| 1. |
- Kristoffersson, Emelie, 1986-
(author)
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Är det bara jag? Om sexism och rasism i läkarutbildningens vardag : erfarenheter, förklaringar och strategier bland läkarstudenter
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Medical education is characterized by unequal conditions for women/men and white/racialized students. Even subtle interactional processes of inclusion and exclusion convey messages about who rightfully belongs in medical school. Insights into these processes, though, are scarce – especially in the Swedish context. In this thesis, the concepts ’everyday sexism/racism’ and ’gendered/racial microaggressions’ serve as a theoretical framework for understanding these processes.Aim: The main objective of this thesis is to explore and analyze how medical students experience, understand, and handle the norms, perceptions, and expectations about gender and culture/ethnicity that are expressed and (re)created in the specific contexts of medical education and clinical practice. In the analysis, a particular focus is placed on power inequalities. The role that the image of Sweden, which is characterized by equality, and the notion of medical education as characterized by objectivity and neutrality play in the participants' understanding and actions is discussed.Method: The four articles that make up this thesis are based upon three empirical studies conducted among medical students at Umeå University. In the first study, focus groups were performed with 24 students (15 women, 9 men) to explore their experiences of situations during clinical training where they perceived that gender mattered. The material was explored using qualitative content analysis. In the second study, 250 students’ written answers to two short essay questions were analyzed to explore the impact of medical school experiences on specialty preferences. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that thereafter were compared quantitatively between men and women. In the third study, generating two articles, individual interviews were conducted with 18 students (10 women, 8 men) who self-identified as coming from cultural or ethnic minority backgrounds, exploring their experiences of interactions related to their minority position. Inspired by constructivist grounded theory, data collection and analysis were iterative.Findings and reflections: In individual interviews and focus groups, many participants initially described the medical school climate as equal and inclusive. Still, in their narratives about concrete experiences they gave another picture. In interactions with supervisors, staff, and patients almost everyone had regularly encountered stereotypes, discriminatory treatment, and demeaning jargon. Simultaneously, a subtle favoring of male and white majority students was noted. Thus, values, norms, and hierarchies concerning gender and culture/ethnicity were crucial dimensions in their narratives.These experiences made female students feel like they were rendered invisible and not taken seriously, and marked racialized minority students’ status as ’Others’ – making both female- and minority students feel less worthy as medical students. However, most were unsure whether they could call their experiences “sexist”, ”racist”, or ”discriminatory”. Instead, they found other explanations for people's actions such as curiosity, fear, or ignorance. Participants strove to manage the threat of constraining stereotypes and exclusion while maintaining an image of themselves as professional physicians-to-be. They opposed being seen – and seeing themselves as – problematic and passive victims. The clinical power hierarchy, fear of repercussions, and lack of support from bystanders affected what modes of action seemed accessible. Consequently, participants tended to stay silent, creating emotional distance, and adapting to avoid stereotypes rather than resisting, confronting, and reporting unfair treatment. The school climate also had consequences for specialty preferences. Both women and men expressed that working tasks and potential for work-life balance were motifs for their specialty preference. These aspects, however, were often secondary to feeling included or excluded during clinical practice. More women than men had been discouraged by workplaces with perceived hostile or sexist climates. In contrast, more men had been deterred by specialty knowledge areas and what they thought were boring work tasks. Conclusions: Medical students experience everyday sexism- and racism or microaggressions, i.e., practices that, intentionally or inadvertently, convey disregard or contempt. However, the contemporary discourse, which confines sexism and racism into conscious acts perpetrated by immoral or ignorant people, and the pretense that these phenomena no longer pose a problem in Sweden or in medical school, obscure their structural and systemic nature. In fact, this limited view of sexism and racism leaves inequities normalized and disempowers those targeted by discrimination. Constraining stereotypes and exclusion are not caused by the actions of their recipients, that is, female or racialized/minority students. Consequently, their behavioral changes like avoidance and adaptation will not eliminate discrimination but, instead, tend to re-establish the white male medical student as the norm. As long as students who do not fit the norm, rather than the norm itself are regarded as the problem, the sexist and racist practices described in this study will remain part of the hidden curriculum and part of the process of becoming and being a physician. Simultaneously, formal commitments to equality are at risk of being only symbolic while inequities persist. To counteract these inequities, the medical community needs to acknowledge female and racialized medical students’ knowledge about sexist and racist practices within our institutions. Further, medical school leadership should provide students, supervisors, and teachers with an account of structural and everyday sexism and racism, encourage them to engage in critical self-reflection on their roles in sexist and racist power relations, and with strategies and training on how to intervene as bystanders and allies.
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| 2. |
- Randell, Eva, 1960-
(author)
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Adolescent boys’ health : managing emotions, masculinities and subjective social status
- 2016
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Doctoral thesis (other academic/artistic)abstract
- The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS).This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted.In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied.The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV).Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions.In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.
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| 3. |
- Zetterström Dahlqvist, Heléne
(author)
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Determinants of Depressive Symptoms in Adolescents : The Role of Sexual Harassment and Implications for Preventive Interventions
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Background: Depression is considered the worldwide leading cause of illness and disability in young people and an urgent public health issue. Within the field of public health it is of interest to deepen the understanding of determinants of depressive symptoms (DS) that are possible to address on a political or an organizational level. Also, it is of great importance to find methods to prevent depression in adolescents. To address these issues, the present thesis had two Aims: I) To study determinants of DS in adolescents, and II) to, by means of a non-randomized pragmatic trial evaluation, investigate the effectiveness a cognitive-behavioral intervention (DISA) in a real-world setting in relation to determinants of DS in adolescent girls. This was addressed by asking a) Which determinants on individual, psychosocial and structural levels are associated with DS in adolescents? (Paper I); b) What are the directional pathways between sexual harassment (SH) and DS? (Paper II); c) Which features characterize students who were assigned to a cognitive-behavioral intervention regarding levels of DS, psychosocial aspects and socioeconomic status of the respondents as well as of schools? (Paper III); d) Does DISA have an effect on DS in girls aged 14-16? (Paper IV); and e) Are there differences between the DISA participants and non-participants in the effects of psychosocial and structural determinants on DS? (Paper IV). Method: Data was collected in January 2010, 2011, and 2012, by means of a self-administered, electronic questionnaire in school. Students aged 14-16 in all nine public and one independent high school in a municipality in northern Sweden participated in the study (~1,000-1,200 students depending on the wave). All studies had DS as the single outcome variable. Individual level determinants were self-esteem and self-efficacy. Psychosocial determinants were parental/peer/teacher support; school demands; sexual harassment; and bullying. Structural determinants were family material affluence; parental foreign background, parental employment status; disrupted family, and personal relative affluence. Logistic regression was employed for research question a) (Paper I). Structural equation (SEM) cross-lag models were modeled for research question b) (Paper II). The Mann-Whitney U statistic was employed for research question c) (Paper III). SEM was used for research questions d-e) (Paper IV). Results: Determinants on individual, psychosocial and structural levels were independently associated with depressive symptoms in both genders. Self-efficacy, low teacher support, bullying victimization, and low personal relative affluence was associated with elevated levels of DS in both genders (Paper I). In girls, low parental support, high school demands, and sexual harassment victimization (SH) were also associated with elevated levels of DS. Among boys, parental migrant background was also associated with DS. Among girls, both the targeting of girls with elevated DS, and the consequence of SH explained the relationship between DS and SH victimization over time. In boys, only the predating of DS explained the association between DS and SH (Paper II). Only girls were assigned to DISA during 2011 and DISA participants reported higher levels of DS and lower levels of self-esteem than the non-participants at pre-intervention, which indicates that DISA was used as a targeted intervention for girls with elevated symptoms. Also, DISA participants reported higher levels of SH victimization, less peer support, and lower personal relative affluence (Paper III). In contrast to the non-participants, DISA participants did not increase their mean scoring on DS at an eight months follow-up. However, SEM analyses showed that the effect of DISA participation on DS at follow-up was negligible (Paper IV). Conclusions: This study showed that SH victimization was an important determinant for DS in girls followed by personal relative affluence. Among boys, personal relative affluence and parental migrant background were the most important factors. SH victimization had mental health consequences in girls only. DISA was implemented as a targeted intervention rather than as selective or universal one, and did not have an effect on DS in this group of girls. Implications for further research and health promotion practice in the school setting are discussed.
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| 4. |
- Brännström, Lotta, 1973-
(author)
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"Alltså det finns ju ingen respekt!” : Tjejers perspektiv på (o)trygghet och genusrelaterat våld i vardagen– en photovoicestudie
- 2021
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Licentiate thesis (other academic/artistic)abstract
- Genusrelaterat våld, och då specifikt killar och mäns våld mot tjejer och kvinnor är ett allvarligt globalt folkhälsoproblem, en kränkning av mänskligarättigheter och ett hot mot ett demokratiskt samhälle. De flesta studierna gällande genusrelaterat våld är genomförda i städer eller stadsnära områden och vi saknar tillräcklig kunskap om våld mot tjejer och unga kvinnor på landsbygd. Därför är det övergripande syftet med licentiatavhandlingen att öka kunskapen om genusrelaterat våld mot tjejer på landsbygd genom den participatoriska metoden photovoice.Licentiatavhandlingen består av en kappa och två publicerade delstudier [I‐II] som syftar till att skapa en djupare förståelse för genusrelaterat våld mot tjejer på landsbygd i Sverige, utifrån tjejers egna perspektiv. I studie [II] utökades syftet till att också diskutera metodens potential att nå nyckelpersoner inom policyfältet och leda till social förändring, utöver dess förmåga att informera och engagera. Det är genomgående kvalitativa studier. Det empiriska materialet består av insamlat data genom photovoice samt workshops och gruppintervjuer [I‐II]. Materialet består även av intervjuer med beslutsfattare (tjänstepersoner och politiker) och material från en inspelad podcast [II]. Insamlat data analyserades med hjälp av induktiv och deduktiv tematisk analys [I], en beskrivande aktionsorienterad analys samt innehållsanalys [II].Analysen i studie [I] utmynnade i två primära teman: det första temat konstant rädsla har två sub‐teman som förklarar en rädsla som är integrerad i tjejernas vardag, och som förminskar deras handlingsutrymmen. Det andra temat fokuserar på de strategier som tjejerna använder för att hantera denna konstanta rädsla, och detta bryts sedan ner i två sub‐teman som visar hur genusnormer till stor del påverkar beteende och förväntningar. Även resultatet i studie [II] visar att tjejernas känsla av kontroll var begränsad och att olika situationer i vardagslivet präglades av känslor av minskat handlingsutrymme och agens. Studien visar också att photovoice är en lämplig metod för att visuellt förmedla deltagarnas perspektiv samt att engagera och informera beslutsfattare, men att enbart metoden i sig inte kan garantera social förändring.Normativa föreställningar om genus påverkar i hög grad både språk och beteende bland ungdomar, och trots att Sverige ofta omtalas och framställs som ett jämställt samhälle finns det flera indikationer på det motsatta. Tjejers handlingsutrymme är betydligt mindre jämfört med killars, och tjejer marginaliseras i en mängd situationer och sociala interaktioner. Deltagarna i studien såg också ett tydligt samband mellan genusrelaterat våld och allvarliga hälsokonsekvenser, och studien hjälper oss förstå hur och på vilket sätt tonårstjejer i Sverige påverkas negativt av genusrelaterat våld. Den alarmerande höga förekomsten av genusrelaterat våld bland unga visar betydelsen av att adressera problemet redan från tidig ålder.
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| 5. |
- Carlerby, Heidi, 1967-
(author)
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Health and Social Determinants Among Boys and Girls in Sweden : Focusing on Parental Background
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The majority of Swedish boys and girls have good psychosomatic health. Despite that the risk of mental health problems such as nervousness, feeling low and sleeping difficulties has increased steadily in recent decades. Moreover, previous surveys on health and well-being indicate that boys and girls of foreign extraction in Sweden are at increased risk of ill health compared to boys and girls of Swedish background. The main aim of this thesis was to analyse health and social determinants among boys and girls of foreign extraction in Sweden. The factors explored in papers I–IV include parental background, family affluence and gender and their associations with subjective health complaints, psychosomatic problems or health risk behaviours. Other included risk factors for ill health were involvement in bullying, low participation and discrimination at school. This thesis takes an intersectional perspective, with ambitions to be able to emphasize the interplay between different power relations (i.e. gender, social class and parental background). Two sets of cross-sectional data were used. Three papers were based on the Swedish part of the World Health Organization’s Health Behaviour in School-Aged Children. The sample consisted of 11,972 children (boys n = 6054; girls n = 5918) in grades five, seven and nine from the measurement years 1997/98, 2001/02 and 2005/06. The response rate varied between 85 and 90%. About one fifth of the included children were of foreign extraction. For the fourth paper regional data from Northern Sweden were used. Boys (n = 729) and girls (n = 798) in grades six to nine answered a questionnaire in 2011 and the response rate was 80%. About 14% of the included children were of foreign extraction. Statistical methods used were chi-square test, correlation analyses, logistic regression analyses, cluster analyses and test of mediating factor. The results showed that girls of foreign background were at increased risk of subjective health complaints (SHC) and boys of mixed background were at increased risk of psychosomatic problems (PSP). Increased risk of allocation to the cluster profile of multiple risk behaviour was shown in boys and girls of mixed background, in girls of foreign background and in girls of low family affluence. Increased risk of allocation to the cluster profile of inadequate tooth brushing was shown in boys and girls of foreign background and in girls of low family affluence. General risk factors for increased risk of ill health for boys and girls in Sweden were: any form of bullying involvement, low family affluence, low participation and discrimination at school, of which the latter also was a mediating factor for ill health. Living with a single parent was a risk factor for ill health among girls. The results can function as a basis for developing health promotion programmes at schools that focus on social consequences of foreign extraction, family affluence, participation as well as health risk behaviours and gender.
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| 6. |
- Warne, Maria, 1957-
(author)
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Där eleverna är : Ett arenaperspektiv på skolan som en stödjande miljö för hälsa
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Hälsa skapas inte i ett vakuum utan i relation mellan individer och omgivning. Skolan är därför en viktig arena för barn och ungdomar eftersom de tillbringar större delen av sin vakna tid där. Tidigare forskning har framförallt riktats mot riskfaktorer relaterade till barn och ungas psykiska ohälsa, mindre mot vad som främjar och stärker möjligheterna till deras positiva hälsa. Genom ett salutogent perspektiv kan kunskap erhållas om faktorer som bidrar till en stödjande miljö för hälsa. För att få förståelse för nya generationers behov och värderingar behöver elever göras delaktiga i studier och utveckling av sin egen vardagsmiljö.Avhandlingens syfte var att studera skolan som en stödjande miljö för hälsa genom att involvera elever och att finna metoder för att studera de positiva aspekterna av hälsa. Artiklarnas syften inkluderade utmaningar och möjligheter att använda en metod för ökad delaktighet, fördjupa förståelsen om aspekter som främjar hälsa och lärande, med särskilt fokus på delaktighet och stöd samt hur positiv hälsa kan mätas.Elever på en gymnasieskola valdes som deltagare i två kvalitativa studier. Metoden photovoice studerades genom ljudinspelning av elevernas dialog under arbetet med photovoice och deras och lärarnas synpunkter under fokusgruppsintervjuerna. Data analyserades med innehållsanalys (I). Grundad teori användes för att studera elevernas syn på vad som var viktigt för hälsa och lärande (II). En enkät användes för att ta fram en positiv hälsoskala och för att studera faktorer associerade till hälsa bland elever årskurs 6-9. Enkäten besvarades av 1527 elever (52,3% flickor, 47,7% pojkar) i årskurs 6-9 i skolorna i Östersunds kommun. Svarsfrekvensen var 80%. En principalkomponentanalys användes anpassa och validera en positiv hälsoskala till åldersgruppen 12-16 år (III). För att studera associationen mellan faktorer som kunde vara associerade till positiv hälsa valdes multipel logistisk regressionsanalys (IV).Resultatet visade att photovoice fungerade som en metod i gymnasieskolan för ökad delaktighet i frågor relaterade till hälsa och lärande. Metoden behövde dock anpassas till elevgruppen. Photovoice upplevdes som stimulerande men också utmanade av både lärare och elever. Kritiska aspekter för metodens användbarhet var knutna till lärarrollen och den demokratiska organisationen (I). Elevernas syn på vad som främjade hälsa och lärande var relaterat till bemötande, personligt och pedagogiskt stöd samt möjligheter till återhämtning. Resultatet visade också att eleverna upplevde att skolan bidrog till att skapa skillnad mellan dem som upplevde sig vara låg- respektive högpresterande (II). Den positiva hälsoskalan (PHS) visade sig vara valid för elever 12-16 år och skalan bör kunna användas i ett sytematiskt hälsofrämjande arbetet där utgångspunkten är ett salutogent perspektiv (III). Faktorer associerade till positiv hälsa bland flickor och pojkar, 12-16 år, var: upplevd delaktighet i klassrummet, stöd från lärare och kamrater samt stöd från båda föräldrarna. Socioekonomisk status, mätt som att ha pengar som kompisar, visade sig vara oberoende associerat till positiv hälsa (IV).Slutsatsen var att betydelsefulla faktorer för en stödjande miljö för hälsa i skolan är; elevers upplevelse av och möjlighet till delaktighet i klassrummet och i skolans arbetsmiljö, personligt stöd från lärare såväl som stöd i undervisningen, stöd från kamrater och förutsättningar för återhämtning under och efter skoldagen. Samtidigt visade resultatet att det finns skillnader mellan olika grupper av elever relaterat till hälsa och stöd.För att utveckla en stödjande miljö för hälsa i skolan kan photovoice användas för att involvera eleverna och upptäcka unika aspekter på den enskilda skolan. Med hjälp av den positiva hälsoskalan (PHS) kan främjande faktorer kartläggas, vilket ökar möjligheterna till ett systematiskt hälsofrämjande arbete med ett salutogent perspektiv.
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