| 1. |
- Bergmark, Magnus, 1975-
(author)
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Integrerade psykosociala insatser : Policy, implementering och praktik i ett komplext verksamhetsfält
- 2017
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Doctoral thesis (other academic/artistic)abstract
- InledningAlltsedan psykiatrins avinstitutionalisering tog fart under 1980- och 1990-talen har en utveckling av samhällsbaserade psykosociala insatser förespråkats för att erbjuda vård och stöd till personer med psykisk funktionsnedsättning. Insatserna förväntas bidra till att brukarna får tillgång till effektiv vård och stöd, samtidigt som de inkluderas i samhället. Vidare förutsätts insatserna baseras på kunskap och evidens, samt bygga på brukarens delaktighet och stödja dennes återhämtning. En annan målsättning är att vissa insatser ges i form av integrerade modeller, så att personer ur målgruppen får tillgång till sammanhållet stöd från inblandade myndigheter. Även om Sverige räknas som ett resursstarkt land som har kommit långt på området, så förekommer kritik mot utvecklingen. Kritiken har berört både planering och styrning på politisk nivå, men även utförandet av de insatser som erbjuds till brukarna. Kritiken har bland annat handlat om bristande samverkan mellan landsting och kommuner, och om stora lokala variationer i den erbjudna servicens kvalitet. I den här avhandlingen studeras dels utformningen av policy på området, dels implementering av specifika insatser. Syftet med avhandlingen är att undersöka hur svenska policymakare på nationell nivå har hanterat utvecklingen av psykosociala insatser för personer med psykisk funktionsnedsättning, samt att analysera möjligheter och svårigheter för organisationer och personal när det gäller att implementera de insatser som förespråkas av beslutsfattare. De frågeställningar som avhandlingen söker besvara är följande:Hur formuleras policy som syftar till att införa samhällsbaserade psykosociala insatser, och vad kan policyns egenskaper innebära för genomförandet av den?Vilka styrstrategier uttrycks i statliga policydokument?Vad hämmar respektive underlättar implementeringen av föreslagna integrerade psykosociala insatser?Hur kan vi förstå vad som påverkar möjligheten att erbjuda integrerade psykosociala insatser, i termer av lokala förutsättningar och strategier för implementering?MetodPolicy på området studerades genom en studie av tre av de övergripande dokument som beslutats på regeringsnivå de senaste 20 åren. Riktade kvalitativa innehållsanalyser baserade på relevant litteratur genomfördes. Implementering av insatser studerades genom att 15 program följdes under 3 års tid. 14 av dessa arbetade med att implementera arbetsrehabiliteringsprogram utifrån modellen Individual Placement and Support (IPS). Under samma tidsperiod följdes ett team som implementerade den intensiva samordnings-, vård- och stödmodellen Assertive Community Treatment (ACT). För att bedöma verksamheternas följsamhet till modellerna genomfördes programtrohetsskattningar av samtliga program. Data avseende programmens målgrupp samlades också in. Tre IPS-program deltog i en fördjupningsstudie där kvalitativa intervjuer genomfördes med ledare, personal och samverkanspartners. Implementeringen av dessa program analyserades utifrån implementeringsramverket the Consolidated Framework for Implementation Research. Implementeringen av samtliga 14 IPS-program studerades med hjälp av skattningsskalan the Sustainable Implementation Scale (SIS). När det gäller ACT-teamet genomfördes dels kvalitativa innehållsanalyser av djupintervjuer, och dels skattningar av implementeringskomponenter med hjälp av SIS.ResultatPolicy på området har innehållit stora mått av otydlighet och konflikt, både gällande de mål och medel som har formulerats. Regeringen har främst förespråkat så kallade mjuka styrstrategier, vanligen i form av statliga stimulansbidrag. Vissa förtydliganden och konkretioner har skett under tid, vilka ibland går i linje med de internationella rörelserna New Public Management och evidensbaserad praktik. Exempel på försök att strama upp styrningen är målformuleringar som förespråkar riktade och prestationsbaserade stimulansbidrag, samt nationella riktlinjer för att styra utvecklingen mot utvalda specificerade insatser. Trots detta är det fortfarande de berörda myndigheterna som är ansvariga för att välja ut, utforma och implementera psykosociala insatser. På verksamhetsnivå leder detta till att många otydligheter består, vilka ibland är relaterade till svårigheter att avgränsa ansvarsområden och att förändra hindrande regelverk och traditioner. Dessutom förekommer konflikter, exempelvis i form av konkurrerande målsättningar och ojämn resurstilldelning.Studierna av de integrerade modellerna IPS och ACT visar att implementering av dessa är möjlig, även i en sektoriserad välfärdskontext som den svenska. Det finns dock en rad faktorer på såväl organisationsnivå som teamnivå, som försvårar implementeringen. Exempel på dessa är de involverade organisationernas varierande målsättningar och traditioner, regelverkens utformning, samt svårigheter att erhålla långsiktig finansiering. I en del fall beskrivs de arbetssätt som modellerna förespråkar som försvårande, då de upplevs som annorlunda och utmanande för existerande rutiner och uppfattningar om stöd till målgruppen. Ett stort hinder för effektiv implementering är svårigheter att samverka, främst mellan, men även inom inblandade organisationer. De flesta program som lyckades genomföra en hållbar implementering hade personal som var duktiga på att navigera förbi de hinder som orsakades av ogynnsamma regler, och de lyckades även hitta vägar för att etablera samverkan, både horisontellt (med samarbetspartners på samma hierarkiska nivå) och vertikalt (mellan ledning och personal). En verksamhetsledare som har möjlighet att påverka samverkansrelationer i både horisontell och vertikal riktning är gynnande för implementeringen. Andra betydelsefulla komponenter som underlättar implementering är en noggrann planering innan ett program startas, medveten rekrytering av personal, formering av ändamålsenliga styrgrupper, samt att tidigt i processen arbeta strategiskt för att lösa finansieringsfrågan. Även programtrohetsskattningar var betydelsefulla, då de både fungerade som instrument för att identifiera förbättringsområden för programmen, men också hade en legitimerande funktion vid återkoppling till ledningen.SlutsatserDet råder en samstämmighet i övergripande målsättningar som syftar till att utveckla området integrerade psykosociala insatser. På en mer konkret nivå är läget betydligt oklarare, både gällande målsättningar i policy och av vem och hur insatserna ska implementeras. Även om vissa förändringar skett, står regeringen fortsatt för en mjuk styrning vilken lämnar ett stort ansvar till de myndigheter som ska implementera valda insatser. Detta innebär en rad svårigheter för frontlinjepersonalen, vilket leder till att de ofta behöver lägga mycket tid och energi på att hitta vägar för att överkomma dessa svårigheter.I många fall har ledare och personal goda möjligheter att uppnå en hög programtrohet på teamnivå, men för en hållbar implementering krävs det att ett program är väl förankrat både vertikalt och horisontellt. Därför finns ett behov av att forskare och beslutsfattare tar ett tydligare helhetsgrepp, både på området policy och implementering av specifika insatser. Skattningar av programtrohet och implementering kan vara ett stöd i att identifiera vad som fungerar samt vad som behöver förändras i och mellan organisationer. Men för att programmen ska lyckas med en effektiv implementering på organisationsnivå behöver deras legitimitet stärkas vertikalt, och planering för långsiktig lokal finansiering behöver göras i ett tidigt skede.
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| 2. |
- Bohlin, Margareta, 1970-
(author)
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Music and risk in an existential and gendered world
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Adolescents in Western society often expose themselves to high levels of sound at gyms, rock concerts, discotheques etc. These behaviours are as threatening to young people’s health as more traditional risk behaviours. Testing boundaries and risk taking are fundamental aspects of young people’s lives and the processes of developing their identities. There is, however, a need to balance reasonable risk taking and risks that can damage health. The aim of Study I was to analyze the relationship between self-exposure to noise, risk behaviours and risk judgements among 310 Swedish adolescents aged 15-20 (167 men/143 women). The adolescents’ behaviour in different traditional risk situations correlated with behaviour in noisy environments, and judgements about traditional risks correlated with judgement regarding noise exposure. Another finding was that young women judge risk situations as generally more dangerous than young men, although they behave in the same way as the men. We suggest that this difference is a social and culture based phenomenon which underlines the importance of adopting a gender perspective in the analysis of risk factors. Adolescents reporting permanent tinnitus judged loud music as more risky than adolescents with no symptoms and they did not listen to loud music as often as those with occasional tinnitus. The aims of study II were to illuminate the complexity of risk behaviour, the meaning and purpose of adolescent risk-taking in both a traditional sense (e.g. smoking and drug use) and in noisy environments (e.g. discotheques and rock concerts), in relation to norms and gender roles in contemporary society. In total, 16 adolescents (8 men/8 women, aged 15-19) were interviewed individually and in focus groups. The interviewees’ responses revealed social reproduction of gender and class. Main themes of the phenomena for both genders emerged: Social identity and Existential identity of risk taking. The descriptive sub themes, however, which together formed the general structure, were rather diverse for men and women. The incorporation of social and existential theories on gender as basic factors in the analysis of attitudes towards risk-taking behaviours is considered to be of utmost importance. Likewise, research on hearing prevention for young people needs to acknowledge and make use of theories on risk behaviour and similarly, the theories on risk behaviour should acknowledge noise as a risk factor. Study III aims to increase the knowledge about young women’s and men’s risk judgement and behaviour by investigating patterns in adolescent risk activities among 310 adolescents aged 15-20 (143 women; 167 men). The Australian instrument ARQ, developed by Gullone et al, was used with additional questions on hearing risks [1] and a factor analysis was conducted. The main results showed that the factor structure in the judgement and behaviour scale for Swedish adolescents was rather different from the factor structure in the Australian sample. The factor structure was not similar to the Australian sample split on gender and there were differences in factor structures between genders among Swedish adolescents. The results are discussed from a gender and existential perspective on risk taking, and it is emphasized that research on risk behaviour needs to reconceptualize stereotypical ideas about gender and the existential period in adolescence. The aim of Study IV was to investigate possible gender differences regarding psychometric scales measuring risk perception in noisy situations, attitudes towards loud music, perceived susceptibility to noise, and individual norms and ideals related to activities where loud music is played. In addition, the purpose was to analyze whether these variables are associated with protective behaviour, e.g. the use of hearing protection. A questionnaire was administered to a Swedish sample including 543 adolescents aged 16 to 20. The result revealed significant gender differences for all the psychometric scales. Furthermore, all psychometric measures were associated with hearing protection use in musical settings. Contrary to previous studies, gender did not solely contribute to any explanation of protective behaviour in the analysis. One conclusion is that although gender does not contribute solely to the explanation of protective behaviour, gender may affect psychological variables such as risk perception, attitudes and perceived susceptibility and these variables may in turn be valuable for decision-making and protective behaviour in noisy situations. Although women tend to be more ’careful’ psychologically, they nevertheless tend to behave in the same way as men regarding actual noise-related risk-taking.
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| 3. |
- Boström, Katrin, 1955-
(author)
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Living with deteriorating and hereditary disease : experiences over ten years of persons with muscular dystrophy and their next of kin
- 2005
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to elucidate haw persona with muscular dystrophy (MD) and their next of kin experience and describe their daily lives over the last ten years. MD is a group of inherited disorders characterised by muscular weakness caused by muscle wasting. Both qualitative and quantitative methods were used. Forty-isx individuals with MD and 36 next of kin were interviewed (Studies I, III, IV). Both groups completed the questionnaire Subjective Quality of Life (SQoL), (Study V). Persons with MD also completed the questionnaires Sickness Impact Profile and Self-report ADL (Study II). The interviews were subjected to qualitative content analysis. The persons with MD described the change from being independent to being an individual in need of assistive devices and/or personal support to manage activities of every day life (StudyI). Besides muscular weakness persons with MD have hte strain it means to have a hereditary disease, which also affects the family (Study III). The deterioration during a decennium was primarily with regard to ambulation. The number of persons walking without assistive devices has decreased from 40 to 23 and that of those working has almost been halved, from 21 to 11 (Study II). Next of kin have a special vulnerability in form of an emotional and practical lonliness in addition to actual and anticipatory losses. The relationship was described as related to obligation and/or love. To have an orientation towards tasks (obligation) was linked to a feeling of being weighed down by demands, while having an orientation towards relationship (love) was linked to a feeling of quality in life (Study IV). The persons with MD scored lower on most items in the SQoL than the next of kin (Study V). Patients without a partner scored lower on QoL as a whole than those with a partner. Those with an early onset of disease scored lower on personal economy. Next of kin who gave daily help assessed their relationships to friends lower than those who gave weekly help (Study V). This thesis provides knowledge of the trajectory with MD over time on the basis of a ten-year follow up. It also broadens the knowledge of how the hereditary aspect is experienced both by those with MD and their next of kin. How the next of kin of adult persons with MD experience their situation is an issue that has been overlooked in previous research.
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| 4. |
- Carlsson, Per-Inge, 1959-
(author)
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Hearing impairment and deafness : genetic and environmental factors - interactions - consequences : a clinical audiological approach
- 2005
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Doctoral thesis (other academic/artistic)abstract
- OBJECTIVES - Hearing impairment (HI) can be due to genetic or environmental factors, e.g. noise. More than 50% of HI cases are thougt to be hereditary. HI can affect social participation in different ways. How serious these problems becomes depends on several factors, for example, the type of social environment the person lives in. The objective of the present study was to point out the importance of studying HI and deafness in a broad perspective, from the molecular - biological level to the psychological - social level and to evaluate how interactions of factors at several levels form the consequences, in a long-term perspective, to witch HI and deafness can lead. MATERIAL AND METHODS - Three different study populations have been used to study the four levels in this study: Papers I - III; 1200 noise-exposed workers (molecular and biological levels), Paper IV; 50 persons with HI since early childhood, with or without a family history of HI (FHHI)(biological, psychological and social level), and in Paper V; 600 persons with early onset of deafness in two counties with differently strong Deaf communities (psychological and social level). RESULTS - The molecular genetic studies (Papers I – III) showed that the combination of smoking and having a mutation in the protective antioxidant system revealed an additional risk for noise induced hearing loss. In Paper IV, only small differences was found between subjects with and without a FHHI. The results in Paper V indicated that differences in the social environment, in terms of the strength of the Deaf community, influence family factors such as marriages, divorces and the number of children born. CONCLUSIONS - Analysing complex issues such as HI and deafness from a medical audiological perspective requires a multi- level approach at several levels. The results indicate that interactions of factors at all four levels form the consequences, in a long-term perspective, to wich HI and deafness can lead. Furthermore, this multi-level approach - here called a clinical audiological approach - is essential when using the ICF framework in audiological rehabilitation/habilitation.
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| 5. |
- Germundsson, Per, 1956-
(author)
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Lärare, socialsekreterare och barn som far illa : om sociala representationer och interprofessionell samverkan
- 2011
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Doctoral thesis (other academic/artistic)abstract
- The aim of the thesis is, through use of the theory of social representations, to increase knowledge about the meeting between social workers and teachers, as professional groups, during collaboration with regard to the target group, children at risk. The thesis intends to capture the parties’ perceptions of one another and of that about which they are cooperating, as well as to discuss possible consequences of these perceptions in the context of interprofessional collaboration on children at risk. Empirical data was collected through an association study. The informants consisted of 200 teachers and social workers who had participated in various collaborative projects concerning the target group of children at risk. The study shows that the two professional groups have similar representations of children at risk. The social workers’ representations of the teachers are mostly positive, but the teachers are perceived, in many cases, to lack knowledge about social workers and their field of expertise. Teachers’ representations of social workers are colored to a much greater extent by negative associations. The negative image is primarily related to social services as an organization, not to social workers as individuals. In relation to the specific area of interprofessional collaboration on children at risk, the study indicates that the involved parties’ social representations play a significant role in the collaboration process. The research of this thesis has shown that the theory of social representations provides an effective framework for the study of the collaborating professionals’ group perceptions of one another and of children at risk. A preliminary model that seeks to illuminate the role of social representations, trust, and communication in the collaborative process has been presented.
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| 6. |
- Gustafsson, Johanna, 1975-
(author)
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Supported employment i en svensk kontext : förutsättningarnär personer med funktionsnedsättning når,får och behåller ett arbete
- 2014
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis is to discover, to value and to explain, if and why Supported Employment functions in a Swedish context and to also highlight those mechanisms which provide meaningful conditions within that context, when a person with a disability reaches, procures and retains employment. The empirical part consists of four studies that examine (1) whether SE has an effect on the employment rate, disposable income and sum of allowances, (2) the employer´s perspective of employing people with disabilities, (3) how employers perceive support from SE in the employment process and (4) how employees with disabilities perceive their work situation and social inclusion in the workplace. The studies within the thesis show that in a Swedish context, SE is encompassed by norm structures, production structures and economical structures which affect conditions for people with disabilities to reach, procure and retain employment. Supported Employment’s mode of practice and the ability to meet, co-exist and co-operate with these social structures has, in many ways, affected the prerequisites for people with disabilities to reach employment. These structures do not in themselves however, constitute a sufficient frame of ideas to enable an understanding of how SE works in a Swedish context, or how to explain the factors that affect conditions when people with disabilities reach, procure and retain employment. In the qualitative studies, trust features prominently and is considered an important mechanism in holding the process together.
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| 7. |
- Hillborg, Helene, 1968-
(author)
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Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv : brukarens och de professionellas perspektiv
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Erfarenheter av rehabiliteringsprocessen mot ett arbetsliv - brukarens och de professionellas perspektiv. Örebro, Studies from the Swedish Institute of Disability Research No 34, 107 pp.The overall aim of this dissertation is to (1) describe and analyse perceived barriers and opportunities from the perspective of the individual receiving vocational rehabilitation services as a result of unemployment and psychiatric disability (2) describe and analyse perceived barriers and opportunities in services for unemployed people with psychiatric disabilities from the perspective of professionals working in the area of vocational rehabilitation and (3) utilize empowerment theory to explore and develop a deeper understanding of the experiences and perceptions described by these individuals and professionals. The data consists of open-ended interviews with service users and professionals’ working in the area of vocational rehabilitation. A content analysis together with an interpretive approach was used to analyse the data. The results revealed that support and the psychosocial work environment are important factors that influence the rehabilitation process for the individual. These factors can facilitate opportunities to develop skills in contacts with fellow employees, increase belief in one’s own abilities, and can contribute to the achievement of specified goals. These factors are also seen as supporting empowerment and active participation in the rehabilitation process. However, the results also revealed that the rehabilitation process is negatively effected by environmental factors to which the professionals and their organizations contributed. Barriers related to interagency collaboration contributed to barriers to a successful rehabilitation for the individual. The professionals were consistent in what they viewed as enabling factors in the rehabilitation process but the results also showed how difficult it was for the service system to create a rehabilitation context in line with their knowledge and experience.Keywords: Psychiatric disabilities, vocational rehabilitation, empowerment, interagency collaboration, support system.
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| 8. |
- Möller, Kerstin, 1950-
(author)
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Impact on participation and service for persons with deafblindness
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Persons with deafblindness experience difficulties in daily life and they experience service to sometimes barrier. The overall aim of this thesis is therefore to discover, evaluate and explain: 1. mechanisms that might have impact on participation restrictions for people who have visual and hearing impairment i.e. deafblindness and 2. mechanisms that might barrier service to these people. Service is used as an umbrella term for health care, education and certain service for persons with disabilities. Materials from multiple sources have been used: literature (Study I No 96 papers). Interviews (Study I and V) with 32 and 3 adults with deafblindness respectively. Questionnaires (Study II and III): answered by 33 and 34 adults and youth with deafblindness. Patient records (Study IV and V): records from 9 and 3 adult females with USH I respectively. Materials mostly retrospectively cover the period from 2005 and about 40–50 years. Both quantitative and qualitative methods were used. International Classification of Functioning, Disability and Health (ICF) were consequently used as a framework to describe as well as a tool to analyze mechanisms. Further, the Ecological approach, Disability as a laminated system and Life course approach were used in order to evaluate and explain mechanisms. The conclusions that can be drawn from an ecological, laminated and life course approach are: Participation restrictions for people with deafblindness are far-reaching and are embedded in a complex process of interaction between the person with deafblindness and the environment. Services entail systematical barriers. In order to improve service it is extremely important to understand the role of participation restrictions in deafblindness. Primary activity limitation is to not see and hear enough for comprehension. Hence, not taking part in the visible and audible world is primary participation restriction. Performing activities without basic information includes risk. One important aspect of deafblindness is exposure. Persons with deafblindness require rehabilitation in a life perspective. In order to increase people’s participation and protection requirement of individually adapted support and assistive devices is necessary. ICF and the UN convention support service alterations.
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| 9. |
- Rehnman, Anna-Carin, 1955-
(author)
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Lära och Leva : Kunskapsutveckling hos personer med en ärftlig dövhet/hörselnedsättning
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The aim of this study is to explore the development of how people in different generations of a family with a hereditary hearing loss developed knowledge and to examine the role of the educational system and how it influenced this development.The research questions are:What is the prevalence of the deafness spoken of in the family chronicle?What different kinds of knowledge did the family members with deafness/hearing loss develop and how did they make use of them?In what ways may they have experienced their deafness/hearing loss as a suffering?What knowledge did they develop because the hearing loss recurred in several successive generations?The studied material includes answers from a questionnaire, different historical documents and sixteen interviews. Descendants of the first man born in the family in 1816 described as deaf. Among the descendants a total of 84 persons with a hereditary hearing loss have been found, at most in seven successive generations. The sixteen persons interviewed have spoken about themselves, their parent, mother or father-parent, with hearing loss. This has made it possible to explore the development of knowledge in different areas. The findings from the interviews are interpreted in four chapters where the development knowledge in the different generations has been related to each other and to the hearing loss.The study shows that the generations developed various forms of competence and knowledge and that this occurred mainly in the homes. The members of the family with hearing loss were educated by themselves. The role of public school was small. The last generation, however, has been able to carry out higher studies. The communicative practice at home was spoken Swedish, eye contact, a loud and clear voice and speechreading. The speech of children was read before the children themselves had to read the speech of others.
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| 10. |
- Rydberg, Emelie, 1978-
(author)
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Deaf people and the labour market in Sweden : education - employment - economy
- 2010
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Doctoral thesis (other academic/artistic)abstract
- This thesis focuses on deaf people’s educational attainment, position on the labour market and sources of revenue. These issues are interrelated, for instance a higher level of educational attainment seems to be associated with a lower unemployment rate and higher levels of income. The national context is Sweden and the Swedish welfare state in 2005. All studies in the thesis compare a deaf population, consisting of 2,144 persons born between 1941 and 1980 who have attended a school for the deaf in Sweden, with a general reference population, consisting of 100,000 randomly chosen persons from the total Swedish population born between 1941 and 1980. Data for all studies consisted of registered information about the persons in the year 2005. The results show that there are differences between the deaf and the reference population regarding level of educational attainment, position on the labour market and sources of revenue and disposable income, with the deaf population having a poorer position than the reference population in all areas. There are also differences between the workplaces of the deaf and the people in the reference population, and it is twice as common for people in the deaf population than for people in the reference population to have a higher level of educational attainment than is required for their occupation. These differences between the deaf and the reference population cannot be associated with differences in the independent factors, as for instance sex, age and immigration background, for which the results have been adjusted. This thesis shows that being part of the deaf population appears to be of importance. Factors in conjunction with deafness that can increase our understanding of the differences between the deaf and the reference populations in an educational context, labour market context and economic context are discussed in the thesis.
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