| 1. |
- Biswas, Animesh, 1978-
(författare)
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Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.
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| 2. |
- Islam, Farzana, 1969-
(författare)
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Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Bangladesh, research focusing on the quality of maternal and newborn health (MNH) services in hospitals remains neglected. There have only been a few studies conducted on quality issues and found the quality of MNH care provided at district and sub-district hospitals to be poor. The overall objective of this thesis was to develop, implement and evaluate a framework for quality improvement (QI) system for MNH care at the district and sub-district level government hospitals in Bangladesh. The thesis is comprised of four papers. Mixed methods were used in paper I and paper IV. In paper II quantitative methods were utilized, and to develop the “Model QI System”, exploratory methodological approaches were used and illustrated in paper III. Group discussions, focus group discussions, in-depth interviews, documents review and photography were utilised as qualitative data collection techniques. Through structured observation and exit interviews quantitative data were obtained. Findings of baseline survey identified several keyfactors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under useof patient-management protocols; lack of training; and insufficient supervision. The clinical performance of health care providers was found unsatisfactory. Utilizing the baseline survey findings and existing information on QI models, theories and QI intervention programmes implemented in defferent settings an adapted “Model QI System” and its implementation framework, guidelines and tools were developed. The key areas of this “Model QI System” included health system support, clinical service delivery, inter-departmental coordination; and utilization of services and client satisfaction. The adopted “Model QI System” was incorporated within the existing hospital management system and it was found that the quality of care improved. The evaluation of the study showed that the “Model QI System” was acceptable to the top health managers, health care providers and hospital support staff and feasible to implement in district and sub-district hospitals in Bangladesh.
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| 3. |
- Lytsy, Per, 1968-
(författare)
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Power of the Pill : Views about Cardiovascular Risk and the Risk-reducing Effect of Statins
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Medical treatments with statins are prescribed to patients with increased risk of cardiovascular events. The benefits from statin treatment are well documented in clinical trials, but long-term adherence in patients is low, indicating that patients have an uncertainty about the necessity and benefits of treatment. The aims of this thesis were to investigate how patients and doctors view different aspects of statin treatment. Further aims were to investigate if the cardiovascular risk level in patients affects their views about different aspects of statin treatment. Yet further aims were to compare health behaviours and views about risk factors in patients using statins to a non-treated population. Data was obtained from patients (n = 829), doctors (n = 330) and a population sample (n = 720) using postal questionnaires. Views about the effect of statin treatment were assessed in different ways for patients and doctors. Patients based their assessments on their own situation, and doctors’ treatment decisions and assessments of anticipated effect of treatment were based on two hypothetical patient cases. The results indicate that patients greatly overestimate the general effect of statins, compared to efficacy results reported from clinical trials. Patients’ previous coronary heart disease or high overall risk were factors not associated with their views and expectations of treatment effect. Statin users with an internally perceived health control and patients satisfied with their doctor’s treatment explanation reported higher beliefs in treatment necessity and benefits. Statin users reported having better health behaviours and generally rated risk factors as more important than the non-treated population. Doctors had suboptimal understanding of the number of patients expected to benefit following five years of statin treatment and had a varying understanding of statins’ ability to prolong life. Overall the results illustrate that patients and doctors have different perspectives and views of the benefits from statin treatment which puts emphasis on how statin treatment is discussed in the clinical setting.
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| 4. |
- Åkerman, Eva, 1978-
(författare)
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Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to obtain an understanding of immigrant women’s access to healthcare services in Sweden in relation to sexual and reproductive health and rights (SRHR). Data were obtained from three different quantitative cross-sectional studies using self-administrated questionnaires and one qualitative study based on in-depth interviews. The sample consists of immigrant women, predominantly refugees from Afghanistan, Iraq, Syria, and Somalia in Study I (n=288) and Thai immigrant women in Studies II–IV: Study II (n=804), Study III (n=19) and Study IV (n=266). The results indicate that social capital factors seem to play an important role in knowledge about sexual and reproductive health (SRH) services. About one-third of immigrant women reported lack of knowledge of where to go for contraceptive counselling. Lack of knowledge was associated with experiencing lack of emotional social support and not having children. An even higher proportion lacked knowledge of where to go for HIV testing, which was associated with not having participated in a health examination. In a sample of Thai immigrant women, lack of knowledge about SRH services was associated with living without a partner, having low trust in others, having predominantly bonding social relationships and belonging to the oldest age groups. In all studies, the majority had not been tested for HIV or participated in contraceptive counselling. Among the Thai women, despite expressing a need for SRH care, most participants had not sought this type of care. Women found it challenging to seek care in Sweden due to lack of knowledge about the healthcare system and language difficulties. The majority of Thai women reported a significant need for information related to SRH services. Women who had never been HIV tested in Thailand had increased odds of not being tested in Sweden.Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women is a missed opportunity, as all citizens in Sweden have free access to these services. Providing information on SRH services to all immigrants in their native language, regardless of immigration status, is an important step in achieving equal access to SRH care.
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| 5. |
- Berglund, Erik, 1980-
(författare)
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Adherence to drug treatment and interpretation of treatment effects
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Suboptimal adherence to medical treatments is prevalent across several clinical conditions and can lead to treatment failure. Adherence is a far from fully explored phenomenon and there is little knowledge about how patients interpret treatment effects. Commonly used treatment evaluation measures are often relative measures, which may be difficult for lay people and patients to understand.The overall aim of this thesis was to investigate factors with relevance to adherence, to estimate treatment effects with the time-based Delay of Event (DoE) measure in anticoagulant preventive treatments, and to explore how lay people responded to the DoE measure, as compared with established measures, regarding treatment decisions and effect interpretation.A quantitative population-based cross-sectional design was used for Study I. Study II used data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial and estimated effects as DoEs. Studies III and IV were carried out as randomised survey experiments.The results showed that general adherence behaviour was associated with both environmental and social factors. Estimations of DoE showed that stroke or systemic embolism was delayed 181 (95% CI 76 to 287) days through twenty-two months of apixaban use, as compared with warfarin use. The delay of major and intracranial bleeding was 206 (95% CI 130 to 281) and 392 (95% CI 249 to 535) days, respectively, due to apixaban use for twenty-two months, as compared with warfarin use. Presenting preventive treatment effects as DoEs to lay people was associated with high willingness to initiate treatment and positive views on treatment benefits and willingness to pay for treatment.Non-optimal adherence was partly associated with modifiable factors and it might be possible to increase adherence by managing these factors. Estimations of DoEs in preventive treatments gave information on effects regarding delay of different outcomes; the estimation also provides tools that might be useful for interpreting and communicating treatment effects in clinical decision-making. Lay people seemed to react rationally to variations in DoE magnitude; a higher proportion accepted treatment when the magnitude was greater.
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| 6. |
- Berglund, Erik, et al.
(författare)
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Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy : a randomised survey experiment
- 2018
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Ingår i: BMC Medical Informatics and Decision Making. - : BMC. - 1472-6947. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.
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| 7. |
- Grandahl, Maria
(författare)
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Prevention of Human Papillomavirus in a school-based setting
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents.The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study.The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention.Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer.
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| 8. |
- Kunkel, Stefan, 1975-
(författare)
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Quality Management in Hospital Departments : Empirical Studies of Organisational Models
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to empirically explore the organisational characteristics of quality systems of hospital departments, to develop and empirically test models for the organisation and implementation of quality systems, and to discuss the clinical implications of the findings. Data were collected from hospital departments through interviews (n=19) and a nation-wide survey (n=386). The interviews were analysed thematically and organisational models were developed. Relationships among aspects of organisation and implementation were hypothesised and analysed with structural equation modelling. The result was a new framework with three organisational aspects of quality systems each with two sub-aspects: structure (resources and administration), process (culture and cooperation), and outcome (evaluation of goal achievement and development of competence). Strong positive relationships were confirmed among structure, process, and outcome. Quality systems could therefore be classified into three organisational degrees. For instance, quality systems of high organisational degree often had adequate resources and administration as well as positive organisational cultures and high cooperation among different professions. Advanced designs required quality systems of high organisational degrees. Examples of such designs were coordination between departments, random check ups, and accreditation. The organisationally demanding quality systems had been implemented through cooperative implementation, that is, directed by managers while at the same time giving opportunities for staff to participate in planning and designing. The results can be useful to managers, quality coordinators, and clinicians when they describe, develop, implement, and evaluate the effectiveness and efficiency of quality systems in hospital departments.
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| 9. |
- Larsson, Margareta, 1950-
(författare)
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The Adoption of a New Contraceptive Method – Surveys and Interventions Regarding Emergency Contraception
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to examine the adoption of emergency contraceptive pills (ECP) in Sweden. Two cross-sectional surveys and two quasi-experimental studies were used. Reasons for induced abortion, contraceptive practices and contraceptive failure were examined in a group of abortion applicants with a waiting-room questionnaire (I) and knowledge, use and practices of ECP were assessed with a postal questionnaire in a population-based sample of young women (II). One community-based information campaign was evaluated with a repeated postal questionnaire (III) and a school-based education intervention was evaluated with repeated class-room questionnaires (IV). Abortion applicants had inadequate contraceptive practices and a low use of ECP. One year after the deregulation of ECP women were highly aware of the method and preferred the pharmacy for the purchase of ECP. Correct knowledge and positive attitudes influenced the willingness to use ECP in the future. The information campaign was noticed by two-thirds of the women and there was an overall trend towards better knowledge, improved attitudes and increased use among all women at follow-up. The school-based intervention improved the students’ knowledge of, and attitudes to, ECP without jeopardizing condom use. The adoption of ECP in Sweden seems to have gone through the first stages of diffusion of an innovation, i.e., developement, dissemination, and adoption, and has reached the stage of implementation since the studies indicated a general awareness of more than 90%, an intention to use in case of need of more than 70%, and womens’ own experience of use of around 30%. The most cited information channels were media, friends and the local Youth Clinic. ECP is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, but must be considered as being only one of many tools in the prevention of unintended pregnancies.
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| 10. |
- Ohlsson, Anna, 1975-
(författare)
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Equity in Treatment and Outcomes among Heart Failure Patients in Sweden : The role of gender, age and socioeconomic factors in access to treatment and mortality
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is extensive empirical evidence for inequity in health and health care between and within countries across all economic levels worldwide. In Sweden, the Health and Medical Services Act states that health care should provide good health and equal health care for the entire population, but this goal has yet to be fulfilled. Equity has been defined as “differences which are unnecessary and avoidable, but in addition are considered unfair and unjust”. Equity in health is closely linked with the so-called social determinants of health, or the conditions in which people are born, grow, live, work, and age.Heart failure (HF) is a common disease globally, carrying high morbidity and mortality, and is one of the major causes of hospitalisations in Sweden. There is a strong evidence base for renin angiotensin system blockers (RASb) as well as beta-blockers (BB) reducing mortality in HF, and long-standing recommendations for these medications in treatment guidelines. However, not all eligible patients receive this first-line treatment. There has been some evidence of inequity by gender and age in treatment of HF, but evidence regarding socioeconomic risk factors has been scarce.In this thesis, differences in access to pharmacological therapy by demographic and socioeconomic factors were investigated.Observational studies with cohort designs were performed. In Study I–III large national population-level interlinked register materials were investigated, and in Study IV a well characterised cohort including clinical and prescription data from the SwedeHF, a Swedish HF quality register, was analysed.In Study I, we investigated differences in access to angiotensin-converting enzyme inhibitors (a type of RASb) by gender, age, educational level, employment status, income and immigration status among hospitalised HF patients in Sweden. In Study II we aimed to investigate effectiveness, i.e., the association between RASb exposure and mortality, among hospitalised HF patients in Sweden, and whether effectiveness varied with gender and age. In Study III, RASb access and mortality by employment status and educational level among hospitalised HF patients in Sweden of working age was analysed, along with possible excess mortality among non-employed patients without access to RASb. In Study IV, medication adherence to mortality-reducing HF medications, i.e., RASb and BB, was examined by age, gender, educational level, marital status and income.In conclusion, the studies in the thesis showed that access to RASb treatment appeared inequitable for women, the non-employed, and the elderly among hospitalised HF patients, although this treatment was associated with lower mortality for all these groups. Furthermore, RASb treatment was associated with similar reductions in mortality for women and men, but the association was somewhat weaker among older compared with younger hospitalised HF patients. In addition, non-employment and lower educational level were associated with higher mortality in hospitalised HF patients, and non-employment was associated with less access to RASb treatment. Finally, lower income and single status were associated with lower adherence to mortality-reducing treatment with BB and RASb in a quality register HF cohort, while associations were more unclear regarding gender and age.
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| 11. |
- Paulsson Do, Ulrica
(författare)
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Psychosocial Vulnerability Underlying Unhealthy Behaviours in Swedish Adolescents
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to examine the relationship between Swedish school adolescents´ health-related behaviours and psychosocial and socio-demographic factors, with the purpose of identifying vulnerability factors for unhealthy behaviours and exploring adolescents’ own experiences and thoughts about this.Three studies were quantitative cross-sectional studies and used data from two different questionnaires. The fourth study was a qualitative study based on focus group interviews. The sample in study I consisted of 13–18-year-old adolescents (n= 10,590) and 15–16-year-old adolescents in studies II (n=492), III (n=492) and IV (n=36). The quantitative data were analysed using a number of different statistical methods. Foremost, structural equation modelling was used in studies I and II and Poisson regression analysis in study III. Study IV used qualitative content analysis by Graneheim and Lundman.The results indicated that nearly 60 per cent of 15–16-year-old adolescents have at least two unhealthy behaviours. Interrelated psychosocial and socio-demographic factors constituted vulnerability for unhealthy behaviours in general in adolescents. Good psychosocial relationships were strongly related with high well-being, whereas poor social relationships and low well-being were associated with unhealthy behaviours in general. Low socio-economic group was associated with unhealthy behaviours in general but the strength of this association varied between the adolescent age groups. Encouragement from parents to adopt healthy behaviours was associated with less unhealthy behaviours. Having adolescents who cared about what their parents said regarding health-related behaviours was also associated with a lower number of unhealthy behaviours. The school and family were important social environments for adolescents´ health-related behaviours. Similarly, friends and social media were important social contexts. Fellowship, and close social relationships, in particular, was important to healthy behaviours. Fellowship with others was also stated to influence high well-being. The experience of feeling pressure was stated to be associated with low well-being and unhealthy behaviours in adolescents.The thesis brings new knowledge to the field of psycho-social and socio-demographic factors associated with unhealthy behaviours in Swedish adolescents. Findings may be useful in supporting adolescents to reach positive health-related behaviours.
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| 12. |
- Westin, Marcus, 1965-
(författare)
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Health and Healthcare Utilization Among Swedish Single Parent Families
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One of the most vulnerable groups in Swedish society today is single parent families, a group that has increased over the last thirty years in proportion to married and cohabiting parents. The aims of this thesis are to study inequality and inequity in health and health care utilization with regard to whether parents are single or couple (married/cohabiting), to investigate whether the concept of social capital may provide us with further understanding when analyzing inequality and inequity in health and to investigate how the mental health of single parent children may differ from couple parent children and to what extent this difference may be due to parental socio-economic and socio-demographic characteristics, including social capital. The results from the papers on which this thesis is based indicate that both single mothers and single fathers have poorer health than couple mothers and fathers. Single mothers also refrain from seeking medical care to a greater extent. The financial advantage of single fathers, in comparison with single mothers, might have an impact on their medical care utilization, since they seemingly seek and consume health care to an extent that matches their poorer health. Social capital has as robust an association with self-rated health as any traditional social determinant of health. Four parental characteristics were found to be independently associated with children’s mental health; being a single parent, ‘poor parental health’, limited social support and low levels of social capital. The uneven distribution of all investigated determinants of health, including social capital, gives us reason to conclude that our findings indeed raise concerns about equity. Action taken by society to enable single parents to increase their social capital might improve their and their children’s health. It may also be clearly stated that financial status has a major impact on both health and health care utilization. This particular characteristic is also rather accessible to alteration, for example through financial transfers between groups in society.
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| 13. |
- Wångdahl, Josefin, 1983-
(författare)
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Health literacy among newly arrived refugees in Sweden and implications for health and healthcare
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to examine the distribution of health literacy (HL) levels in newly arrived Arabic-, Dari-, or Somali-speaking refugees in Sweden. Further aims were to investigate sociodemographic characteristics associated with inadequate HL in this group, and to investigate whether HL levels are associated with experiences of the health examination for asylum seekers (HEA), health seeking behaviour and health.Three quantitative cross-sectional studies, using data from two different surveys, were conducted among Arabic-, Dari-, and Somali-speaking, newly arrived refugees taking part in courses in Swedish for immigrants or civic orientation. In addition, an explorative qualitative study, based on focus group discussions, was performed on Arabic- and Somali-speaking newly arrived refugees who had taken part in an HEA. All data were collected 2013-2016. The quantitative data were analysed using different statistical methods, foremost descriptive statistics and univariate and multivariate binary logistic regression analyses. The qualitative data were analysed using Graneheim and Lundman’s method for latent content analysis.The main findings were that the majority of Arabic-, Dari-, or Somali-speaking refugees in Sweden have limited functional health literacy (FHL) and/or limited comprehensive health literacy (CHL). Having a low education level and/or being born in Somalia were associated with having inadequate FHL, but not with having inadequate CHL. Limited FHL was associated with inadequate CHL. Experiences of poor quality of communication and having benefited little from the HEA were more common among those with limited CHL, as compared to those with higher CHL. Experiences of communication problems and a lack of information related to the HEA were found in the qualitative studies as well. In addition, it was more common that those with limited CHL reported poor general health and impaired psychological well-being, and that they had refrained from seeking healthcare.In conclusion: limited HL is common among newly arrived refugees in Sweden and seems to be of importance for the experience of the HEA, health-seeking behaviour and health. HL needs to be taken into consideration in the work with refugees in order to increase equity in healthcare and health.
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| 14. |
- Åhs, Annika, 1971-
(författare)
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Health and Health Care Utilization among the Unemployed
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The number of persons who are not employed has increased in Sweden since the early 1990s. Unemployment has been found to influence health, especially when unemployment rates are low. The extent to which unemployment affects health when unemployment is high is less clear, and this needs to be further studied. To improve health in the population, the health care system should offer equal access to health care according to need. It is important to study whether the employment status hinders the fulfilment of this goal.This thesis is based on four papers: Paper I and II aimed at analysing self-rated health versus mortality risk in relation to employment status, during one period of low unemployment and one period of high unemployment. Paper III and IV assessed the use of medical health care services and unmet care needs among persons who were unemployed or otherwise not employed. The goal was to analyse what health problems lead people to either seek or abstain from seeking care, and what factors encumber or facilitate this process.The overall results indicate that being unemployed or outside the labour force was associated with an excess risk of poor self-rated health, symptoms of depression, mental and physical exhaustion and mortality. The differences in self-rated health between the unemployed and employed were larger when unemployment levels were high, than when they were low. More groups of the unemployed were also afflicted with poor health when unemployment was high. Thus, poor health among the unemployed seems to be a public health problem during high levels of unemployment. Lack of employment was related to abstaining from seeking care, despite perceiving a need for care, and this was related to psychological symptoms. To deal with the needs of the unemployed and others who are outside the labour force it would be useful to develop and implement interventions within the health care system. These should focus on psychological and psychosocial problems. Future research should analyse how to facilitate health-promoting interventions among persons who are not anchored in the labour market.
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