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- Gaber, Sophie Nadia
(författare)
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The participation of older people with and without dementia in public space, through the lens of everyday technology use
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Participation in activities and places within public space has been linked to numerous health benefits and yet, little is known about participation among older people with and without dementia. Insights about participation in activities and places within public space can contribute to the somewhat ambiguous definition of participation, as “involvement in a life situation”, by acknowledging the complexity and interrelatedness of subjective, social, contextual, temporal, and technological aspects of participation. Thus, the overarching aim of the four studies was to explore participation in activities and places within public space, among older people with and without dementia in two European countries (Sweden and UK), and to evaluate how different aspects, such as the relevance and perceived ability to use Everyday Technologies (ETs), interact with and influence participation, over time.Across all studies, interviews used the Participation in Activities and Places Outside Home Questionnaire (ACT-OUT) and the Everyday Technology Use Questionnaire (ETUQ), in order to focus on the perspectives of older people with and without dementia themselves. Study one explored stability and changes in participation in places visited within public space in relation to the relevance of ETs used in public space, among a baseline Swedish sample. Study two utilised ordinal regression to investigate the ways in which perceived risks and ET use were associated with out-of-home participation, among a UK sample of older people. Using a mixed methods design and data visualisations, study three delved into aspects of social participation in more depth, including ET use and social deprivation of the living environment, among two UK sub-samples of older people with and without dementia. Study four’s longitudinal design and multilevel modelling deepened the knowledge about how use of ET outside home, relates to participation in places visited within public space among a Swedish sample of older people with dementia over time.Study one’s findings demonstrated a statistically significant positive association between a higher person measure of ability to use ETs and higher participation in places visited within public space, among the Swedish sub-sample of older people with dementia but not those without dementia. According to the ordinal regression model in study two, a higher probability of ET use was associated with a higher level of out-of-home participation, among the UK sample of older people. By elucidating motivators, considerations that require extra attention, and management strategies among UK sub-samples of older people with and without dementia, study three provided insights into the nuances of social participation. Finally, study four’s findings revealed that decreasing use of ET outside home was associated with decreasing participation in places visited within public space, in a statistically significant way when accounting for age.In summary, this thesis contributes empirical insights about the participation of older people with and without dementia in activities and places within public space, through the lens of ET use. Such knowledge can be used to develop targeted health and social care planning and the design of more inclusive places, technologies, and services.
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| 2. |
- Johansson, Anette
(författare)
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Hemrehabilitering ur ett personcentrerat perspektiv
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med avhandlingen var att studera hemrehabilitering ur ett personcentrerat perspektiv där de tre första delstudierna utgår ifrån ett kommunalt hemrehabiliteringsprojekt som pågick mellan 2015-2022 i södra Sverige. Kvalitativa och kvantitativa data som samlades in i utvecklingssyfte inom hemrehabiliterings-projektet gjordes tillgängliga för vetenskapliga analyser inom doktorandprojektet. Första delstudien är en kvalitativ studie som utforskade vilka aspekter äldre personer upplevde var av värde för dem i hemrehabilitering. Andra delstudien är en kvantitativ analys av förändringar i funktion och aktivitetsförmåga och hälsa samt faktorer som kan ha påverkat dessa förändringar. Tredje delstudien undersökte relationer mellan standardiserade tester och ett självrapporterat frågeformulär som används vid hemrehabilitering och om det fanns könsskillnader inom och mellan bedömningarna. Avhandlingens fjärde och sista delstudie är en scoping review för att undersöka det internationella kunskapsläget av äldre personers upplevelser av hemrehabilitering. Det sammanlagda resultatet beskrivs och reflekteras utifrån McCormack & McCance’s ramverk för personcentrerad praktik.Resultatet visade att förutsättningar för personcentring fanns i hemrehabiliteringen då deltagarna upplevde personalen som professionellt, socialt och känslomässigt kompetenta. Hemmet som rehabiliteringens sammanhang var uppskattat av de äldre personerna och upplevdes som naturligt att träna i. Det fysiska hemmet innebar både möjligheter och hinder för vardagliga aktiviteter och delaktighet i samhället. För personcentrerade processer var teamsamverkan med internt lärande i hemmet viktigt. När deltagarna involverades som en naturlig del i teamet i hemmet främjades en jämlik relation mellan personal och deltagare. Dock upplevde vissa deltagare en bristande respekt från personalen kring deras integritet och att deras autonomi begränsades när hemmet blev en arbetsplats. En kombination av standardiserade tester och ett självskattningsinstrument bidrog till en kompletterade bedömning av funktion och aktivitetsförmåga. Det framkom dock könsskillnader inom och mellan bedömningsinstrumenten. Hemrehabiliteringen baserades på vad deltagarna själv ansågs vara viktigt för dem. Dock fanns upplevelser av motsatsen där insatsen inte överensstämde med önskemål eller behov. Intensiv rehabilitering med träning av arbetsterapeut och, med statistisk tendens, fysioterapeut var associerat med en förbättrad mobilitet. För deltagare som inte kunde påverka antalet besök och tidpunkt upplevdes ibland besöken som olägliga eller som alltför frekventa. Personcentrerade resultat av hemrehabiliteringen var upplevd förbättrad funktion och aktivitetsförmåga, ökad självständighet, insikt i och ökad tillit till egna förmågor och en känsla av kontroll i vardagen. Mätbara förbättringar framkom inom funktion och aktivitetsförmåga samt självskattad hälsa. De flesta deltagare upplevde att de fått vara delaktiga i beslut och var nöjda med insatsen, vilket dock inte gällde för alla. Avhandlingens slutsats är att hemmet som sammanhang för rehabilitering verkar ha förutsättningar att kunna bidra till skapandet av en personcentrerad praktik. Vissa komponenter och mekanismer kan dock påverka hemrehabiliteringsprocessen negativt. Därför är personalens kompetens och färdighet i att kunna förstå, bedöma och hantera den äldre personens sociala, fysiska och känslomässiga hem som sammanhang för rehabilitering en förutsättning för att en personcentrerad process med personcentrerade resultat kan kunna ske. Avhandlingens implikationer för praktiken presenteras i form av en standardiserad strukturerad hemrehabiliteringsmodell för att guida en personcentrerad praktik.
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| 4. |
- Ramji, Rathi
(författare)
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Health promotional interventions informed by community-based participatory research in a socially disadvantaged neighbourhood : development, exploration and evaluation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to understand the impact of community-based participatory research-informed health promotional initiatives on the health of communities living in socially disadvantaged neighbourhoods in Southern Sweden. The thesis was part of a larger program, Health promotion, Innovation in Collaboration which was a community-based participatory research program aiming to create novel ways to improve health through participatory and collaborative strategies. The thesis embraces one mixed-method study, a quantitative study, a qualitative study and finally a participatory action research study with a qualitative approach. A total of 49 citizens and 10 families with children aged 7-14 years from a disadvantaged neighbourhood in Southern Sweden participated in the different studies. The mixed-method study (Study I) described the development of initial evaluation of a Community-based participatory research(CBPR) informed physical activity intervention, which showed the need for the intervention to be offered cost-free and exclusively for women. In line with the results of the first study, the CBPR physical activity intervention was offered to 35 women in the neighbourhood and the effect of the intervention was assessed over time both quantitatively (Study II) and qualitatively (Study III), including a perspective on the pandemic. The last study (Study IV) focused on diet and oral health among families, particularly mothers and children. In this study, the children were initially engaged in a photovoice interview which was followed by a focus group with parents. The pre-study revealed that children disliked school lunch and did not eat breakfast regularly owing to time constraints and family situations. Furthermore, children also consumed a high amount of sugar. To this, the parents expressed that they were not able to guide their children appropriately and needed help with aspects such as diet focusing on breakfast, lunch and dinner, as well as knowledge on oral hygiene habits. The quantitative part of Study I and Study II were repeated measures data at different time points before and after the intervention. The qualitative data in studies I and III were collected in form of focus group interviews in parallel to the quantitative data. The mode of data collection in Study IV was Multi-staged focus groups where the same families met at different time points and engaged in dialogue and reflection on different topics at each meeting. The results of the first three studies show that a CBPR informed physical activity intervention when offered in groups improved health-related quality of life, physical health, induced behavioural change and potentially builds resilience to withstand the psychosocial and physical effects of the pandemic. The last study shows that a CBPR informed oral health promotion through reflection and dialogue among families together with other stakeholders, influences behavioural change and perceived changes in health among parents and children living in a disadvantaged neighbourhood. In conclusion, this thesis highlights that social support is key to improved perceived health, empowerment, and sustainable behavioural change among citizens in the neighbourhood. Although women are most in need of support, they are also gateways to the families and thereby their communities. And finally, health promoters have had a vital role in engaging communities in health promotional efforts and bringing them closer to other societal actors, strengthening their social bonds and helping build community resilience in the face of adversity.
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