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1.
  • Lundin, Anette (författare)
  • Rättfärdigade prioriteringar : en kvalitativ analys av hur personal i äldreomsorgen hanterar motstridiga verksamhetslogiker
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This dissertation aims at contributing to social scientific knowledge about prevailing prioritizations in eldercarepractice by looking at an economic and a caring logic, and how these logics are overlapping, contradictory or comein conflict with each other. A more concrete aim is to understand how the personnel describe their work with orfor balance between the logics and their justifications prioritizations made in the care of older persons. The researchquestion is: How do personnel and care unit manager at a public nursing home understand and handle the twologics that govern care work for facilitating wellbeing of the residents. The aim and research question led to threesub-aims: 1) to analyze the personnel’s experiences of and meaning making about the care work they carry out, 2)to illuminate and problematize the two logics above, and 3)to analyze how the personnel justify their prioritizationsin prevailing context, and how their accountability have an effect on their professional identities.Empirical material was gathered through 13 individual interviews with care personnel and their care unitmanager at a public nursing home in Sweden. These interviews were complemented by a group interview. Thematerial was analyzed by the use of three methods: phenomenology (Paper I and II), reflexive analysis (Paper III),and a positioning analysis (Paper IV). Paper I found that the personnel understands the residents’ well-being asbeing characterized by feeling of being existentially touched. This essence is constituted by feeling freedom ofchoice, pleasure, and closeness to someone or something. In Paper II, the work for facilitating this kind of wellbeingwas characterized by three ambiguities: (i) freedom of choice for the older persons vs. institutionalconstraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need forroutine vs. the eldercarers' not being able to know what the residents need. Paper III showed that the care unitmanager created a hybrid of the two logics (economy is care and vice versa) and that the personnel oppose thishybrid. The opposition is shaped as the personnel divides their work in care and “those other things”. Thesefindings showed how interaction between the logics expresses itself in practice and that it is the personnel who hasto handle contradictions between the logics in their everyday care work. The positioning analysis in Paper IV hadthree levels. The first level showed how the carers align with their peers and that they find the organizationalframe, within which they have agency, changed due to increased workload. This change led to an order of priorities.The second level showed that the carers relate to three aspects when making accounts: the care itself, the olderpersons, and the media. The third level showed that the carers share a view of administration, cleaning, servingmeals, and filling up supplies, as not being parts of caring.The dissertation’s theoretical framework focused on theories on logics, accountability, and professionalidentity. The conclusion is that both logics are needed in order to facilitate the well-being of the older persons. Therelationships between the two logics are not always clear and if their contradictions are not illuminated, there is arisk for a care practice that does not facilitate the well-being of their residents. An important theoreticalcontribution is that logics of activities should be understood vertically (form political, through management, anddown to the level of practice) instead of horizontally. The practical implications emphasize the importance ofsupporting the personnel’s professional identity on the one hand, and discussing the logics on the other. Byunderstanding differences between definitions on management-level and practice level, a homogeneity can bereached.
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2.
  • Schön, Ulla-Karin, 1970- (författare)
  • Kvinnors och mäns återhämtning från psykisk ohälsa
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder. Four studies have been carried.  Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness. The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.
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3.
  • Andersson, Peter, 1980-, et al. (författare)
  • Exploring stakeholder perspectives to facilitate the implementation of shared decision-making in coordinated individual care planning : [Utforskande av stakeholderperspektiv för att stödja implementeringen av delat beslutsfattande i samordnad individuell vårdplanering]
  • 2023
  • Ingår i: European Journal of Social Work. - : Routledge. - 1369-1457 .- 1468-2664.
  • Tidskriftsartikel (refereegranskat)abstract
    • This article explores conditions for implementing shared decision-making (SDM) in coordinated individual care planning (CIP) with individuals with complex mental health needs. SDM in CIP are described as central, although such user centred collaboration still remains to be realised. Research underlines the need for a changed way of working, where user expertise is valued and a balance of power is promoted. The aim of the present study is to investigate the conditions for implementing SDM in connection with CIP for and with people with mental illness. To better understand the context and conditions that can promote such an implementation, altogether 15 participants were interviewed in three regions in Sweden within the scope of a stakeholder analysis. Both hindering and supporting factors were identified with respect to an implementation process, such as staff turnover, differences in work culture and committed leadership. Further focus should be directed specifically towards professionals working more closely with CIP and towards in-depth analysis of the construct of culture in terms of implementation processes. 
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4.
  • Andersson, Peter, et al. (författare)
  • Exploring stakeholder perspectives to facilitate the implementation of shared decision-making in coordinated individual care planning
  • 2024
  • Ingår i: European Journal of Social Work. - Abingdon, Oxon : Routledge. - 1369-1457 .- 1468-2664. ; 27:5, s. 1073-1085
  • Tidskriftsartikel (refereegranskat)abstract
    • This article explores conditions for implementing shared decision-making (SDM) in coordinated individual care planning (CIP) with individuals with complex mental health needs. SDM in CIP are described as central, although such user centred collaboration still remains to be realised. Research underlines the need for a changed way of working, where user expertise is valued and a balance of power is promoted. The aim of the present study is to investigate the conditions for implementing SDM in connection with CIP for and with people with mental illness. To better understand the context and conditions that can promote such an implementation, altogether 15 participants were interviewed in three regions in Sweden within the scope of a stakeholder analysis. Both hindering and supporting factors were identified with respect to an implementation process, such as staff turnover, differences in work culture and committed leadership. Further focus should be directed specifically towards professionals working more closely with CIP and towards in-depth analysis of the construct of culture in terms of implementation processes. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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6.
  • Bromark, Kristina, et al. (författare)
  • Practitioners exploring intertwined challenges and possible solutions for user participation in social services
  • 2022
  • Ingår i: Nordic Social Work Research. - 2156-857X .- 2156-8588.
  • Tidskriftsartikel (refereegranskat)abstract
    • Despite a strong emphasis on user participation in social services, scientific knowledge on how to achieve these goals is limited. The aim of this study is to explore what social work practitioners identify as challenging in implementing user participation and what solutions they propose to be necessary to meet these challenges. Future workshops were applied, combining data from brainstorming processes and from the participants’ analytical work, identifying current obstacles and co-creating solutions. The workshops took place at the Personal Social Services section in a suburban area outside a large city in Sweden with 95 participants. The findings are discussed in relation to a model of participation, where creating openings, opportunities, and obligations are essential. The participants highlighted the need to strengthen commitment to user participation, increased access to knowledge and methods that enhance user participation, and support from management, with increased resources to ensure continuous development and maintenance. Practitioners must be able to engage in user participation, and actions need to be taken at all organizational levels. To overcome a complex and intertwined set of challenges, an intertwined set of solutions is required. 
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7.
  • Bromark, Kristina, et al. (författare)
  • Samskapande processer : om makt, ansvar och epistemisk rättvisa i deltagande forskning
  • 2023
  • Ingår i: Socialvetenskaplig tidskrift. - : Linköping University Electronic Press. - 1104-1420 .- 2003-5624. ; 29:3-4, s. 325-344
  • Tidskriftsartikel (refereegranskat)abstract
    • Participatory research designs are often used to improve the opportunities of marginalized groups to participate in knowledge production. This article is based on experiences from a research project, where participatory design was used to develop and implement user participation for children and young people in out-of-home care. The aim is to discuss opportunities and challenges within different stages of this research project to problematize which participation in participation research involves. Special emphasis is placed on the power relations between researchers, professionals and users through the different stages of the research process – from research design and co-creation to the implementation of co-created knowledge – and to explore how the opportunity maintaining epistemic justice varies among participants throughout this process. This article shows that the conditions for maintaining justice and epistemic justice change when the participatory research process goes from knowledge production to implementation of co-created knowledge. The implementation of knowledge takes place in a context of complex and competing interests, where the responsibility and power of researchers are weakened in favor of the responsibility and power of professionals. At this stage, users' opportunities for power and responsibility is also weakened. This shift of responsibility and power has ethical implications, which users at this stage may feel let down about their expectations of change that were raised in the past stages of the process, are not met in practice.
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9.
  • Bromark, Kristina, 1973- (författare)
  • The user as a key actor in user participation : Exploring knowledge production in personal social services with a participatory approach
  • 2024
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The concept of user participation in social work is frequently debated. In Sweden, users are supposed to be active and involved in matters concerning them, a stance which is regulated in policy and law. The involvement of users in practice can be considered a form of knowledge production that can strengthen and develop users as well as the organizations. In practice, however, research shows that actual engagement, education or activation of users is difficult to attain and can be understood as a devaluation of user knowledge. The aim of this dissertation is to increase knowledge of how to understand and enhance the conditions for user participation in personal social services. To study this question, the dissertation focuses especially on young people’s participation in the context of out-of-home care. To explore user participation in personal social services, a participatory approach was applied. Data was gathered with young people and staff using participatory techniques as well as qualitative interviews. To explore challenges and possibilities with user participation, a future workshop was held with staff in personal social services (study I). This was followed by a co-design process in which staff, young people, and researchers collaborated on a support tool (study II), later to be implemented in practice (study III). The implementation process was explored by interviewing both staff and managers as well as a user representative (from a youth council). The co-design and implementation processes are problematized and discussed in the dissertation from a researcher’s perspective (study IV). The theoretical framework for understanding how users can be devalued as knowers is epistemic injustice. The assumption is that the role of a knower can shift, depending on social power and the structures in a context. The findings in this dissertation show that user participation is contingent on the distribution of power and responsibility and on perceptions of knowers and knowledge in practice. Although the general attitude towards user participation is positive, a reluctance in practice is revealed. It appears to be a challenge for staff to acknowledge the expertise of users, despite the fact that the users’ have the capacity and are willing to contribute with their knowledge. Work with user participation is identified as a team effort that requires actions at all levels of the organization as well as increased resources, leadership and a coherent understanding and agreement of the concept. A participatory approach to knowledge production with users is identified as a possible way to enhance epistemic justice and the inclusion of all relevant actors in activities and processes. The dimensions important to user participation can be acknowledged. For the dynamics to be maintained in a wider sense, however, an organizational infrastructure, with routines and methods, is necessary. To sustain epistemic justice in the implementation of user participation, a participatory culture with a solid and coherent understanding of user participation in practice is encouraged. A realization of user participation in practice requires a critical exploration of power and positions, systematic changes to infrastructure and transparency about roles and responsibility. 
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10.
  • Dahlqvist Jönsson, Patrik, 1974-, et al. (författare)
  • Service users' experiences of participation in decision making in mental health services
  • 2015
  • Ingår i: Journal of Psychiatric and Mental Health Nursing. - Chichester : Wiley-Blackwell. - 1351-0126 .- 1365-2850. ; 22:9, s. 688-697
  • Tidskriftsartikel (refereegranskat)abstract
    • Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.
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12.
  • Erlandsson, Sara, 1979-, et al. (författare)
  • Perceptions of participation: how nursing home staff and managers perceive and strive for participation of older residents : [Brukardelaktighet på äldreboenden – vad vill personal och chefer uppnå?]
  • 2023
  • Ingår i: European Journal of Social Work. - : Informa UK Limited. - 1369-1457 .- 1468-2664. ; 26:5, s. 815-827
  • Tidskriftsartikel (refereegranskat)abstract
    • User participation is increasingly emphasised in policies guiding social services. However, translating policy into practice is fraught with difficulties. The staff’s approaches to user participation are crucial for the users’ opportunities to participate in decision-making, particularly for users with extensive care needs and reduced autonomy. The aim of this article is to explore how nursing home staff and managers perceive the participation of older residents and what the implications are for residents’ involvement in decision-making in everyday life. Interviews and future workshops were carried out with staff and managers in two Swedish nursing homes. The analysis identified differing and partly conflicting perceptions of user participation that have different implications for the residents’ opportunities to be involved in decisions. The staff’s and managers’ approaches to participation ranged from encouraging independent decision-making to excluding the residents from decisions, depending on the situation and the assessment of residents’ abilities. In addition, the analyses showed that perceptions of participation are intertwined with perceptions of good care and with the staff’s and managers’ understandings of their mission and responsibilities. The findings indicate that increasing user participation in nursing homes requires organisational policies that clarify what user participation is and strategies for implementation in daily practice. 
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13.
  • Grim, Katarina, et al. (författare)
  • Development- and testing of a web-based decision support for users and health professionals in psychiatric services
  • 2017
  • Ingår i: ENMESH. ; , s. 48-48
  • Konferensbidrag (refereegranskat)abstract
    • Aim: Shared decision making (SDM) is considered a central component in a recovery-oriented practice. While decision aids are often regarded as an essential component for successfully implementing SDM they are still largely lacking within psychiatric services.The aim of this study was to utilize a participatory design in order to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the developmental- and usability processes are reported.Methods: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were employed with potential end users who participated as informants in focus group interviews and individual interviews, and as usability and pilot testers.Results: Interviewing and testing identified usability problems which led to refinements making the subsequent prototypes increasingly user friendly and relevant, and which. In each phase of the development process, feedback from potential end-users provided indispensable guidance in the formation of a decision aid for strengthening the position of users by building on an interactive web based environment.Conclusions: The decision aid which resulted from this process has the potential to strengthen service users’ experience of self-efficacy and control as well as giving staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to developing and implementing tools that reflect user perspectives.
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14.
  • Grim, Katarina, et al. (författare)
  • Development- and usability testing of a web-based decision support for users and health professionals in psychiatric services
  • 2017
  • Ingår i: Psychiatric rehabilitation journal. - Washington, DC : American Psychological Association (APA). - 1095-158X .- 1559-3126. ; 40:3, s. 293-302
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. Method: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Results: Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. Conclusions and Implications for Practice: This web-based decision aid has the potential to strengthen service users’ experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives.
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15.
  • Grim, Katarina, et al. (författare)
  • Exploring psychiatric users’ decisional and information needs in Shared Decision Making in the light of Elwyn´s three-step model for Clinical practice
  • 2015
  • Ingår i: Closing the gap between research and policy in mental health. - Málaga : ENMESH. - 9788460827818 ; , s. 118-119
  • Konferensbidrag (refereegranskat)abstract
    • Introduction: Using medication and participating in psychosocial interventions are active processes that often involve complex decision-making. Shared decision making, SDM, provides a model for user and practitioner to cooperatively assess a treatment’s advantages and disadvantages. Decision aid tools adapted to the needs of users have the potential to restructure how people with mental illness and staff work together to arrive at shared decisions about the next steps in treatment or support.Aims: The objective of this study is to investigate decisional and information needs among users with mental illness as a pre-requisite for the design and development of a decision aid aimed at supporting user participation in SDM.Methods: Needs and preferences regarding information transfer in SDM were explored through semi-structured focus group interviews. Participants were adults with psychiatric diagnoses and experience of psychiatric services or close relatives to someone with a psychiatric illness.Qualitative content analysis was used to analyze the data. The transcriptions were initially analyzed in accordance with a conventional, inductive approach. A directed content analysis was then utilized, with Elwyn’s three step model for SDM as a theoretical framework from which to further operationalize the categories rendered in the first step of analysis.Results: The majority of the findings were easily integrated within Elwyn ́s categories. However, some elements which emerged in the data and which are worth noting were not encompassed within Elwyn’s model, such as the wish for information prior to the meeting regarding the time frame and agenda. The importance of heeding the prior knowledge of the user as valuable for the decision process and not solely checking it in order to correct possible misinformation was frequently expressed, as was the value of follow-ups.Conclusions: Even though Elwyn’s model is constructed as a pedagogic tool to be used by staff, while our focus is directed towards creating a tool for users, the application of the model upon our data was indeed helpful in rendering clearly defined and distinguishable codes from our categories. We therefore consider it to be a suitable model to continue to build upon in the development of a decision aid.
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16.
  • Grim, Katarina, 1971- (författare)
  • Legitimizing the knowledge of mental health service users in shared decision making : Promoting participation through a web-based decision support tool
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The overall aim of this thesis was to explore the manner in which user knowledge and user perspectives can be included and supported in shared decision making (SDM) in mental health services.The thesis consists of four studies. Study I explored what needs service users identify to participate in deliberative processes and decision making in their care. Study II examined how a decision support tool (DST) for SDM can be designed to enhance service users’ ability to have active and meaningful roles in SDM. Study III investigated barriers and facilitators associated with the implementation of a web-based DST designed to provide a concrete structure to support SDM. In study IV, a theoretical analysis was performed to elucidate the barriers associated with user knowledge being expressed and legitimized in decision-making processes.Methods: A key feature of the project involved a process of exploring decisional and informational needs and of developing, testing and implementing a DST for SDM. Qualitative data have been collected through focus group and individual interviews with service users and service providers, usability testing with service users and checklists.Findings: The findings show a number of characteristics specific to the mental health service context that need to be considered when developing support for SDM. Decisions were often complex and found to encompass a number of life domains. Issues related to social context and individual recovery highlighted the necessity to include the knowledge perspectives of service users throughout decision processes. In response, phases for preparation and follow-up was emphasized in the DST. The results indicate that supportive structures are required for service users to express their knowledge perspectives and for providers to include them in their decision-making. Moreover, existing barriers related to organizational structures and to power differentials need to be addressed.        Conclusions and implications: A DST specifically designed for the mental health context, that methodically invites service users to participate in each phase of the decision-making process might function as a guiding structure to validate service users as knowledgeable agents.
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17.
  • Grim, Katarina, 1971-, et al. (författare)
  • Legitimizing user knowledge in mental health services : Epistemic (in)justice and barriers to knowledge integration
  • 2022
  • Ingår i: Frontiers in Psychiatry. - Lausanne : Frontiers Media S.A.. - 1664-0640. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • Including the voices and knowledge of service users is essential for developing recovery-oriented and evidence-based mental health services. Recent studies have however, suggested that challenges remain to the legitimization of user knowledge in practice. To further explore such challenges, a co-production study was conducted by a team of researchers and representatives from user organizations in Sweden. The aim of the study was to explore the barriers and facilitators to the legitimacy of user knowledge, as a central factor in sustainably implementing user influence in mental health practice. A series of workshops, with representatives of mental health services and user organizations were conducted by the research team to explore these issues. The analysis built on the theoretical framework of epistemic injustice, and the underlying aspects, testimonial, hermeneutic and participation-based injustice, were utilized as a framework for a deductive analysis. Results suggest that this is a useful model for exploring the complex dynamics related to the legitimacy of user knowledge in mental health systems. The analysis suggests that the legitimacy of user knowledge is related to the representativeness of the knowledge base, the systematic formulation of this knowledge inapplicable methods, access to resources and positions within the mental health system and participation in the process of integrating this knowledge-base in mental health contexts. Legitimizing user knowledge in practice additionally challenges mental health systems to support readiness for change in working environments and to address the power and role issues that these changes involve. Copyright © 2022 Grim, Näslund, Allaskog, Andersson, Argentzell, Broström, Jenneteg, Jansson, Schön, Svedberg, Svensson, Wåhlstedt and Rosenberg.
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18.
  • Grim, Katarina, et al. (författare)
  • Shared decision-making in mental health care : a user perspective on decisional needs in community-based services
  • 2016
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - Järfälla : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice.Objective: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden.Methods: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.’s model of SDM.Results: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process.Conclusions and Implications for Practice: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system. 
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19.
  • Grim, Katarina, 1971-, et al. (författare)
  • The Legitimacy of User Knowledge in Decision-Making Processes in Mental Health Care : An Analysis of Epistemic Injustice
  • 2019
  • Ingår i: Journal of Psychosocial Rehabilitation and Mental Health. - : Springer Science and Business Media LLC. - 2198-9834 .- 2198-963X. ; 6, s. 157-173
  • Tidskriftsartikel (refereegranskat)abstract
    • The experience-based knowledge of users is considered to provide vital input in shared decision making (SDM). However, mental health service users frequently express having negative experiences from meetings with providers, which are of an epistemic nature (e.g., being ignored or not regarded as credible). This study aimed to explore the barriers involved in legitimizing user knowledge in decision-making processes. Interview data from service users and providers were viewed from a theoretic framework of epistemic injustice. Abductive content analysis was conducted on data collected during a project to develop and implement SDM in mental health services. In describing obstacles to legitimize user knowledge, service users highlighted relational issues: being dependent, often dismissed and choosing to edit their testimonies. Service providers typically described workflow issues, users’ insufficient decision- making competence and users’ vulnerability to stress factors. The findings suggest that greater epistemic justice might be achieved by a SDM process in which the service user is engaged as a full partner in collaboration in various activities related to their care.
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20.
  • Grimm, Katarina, et al. (författare)
  • Shared decision making in community mental health services : Supporting user needs for information and participation
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • Objectives: Shared decision making (SDM) is a central component in a recovery-oriented practice. While decision aids are essential for implementing SDM, they are still lacking within psychiatric services. The aim of this study was to develop a user-generated, web-based decision aid to support shared decision making in Swedish mental health services.Methods: A decision aid was developed and tested in a preliminary study using a community-based participatory design. This digital tool was then included in a multifaceted intervention study which included staff training and an implementation study that included process and impact evaluation.Results: Models created for SDM in somatic care, fit well for mental health services. However, the results also suggest adaptations since decisions related to mental illness are often complex and involve multiple life domains. Issues related to social context and individual recovery point to a focus on establishing cooperation as well as follow-up over time.Conclusions: The study contributes to an understanding of decisional and information needs, as well as relationship-based and cognitive factors important to consider in adapting SDM in the community mental health system. The decision aid which resulted can strengthen service users’ experience of self-efficacy and control as well as giving staff access to user knowledge and preferences.
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21.
  • Hultman, Lill, et al. (författare)
  • Exploring the Sharing and Legitimacy of Experience-Based Knowledge of Living with Acquired Brain Injury in Two Practice Communities
  • 2023
  • Ingår i: Health & Social Care in the Community. - : Hindawi Publishing Corporation. - 0966-0410 .- 1365-2524. ; 2023
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Involving people with acquired brain injury in service development has the potential to improve service and give experience-based knowledge legitimacy. The objective of this study was to explore experiences of sharing experience-based knowledge of living with acquired brain injury with others, with a particular focus on the conditions for sharing and learning, and the legitimacy of experience-based knowledge. Materials and Methods. Using a single case study design, the processes in two groups that were part of a Swedish supportive network for people with acquired brain injury were explored. One group consisted mainly of people with acquired brain injury who authored a blog and the other group consisted of healthcare staff who produced educational material with the involvement of a person with own experience of acquired brain injury. The data consisted of forty-one collective blogs, fifteen semistructured individual interviews, and ten observations from meetings. The data were analysed by utilizing the community of practice framework and the concepts of legitimate peripheral participation and epistemic injustice. Results. The findings showed that both groups developed learning processes with a focus on everyday rehabilitation as a joint enterprise. Mutual engagement developed from doing activities together and legitimacy in the groups came from engagement in these activities. In the education group, the ambition to involve people with own experience of acquired brain injury was never realized in practice. Hence, experience-based knowledge of living with acquired brain injury never got legitimacy in the group. Conclusions. We conclude that integrating experience-based knowledge from people with own experience of acquired brain injury demands careful and deliberate planning with specific consideration to existing power asymmetries between healthcare professionals and people with own experience. Mitigating epistemic injustice and gaining legitimacy for such knowledge require that people with experience of living with acquired brain injury are recognized as knowledge producers. 
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22.
  • Jones, Amanda, et al. (författare)
  • Coordinated individual care planning and shared decision making: staff perspectives within the comorbidity field of practice : [Personals perspektiv på samordnad individuell planering och delat beslutsfattande inom samsjuklighetsområdet]
  • 2022
  • Ingår i: European Journal of Social Work. - : Informa UK Limited. - 1369-1457 .- 1468-2664. ; 25:2, s. 355-367
  • Tidskriftsartikel (refereegranskat)abstract
    • Integrated treatment is recommended for users with a comorbidity of mental illness and substance misuse. However, due to a divided support system, coordinated individual care planning (CIP) and user participation are emphasised to provide users with the necessary support. One way of increasing user participation is through shared decision making. However, the challenges are evident why coordination and user participation are not used in practice as intended. To contribute with knowledge to bridge the gap between the intended CIP process and practice, this study examined the problems and solutions perceived by staff. Future workshops were conducted with 17 staff members from social services and health care. Problems and solutions were identified within three main areas: organisation and staff knowledge, coordination among staff, and staff attitudes and user participation. The problems are in agreement with previous research, but this study contributes with knowledge regarding solutions. Overall, the solutions expressed relate to improving collaboration between providers and users and having more resources to conduct this work. However, the study also assents to the question if CIP is the best way to coordinate support or if integrated treatment should be the future.
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23.
  • Jones, Amanda, et al. (författare)
  • How do users with comorbidity perceive participation in social services? A qualitative interview study
  • 2021
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 16:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: This study aims to construct a theoretical framework that explains how users with comorbidity of substance use and mental illness/neuropsychiatric disorders portray user participation in social work encounters.Methods: To construct this framework a constructivist grounded theory approach was used with semi-structured qualitative interviews with 12 users.Results: The main concern of the participants was the low trust in the social services and perceiving that this lack of trust is mutual. Establishing mutual trust is a social process that cuts through the whole framework. In the framework, prerequisites for participation are explained. The prerequisites are users being motivated and having the willingness to stop using drugs and receiving support, making use of user and staff knowledge and decision-making abilities and accessing help and support.Conclusion: Unlike previous frameworks, the model describes participation as a social process and does not explain participation at different levels of power. The results suggest that staff need to be aware of low trust perceptions and work on establishing mutual trust. In addition, the staff need to see each user as an individual and consider how the user would prefer to be involved in decision-making.
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24.
  • Knutsson, Ola, et al. (författare)
  • Co-creating a process of user involvement and shared decision-making in coordinated care planning with users and caregivers in social services
  • 2020
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Although user participation and shared decision-making in formal statutory coordinated care planning are described as central, they remain to be implemented. The aim of this study is to explore how collaboration and shared decision-making in the social services can be realized in formal care planning activities with people with mental disabilities.Methods: We conducted eight workshops with 12 users and 17 caregivers to investigate existing barriers to and possible solutions for participation in coordinated care planning.Results: Workshop formats and techniques from participatory design generated rich research materials illustrating challenges currently experienced by users and caregivers in care planning work, as well as a large variety of solutions to these challenges. They also illustrated differences in how participation is understood and the conditions required to realize shared decision-making between users and caregivers.Conclusions: An improved coordinated individual plan (CIP) process emerged, based on the active participation of users and caregivers. This process is a familiar and transparent process for users and caregivers, reflecting the needs and preferences of users at all stages. It requires careful preparation and collaboration with the users, as well as caregiver flexibility.
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25.
  • Kylén, Maya, et al. (författare)
  • Patient Participation and the Environment : A Scoping Review of Instruments
  • 2022
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O’Malley’s framework to identify instruments intended to measure patient participation. We assessed those instruments’ characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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26.
  • Ljungberg, Malin, et al. (författare)
  • Who cares? A scoping review about the experiences of parental caregivers of autistic adults
  • 2023
  • Ingår i: JARID. - 1360-2322 .- 1468-3148. ; 36:5, s. 929-939
  • Forskningsöversikt (refereegranskat)abstract
    • Background: The autistic population is growing and ageing and this also applies to the parents. Despite this, research about parental experiences is still relatively scarce. Even though studies show, compared with adults with other disabilities, parents of autistic adolescents and adults report a decrease in well-being and that caregiving is often a lifelong commitment. MethodThis scoping review maps, synthesises and identifies gaps in previous research as regards the experiences of parental caregivers of adult autistic children. The review was based on Arksey and Malley's framework and six databases were searched. Results: The results show how the research has focused on the well-being and consequences of daily caregiving for an American middle-class mother who co-resides with an adult son. Conclusion: To enhance knowledge about formal services and service needs, more research is necessary on different welfare regimes and social contexts.
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27.
  • Markström, Urban, et al. (författare)
  • Developing sustainable service user involvement practices in mental health services in Sweden : the “Userinvolve” research program protocol
  • 2023
  • Ingår i: Frontiers in Psychiatry. - Lausanne : Frontiers Media S.A.. - 1664-0640. ; 14, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The purpose of this paper is to outline the protocol for the research program “UserInvolve,” with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. Methods: This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022–2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. Results or conclusion: The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field. Copyright © 2023 Markström, Näslund, Schön, Rosenberg, Bejerholm, Gustavsson, Jansson, Argentzell, Grim, Engdahl, Nouf, Lilliehorn and Svedberg.
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28.
  • Moberg, Jennie, et al. (författare)
  • Review : Young people’s recovery processes from mental health problems – a scoping review
  • 2023
  • Ingår i: Child and Adolescent Mental Health. - : Wiley. - 1475-357X .- 1475-3588. ; 28:3, s. 393-407
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Recovery from mental illness and mental health problems is relatively well-researched among adults, but evidence that focuses on the recovery experiences of young people and what characterizes it is scarce. With this in mind, this article aims to map out the existing research in order to identify prevailing knowledge about the recovery of young people between the ages of 12 and 25. Method: Drawing on scoping review methodology, this article is based on an analysis of 33 articles conducted in the USA, Australia, and Eur-ope. Results: Our findings reveal that young people express both similar and divergent lines of reasoning about recovery compared with adults. Our findings also indicate that young people often fluctuate in the way they view recovery, and that they thus tend to be ambivalent about what recovery means. Parents usually high-light the importance of professionals facilitating recovery, while care staff problematize the organizational frameworks available as aggravating circumstances for implementing personal recovery. Young people, parents, and care staff consistently describe recovery as a way to, despite lingering problems, enable a satisfying life. Conclusions: Through this review, we outline the need for a more distinct focus on agency and participation in young people’s recovery processes, at the same time as family involvement needs to be further investigated and operationalized.
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29.
  • Moberg, Jennie, 1984-, et al. (författare)
  • Staff’s experiences of implementing patient-initiated brief admission for adolescents from the perspective of epistemic (in)justice
  • 2022
  • Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The implementation of Patient-Initiated Brief Admission (PIBA) in child and adolescent psychiatry (CAP) in Sweden is ongoing. This intervention enables adolescents between the ages of 13–17 and with complex mental health problems to initiate a short care period for relief and support rather than the care apparatus being controlling in this process. Offering it is likely to promote epistemic agency, an exchange of knowledge and recovery from mental health problems.Aim: The aim of this study was to explore staff’s perspectives of PIBA for adolescents with complex mental health problems, and what facilitates or hinders its implementation.Methods: Twenty seven employees, 21 women and six men, with various professions in CAP were interviewed and the material was analyzed thematically.Results: Two overall themes emerged: “Staff’s Experiences of PIBA” and “Managing Clinical PIBA Work.” The results were discussed in relation to the theoretical frameworks of epistemic injustice and Normalization Process Theory (NPT). The main findings indicate that PIBA was generally viewed in a positive way, but that obstacles arose when it was actually put into practice. Findings also point at an overall lack of agency among staff when implementing this new way of working, at the same time as the need to adapt PIBA from an adult psychiatric intervention to one for adolescents in CAP is addressed.Conclusion: This article offers insights into the views of psychiatric staff regarding the implementation of PIBA. If staff wish to support epistemic agency and recovery among adolescents, their agency may be an important aspect in the continued implementation. Furthermore, in order for PIBA to become normalized in a sustainable way, we suggest that the continued implementation should be characterized by a youth-friendly framework.
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30.
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31.
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32.
  • Olsson, Helén, 1961-, et al. (författare)
  • Reducing violence in forensic care : How does it resemble the domains of a recovery-oriented care?
  • 2016
  • Ingår i: Journal of Mental Health. - : Informa UK Limited. - 0963-8237 .- 1360-0567. ; 25:6, s. 506-511
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Forensic psychiatry is characterized by involuntary treatment and risk of violence. The concept of recovery is rarely in focus as the primary focus is on risk assessment, violence prevention and reducing coercion in care.Aim: To determine what resources forensic staff use to avoid or prevent violent situations, and to explore how these practices resemble the domains of recovery-oriented care.Method: Semi-structured interviews with staff who were identified by forensic patients as key workers in their recovery process. Interview texts were analyzed using interpretive content analysis.Results: Staff prevent violent situations using tacit knowledge and experience, and through a shared collegial responsibility. Staff safeguard patients, encourage patient participation, and provide staff consistency.Conclusions: The results have implications for forensic care as well as psychiatry regarding the process of making recovery a reality for patients in the forensic care setting.
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33.
  • Osman, Fatumo, et al. (författare)
  • A Support Program for Somali-born Parents on Children's Behavioral Problems.
  • 2017
  • Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 139:3
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The objectives of this study were to evaluate a culturally tailored parenting support program (Ladnaan) for Somali-born parents and to determine its effectiveness on children's emotional and behavioral problems.METHODS: This randomized controlled trial included 120 Somali-born parents with children aged 11 to 16 years. The parents reported self-perceived stress in relation to parenting practices. The intervention consisted of culturally tailored societal information combined with the parenting program Connect. Parents received 12 weeks of intervention, 1 to 2 hours each week, in groups of 12 to 17 parents. Nine group leaders with a Somali background who received a standardized training program delivered the intervention. The primary outcome was a decrease in emotional and behavioral problems based on a Child Behavior Checklist. Parents were randomly allocated either to an intervention group or a wait-list control group. Covariance analyses were conducted according to intention-to-treat principles.RESULTS: The results showed significant improvement in the children in the intervention group for behavioral problems after a 2-month follow-up. The largest effect sizes according to Cohen's d were in aggressive behavior (95% confidence interval [CI], 1.06 to 3.07), social problems (95% CI, 0.64 to 1.70), and externalizing problems (95% CI, 0.96 to 3.53).CONCLUSIONS: The large effect sizes in this study show that this 12-week culturally tailored parenting support program was associated with short-term improvements in children's behavior. The study adds to the field of parenting interventions by demonstrating how to culturally tailor, engage, and retain parenting programs for immigrant parents.
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34.
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35.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting : a randomised controlled trial
  • 2017
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:12
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.DESIGN: Randomised controlled trial.SETTING: A city in the middle of Sweden.PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.CLINICAL TRIAL REGISTRATION: NCT02114593.
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36.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Impact of a culturally tailored parenting programme on the mental health of Somali parents and children living in Sweden : a longitudinal cohort study
  • 2021
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives This study aimed to evaluate the long-term impact (3-year follow-up) of a culturally tailored parenting support programme (Ladnaan) on the mental health of Somali-born parents and their children living in Sweden.Methods In this longitudinal cohort study, Somali-born parents with children aged 11-16 were followed up 3 years after they had participated in the Ladnaan intervention. The Ladnaan intervention comprises two main components: societal information and the Connect parenting programme delivered using a culturally sensitive approach. It consists of 12 weekly group-based sessions each lasting 1-2 hours. The primary outcome was improved mental health in children, as measured by the Child Behaviour Checklist (CBCL). The secondary outcome was improved mental health in parents, as measured by the General Health Questionnaire-12. Data were collected from the parent's perspective.Results Of the 60 parents who were originally offered the intervention, 51 were included in this long-term follow-up. The one-way repeated measures (baseline to the 3-year follow-up) analysis of variance for the CBCL confirmed maintenance of all the treatment gains for children: total problem scores (95% CI 11.49 to 18.00, d=1.57), and externalising problems (95% CI 2.48 to 5.83, d=0.86). Similar results were observed for the parents' mental health (95% CI 0.40 to 3.11, d=0.46).Conclusion Positive changes in the mental health of Somali-born parents and their children were maintained 3 years after they had participated in a parenting support programme that was culturally tailored and specifically designed to address their needs. Our findings highlight the long-term potential benefits of these programmes in tackling mental health issues in immigrant families.
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37.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Ladnaan - att må bra : En utvärdering av ett riktat stöd till somaliska föräldrar i Borlänge Kommun
  • 2015
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Folkhälsomyndigheten har finansierat ett samarbetsprojekt mellan Borlänge kommun och Högskolan Dalarna för att anpassa och implementera ett föräldrastödsprogram till somaliska föräldrar, samt att mäta effekten av denna intervention avseende föräldrars och barns psykiska hälsa. Studien började med en explorativ delstudie med syfte att samla kunskap om vad somaliska föräldrar upplever som utmanande i sitt föräldraskap i Sverige, vilket behov av föräldrastöd de behöver samt hur ett sådant stöd ska vara utformat. Studien genomfördes med hjälp av fokusgruppsintervjuer med 23 föräldrar (15 mammor och 8 pappor) boende i Borlänge. Resultatet visade att föräldrarna upplevde en rad utmaningar i sin nya livssituation och i sitt föräldraskap i nya landet. De beskrev skillnader i synsätt på barnuppfostran och föräldraskap mellan hemlandet och Sverige och eftersträvade därför att kulturanpassa sitt föräldraskap.Resultaten från denna studie samt en genomgång av forskning kring föräldrastöd låg till grund för valet av föräldrastödsprogram samt ett samhällsorienterande tillägg till programmet. Målgrupp för studien var föräldrar med barn i åldrarna 11-16 år och som upplevde stress i sitt föräldraskap. Föräldrarna erbjöds sammanlagt 16 timmars utbildning fördelat på 12 träffar (10 timmar Connect föräldrastöd + 6 timmar samhällsorienterande tillägg). Effekten av föräldrastödet undersöktes genom en randomiserad kontrollerad studie där totalt 120 föräldrar ingick. De preliminära resultaten visar att deltagande föräldrars barn har förbättrats signifikant i subskalorna ”socialt” och ”skola”. Dessutom minskade barnens oro, somatiska problem, sociala problem och brytande av regler. Föräldrarna var nöjda med interventionen. De upplevde att de fått en ökad kunskap om hur socialtjänstens arbete fungerar och fått förtroende för deras arbete kring barn och unga. Över hälften av föräldrarna upplevde sig mer säkra i sin föräldraroll och att deras relation med barnen hade förbättrats. Genom en processutvärdering av implementeringen av föräldrastödet har framgångsfaktorer för genomförandet avföräldrastödsprogrammet studerats. Resultatet visade att de olika strategier som vidtagits vid rekrytering av föräldrar och implementering av interventionen har varit lyckade. Exempel på sådana strategier har varit att projektmedarbetarna som rekryterat till föräldrastödet har varit av Somaliskt ursprung, kursen har getts på somaliska men framförallt att föräldrastödet utgick ifrån föräldrarnas upplevda behov.
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38.
  • Osman, Fatumo, et al. (författare)
  • Parenthood in transition : Somali-born parents' experiences of and needs for parenting support programmes
  • 2016
  • Ingår i: BMC International Health and Human Rights. - : Springer Science and Business Media LLC. - 1472-698X. ; 16:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting.METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied.RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities.CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.
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39.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants
  • 2019
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 108:8, s. 1482-1490
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: Parenting programmes tailored to immigrant parents have been reported to improve the mental health of the children and parents, as well as parents' sense of competence in parenting. However, research on parents' experiences of programmes tailored to their needs is scarce. This qualitative study aimed to describe Somali parents' experiences of how a culturally sensitive programme affected their parenting.METHODS: The study was conducted in a middle-sized city in Sweden in 2015. Data were collected through semi-structured interviews with 50 participants two months after they took part in a parenting support programme. Inductive and deductive qualitative content analyses were used.RESULTS: A light has been shed was a metaphor that emerged from the analysis and that captured the knowledge the parents gained from the parenting system in Sweden. Parents gained confidence in their parenting role and became emotionally aware of their child's social and emotional needs and how to respond to them. Holding the sessions in the participant's native language was important for the parents' participation and acceptance of the programme.CONCLUSION: Parenting programmes should be tailored to the specific needs of the participants and cultural sensitivity should be factored into programmes to attract immigrant parents. This article is protected by copyright. All rights reserved.
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40.
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41.
  • Osman, Fatumo, 1973-, et al. (författare)
  • The implementation of a culturally tailored parenting support programme for Somali immigrant parents living in Sweden : A process evaluation
  • 2022
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:9
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Parental support programmes aim to strengthen family functioning and the parent-child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components of the implementation process with a focus on Reach, Adaptation, and Fidelity of Ladnaan intervention.METHOD: This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Council's guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes and observations of the sessions. The data were then analysed using content analysis and descriptive statistics.RESULTS: Of the 60 parents invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the parenting programme's implementation facilitated reaching Somali-born parents. To retain the programme participants, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme and reported increased knowledge about children's rights and the support they could seek from social services.CONCLUSIONS: This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to attract immigrant parents to and engage them in participating in parenting support programmes.
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42.
  • Quarles van Ufford, Sara, et al. (författare)
  • Discretion and Strategies for Investigating Child Abuse : Social Workers' Conceptions of Child Abuse Investigations and Police Reporting
  • 2024
  • Ingår i: British Journal of Social Work. - 0045-3102 .- 1468-263X. ; 54:4, s. 1554-1573
  • Tidskriftsartikel (refereegranskat)abstract
    • Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex, and dependent on the specific CW context. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children who need protection. Drawing on an understanding of social service organisations as street-level bureaucracies, this article explores discretion in child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Thematic analysis of interviews with Swedish supervising social workers showed that staff's conceptions of the CW system influenced the exercise of discretion, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, highlighting the wide margin of discretion. This article concludes that the interplay between knowledge and governance is central to equal child protection. This article contributes to the discussion of discretion in CW organisations by underlining the importance of being particularly vigilant about discretion when both children and parents are considered clients, as the child risks being lost as a subject with individual needs and rights. Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children in need of protection. This article explores the handling of child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Analysis of interviews with Swedish supervising social workers showed that staff's conceptions of the CW system influenced the handling, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, underscoring the importance of being particularly vigilant about discretion when both children and parents are considered clients: the child risks being lost as a subject with individual needs and rights. This article concludes that the interplay between knowledge and governance is central to equal child protection.
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43.
  • Quarles van Ufford, Sara, et al. (författare)
  • The Swedish social services' police reporting and children's access to protection and support in child abuse cases : A quantitative content analysis
  • 2022
  • Ingår i: International Journal of Child Abuse & Neglect. - : Elsevier BV. - 0145-2134 .- 1873-7757. ; 133
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The UN Convention on the Rights of the Child prohibits all forms of violence against children. Sweden was early in introducing a ban on disciplinary violence; however, difficulties have been noted in identifying children in need of protection and providing help for children exposed to violence.Objectives: The purpose of this study was to explore the social services' police reporting and children's access to protection and support in cases of physical and sexual child abuse.Methods: The sample consisted of 291 child welfare reports from three Swedish municipalities. Data were collected from child welfare reports, investigations, and child social records and analyzed using quantitative content analysis.Results: A majority of the cases, including cases with a high indication for police reporting, were not reported to the police by the social services. Although the child in 60.1 % of cases provided information about violence, 70.7 % of all child welfare investigations were completed without support measures, and only 8.2 % led to protection or support linked to violence. Children's participation was limited, suggesting inadequate conditions for children's access to protection and support.Conclusions: Children's right to protection against violence requires the recognition of children as active participants with access to safe participation. Failure to report suspected crimes against children risks minimizing acts of violence or making violence invisible. Difficulties in handling conflicts of interest between children and parents risk neither protection nor support being provided for the child.
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44.
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45.
  • Rosenberg, David, 1957-, et al. (författare)
  • Establishing a Recovery Orientation in Mental Health Services : Evaluating the Recovery Self-Assessment (RSA) in a Swedish Context
  • 2015
  • Ingår i: Psychiatric rehabilitation journal. - Washington, DC : American Psychological Association (APA). - 1095-158X .- 1559-3126. ; 38:4, s. 328-335
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Although there has been an emphasis on developing knowledge regarding recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Instruments, which present the components of recovery as measurable dimensions of change, may provide a framework for program development. Involving users is an essential factor in the utilization of such tools. The purpose of this study was to evaluate the psychometric properties of the Recovery Self-Assessment (RSA) measure and its potential for being utilized in a Swedish context.METHODS: The sample consisted of 78 participants from 6 community mental health services targeting people with serious mental illnesses in a municipality in Sweden. They completed the RSA at the study baseline and two weeks later. User panels participated in the translation and administration of the RSA and the reporting of results.RESULTS: The Swedish version of the RSA had good face and content validity, satisfactory internal consistency, and a moderate to good level of stability in test-retest reliability. The user panels contributed to establishing validity and as collaborators in the study.CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Establishing the RSA as a valid and reliable instrument with which to focus on the recovery orientation of services is a first step in beginning to study the types of interventions that may effect and contribute to recovery oriented practice in Sweden. © 2015 APA, all rights reserved
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46.
  • Rosenberg, David, 1957-, et al. (författare)
  • Establishing a Recovery Orientation in Swedish Mental Health Services : From attitudes to instruments.
  • 2015
  • Konferensbidrag (refereegranskat)abstract
    • Introduction: Although there has been an emphasis on developing knowledge of recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Educational initiatives focused primarily on changing attitudes have not produced concrete outcomes. Instruments that define the components of recovery as measurable dimensions of change may provide a framework for implementing recovery-oriented services. Aims: The aim of this study was to investigate whether the use of instruments which measure a recovery orientation in services could provide program level outcome indicators, that could point to concrete needs for change. An additional aim was to study the contribution of peer support workers to this process. Methods: Two internationally tested and validated instruments were distributed to 85 clients from 6 community mental health services targeting people with a diagnosis of psychosis in a municipality in Sweden. These focused respectively on the recovery orientation of services (RSA) and the recovery orientation of relationships with the primary contact person (Inspire). An additional instrument (RKI) was distributed to all staff at these clinics to assess their knowledge of recovery paradigms.  Peer support workers participated in the translation, administration and reporting of results.   Results: The instruments were translated to Swedish, tested and found to have acceptable psychometric properties. The reports produced from these instruments highlighted specific areas for improvement which these user assessments had indicated. These included for example; opportunities to influence services and care plans, to receive support for activities outside of psychiatry, to have their strengths included in assessments and to have more access to experience-based knowledge. The peer support workers provided valuable support to the process and were additionally seen by the clinic staff as a valuable resource in future work.   Conclusions: Instruments which measure a recovery orientation in mental health services can contribute to a focus on specific knowledge, attitudinal and skill gaps that service organisations can target in their quality development activities.  In the present study, staff were more accepting of this feedback since it came directly from their clients and was collected and presented systematically
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47.
  • Rosenberg, David, 1957-, et al. (författare)
  • Establishing a Recovery Orientation in Swedish Mental Health Services; From attitudes to instruments
  • 2015
  • Ingår i: Closing the gap between research and policy in mental health. - Málaga : ENMESH. - 9788460827818 ; , s. 114-114
  • Konferensbidrag (refereegranskat)abstract
    • Introduction: Although there has been an emphasis on developing knowledge of recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Educational initiatives focused primarily on changing attitudes have not produced concrete outcomes. Instruments that define the components of recovery as measurable dimensions of change may provide a framework for implementing recovery-oriented services.Aims: The aim of this study was to investigate whether the use of instruments which measure a recovery orientation in services could provide program level outcome indicators, that could point to concrete needs for change. An additional aim was to study the contribution of peer support workers to this process.Methods: Two internationally tested and validated instruments were distributed to 85 clients from 6 community mental health services targeting people with a diagnosis of psychosis in a municipality in Sweden. These focused on the recovery orientation of services (RSA) and the recovery orientation of relationships with the primary contact person (Inspire). An additional instrument (RKI) was distributed to all staff to assess their knowledge of recovery paradigms. Peer support workers participated in the translation, administration and reporting of results.Results: The instruments were translated to Swedish, tested and found to have acceptable psychometric properties. The reports pro-duced from these instruments highlighted specific areas for improvement which these user assessments had indicated. These included for example; opportunities to influence services and care plans, to receive support for activities outside of psychiatry, to have their strengths included in assessments and to have more access to experience-based knowledge. The peer support workers provided valuable support to the process and were additionally seen by the clinic staff as a valuable resource in future work.Conclusions: Instruments which measure a recovery orientation in mental health services can contribute to a focus on specific knowledge, attitudinal and skill gaps that service organisations can target in their quality development activities. In the present study, staff were more accepting of this feedback since it came directly from their clients and was collected and presented systematically.
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48.
  • Rosenberg, David, 1957-, et al. (författare)
  • Ett återhämtningsorienterat arbetssätt i Jönköpings län : erfarenher från ett uppföljningsarbete
  • 2014
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Under de senaste åren har forskning om återhämtning från psykisk ohälsa resulterat i ny kunskap som fått relevans för såväl socialtjänstens som psykiatrins verksamhetsfält. Allt fler verksamheter som ger stöd och vård till människor med psykisk ohälsa syftar att bli mer återhämtningsinriktade. Det innebär att verksamheter fokuserar mer på insatser som främjar individens önskemål och delaktighet, och mindre på omsorgsinriktade insatser som främst fokuserar på symtom eller funktionsnedsättning. De brukare som beskriver sin återhämtning lyfter fram delaktighet, hopp för framtiden, meningsfullhet och egenmakt som centrala i den individuella återhämtningsprocessen. Det utbildningsarbete som sedan 2010 har bedrivits i Jönköpings län kring ett återhämtningsinriktat arbetssätt, dialogutbildningar, resurspersoner och återhämtningsombud, ligger i linje med nationell och internationell forskning och utveckling. Syftet med dessa utbildningar har varit att utveckla värderingar och attityder i socialtjänst och psykiatri för att främja brukares återhämtning samt att omvandla återhämtningsperspektivet till konkreta arbetssätt. Under hösten 2013 kontaktades författarna till denna rapport av representanter från Regionförbundet i Jönköping för en diskussion om hur ett återhämtningsperspektiv kan omvandlas till konkreta arbetssätt. Återhämtningsombud hade utbildats och varit aktiva i de dialogutbildningar som genomförts. Man ville nu genomföra ett utvärderingsarbete av dialogutbildningarna för att undersöka vilken betydelse de hade på personalens förhållningssätt och bemötande, samt studera om det hade haft någon betydelse på brukarnas upplevelser av de insatser de får från psykiatri och socialtjänst. Föreliggande rapport är ett resultat av det utvärderingsarbetet.
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49.
  • Rosenberg, David, 1957-, et al. (författare)
  • Obstacles and possibilities for implementing SDM in Swedish mental health services : Supporting interactivity and participation
  • 2017
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Despite Swedish health care policy, which emphasizes patient participation in the planning of health care services, few programs have concrete methods for achieving this goal. Previous studies have shown that staff attitudes and systems which maintain power differentials, create obstacles for achieving participation despite methods such as SDM.The purpose of the study was to explore implementing SDM with an interactive digital decision tool, designed for users in community mental health services in Sweden. The tool was specifically developed, in collaborative research with users, to overcome disempowering experiences as they attempt to participate in treatment decisions.Method: A process evaluation design (Moore et al. 2015) was utilized in order to investigate obstacles and possibilities for a structured intervention to facilitate participation in decision making. The design utilized in the study included collecting qualitative and quantitative data focused on three identified evaluation components; Context, Implementation and Mechanism of impact.Results: Staff considered that SDM was most appropriate for formal treatment planning and that the use of the digital decision tool, which enabled interactive communication between staff and users, did support the user to be prepared for decisions, as well as helping staff to stay focused on user wishes.SDM was most often used voluntarily by each staff member, based on their experience and attitude, rather than a common practice for the service. Another barrier concerned capacity, with staff sometimes feeling they did not have formal power regarding treatment planning decisions, and expressing doubt as to the patient's willingness and ability to participate in decisions.Discussion: The results suggest that contextual barriers to implementing shared decision making can be addressed by utilizing interactive decision tools which concretely structure the interaction between users and staff and are connected to formally required treatment planning processes that are essential for user participation.
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50.
  • Rosenberg, David, 1957-, et al. (författare)
  • Shared decision making in community mental health services - an evaluation of three self-reporting instruments
  • 2017
  • Ingår i: Journal of Mental Health. - Abingdon, Oxon : Routledge. - 0963-8237 .- 1360-0567. ; 26:2, s. 142-149
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers.Aim: The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context.Method: The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity.Results: The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden.Conclusions: The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.
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