| 1. |
- Sandqvist, Jan, 1968-
(författare)
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Development and Evaluation of Validity and Utility of the Instrument Assessment of Work Performance (AWP)
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The last decades have shown a great need for vocational rehabilitation due to high levels of absenteeism due to sickness and disability pension. An essential part of the vocational rehabilitation process is assessment of persons with reduced work functioning. Adequate and reliable methods for assessment of clients with work disabilities are crucial for both the individuals who are assessed and for society as a whole. Sound and precise work assessments are needed to guide clients to suitable interventions using a minimum of rehabilitation resources. However, work function assessments are complex and there is confusion over work assessment concepts. Therefore, further development and evaluation of adequate concepts and theoretical models within the area of work assessment is needed. Furthermore, vocational rehabilitation lacks adequate and reliable assessment instruments, especially instruments used to observe clients.This dissertation thesis focuses specifically on the following:- Development of a conceptual framework for assessment of work functioning [Study I]- Development and evaluation of validity and utility of the observation instrument Assessment of Work Performance (AWP) [Study II-IV]Study I proposes a conceptual framework for different dimensions of work functioning and highlights important factors for work assessment. The study also creates a framework to define the purpose, delimination, and possible assessment outcomes of the assessment instrument AWP.Study II develops an observation instrument for assessment of work performance, the Assessment of Work Performance (AWP) and conducts an initial evaluation of face validity and utility for the instrument. The initial evaluation in study II was made within a group of 21 assessors in Sweden, and the result indicated face validity and utility for the AWP, a result that supported further development and evaluation of the instrument.Study III investigates the content validity and utility of the AWP. A questionnaire was answered by 67 respondents who used the AWP in various vocational rehabilitation settings in Sweden. The result indicated content validity and utility for the AWP.Study IV investigates the construct validity of the instrument AWP. This study is based on 364 assessments with the AWP (version 1.1). The clients had various work-related problems and went through an insurance medicine investigation at a Social Insurance Office in Sweden between 2004 and 2005. The major findings in this study indicated that the AWP has construct validity, sensitivity, and the ability to discriminate between clients. It is also gender neutral.The future evaluation of AWP will comprise testing of predictive validity, inter-rater reliability and internal consistency reliability as well as an evaluation of how and with what results the instrument can be combined with other work-related assessment instruments.
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| 6. |
- Borgestig, Maria, 1968-, et al.
(författare)
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Eye gaze performance for children with severe physical impairments using gaze-based assistive technology : a longitudinal study
- 2016
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Ingår i: Assistive technology. - : Taylor & Francis Group. - 1040-0435 .- 1949-3614. ; 28:2, s. 93-102
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Tidskriftsartikel (refereegranskat)abstract
- Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with an AB design was conducted on ten children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.
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| 7. |
- Borgestig, Maria, 1968-, et al.
(författare)
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Gaze-based assistive technology in daily activities in children with severe physical impairments : an intervention study
- 2017
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Ingår i: Developmental Neurorehabilitation. - : Taylor & Francis. - 1751-8423 .- 1751-8431. ; 20:3, s. 129-141
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents’ satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.Methods: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1–15 years) participated in gaze-based AT intervention for 9–10 months, during which period the gaze-based AT was implemented in daily activities.Results: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents’ satisfaction with the AT and with services was high.Discussion: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.
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| 10. |
- Haglund, Lena, 1953-, et al.
(författare)
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Hur kan vi behålla våra manliga studenter?
- 2004
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Ett angreppssätt för att söka komma närmare en lösning på problemen som växte fram i diskussioner mellan lärare och studenter i den Jämställdhetsgrupp som finns vid utbildningen, var att utbildningen måste stödja de manliga studenterna. De manliga studenterna bör under utbildningstiden erbjudas möjlighet att skapa sig en bra och trygg yrkesidentitet som gör att de väljer att stanna kvar i yrket och därmed kan bli förebilder för andra män som söker utbildningen. Stimulansmedel för integration av genusperspektiv i grundutbildningen vid Linköpings Universitet har sökts och erhållits vid två tillfällen. Målsättningen har varit att utveckla kunskap som kunde leda till bearbetning av befintliga attityder och värderingar vid Arbetsterapeututbildningen hos såväl studenter som lärare för att stödja manliga studenter att fullfölja och avsluta sin grundutbildning till arbetsterapeut.
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| 11. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Communication characteristics between clients and stakeholders within the Swedish sickness insurance system : a document analysis of granted and withdrawn sickness benefit claims
- 2020
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 42:23, s. 3316-3326
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect clients’ cases.Materials and methods: This was a document study using 30 client files from the Swedish Social Insurance Agency (SIA). The clients included had been on a work ability evaluation during their sick leave spell and were aged 32–64 years. The material was analyzed using qualitative document analysis.Results: The results show different approaches to communication, characterized by emotional argumentation, matter-of-fact driven argumentation and information exchange, which have diverse success in affecting official decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected by the authorities compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates.Conclusion: There are differences regarding how clients and stakeholders communicate the clients’ needs and pre-requisites, and how this affects official decisions. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance system, and whether there are differences between diverse groups that could lead to injustices.Implications for rehabilitationWithin a social insurance context, professionals need to provide clients with adequate and individually adapted information in order for procedures to be perceived as comprehensible and manageable by the clients.The support from stakeholders such as the treating physician and/or employer can affect clients’ sick-leave process.Clients’ treating medical professionals can contribute to ensuring that clients rights are met by communicating the clients’ needs to other stakeholders in a formal way.
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| 12. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Communication Characteristics Between Clients And Stakeholders Within The Swedish Sickness Insurance System – A Document Analysis Of Granted And Withdrawn Sickness Benefit Claims
- 2019
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: Previous studies show differences regarding which clients receive sickness benefits as well as which clients are questioned or not within the sickness insurance system. There are indications that the characteristics of communication can have an impact on the sick leave process, which motivates this study with the following purpose.PURPOSE: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect the clients’ case.MATERIALS AND METHODS: This was a document study using thirty client files including the correspondence between clients, their case-manager at the Swedish Social Insurance Agency (SIA) as well as other stakeholders. The clients included had been on a work capacity evaluation during their sick leave spell and were aged 32-64 years. There were twenty women and ten men in this study, with a variety of the degree of sickness absence, disability pension and part time work. The material was analyzed using qualitative document analysis.RESULTS: The results show different approaches in communication, characterized by emotional communication, matter-of-fact driven communication and information exchange, which have diverse success in affecting authority decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates. There are also differences in how information about the client is interpreted by different professionals.CONCLUSION: There are differences regarding how clients and stakeholders communicate the clients’ needs and prerequisites, and how this affect the SIA. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance, and whether there are differences between diverse groups that could lead to injustice in the system.
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| 13. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Initial evaluation of psychometric properties of a structured work task application for the Assessment of Work Performance in a constructed environment
- 2018
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 40:21, s. 2585-2591
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The Swedish Social Insurance Administration has developed a new assessment tool for sickness insurance. This study is a part of the initial evaluation of the application, called the Assessment of Work Performance, Structured Activities, and focuses on evaluation of the psychometric properties of social validity, content validity, and utility.Materials and methods: This was a qualitative study using semi-structured telephone interviews with occupational therapists. A convenience sample was used and participants who fulfilled inclusion criteria (n = 15) were interviewed. Data were analyzed using content analysis with a directed approach.Results: The results indicate that the application provides valuable information and that it is socially valid. Assessors found work tasks suitable for a diverse group of clients and reported that clients accepted the assessments. Improvements were suggested, for example, expanding the application with more work tasks.Conclusion: The instrument has benefits; however, further development is desired. The use of a constructed environment in assessments may be a necessary option to supplement a real environment. But depending on organizational factors such as time and other resources, the participants had different opportunities to do so. Further evaluations regarding ecological validity are essential to ensure that assessments are fair and realistic when using constructed environments.Implications for rehabilitationThis study indicates that assessment in a constructed environment can provide a secure and protected context for clients being assessed.Psychometric evaluations are a never-ending process and this assessment instrument needs further development. However, this initial evaluation provides guidance in development of the instrument but also what studies to give priority to.It is important to evaluate social validity in order to ensure that clients and assessors perceive assessment methods fair and meaningful. In this study, participants found the work tasks appropriate and usable when assessing their clients but client’s perspective must also be included in following studies.This assessment instrument is the only activity-based assessment instrument within the Swedish Social Security Insurance. Psychometric evaluations are important since it affects so many individuals in Sweden.
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| 14. |
- Karlsson, Elin, 1985-
(författare)
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Legitimacy and comprehensibility of work-related assessments and official decisions within the sickness insurance system
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to contribute to the development of empirical and theoretical knowledge about the legitimacy and comprehensibility of assessment- and decision-making processes within the sickness insurance system from a client perspective. The focus has been on interactions between clients and other stakeholders within the system, and the extent to which the clients understood and accepted the procedures. In addition, the legitimacy and comprehensibility of the system were studied through the lens of three theoretical concepts: social validity, social insurance literacy (SIL), and moral hazard. For this thesis, a mixed methods approach was adopted, consisting of one quantitative and three qualitative studies, including interviews, files, register data, and a questionnaire. Overall, the findings demonstrates that interactions between clients and other stakeholders were important both for the client’s sick-leave case and for their perceptions of sickness insurance procedures. A continuing dialogue between client and case manager tended to facilitate the client’s understanding and acceptance of the steps taken in the sick-leave process. Furthermore, a client’s perception of the justice of processes in the system was associated with the system’s ability to provide understandable and logical information and procedures. This thesis also demonstrates that assumptions of moral hazard were clearly present and that acts of power and mistrust occurred between stakeholders, as different stakeholders tried to influence the client’s sick-leave process. An acceptable and fair sick-leave process was described by the clients as being one that consisted of relevant procedures, was applicable to the unique client, and was a result of support from other stakeholders. In order to increase the comprehensibility, as well as the legitimacy and fairness, the authorities need to explain and justify a diverse range of steps beyond just the official decisions, so that clients are able to comprehend the what, how, and why of sickness insurance. In terms of SIL, clients’ abilities to obtain, understand, and act on information, did not influence whether they received sickness benefits or their perceived justice. On the other hand, higher scores of perceived justice was associated with high scores of perceived system comprehensibility and being granted sickness benefits. This indicates that what the system does, and what it does not do, influenced clients’ opinions of it, regardless of their own prerequisites.
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| 15. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Maktspel och arbetsmoral bland sjukskrivna och andra aktörer - Sjukförsäkringssystemet och moral hazard
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Aktiveringspolicy och teorier om moral hazard har influerat utformningen av sjukförsäkringssystem i flera delar av västvärlden. Detta har lett till att sjukpenning blivit allt svårare att erhålla, mer kopplat till arbete och aktivitet, samt insatser för att genomskåda fusk bland sjukskrivna.Syftet med studien var att utforska hur makt och arbetsmoral uttrycks av sjukskrivna och andra aktörer i sjukförsäkringssystemet.Metod: Detta var en kvalitativ longitudinell studie baserad på intervjuer och akter från 31 sjukskrivna som varit på en försäkringsmedicinsk utredning. Data analyserades genom tematisk analys.Resultat: Resultatet visar hur olika aktörer misstänkliggör varandras agendor och kompetens, samt hur olika maktmedel används för att rättfärdiga deras slutsatser. Det framkom även vissa allianser mellan aktörer där dessa präglas av samsyn och samarbete mot gemensamma mål i sjukskrivningsprocessen. Primärt ses dessa allianser mellan sjukskriven och sjukskrivande läkare, men även i enstaka fall mellan handläggare och sjukskrivande läkare i de fall läkaren förespråkar aktivering. De sjukskrivna personerna uttryckte en stark vilja och försök mot arbete eller aktivitet, och deras arbetsmoral verifierades ofta av andra aktörer. Slutsats: Maktspel förekommer på olika sätt inom sjukförsäkringssystemet och de medel som användes i den här studien gavs olika betydelse beroende på vilken aktör som använde dem (exempelvis tolkningen av en försäkringsmedicinsk utredning). Den här studien kan ifrågasätta vissa antaganden om moral hazard och simulering bland sjukskrivna då personerna ofta presterade över sin förmåga under en försäkringsmedicinsk utredning i förhoppningen om att i någon mån visa sig förmögen att bidra till samhället, vilket även verifierades av andra aktörer.
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| 16. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut inom sjukförsäkringen
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: I det svenska sjukförsäkringssystemet utförs försäkringsmedicinska utredningar av särskilda enheter inom hälso- och sjukvården på uppdrag av Försäkringskassan. Dessa utredningar ligger sedan till grund för handläggares beslut om sjukskrivnas rätt till sjukpenning. Studier av social validitet är ännu ovanliga inom försäkringsmedicin och folkhälsa men kan bidra med kunskap om vad som främjar eller hindrar att metoder uppfattas som godtagbara, begripliga och betydelsefulla.Syfte: Att utforska sjukskrivna personers upplevelse av social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut avseende sjukpenning inom sjukförsäkringen.Metod: Detta var en kvalitativ longitudinell studie baserad på telefonintervjuer med 30 sjukskrivna som varit på en försäkringsmedicinsk utredning, samt delvis deras akter från Försäkringskassan. En deduktiv innehållsanalys användes.Resultat: Sjukskrivnas förståelse för utredningen var beroende av huruvida de specifika testerna var tydligt relaterade till personernas svårigheter eller ej och vilken information de hade fått. De anser att den standardiserade strukturen inte är relevant för alla och att bristen på individanpassning förvårar möjligheten att få en rättvis bild av deras arbetsförmåga. Diskussion: Social validitet utforskades för försäkringsmedicinska utredningar och myndighetsbeslut i termer av godtagbarhet, begriplighet och betydelse. Utredningarna indikerar en låg social validitet i termer av godtagbarhet på grund av bristen på individanpassning, även om vissa delar är mer socialt valida än andra. Vidare varierade utredningarnas begriplighet beroende på deras applicerbarhet och den erhållna informationen, medan dimensionen betydelse indikerar en högre grad av social validitet. Handläggarens påföljande myndighetsbeslut ansågs däremot orelaterat till utredningens resultat, sakna konkreta argument och ibland motsägande andra aktörers rekommendationer, vilket indikerar en låg social validitet i termer av både godtagbarhet, begriplighet och betydelse. Slutsats: Social validitet finns för delar av utredningarna men är låg för det påföljande myndighetsbeslutet.
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| 17. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Social validity for work ability assessments and official decisions – clients’ experiences
- 2019
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 29:Supplement_4, s. 496-497
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundProfessionals need to be able to express what is at stake during the decision-making process and the discrepancy between formal rules and practical rationality need to be bridgeable and transparent for outsiders. Investigations of social validity for work ability assessments are rare. However, the concept can provide valuable information upon the acceptability and comprehensibility of procedures and how professionals can increase clients’ participation.The purpose of this study was to investigate social validity for work ability evaluations within the sickness insurance system and the official decisions they lead to.MethodsThis was a longitudinal qualitative study using telephone interviews and files from the Swedish Social Insurance Agency. Clients (n = 30) were interviewed after their participation in a work ability evaluation as well as after receiving an official decision upon eligibility for sickness benefits. Data was analyzed using a deductive content analysis.ResultsPreliminary findings show that clients’ comprehensibility of the different tests and their composition were depending on whether the specific tests were perceived as clearly related to the clients’ difficulties and what information they had received. In order to receive a fair description of the client’s work ability, clients state that the work ability evaluation needs to be individually adapted and that the standardized structure is not relevant for all. What is acceptable and fair to one client could be unacceptable to another, depending on what arguments and information case-managers and evaluation professionals provided.ConclusionsAuthorities need to express and motivate the reasons for a diverse range of steps during clients sick-leave process, not only regarding official decisions. Social validity for work ability evaluations is depending on the provided information and the applicability to the clients’ situation.Key messagesSocial validity is depending on the provided information and the applicability to the clients’ situation.Authorities need to communicate clearly with clients through the whole sick-leave process.
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| 18. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Social validity in work related assessments
- 2018
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTIONOver the last years the Swedish Social Insurance Agency has implemented and evaluated a national assessment tool with the purpose of a secure and equivalent process in assessing work ability within sickness insurance. An application with structured work tasks was created for the observation based instrument the Assessment of Work Performance (AWP). Social validity investigates whether an assessment is acceptable and socially appropriate. OBJECTIVEInvestigate social validity, content validity and utility of the application of the Assessment of Work Performance (AWP). METHODThis was a qualitative study with semi-structured interviews. A convenience sample was conducted and the occupational therapists who agreed to participate applied the application at their work. Those who had used the application (n=15) was interviewed and data was analysed using content analysis. RESULTSThe results indicate that the application provides valuable information since clients accepted assessments and assessors found work tasks suitable for a diverse group of clients. Improvements were suggested, for example expanding the application with more work tasks to choose from. CONCLUSIONIt appears to exist social validity, content validity and utility for the application. This study investigates social validity, a psychometric property unusual to investigate in vocational rehabilitation. It is important since an assessment with a non-socially valid instrument can be inappropriate and irrelevant for clients. When an assessment is acceptable and relevant for clients, the complexity of assessment results can be reduced. Therefore it is essential that occupational therapists as well as other professionals ensure quality and acceptability when assessing work ability.
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| 19. |
- Karlsson, Elin, 1985-, et al.
(författare)
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Social validity of work ability evaluations and official decisions within the sickness insurance system : a client perspective
- 2021
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Ingår i: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 70:1, s. 109-124
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures. OBJECTIVE: The aim of this study was to explore clients’ perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system.MATERIALS AND METHODS: This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis. RESULTS: Clients’ understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients’ situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone. CONCLUSION: The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension ‘importance’ indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders’ recommendations indicating poor social validity.
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| 30. |
- Sargenius Landahl, Kristina, et al.
(författare)
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Is a structured work task application for the assessment of work performance in a constructed environment, useful for patients with attention deficits?
- 2021
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Ingår i: Disability and Rehabilitation. - : TAYLOR & FRANCIS LTD. - 0963-8288 .- 1464-5165. ; 43:12, s. 1699-1709
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of our study was to develop a Structured Work Task application for the Assessment of Work Performance for patients with attention deficits. Material and methods: We developed a computer-based registration task titled the Attention-demanding Registration Task. It had a structured administrative procedure with additional scoring regarding time and accuracy, also linked to the original scoring of the Assessment of Work Performance. We evaluated the Attention-demanding Registration Task for content validity. Furthermore, we investigated it concerning sensitivity and specificity in patients with attention deficits due to acquired brain injury (n = 65) against a comparison group of healthy people (n = 47). Results: Our investigation on content validity using the Assessment of Work Characteristics confirmed that the Attention-demanding Registration Task sets high demands on process skills, especially on energy, temporal organization, and adaptation. The Attention-demanding Registration Task showed high sensitivity and specificity in differing between patients with attention deficits and a healthy working group; nine out of ten participants were placed in the correct group. Conclusions: To assess work performance, the use of a Structured Work Task application, the Attention-demanding Registration Task, linked with the Assessment of Work Performance, proved to be sensitive to attention deficits.
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| 31. |
- Ståhl, Christian, 1980-, et al.
(författare)
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Aktivitetsförmågeutredning (AFU) : Tillämpning, upplevelser och utfall
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Försäkringskassan har sedan 2010 utvecklat en metod, aktivitetsförmågeutredning (AFU), för bedömning av arbetsförmåga i relation till normalt förekommande arbete på arbetsmarknaden. Utredningen tar sin utgångspunkt i individens självrapporterade förmåga och involverar en bedömning av särskilt utbildade läkare, och vid behov även arbetsterapeuter, fysioterapeuter, och psykologer. AFU har testats i begränsad skala sedan 2011, vilket sedan stegvis har utökats.I denna studie har 300 utredningar analyserats kvantitativt i relation till registerdata från Försäkringskassan, och 30 ärenden har analyserats kvalitativt genom aktanalyser. Därtill har intervjuer genomförts med handläggare, läkare och sjukskrivna. Studien har granskat utredningar genomförda under perioden 2013–2014.Sammantaget tyder resultaten från de olika delstudierna i denna rapport på att AFU som bedömningsmetod oftast är i linje med den sjukskrivnes egen bedömning, och att inga skillnader i fortsatt sjukskrivning efter AFU finns beroende på kön eller ålder. Läkarens bedömning i AFU tycks inte predicera framtida sjukskrivning, vilket däremot individens självskattning gör. Handläggare och bedömningsläkare (dvs. den läkare som utför AFU) anser generellt att AFU är en bra metod som ger relevant och användbar information. Dock används metoden sparsamt, vilket huvudsakligen tycks bero på ofullständig implementering. Utvidgade undersökningar uppskattas av handläggare och läkare då de ger ett bättre underlag. Dock finns det inga skillnader i fortsatt sjukskrivning mellan dem som fått utvidgad undersökning och övriga ärenden.AFU leder till olika typer av utfall beroende på ärendets karaktär, där vissa får fortsatt sjukpenning eller sjukersättning, medan andra nekas fortsatt sjukskrivning. Utredningen spelar en mera central roll i ärenden där Försäkringskassan beslutar att neka sjukpenning, då den bidrar till att legitimera beslutet. I ärenden där sjukpenning beviljas bekräftar AFU huvudsakligen innehållet i tidigare underlag och får därmed en mera underordnad roll i kommunikationen med den sjukskrivne. Sjukskrivnas upplevelser av AFU skiljer sig åt, och inte enbart beroende på om utredningen lett till beviljad eller nekad sjukpenning. Försäkringskassans bemötande och handläggarnas dialog med de sjukskrivna tycks ha stor betydelse för hur sjukskrivna uppfattar utredningen och de beslut den leder till. Såväl handläggare som bedömningsläkare och andra inblandade vårdprofessioner har ett pedagogiskt ansvar i att förklara syftet med utredningen och de ingående momenten för att inte den sjukskrivne ska uppleva bedömningen som alltför standardiserad där individuella faktorer inte tas hänsyn till.
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| 32. |
- Ståhl, Christian, 1980-, et al.
(författare)
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Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context
- 2019
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 6, s. 656-665
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists.MATERIALS AND METHODS: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis.RESULTS: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to.CONCLUSIONS: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits. Implications for rehabilitation The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome. What is considered fair differs between assessing professionals and persons being assessed. Professionals may influence the perceptions of fairness through their way of communication. Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.
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| 33. |
- Ståhl, Christian, et al.
(författare)
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Social insurance literacy: a scoping review on how to define and measure it
- 2021
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 43:12, s. 1776-1785
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Sickness insurance and workers? compensation systems decide on peoples? eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients? dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. Methods: The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. Results: Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. Conclusions: Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.
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| 34. |
- Ståhl, Christian, et al.
(författare)
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The Social Insurance Literacy Questionnaire (SILQ) : Development and Psychometric Evaluation
- 2023
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Ingår i: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688.
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Tidskriftsartikel (refereegranskat)abstract
- PurposeFor clients to understand social insurance decisions and processes, information from authorities needs to be comprehensible, and clients need sufficient individual abilities. These dimensions are captured by the concept social insurance literacy, which has been operationalized into a measure, the Social Insurance Literacy Questionnaire (SILQ). The aim of this study was to describe the development of the SILQ and evaluate its psychometric properties using Rasch measurement theory.MethodsThe development of the SILQ included a Delphi study and cognitive interviews. A preliminary version, divided on four scales corresponding to the domains of the concept (obtaining information, understanding information, acting on information, and system comprehensibility) was psychometrically evaluated according to Rasch measurement theory, in a survey to a stratified random sample of people on sick leave (n = 1151) sent out in the fall of 2020.ResultsOverall, the items in the final version of the SILQ demonstrated good fit to the Rasch model, and the response scale worked as intended. Unidimensionality was supported for all scales, but minor problems with local dependency was detected for three items. The person separation was 0.80 for the Obtain scale, 0.82 for the Understand scale, 0.68 for the Act scale, and 0.81 for the System scale. Corresponding ordinal alpha values were 0.91, 0.91, 0.86, and 0.91, respectively.ConclusionThis study is a first step toward exploring literacy in the social insurance field. The SILQ covers individual abilities and systems' comprehensibility, and the results show that it has acceptable psychometric properties.
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