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- Nygren, Ulrika Svea, 1966-
(författare)
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Interprofessionella teambesök i svensk barnhälsovård - en resurs att utveckla : En studie om teamarbete ur sjuksköterskors, läkares och psykologers perspektiv
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Interprofessional teamwork has been described as a key method in promoting health and preventing illness in children. However, evidence-based knowledge about which form of teamwork in Child Healthcare Services (CHS) that enables a holistic view of the child in his or her family, considering medical, psychological and social circumstances, is required.This thesis aimed to produce evidence-based knowledge about teams and interprofessional teamwork that could be used in the Swedish CHS, as well as an understanding of influencing factors at the individual, organisational and societal levels based on nurses’, physicians’ and psychologists’ perceptions.The thesis includes four studies (I–IV) that used quantitative, qualitative and mixed method design to answer the overall purpose of the doctoral thesis. Together, these methods form an exploratory sequential mixed method design. For the quantitative studies (I and II) and the mixed study (III), a national cross-sectional study in the form of a web survey was answered by 1119 nurses, physicians and psychologists engaged in the Swedish CHS. In study IV, an explorative qualitative design was used, and data was obtained from seven digital focus group interviews with nurses, physicians, and psychologists engaged in CHS.Interprofessional teamwork within the CHS, in the form of physical meetings such as team-based visits and parental groups held by a team, where professionals, the child, and the parents are present at the same time, was found to be important to achieve the goals of the team and meet the unique needs of the child and his/her family. Team-based visits contribute to a holistic view of the child in his/her family where medical, psychological and social circumstances are considered. Healthcare professionals require team-based visits delivered by interprofessional teams, in line with proportionate universalism. However, perceived needs for targeted team-based visits exceed its existence, especially in cases of psychosocial or complex indications.Based on the findings, there are reasons to consider interprofessional team-based visits in the CHS as an important resource to be developed. For optimal team-based visits within CHS, factors at the individual, organisational and social level are required. These factors include: 1) placing the child at the centre, 2) physical meetings, 3) equality and equity, 4) continuity, 5) trust and confidence, 6) competence and learning, 7) communication, 8) goals and motivation, 9) responsibilities and roles, 10) flexibility, 11) safety and effectiveness and 12) well-being and meaningfulness.
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| 2. |
- 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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| 3. |
- Haraldsson, Johanna, 1976-
(författare)
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Exploring adolescent males’ consultations with general practitioners in the context of psychosocial health
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aimed to explore adolescent males’ experiences of consultations with general practitioners (GPs) with a particular focus on confidentiality in relation to poor mental health and health-compromising behaviours.First, a model describing the covariation of poor mental-health symptoms, associated somatic symptoms, and health-compromising behaviours was developed through explorative and confirmative factor analysis (paper I). The model was then applied in a structural equation modelling approach to study whether these symptoms and behaviours influenced how adolescent males valued and experienced confidentiality as well as whether they were comfortable asking sensitive questions during their GP consultations (paper II).Next, to gain a deeper understanding, adolescent males’ experiences with GP consultations were further explored through a qualitative lifeworld-based approach. Interviews were analysed with thematic analysis (paper III) and video observations with a phenomenological–hermeneutical method (paper IV). The findings revealed that by providing confidentiality, here defined as private time without parents and explaining the meaning and boundaries of professional secrecy, GPs can facilitate discussions on sensitive topics and make adolescent males feel more comfortable to raise their own concerns. This might be a fruitful approach to address any unmet health needs, which can be achieved through the split-visit consultation model.Another finding was that the studied consultations were very complex. Due to their ongoing development, inexperience with GP consultations, and notions of masculinity, the adolescent males struggled with cognitive, emotional, and relational difficulties while negotiating their right to define the problem and be responsible for their health. The adolescent males emphasized the importance of being listened to and taken seriously, which entails that all aspects of the consultation must be adapted to their individual needs and to their lifeworld. This aligns with Larsen’s consultation model, where the GP strives to understand the patient’s experience and to connect their medical findings to the patient’s lifeworld. Given that both the split-visit consultation model and Larsen’s consultation model offer valuable frameworks for addressing essential, but different, aspects in adolescent males’ GP consultations, the thesis proposes a synthesis of the two approaches.
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| 6. |
- Haraldsson, Johanna, et al.
(författare)
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Understanding adolescent males' poor mental health and health-compromising behaviours : A factor analysis model on Swedish school-based data
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:2, s. 232-244
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim was to develop a factor model of the clustering of poor mental-health symptoms and health-compromising behaviours (HCBs) in adolescent males.METHODS: The study was based on two cross-sectional school-based Swedish surveys in 2011 (response rate 80%, N=2823) and 2014 (response rate 85%, N=2358), both of which comprised questionnaires from males aged 15-16 and 17-18 years. A factor model was developed by exploratory factor analysis on the 2011 survey and validated by confirmatory factor analysis on the 2014 survey.RESULTS: Four aspects of poor mental health and HCBs emerged in the exploratory factor analysis: (a) deviancy as a tendency to substance use and delinquency, (b) unsafety as an inclination towards feelings of unsafety in different environments, (c) gloominess as a tendency towards pessimism and feeling unwell and (d) pain as an inclination to experience physical pain. The model was validated with good model fit. Age did not affect the model structure, but older adolescent males were more influenced by deviancy and gloominess and less by unsafety compared to their younger peers.Conclusions: Separating symptoms of poor mental health and HCBs into four areas - deviancy, unsafety, gloominess and pain - brings new perspectives to the understanding of adolescent males' health. To the best of our knowledge, our factor model is the first to include unsafety and pain in this context. Whenever a comprehensive approach to the health of adolescent males is needed in the clinic or in the field of public health, this factor model may provide guidance.
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| 8. |
- Nygren, Ulrika Svea, et al.
(författare)
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Perceived needs for team-based visits in Swedish child healthcare services exceed ints existence - A mixed method study targeting healthcare professionals
- 2022
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 111:3, s. 653-666
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate both quantatively and qualitatively the differences between participation in team-based visist (TBVs) an perceived needs for TBVs from the perspectives of healthcare professionals, in the context of the Swedish three-tier national child healthcare program.METHODS: A studfy-specific qustionnaire, including multipel-choice questions with fixed and free-text response options, was developed and used. To capture healthcare professionals' experiences and find explanations for the quantitative results in qualitative data, a convergent parallel mixed-methods study design was ued. Descriptive statistics and Mcnemar's test were used to analyze the quantitative data, and content analysis was used to analyse the qualitative data.RESULTS: Healthcare professionals perceived the needs fot TBVs in the Swedish child helathcare services (CHS), especially in cases with complex needs. The largest differences between the perceived needs for TBVs and experienced TBVs was seen for targeted TBVs on indications associated with psyjosocial problems. The quantitative findings were explored by the qualitative findings. Both individual and organisational factors influenced TBVs.CONCLUSION: Perceived needs for TBVs in Swedish (CHS) exceeds ints existence. Healthcare professionals require TBVs delivered by interprofessional teams, in line with proprtionate universalism. To realize this, organisational structurer (e.g. co-location and clear instructions on how to distribute TBVs) and human resources (e.g. psychologists and social workers) are needed.
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| 9. |
- Nygren, Ulrika Svea, et al.
(författare)
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Team-based visits within Swedish child healthcare services : a national cross-sectional study
- 2024
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567.
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Tidskriftsartikel (refereegranskat)abstract
- Complex healthcare needs can be met through effective interprofessional collaboration. Since 2014, Swedish Child Healthcare Services (CHS) include universal team-based visits with a nurse and a physician who perform such visits at the age of 4 weeks, 6 months, 12 months, and 2.5 to 3 years, as well as targeted team-based visits to address additional needs. The aim of this study was to describe the prevalence of team-based visits in the Swedish CHS and possible associations between team-based visits and contextual factors that may affect its implementation. A national cross-sectional survey was conducted using a web-based questionnaire distributed to all reachable nurses, physicians, and psychologists (n =3,552) engaged in the CHS. Data were analyzed using descriptive statistics and binary and multivariate logistic regressions. The response rate was 32%. Team-based visits were reported by 82% of the respondents. For nurses and physicians, the most frequent indication was specific ages, while for psychologists it was to provide parental support. Respondents working at Family Centers were more likely to perform team-based visits in general, at 2.5 to 3 years and in case of additional needs, compared to respondents working at Child Health Centers (CHC) and other workplaces. In conclusion, team-based visits are well implemented, but the pattern differs depending on the contextual factors. Targeted team-based visits and team-based visits at the age of 2.5 to 3 years are most unequally implemented.
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| 10. |
- Nylander, Charlotte, 1979-
(författare)
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Protective factors, health-risk behaviours and the impact of coexisting ADHD among adolescents with diabetes and other chronic conditions
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental health problems are increasing in Swedish adolescents and mortality rates are higher in this age group than among younger. 10-20% of all adolescents suffer from a chronic medical condition (CC). Few protective factors (PF) and clustering of health-risk behaviours (HRB) are frequent among adolescents with CCs.One of the most common CC in Swedish adolescents is type 1 diabetes mellitus (T1DM). Metabolic control often deteriorates during adolescence, especially in girls. Poor metabolic control is associated with increased risk for long-term complications, of which cognitive problems are common. However, the implication of cognitive/executive problems in patients with T1DM has not been sufficiently studied. Neither has the impact of neurodevelopmental problems (NDP), such as ADHD, on HRB in adolescents with CCs been analysed.Methods: In paper I and II the questionnaire ”Life and Health in Youth” was distributed to all students in year nine and year two of the upper secondary school in the county of Sörmland, 2008 (n=5771) and 2011 (n=5550). Adolescents with CCs were compared to healthy peers with regard to PFs and HRBs. In paper III, the ”Five to Fifteen” questionnaire was used in 175 paediatric patients with T1DM. Patients with indications of NDPs were compared with patients without such problems with regard to metabolic control. In paper IV, the BRIEF questionnaire and the ADHD Rating Scale as well as data from the Swedish Childhood Diabetes Registry was used in 241 adolescents with T1DM. Patients with indications of executive problems were compared with patients without such problems with regard to diabetes control.Results: CCs were associated with few PFs and clustered HRBs. The combination of CCs and low numbers of PFs was found to be associated with an increased risk of clustered HRBs. In the presence of coexisting ADHD the pattern of few PFs and clustering of HRBs was aggravated. ADHD was more common among adolescents with other CCs.Definite memory and learning problems as well as mild executive problems were associated with poor metabolic control, especially among adolescents. Executive problems were also associated with many outpatient visits and low physical activity. Girls with T1DM tended to self-report executive problems to a larger extent than boys, while parents more often reported these problems in boys.Conclusion: Knowledge about factors influencing treatment adherence and life in general is essential in the work with chronically ill adolescents. Focus must be put on enhancing PFs in order to avoid HRBs. Identification of coexisting NDPs, such as ADHD, is crucial, since such problems can adversely influence treatment adherence, HRBs and school achievements
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