom att förebygga delirium. För att möjliggöra identifiering av individuella vårdbehov är det en förutsättning att etablera en tillitsfull vårdrelation med den äldre patienten, där patientens perspektiv tillvaratas. Individuella vårdbehov behöver identifieras strukturerat och systematiskt genom bedömning med bedömningsinstrument av symtom, tecken, välbefinnande, delirium och riskfaktorer för delirium innefattande skörhet samt kognitiv funktionsnedsättning. Detta möjliggör individuellt anpassade vårdåtgärder.Ett individuellt anpassat omhändertagande som överensstämmer med ett integrerat personcentrerat och patientsäkert förhållnings- och arbetssätt skulle kunna bidra till att minska incidensen av delirium vilket kan skapa positiva effekter för såväl patienter som för vårdpersonal och hälso- och sjukvård.
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| 2. |
- Andersson, Jenny
(författare)
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Genusgörande och läkarblivande : attityder, föreställningar och förväntningar bland läkarstudenter i Sverige
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The inclusion of a gender perspective in medicine has shown that gender is an essential factor in health and disease, in medical encounters and also in medical students’ educational environment. The aim of this study was to explore attitudes, preconceptions and norms regarding gender within medical education and processes of gender bias. First, we explored medical students gendered beliefs about patients. Second, we examined the medical students ideas about their future careers. Third, we compared awareness on gender issues among medical students in Sweden and the Netherlands.Method and materialThe analyses were based on data from two different sources: one experimental study based on authentic patient narratives about being diagnosed with cancer and one extensive questionaire exploring different aspects of gender issues in medical education. Both studies had a design which enabled both qualitative and quantitative research and mixed methods was used.Study I (Paper I and II): Eighty-one anonymous letters from patients were read by 130 students of medicine and psychology. For each letter the students were asked to state the patient’s sex and explain their choice. In paper I the students’ success rates were analysed statistically and the explanations to four letters were used to illustrate the students’ reasoning. Paper II examined the 87 medical students’ explanations closer to examine gender beliefs about patients.Study II (Paper III and IV): The questionaire started with an open question where medical students were asked to describe their ideal future, it also included a validated scale designed to estimate gender awareness. Paper III examined 507 swedish medical students descriptions about their ideal future and compared answers from male and female students in the beginning and at the end of medical school. Paper IV compared gender awareness among 1096 Swedish and Dutch medical students in first term.Findings with reflectionsPaper I showed that the patient’s sex was correctly identified in 62% of the cases. There were no difference between the results of male and female students. However, large differences between letters were observed, i.e. there were some letters were almost all students correctly identified the patient´s sex, others were almost all students were incorrect and most letters were found somewhere in the middle. Another significant finding was that the same expressions were interpreted differently depending on which initial guess the medical student had made regarding the sex of the patient.Paper II identified 21 categories of justifications within the students’ explanations, twelve of which were significantly associated with an assumption of either a male or female patient. Only three categories led to more correct identifications of the patients’ sex and two were more often associated with incorrect assignments. The results illustrate how beliefs about gender difference, even though they might be recognizable on a group level, are not applicable on individuals. Furthermore, the results show that medical students enter the education with beliefs about male and female patients, which could have consequenses and cause bias in their future work as doctors.Paper III found that almost all students, both male and female, were work-oriented. However, the female students even more so than their male counterparts. This result is particularly interesting in regards to the debate about the “feminization of medicine” in which the increasing number of female students has been adressed as a problem. When reflecting on their own lifes and their future its obvious that medical students nowadays, male and female, expect more to life than work, especially those who are on the doorstep to their professional life.Paper IV found that the national and cultural setting was the most crucial impact factor in relation to the medical students preconceptions and awareness about gender. The Swedish students expressed less stereotypic thinking about patients and doctors, while the Dutch students were more sensitive to gender difference. In both countries, the students’ sex mattered for gender stereotyping, with male students agreeing more to stereotypes.ConclusionsA gender perspective is important in medical education. Our studies show that such initiatives needs to take cultural aspects, gender attitudes and students’ gender into account. Moreover, reflections on assumptions about men and women, patients as well as doctors, need to be included in medical curricula and the impact of implicit gender beliefs needs to be included in discussions on gender bias in health care. Also, the next generation of doctors want more to life than work. Future Swedish doctors, both female and male, intend to balance work not only with a family but also with leisure. This attitudinal change towards their future work as doctors will provide the health care system with a challenge to establish more adaptive and flexible work conditions.
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| 3. |
- Diderichsen, Saima, 1981-
(författare)
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It's just a job : a new generation of physicians dealing with career and work ideals
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.In paper II, five classes of final-year medical students were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression. In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250), and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties.
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| 4. |
- Johansson, Fred
(författare)
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Aspects of the aetiology of mental health problems among university students
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental disorders are among the leading causes of years lost due to disability in young people globally. Students are no exception, both mental disorders and mental health problems are common among university students with dramatic increases reported in recent years. The aetiology of mental disorders and mental health problems is generally assumed to be multicausal, with factors at different levels contributing to their development. Given the complexity of the causal network underlying mental health problems, it has been argued that a clear causal framework is needed when studying the aetiology of mental health problems. This thesis aimed to investigate some aspects of the potential aetiology of mental health problems among university students. Specifically, it focuses on four exposures at the psychosocial level presented in four studies: 1) the coronavirus disease (COVID-19) pandemic, 2) poor sleep quality, 3) procrastination and 4) sexual harassment and sexual violence. In addition to the discussion provided in each respective paper, this thesis discusses limitations and possible interpretations of our results from a modern causal inference perspective.The four studies of this thesis are based on The Sustainable University Life (SUN) cohort. The SUN cohort followed 4262 university students from eight universities in and around Stockholm, Sweden, with web-surveys at five time-points over one year.In Study I, we aimed to determine the mean trajectories of depression, anxiety, and stress symptoms among university students in Stockholm before and during the first months of the COVID-19 pandemic. For this, we included a subsample of 1836 university students that entered the SUN cohort before the outbreak of the COVID-19 pandemic, and were followed during the months before the pandemic, during the first wave of the pandemic and in the summer, months following the first wave of the pandemic. We found that mean depression, anxiety, and stress symptom levels were largely stable during the first wave compared to the months before the pandemic and decreased slightly during the following summer months. Our results indicate that mean levels of mental health symptoms did not change much during the early phase of the pandemic compared to before the pandemic.In Study II, we aimed to determine whether sleep quality statistically interacts cross-sectionally with loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms in university students. We conducted a cross-sectional study using baseline-data from all 4262 participants in the SUN cohort. We found that while all factors were associated with depressive symptoms, only perfectionistic concerns interacted with sleep quality in its relation to depression. This interaction was quite weak and explainedonly a small proportion of the variance in depressive symptoms. Overall, we did not find support for our hypothesis that poor sleep quality could interact with several different potential risk factors for depressive symptoms.In Study III, we aimed to evaluate the associations between procrastination and sixteen subsequent health outcomes (including mental health symptoms, disabling pain, lifestyle behaviours and psychosocial health factors), measured 9 months later, among university students. We used data from all participants responding to the first follow-up in the SUN cohort (n=3525) and found that procrastination was related to several subsequent health outcomes, including symptoms of depression, anxiety and stress, while controlling for multiple potential confounders. Although we cannot rule out non-causal explanations for these associations, the results indicate that procrastination could have an effect on health outcomes among students, but that it is likely to be rather small for any specific health outcome.In Study IV, we investigated the impact of recent exposure to different forms of sexual harassment and sexual violence; 1) unwanted sexual attention, 2) offensive sexual remarks, 3) presentation or distribution of sexist material, 4) uncomfortable touching, 5) being offered benefits for sex and 6) sex against ones will, along with a wide definition of sexual harassment: sexual harassment (wide subjective definition) on levels of depression and anxiety symptoms three, six and nine months later, for women and men, respectively. We conducted a cohort study using data from all women and men responding to the first follow-up in the SUNcohort (n= 3503). Our results showed that women recently exposed to 1) sexual harassment (wide definition), 2) unwanted sexual attention and 3) sex against ones will showed higher subsequent levels of depression and/or anxiety symptoms. The general trend was that all exposures were related to higher symptom levels at three months, but that this difference between exposed and unexposed diminished over time, although these trends are uncertain with wide confidence intervals. The exception was exposure to sex against ones will, where exposed showed elevated symptom levels throughout the follow-up period. For men, the estimates were uncertain overall, and we refrain from interpreting these results. Our results indicate that recent exposure to different forms of sexual harassment and sexual violence may impact later depression and anxiety symptoms among women, and that there could be differences in the strength and long-term impact on mental health between different forms of sexual harassment and sexual violence. Again, we cannot, with certainty rule out non-causal reasons for these associations.Interpreting any of these results as causal effects rests on multiple assumptions, which are discussed in the thesis. Determination of causal effects preferably relies on triangulation of results from different studies with different methodology. Overall, however, I believe that this thesis has strengthened the evidence that procrastination and sexual harassment and sexual violence may be causes of mental health problems among university students. An equally important finding, is that mental health seemed rather stable during COVID-19 pandemic, indicating that the pandemic may not have caused increased mental health problems on the group level.
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| 5. |
- Reitsma, Ewout
(författare)
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Sourcing strategising in the new product development process : Insights from the strategy-as-practice lens and engineer-to-order context
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In many cases, manufacturers have changed from sourcing only a few, simple, and separate components from local suppliers to sourcing a high variety of modules from globally dispersed suppliers. This has resulted in the implementation of a wide variety of sourcing strategies, including, for example, multiple sourcing and supplier integration. All these and other sourcing strategies are aimed at achieving a certain level of supply chain (SC) responsiveness. The level of SC responsiveness ideally matches the characteristics of a product. For example, highly innovative products typically require highly responsive SCs.In order to match products with their SCs, manufacturers are advised to engage in sourcing strategy in their new product development (NPD) process. However, there are at least two knowledge gaps in the literature on this topic: (1) the lack of a widely accepted, comprehensive conceptualisation of how manufacturers can engage in sourcing strategy in NPD, and (2) the lack of empirical insights into manufacturers operating in the engineer-to-order (ETO) context. This dissertation focuses on filling these knowledge gaps.Addressing the first gap, the dissertation uses the theoretical lens of ‘strategy-as-practice’ (SAP) and the literature to conceptualise the ‘doing of sourcing strategy’ in NPD as three interrelated dimensions: (1) practitioners, (2) activities, and (3) practices. Through discussing these dimensions and their potential interplay throughout NPD, the dissertation demonstrates the potential of the SAP lens in providing a common framework and reducing the fragmented nature of the literature. By using the SAP lens, the dissertation also contributes to practice. Despite not being ‘actionable’ in the sense of constituting detailed guidelines for acting, the SAP lens produces insights that can help practitioners to become more reflective. For example, they can learn to see sourcing strategising as a multidimensional, dynamic concept and the place it can occupy in the NPD process.The second knowledge gap in the literature regards the lack of empirical research focusing on the ETO context. Therefore, the dissertation includes a case study focusing on practitioners’ sourcing strategising activities and practices in this context. First, five approaches to performing sourcing strategising activities in NPD are explored in terms of their conditions and intended outcomes. Secondly, four practices that can support sourcing strategising in NPD are identified. These practices – referred to as ‘Design for Supply Chain’ (DFSC) practices – are also examined in terms of their interrelations. Practitioners can use the case study findings to compare the advantages of the five sourcing strategising approaches when sourcing items or services. Furthermore, the findings allow practitioners to assess how the four interrelated DFSC practices can support their sourcing strategising efforts in NPD.
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| 6. |
- Berggren, Eva, 1955-
(författare)
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Students in Academic Entrepreneurship : Entrepreneurship Education and Key Actors Facilitating Student Start-ups in the University Context
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ongoing discussion about academic research not being sufficiently commercialized has overlooked the individual actors in the university context, not least students as potential entrepreneurs. The purpose of this thesis is to enhance our understanding of student entrepreneurs by exploring how entrepreneurship education and key actors in the university context facilitate the formation of student start-ups. Two overall research questions are in focus; i) How does entrepreneurship education at university facilitate start-up formation among students? ii) How and why do key actors in the university context facilitate the formation of student start-ups? These questions are answered by three sub-studies, presented in the five published and appended papers. The data were collected through postal questionnaires as well as interviews in the context of three universities, namely Halmstad University, Chalmers University of Technology and the University of Gothenburg.This thesis makes several contributions. Firstly, it shows that entrepreneurship education at university facilitates start-ups by enabling knowledge spillovers from research to students willing to take on the entrepreneurial role, the so-called missing link in academic entrepreneurship. Secondly, it also demonstrates that entrepreneurship education contributes to the development of long-term entrepreneurial capital, which facilitates future start-ups. Thirdly, entrepreneurship education facilitates start-ups by connecting key actors with different roles; students were found to be present, prepared and persistent entrepreneurs, alumni to be resource-providers and role models, while researchers became enablers with a need for utilization of their research. The revealed reasons for these interconnected key actors to enable student start-ups were; i) students are looking for a career, have start-ups skills from entrepreneurship education and access to role-models and business opportunities in the university context; ii) alumni are anxious to pass on their business experience and maintain the mutually beneficial ties to the university; iii) researchers are reluctant to change their established career but with a strong need for utilization of their research enables students to make commercial use of it.
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| 7. |
- Christianson, Monica
(författare)
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What's behind sexual risk taking? : exploring the experiences of chlamydia-positive, HIV-positive, and HIV-tested young women and men in Sweden
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to explore the experiences of sexual risk taking among Chlamydia Trachomatis positive (CT+), HIV positive (HIV+), and HIV tested young women and men. The specific aims were to explore, from a gender perspective, the course of events, the norms, considerations and emotions involved in sexual risk taking in CT+, explore the perception of sexual risk taking in HIV+ youth, and their understanding of why they caught HIV and look at how the Law of Communicable Diseases Act impacts their sexuality. Moreover, to investigate why young adults test for HIV, how they construct the HIV risk, and what implications testing has for them.42 informants between 17-24 years of age were recruited from a youth clinic in Umeå and from three infection clinics for HIV patients in Sweden.In depth interviews and focus group interviews were tape-recorded, transcribed verbatim and analyzed according to a Grounded Theory approach.The finding revealed that behind sexual risk taking, there was a drive to go steady, where lust and trust guided if sex would take place. In one-night stands women were expected to be less forward compared with men. We found an uneven responsibility concerning condom use where men expected women to be "condom promoters". By catching CT, women experienced guilt, while men felt content through knowing "the source of contamination".Among the HIV+ youth, socio-cultural factors such as; lack of adult supervision, naivité, love, alcohol, drugs, the macho ideal and cultures of silence blinded the informants to the risks and made them vulnerable. By grouping narratives according to degree of consensus in sexual encounters, this demonstrated that sexual risks happened in a context of gendered power relations where the informants had varied agency. The Law of Communicable Diseases Act implied both support and burden for these HIV+ youth. A lot of responsibility was put on them and to be able to handle the infromation duty they tried to switch off lust, switch off the disease, or balance lust and obedience.Among the HIV tested youth, HIV was seen a distant threat. Many had event-driven reasons for testing for HIV; multiple partners being one. Risk zones, like bars were perceived to be a milieu that often was expected to include one-night stands. Responsibility for testing was a gendered issue; "natural" for women, while men rather escaped from responsibility and had a testing resistance. Receiving a "green card" confirmed healthiness and provided relief, and made the informants felt "clean". They could restart with new ambitious, including reconsidering risk.The findings can be used in public health and in health care sectors that work with young people. We present suggestions on how to decrease the spread of STIs:To implement how men could play an equal part in sexual and reproductive health.Promote general CT screening for men.Liberal HIV testing among both young women and men.Promote safer sex behaviour from the uninfected youth, especially focusing on men??.Consider the role of gender and social background in the context of risky behaviours.Give lots of positive rewards concerning HIV disclosure to diminish the risk for HIV transmission.
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| 8. |
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| 9. |
- Jonzon, Robert, 1952-
(författare)
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Health assessments of asylum seekers within the Swedish healthcare system : a study of the interface between control and care, and how structure and procedures may influence access and coverage
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Despite lack of evidence, there is a common notion that diseases are brought along with migrants, and thus a threat to people in the host country. In Sweden asylum seekers are to be offered a health assessment (HA), but national statistics show that the coverage is less than 50%. It has been assumed that asylum seekers do not want to attend, but this research data instead indicate structural barriers.Objectives: To explore to what extent the Swedish healthcare system provides optimal conditions for asylum seekers to access the HA and how the HA could meet their own perceived health needs, as well as society’s demand on detecting contagious diseases, from a public health perspective.Methods: This research project adopted a mixed method approach. A quantitative cross-sectional design was applied where different questionnaires were used, targeting administrators and healthcare professionals as well as former asylum seekers. In addition a qualitative, interpretative and descriptive research approach was applied, guided by grounded theory. Individual interviews were carried out among former asylum seekers.Results: This research revealed that there is no coherent national system for the HAs on asylum seekers in Sweden. The structures, organizations, procedures and outcomes vary significantly between the 21 counties, and the reasons for the low coverage seemed multifold. The former asylum seekers stated feelings of ambiguity and mistrust due to lack of information on the purpose of the HA and how it might influence their asylum application. Poor communication was identified as one of several barriers to access healthcare. The attitude was positive to the HA as such, but it was considered to be just a communicable disease control, without focus on their own perceived health needs, thus an imbalance between control and care.Conclusions: Although being an important contribution, the HA does not suffice to fulfill the right to health of asylum seekers, due to shortcomings regarding accessibility and acceptability of the information, procedures and services that it includes.
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| 10. |
- Karlberg, Eva
(författare)
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Organizing the Voice of Women : A study of the Polish and Swedish women's movements' adaptation to international structures
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The European Union has become an important arena for international politics. Various actors try to influence the European-level executive and legislative authorities. Lobbyists in Brussels are not the only type of actors promoting the interests of others. Today, national-level social movement actors too are present at the European level, pushing the interests of various citizen groups and social issues. To do so, however, they need to adapt to the European Union’s multilevel governance system by speaking with one voice. As this thesis demonstrates, at the national level this adaptation may entail a number of organizational challenges for movements.Organizing the Voice of Women regards national-level social movements adapting to international structures. Taking the cases of the Swedish and the Polish women’s movements and their relation to the European Union as examples, the analysis follows two separate, yet similar, processes of forming and maintaining nationwide meta-organizations – that is, organizations of organizations – that can speak for the two respective movements. Through the cases of the two women’s movements’ adaptation to international structures, the study explores the challenges involved when a new layer of organization is added to a social movement.The results show that organizing the voice of the Swedish and the Polish women’s movements has been particularly challenging when conditions such as a tradition of umbrella organizing and stable financial resources are absent at national level. The results also show that competition and conflicts are apparent in both cases and inherent in meta-organizations, and that they have been possible to deal with differently depending on the two movements’ national settings. With an organizational perspective on social movement coalitions, this study contributes to the classic question of institutionalization, formalization and bureaucratization of social movements. It ultimately asks what it means to organize a field of social movement actors and what happens at the junction of organization and social movement, at the intersection of national and international interests. A wider implication of the study is that the issues it highlights are to be expected whenever the internationalization of national movement activities takes the form of meta-organization.
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