| 1. |
- Dewi, Fatwa Sari Tetra, 1969-
(författare)
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Working with community : exploring community empowerment to support non-communicable disease prevention in a middle-incom country
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Non communicable diseases (NCD) are recognized as a major burden of human health globally, especially in low and middle-income countries including Indonesia. This thesis addresses a community intervention program utilizing a community empowerment approach to study whether this is a reasonable strategy to control NCD.Objective: To explore possible opportunities, common pitfalls, and barriers in the process of developing a pilot community intervention program to prevent NCD in an urban area of a middle-income country.Methods: The study was conducted in Yogyakarta Municipality. The baseline risk factor survey in 2004 (n=3205) describes the pattern of NCD risk factors (smoking, physical inactivity and low fruit and vegetable intake) and demographic characteristics using STEPwise instrument. A qualitative study was conducted in order to illustrate peoples’ perceptions about NCD risk factors and how NCD might be prevented. A pilot intervention was developed based on the baseline survey and the qualitative data. The pilot intervention was conducted in four intervention communities while one community served as the referent area. The intervention was evaluated using quantitative and qualitative approaches. Finally, a second cross-sectional survey conducted in 2009 (n= 2467) to measure NCD risk factor changes during the five year period.Results: Baseline qualitative data showed that people in the high SES (Socio Economic Status) group preferred individual activities, whereas people in the low SES group preferred collective activities. Baseline survey data showed that the prevalence of all NCD risk factors were high. The community intervention was designed to promote passive smoking protection, promote healthy diet and physical activity, improve people’s knowledge of NCD, and provide a supporting environment. A mutual understanding between the Proriva team and community leadership was bargained. Several interactive group discussions were performed to increase NCD awareness. A working team was assigned to set goals and develop programs, and the programs were delivered to the community. There were more frequent activities and higher participation rates in the low SES group than in high SES group. The repeated cross-sectional surveys showed that the percentage of men predicted to be at high risk of getting an NCD event had significantly increased in 2009 compared to 2004.Conclusion: The community empowerment model was a feasible choice as a “moderate”strategy to accommodate with people’s need when implementing a community intervention that also interacts with the service provided by the existing health system. A community empowerment approach may improve program acceptance among the people.
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| 2. |
- Fröding, Karin, 1974-
(författare)
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Public health, neighbourhood development and participation : research and practice in four Swedish partnership cities
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det finns betydande skillnader i hälsa beroende på utbildning, socioekonomisk status, etnicitet, ålder och kön och det har konsekvenser för människors livslängd, livskvalitet och hälsa. Ojämlikheter i hälsa blir särskilt tydliga när man jämför olika geografiska områden, där vissa områden har hög koncentration av fattiga och socialt utslagna människor med dålig hälsa, arbetslöshet och låg utbildning. Att vidta åtgärder mot de utbredda hälsoskillnader som finns mellan människor med vitt skilda förutsättningar är en viktig utmaning för hälsofrämjande arbete. En strategi för att minska skillnader i hälsa mellan människor är att arbeta med områdesutveckling i prioriterade bostadsområden. Ett svenskt samarbete, Partnerskap för Hållbar Välfärdsutveckling, bildades 2003 mellan Helsingborg, Norrköping, Västerås och Örebro, kommunala bostadsbolag i dessa städer, flera nationella parter samt forskare vid Örebro universitet. Det centrala i partnerskapet var att genom erfarenhetsutbyte, metodutveckling och kunskapsspridning arbeta för en hållbar välfärdsutveckling i prioriterade bostadsområden (ett område från varje stad valdes ut). Integrerat i detta arbete var forskningsprogrammet ”Den hälsosamma staden - social integration, nätverkspolitik och hållbar välfärdsutveckling”, som följt partnerskapet vetenskapligt mellan åren 2003 och 2010. Det är av stor betydelse att integrera politik, praxis och forskning för att få kunskap om förutsättningar för en hälsosam utveckling i utsatta bostadsområden. Detta är en unik del av det nästan sjuåriga partnerskapsarbetet. Avhandlingens övergripande syfte har varit att inom ramen för Partnerskap för Hållbar Välfärdsutveckling studera folkhälsostrategier och lokalt utvecklingsarbete i kommuner och bostadsområden med särskild betoning på boendes deltagande för en hälsosam utveckling. Avhandlingens första studie syftar till att beskriva och analysera strategiskt folkhälsoarbete och lokalt områdesutvecklingsarbetet i fyra svenska kommuner samt den tidiga implementeringsfasen av Partnerskap för Hållbar Välfärdsutveckling. Datamaterialet består av dokumenterade intervjuer med folkhälsosamordnare och områdesutvecklare, deltagande observationer och skriftliga dokument. Resultatet visar att det redan i början av partnerskapsperioden fanns formella strukturer för folkhälsoarbetet i kommunen, till exempel ett folkhälsopolitiskt program, en utsedd samordnare, ett kontor och administrativa resurser samt politiker med särskilt ansvar för folkhälsofrågor. I uppbyggandet av de formella strukturerna var också de svenska nationella folkhälsomålen ett viktigt underlag. Vad gäller det lokala bostadsområdes arbete kan det ta sig olika uttryck även om målet är det samma. I partnerskapet fanns också tidigt höga förväntningar KARIN FRÖDING Public Health, Neighbourhood Development, and Participation I 83 att det skulle fungera som en sammanhållande kraft för ömsesidigt lärande och en positiv utveckling av prioriterade bostadsområden. Avhandlingens andra studie syftar till att analysera vad som karaktäriserar människor som deltar i områdesutveckling. Boende från tre av partnerskapskommunerna svarade på en enkät och resultatet visade på att människor som försökt påverka politiken i kommunen på olika sätt i större utsträckning deltar i områdesutveckling. Denna påverkan kan ske genom att kontakta en politiker eller lämna in ett medborgarförslag. Högt engagemang och aktivt deltagande var oberoende av individens sociodemografiska faktorer såsom utbildning eller inkomstnivå. Det var endast personer födda utanför Norden som i mindre utsträckning deltog i områdesutveckling. Avhandlingens tredje studie syftar till att undersöka en områdesbaserad interaktion mellan professionella (anställda), boende och forskare i en av partnerskapets utvalda stadsdelar. Baserat på deltagande observation under två år visar studien ett entydigt resultat: för att processen skall fungera krävdes att deltagarna öppet diskuterade enskilda situationer, personliga åtaganden och ömsesidiga förväntningar. Vidare var det viktigt att demaskera makt och auktoritet bland dem som deltar i processen för att inte några skulle ha mer inflytande på arbetet än de andra. Tiden visade sig vara viktig, att processen fick ta den tid det tog med konsensus som ett ledord. Slutligen var det viktigt att acceptera olika nivåer av deltagande. Allt detta bidrar till att skapa en gemensam känsla av engagemang och demokratisk dialog som är så viktigt i ett interaktivt samarbete. I avhandlingens fjärde studie är syftet att studera utvecklingsprocesser för att nå hållbara strukturer för lokalt områdesutvecklingsarbete i de fyra partnerskapsstäderna. Arbetet i Partnerskap för Hållbar Välfärdsutveckling har liksom kommunerna och det lokal områdesarbetet följts mellan åren 2003-2009. Genom en serie studier inom forskningsprogrammet med intervjuer, enkäter, deltagande observation och dokumentanalys har det utformats en databas för fallstudier. Resultatet visar att det under partnerskapsperioden fanns byggstenar i form av politiskt stöd, lokala partnerskap och boendes deltagande i områdesarbetet. När Partnerskap för Hållbar Välfärdsutveckling upphörde fanns dock få hållbara strukturer för områdesutveckling kvar. Det politiska stödet för områdesutveckling var under partnerskapstiden konstant högt men cykliskt, vilket innebar att prioriteringar ändrades. I samtliga fyra studerade stadsdelar hade områdesarbetet delvis avstannat och politiskt stöd och resurser lagts på andra områden i respektive kommun. I ett lokalt partnerskapssamarbete mellan kommun och kommunalt bostadsbolag finns dock möjlighet att bilda hållbara strukturer när såväl det strategiska som det lokala involveras i den praktiska delen av områdesutveckling. Medborgarnas deltagande verkar också utgöra en viss hållbar struktur för områdesutveckling, trots minskat politiskt stöd och resurser. Sammanfattningsvis visar denna avhandling att ett partnerskap för lokalt folkhälsoarbete kan fungera som en sammanhållande länk för lärande och utveckling bland alla inblandade aktörer. För ett fungerande områdesutvecklingsarbete är den lokala kontexten av största vikt liksom formella strukturer och ett nationellt stöd. Det är dessutom nödvändigt att beakta alla boende som potentiella deltagare i områdesutveckling oberoende av utbildning, kön eller inkomstnivå. När ett projektbaserat partnerskap avslutas måste det dessutom finnas strukturer som kan ta vid efter projekttidens slut. Avslutningsvis visar avhandlingen att ett områdesbaserat samspel med deltagande av professionella, boende och forskare ställer krav på en öppen, jämbördig dialog med ett accepterande förhållningssätt till olika nivåer av deltagande samt stort tidsutrymme.
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| 3. |
- Pettersson, Camilla, 1977-
(författare)
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Parents' possibility to prevent underage drinking : studies of parents, a parental support program, and adolescents in the context of a national program to support NGOs
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Underage drinking is common among Swedish adolescents and is related to problems for individuals, families, and society. From a public health perspective, it is of great importance that knowledge be gained about alcohol prevention. The overall aim of this thesis is, within the context of a national support program for NGOs, to study parents, a parental support program, and adolescents with regard to preventing underage drinking. The Swedish National Board of Health and Welfare (NBHW) has a government commission to distribute funds to non-governmental organizations (NGOs) for alcohol and drug prevention efforts. Study I of the thesis describes and analyses this program with a special emphasis on research and development for an evidence-based practice. It is a research strategy case study with 135 projects and 14 embedded in-depth studies. The results reveal that this program to support NGOs has been successful in engaging a wide range of NGOs in prevention efforts. A trustful partnership between practitioners, national agencies, and researchers has also been developed, which has improved the quality and results of the different projects. Studies II, III, IV, and V all used data from a longitudinal questionnaire study with parents and adolescents within one of the 14 in-depth studies: the study of IOGT-NTO’s parental program Strong and Clear. Additional data, such as telephone interviews and other parental questionnaires, are also used. Study II aims to analyse the significance of socio-demographic factors for parental attitudes and behaviour regarding adolescent alcohol consumption to see if any group of parents is especially important for intervention efforts. The results showed that fathers were more likely than mothers to have non-restrictive attitudes towards underage drinking and to have children who had drunk or tasted alcohol at home. Study III examines reasons for non-participation in the program. Parents with a low educational level were found more likely to be non-participants than highly educated parents. When parents stated their reasons for non-participation it emerged that they did not perceive a need for the intervention and that there were practical obstacles to their participation. Study IV is an effect study of Strong and Clear and showed that the program contributed to maintaining parents’ restrictive attitude toward underage drinking, postponing alcohol debut, and preventing drunkenness among the adolescents. Study V, only presented in the thesis, examined parents’ perceptions about Strong and Clear. Parents primarily thought it had led to their speaking more often about alcohol with their children, and had been a help in this conversation. Many also stated that the program had influenced their ability to set limits for their children. The school and IOGT-NTO were considered as suitable providers of Strong and Clear. This thesis showed that a national support program for NGOs including research and development contributes to a more evidence-based public health practice.
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| 4. |
- Wiklund, Maria, 1962-
(författare)
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Close to the edge : discursive, gendered and embodied stress in modern youth
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Adolescent subjective health and mental problems have become a public health concern not only in Sweden but worldwide. The overall aim of this thesis is to deepen and widen the understanding of young peoples’ subjective health, psychosomatic and stress-related problems. A special focus is put on experienced stress among adolescent girls and young women. The study setting is one youth health centre, and three upper secondary schools in Umeå, a university town in northern Sweden. The research design combines qualitative and quantitative methods with the main focus on qualitative methods. An interdisciplinary theoretical synthesis is utilised, primarily based on bio-psycho-social, phenomenological, and social constructionist approaches. The three qualitative papers (I-III) are based on the same sample of 40 young women who had sought help at the youth health centre because of their stress-related problems. Paper I explores the stressors experienced by the young women, whereas Paper II explores the lived experiences of stress. Paper III examines the young women’s experiences of living in a violent partner relationship as young teenagers, and how this has affected their lives and health over time. Paper IV investigates perceived stress and subjective health complaints among older adolescents in upper secondary school. Methods Data was derived from: a) a qualitative interview study with 40 adolescent girls and young women, aged between 16–25 years, who had sought help at the youth health centre for stress problems. Qualitative content analysis was used in combination with discourse-orientated analysis (Paper I); a phenomenological approach (Paper II), and narrative method (Paper III); b) a school-based survey with a sample of 16–18-year-old boys and girls (n=1027), in upper secondary school, grades 1 and 2, from different educational programs at three schools. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments. Statistical analyses were descriptive and analytical. Results Paper I identified multiple stressors of modernity, gender orders and youth. Contextual factors, including social constructions and practices of gender, played an important role for the stress experienced by these young women. The results revealed that multiple and intersecting stressors and demands connected to essential life spheres, contributed not only to experiences of distress but also to feelings of constraint. Moreover, the roles of excessive taking of responsibility and failing adult support were revealed. Paper II illuminated multidimensional lived and embodied experiences of distress. ‘Living close to the edge’ emerged as the common theme running through all of the interviews and captured the young women’s sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment. Paper III examined two Swedish adolescent girls’ experiences of living in a violent relationship as teenagers, and how this has affected their lives and health over time. The analysis revealed violation, stress, trauma, coping, and agency during adolescence and the transition into adulthood. Paper IV showed a high level of perceived stress, and subjective health and stress complaints among boys and girls. High pressure and excessive demands from school were experienced by a majority of boys and girls. Perceived stress was correlated with subjective health and stress complaints and anxiety. There was a clear gender difference: two to three times as many girls than boys reported subjective health complaints, e.g. headaches, tiredness and sleeping difficulties, musculoskeletal pain, sadness and anxiety. Conclusion Several issues of relevance to public health were raised throughout the thesis. According to the interview results, the young women face multiple and intersecting stressors of modernity, gender orders and being young, which correspond to their multidimensional experiences of ‘living close to the edge’. Their experiences of stress are multidimensional, and include physical, emotional, cognitive, social and existential dimensions. Findings from the qualitative study were also mirrored in the findings from the larger group of adolescents in the school survey, where a high proportion of older adolescents, particularly girls, reported perceptions of stress. Moreover, perceived stress correlated to a variety of subjective health complaints and anxiety. The results can be understood and explained from a variety of perspectives. The experience of ‘managing alone’ indicated perceptions of inadequate social support. The overall results indicated a risk of more negative health development, particularly among adolescent girls and young women. Stressors of modernity, gender orders and youth were prominent. The continuation and normalisation of oppression and violence are also discussed as a severe gendered stressor in young women’s lives. This calls for a broad contextualised and gender-sensitive approach to young people’s stress and health problems. In conclusion, the age and gender gap in adolescent health needs to be further explored, and processes of distress, distrust and disempowerment have to be taken more seriously.
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| 5. |
- Beckman, Linda, 1980-
(författare)
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Traditional Bullying and Cyberbullying among Swedish Adolescents : Gender differences and associations with mental health
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to study the differences between traditional bullying and cyberbullying among adolescents, focusing on gender, psychosomatic problems, and disability, and to gain insight into health staff’s experience of bullying in schools.The four studies in this thesis were based on surveys undertaken among 3,800 adolescents in Grades 7, 8 and 9 in Sweden, as well as focus groups of 16 people consisting of school social workers and school nurses.While almost no gender differences were found among traditional victims, Study I showed that girls were more likely than boys to be cybervictims. Boys were more likely than girls to be traditional bullies, while girls were equally as likely as boys to be cyberbullies. Study II showed that psychosomatic problems were associated with being a victim, a bully or a bully-victim. Cyberbullying showed no stronger association with psychosomatic problems than traditional bullying. Study III: Three main categories emerged from school health staff’s experience: 1) “Anti-bullying team”; 2) “Working style”; and 3) “Perspectives on bullying”. The last two each comprised two sub-categories: “Team member”/“Single worker”; and “Contextual perspective”/“Individual-oriented perspective”. Study IV showed that, regardless of gender and grade, students with a disability were more likely to be bully-victims and, more particularly, bully-victims involved in both traditional bullying and cyberbullying. No differences between disabled adolescents and others were found with respect to the association between bullying and psychosomatic health.The results show that some adolescents are more likely to experience higher levels of psychosomatic health problems than others. They also show that some adolescents are more likely to be involved in bullying, either as victims, bullies or bully-victims. This thesis also discusses contextual and individual approaches adopted by schools in preventing bullying.
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