1.
Lytsy, Per, 1968-
(författare)
Power of the Pill : Views about Cardiovascular Risk and the Risk-reducing Effect of Statins
2010
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.
2.
Wångdahl, Josefin, et al.
(författare)
Health literacy and refugees' experiences of the health examination for asylum seekers : a Swedish cross-sectional study
2015
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual's ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual's competence in accessing, understanding, appraising and applying health information. Little is known about refugees' health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees' experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences.METHODS: A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models.RESULTS: In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25-28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45-17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3.00-21.06) or receiving help with health problems (OR: 8.07, 95 % CI: 2.50-26.07. Functional healthy literacy was not associated with experiences of HEA.CONCLUSION: Refugees' experiences indicate that a low level of comprehensive health literacy can act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacy.
3.
Nordlöf, Hasse
(författare)
Prerequisites and Possibilities for Manufacturing Companies to Prioritize and Manage Occupational Health and Safety
2015
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Legislation demands that health and safety of humans at work must be secured. Today, far from every company has a functioning systematic management of occupational health and safety (OHS) in place to fulfill its legal obligations. Instead, other day-to-day tasks appear to have greater priority.The overall aim of this thesis was to investigate prerequisites and possibilities for manufacturing companies to prioritize and manage OHS, with focus on professional roles, company size, safety culture, and financial performance.Four papers (I–IV) are included in this thesis, based on three data collections. A questionnaire measuring the priority accorded to work environment was completed by 249 representatives of 142 manufacturing companies (I & II). Focus group interviews were conducted with 66 workers at a large steel-manufacturing company, discussing their experiences and perceptions of safety and risks at work (III). A questionnaire measuring OHS management practices, safety culture, and priority given to work environment was completed by 280 representatives of 197 manufacturing companies (IV). Information regarding the companies’ financial performance was retrieved from a credit bureau database.The main findings of the four papers demonstrated that profitability was considered as the most prioritized interest in the companies (I), and that trade-offs between productivity and safety is an obstacle to working safely (III). Managers generally perceived their companies to prioritize work environment factors more than the safety delegates did (I & IV). Perceptions of work environment priority did, however, not differ depending on company size (II & IV). Responsibility for safety was perceived to rest on the individual to the largest extent, and risk-taking was believed to originate from a combination of individual factors and external circumstances in the work environment (III). Larger company size, positive safety culture, and low risk in creditworthiness were found to be associated with better OHS management practices in companies (IV). Correspondingly, smaller company size, negative safety culture, and high risk in creditworthiness were found to be associated with worse OHS management practices.In summary, structural, social, and financial aspects seem to be important in companies’ possibilities for prioritizing and managing OHS. Recommendations for industry and future research are discussed.
4.
Wångdahl, Josefin, 1983-
(författare)
Health literacy among newly arrived refugees in Sweden and implications for health and healthcare
2017
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.
5.
Wångdahl, Josefin, et al.
(författare)
Health literacy among refugees in Sweden – a crosssectional study
2014
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14
Tidskriftsartikel (refereegranskat) abstract
Background Refugees have poorer health compared to indigenous populations, which may be explained by lower health literacy, i.e. not being able to access, understand, appraise or apply health information. This study aims to determine levels of functional and comprehensive health literacy, and factors associated with inadequate health literacy, in refugees coming to Sweden. Method A cross-sectional study was performed among 455 adult refugees speaking Arabic, Dari, Somali or English. Participants in 16 strategically selected language schools for immigrants responded to a questionnaire. Health literacy was measured using the Swedish Functional Health Literacy Scale and the HLS-EU-Q16 questionnaire. Uni- and multivariate statistical methods were used to investigate group differences.
6.
Wångdahl, Josefin, 1983-, et al.
(författare)
Perspectives on health examination for asylum seekers in relation to health literacy - focus group discussions with Arabic and Somali speaking participants
2019
Ingår i: BMC Health Serv Res. - : Springer Science and Business Media LLC. ; 19:1
Tidskriftsartikel (refereegranskat) abstract
Background Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework. Methods Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis. Results One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level." Conclusion The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered.
7.
Åhs, Annika, 1971-
(författare)
Health and Health Care Utilization among the Unemployed
2006
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.
8.
Lecerof, Susanne Sundell, et al.
(författare)
Findings from a prospective cohort study evaluating the effects of International Health Advisors’ work on recently settled migrants’ health
2017
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 17:1
Tidskriftsartikel (refereegranskat) abstract
Background: Several interventions have been carried out to tackle health inequalities between migrant groups, especially refugees, and native-born European populations. These initiatives are often address language or cultural barriers. One of them is the International Health Advisors (IHA) in Sweden; a peer education intervention aimed at providing health information for recently settled migrants. It is known that social determinants, such as educational level and access to social capital, affect health. Social determinants may also affect how health information is received and transformed into practice. The aims of this study was to a) assess the impact of the IHA on recently settled migrants’ self-reported health status, and received health information; b) determine the moderating role of educational level and social capital; and c) critically discuss the outcomes and suggest implications for health promotion practice. Methods: The study was designed as a prospective cohort study. A postal questionnaire translated to Arabic was sent to recently settled Iraqi migrants in eight counties in Sweden, in May 2008 and May 2010. Two of the counties were exposed to the intervention, and six were used as references. Results: The proportion of individuals who reported that they had received information on healthy diet and physical exercise was higher in the intervention group than in the non-intervention group (OR 2.31, 95% CI 1.02-5.22), after adjustments. Low social participation was negatively associated with deteriorated or unchanged health needs (OR 0.47, 95% CI 0.24-0.92). No other statistically significant differences in health outcomes could be observed between the groups. No signs of effect modification on this association by social capital or educational level could be found. Conclusions: Health information provided by the IHA increased self-reported level of knowledge on healthy diet and physical exercise. The interpretation of the observed negative association between low social participation and deteriorated or unchanged health needs is that participation was limited to one’s own social group, and therefore had limited positive influence on health seeking behaviour. The lack of measurable improvements in health status could be explained by limitations in the study, in the theoretical assumptions underlying the intervention, and in the implementation of the intervention. Further research is needed to understand success factors in health promoting interventions among recently settled migrants better.
9.
Lytsy, Per, 1968-, et al.
(författare)
Cardiovascular Risk Factor Assessments and Health Behaviours in Patients Using Statins Compared to a Non-Treated Population
2012
Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 19:2, s. 134-142
Tidskriftsartikel (refereegranskat) abstract
BACKGROUNDThe perception of cardiovascular risk factors is believed to be associated with a person's willingness to carry out lifestyle changes as well as their willingness to adhere to prescribed preventive medications. Little is known about whether these perceptions differ between statin users and those not using statins, including how these factors relate to health behaviours.PURPOSEThe objective was to investigate and compare the perceptions of known modifiable risk factors for cardiovascular disease in patients using statins with those of a non-treated population. One further objective was to investigate if statin use was associated with favourable health behaviours.METHODData about health, perception of the importance of cardiovascular risk factors and health behaviours were collected through questionnaires from 829 statin users and 629 non-statin users. Beliefs about risk factors were compared in univariate analyses, and four health behaviours were compared in multivariate regression models.RESULTSStatin users had better health behaviours in univariate analyses compared to non-statin users. Statin users rated lifestyle-related risk factors as more important contributors for the development of cardiovascular disease than non-statin users. In a multivariate model, statin use was associated with having better eating habits.CONCLUSIONPeople using statins are more concerned about cardiovascular risk factors compared to non-statin users. The behaviour of taking statins seems to be associated with favourable eating habits.
10.
Wångdahl, Josefin, 1983-, et al.
(författare)
Comprehensive health literacy and the experiences of the health examination for asylum seekers
2015
Konferensbidrag (refereegranskat) abstract
Objective: The purposes of the study were to investigate refugees’ experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and to investigate whether health literacy is associated with those experiences.Methods: A cross-sectional study was performed in 2013, among 455 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional health literacy scale and the short European health literacy questionnaire. Experiences of communication and the usefulness of health examination for asylum seekers were measured in several questions. Uni- and multivariate statistical methods were used to investigate group differences.Results: A considerable proportion of refugees in Sweden had bad experiences of the communication and the usefulness of the health examination for asylum seekers. Refugees with inadequate comprehensive health literacy experienced more communication problems and the examination as less useful, compared to those with non-inadequate comprehensive health literacy. No differences in those experiences could be seen between refugees with different levels of functional health literacy.Conclusion: Refugees’ own experiences indicate that a low level of comprehensive health literacy could act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacyPractical Implications: Health literacy must be highlighted and acted upon in clinical praxis to increase the quality of the health examination for asylum seekers.
